Secondary service connection
Hypertension secondary to a psychiatric disorder: BVA grant rates and what wins
From 2017 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to a psychiatric disorder in 1,789 decisions. It granted the issue in 18.9% of them, close to the 17.6% grant rate for all hypertension issues, denied it in 17.8%, and remanded it in 62.0%. Counting only decisions on the merits, 51.4% were granted.
Decisions
1,789
2017–2026
Granted
18.9%
All hypertension: 17.6%
Granted on the merits
51.4%
Granted ÷ (granted + denied)
Remanded
62.0%
Denied: 17.8%
See all hypertension decisions, direct and secondary.
Hypertension secondary to a psychiatric disorder: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2017 | 93 | 10.8% | 26.9% | 57.0% |
| 2018 | 182 | 10.4% | 20.9% | 65.4% |
| 2019 | 186 | 16.1% | 19.9% | 63.4% |
| 2020 | 234 | 15.8% | 21.4% | 61.1% |
| 2021 | 224 | 17.9% | 23.7% | 56.7% |
| 2022 | 194 | 18.6% | 12.4% | 68.6% |
| 2023 | 215 | 16.7% | 14.4% | 68.4% |
| 2024 | 186 | 22.6% | 11.3% | 66.7% |
| 2025 | 187 | 29.4% | 12.3% | 57.8% |
| 2026 | 88 | 37.5% | 19.3% | 43.2% |
Evidence in granted and denied hypertension decisions
For each kind of supporting evidence: how often the Board granted the hypertension issue on the merits when the decision mentioned it, compared with decisions that did not. These are associations, not causes, and evidence is recorded per decision, not per issue.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Positive nexus opinion | 430 | 84.8% | 23.9% | +61.0 pts |
| Private medical opinion | 618 | 68.4% | 33.3% | +35.1 pts |
| Favorable VA exam | 211 | 74.0% | 46.0% | +28.0 pts |
| Treating physician opinion | 105 | 71.2% | 49.8% | +21.4 pts |
| Buddy statement | 49 | 50.0% | 51.5% | −1.5 pts |
| Combat service | 87 | 48.3% | 51.6% | −3.3 pts |
| Lay statement | 1,360 | 43.8% | 85.8% | −42.1 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 76.0% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 20.1% of grants and 7.5% of denials.
Negative evidence in the record
An unfavorable exam or a negative nexus opinion often sits in the same record as favorable evidence, and the Board weighs them against each other. So these rows show how often hypertension was still granted when the record contained the negative item, not that the item helped.
| In the record | Decisions | Granted when present | When absent | Difference |
|---|---|---|---|---|
| Negative nexus opinion | 1,136 | 46.0% | 65.2% | −19.3 pts |
| Unfavorable VA exam | 1,363 | 48.0% | 70.7% | −22.7 pts |
Why the Board granted or denied hypertension
Most common reasons in grants
- Caused by the service-connected disability61
- Current diagnosis established44
- Service connection established36
- Aggravated by the service-connected disability20
- Hypertension diagnosed5
- Service records negative or silent4
- Evidence evenly balanced4
- Secondary service connection granted3
Most common reasons in denials
- VA examiner: less likely than not related to service67
- No in-service complaints, treatment or diagnosis47
- Service records negative or silent35
- Preponderance of the evidence against the claim29
- Aggravated by the service-connected disability13
- No current diagnosis13
- No continuity of symptomatology13
- Continuity of symptomatology since service10
Numbers are decisions that gave the reason. Reasons are short phrases extracted by AI from each decision; common wordings of the same reason are grouped. Benefit of the doubt is reported above.
Recent hypertension decisions
Granted
New and relevant evidence submitted in December 2024 warranted readjudication.; In-service elevated blood pressure readings noted.; Veteran provided competent and credible lay statements of continuity of symptomatology.; Evidence found to be in equipoise, resolving doubt in Veteran's favor.
Competent diagnosis of hypertension since October 1999.; Presumed herbicide exposure due to Vietnam service.; Probiric February 2020 VA examiner opinions linking anxiety/PTSD to hypertension.; Resolving all doubt in Veteran's favor.
Hypertension diagnosed.; Evidence divided on secondary link to depression.; VA opinion found unlikely due to pre-existing depression; Board found opinion limited.; Private opinion supported link.; Approximate balance of evidence invoked benefit of doubt.
Denied
No evidence of in-service chronicity, manifestation within presumptive period, or continuity of symptomatology.; Service treatment records silent regarding hypertension; post-service diagnosis years later.; No evidence of herbicide exposure to support presumptive claim.
No competent positive nexus opinion; VA examiner opined less likely than not caused by toxic exposure; Hypertension attributed to lifestyle factors
No in-service hypertension diagnosis; Negative VA nexus opinion; Psychiatric condition not service-connected
Rules that apply to secondary hypertension claims
- 38 CFR 3.310
Secondary service connection and aggravation
Read it in VA Law Explorer - M21-1 V.ii.2.D
Secondary service connection and aggravation of non-service-connected disabilities
Read it in VA Law Explorer - 38 CFR 3.102
Reasonable doubt (benefit of the doubt)
Read it in VA Law Explorer - 38 CFR 4.104 · DC 7101
Schedule of ratings: cardiovascular system
Read it in VA Law Explorer - M21-1 V.iii.5.3
Hypertension: definitions, blood pressure readings required, predominant blood pressure
Read it in VA Law Explorer - M21-1 V.iii.11.2.e
When hypertension is or is not a complication of diabetes
Read it in VA Law Explorer
Research your hypertension case
Narrow by year, judge, evidence or secondary condition, read the decisions, and export a research memo.
How these numbers are calculated
- Counts decisions in which the Board decided a hypertension issue claimed as secondary to a psychiatric disorder, by the outcome of that issue.
- The primary disability is read from the decision text ("secondary to …") and grouped by name, so spellings such as "PTSD" and "posttraumatic stress disorder" count together.
- Secondary claims also include aggravation of a non-service-connected condition by a service-connected one (38 CFR 3.310(b)).
- The data comes from CaseScribe's AI extraction of public BVA decisions (2017–2026) and can contain errors. It is updated automatically as new decisions are added.