Secondary service connection
Hypertension secondary to PTSD: BVA grant rates and what wins
From 2018 to 2026, the Board of Veterans' Appeals decided hypertension claimed as secondary to PTSD in 2,879 decisions. It granted the issue in 17.0% of them, close to the 18.3% grant rate for all hypertension issues, denied it in 18.4%, and remanded it in 63.0%. Counting only decisions on the merits, 48.0% were granted.
Decisions
2,879
2018–2026
Granted
17.0%
All hypertension: 18.3%
Granted on the merits
48.0%
Granted ÷ (granted + denied)
Remanded
63.0%
Denied: 18.4%
See all hypertension decisions, direct and secondary.
Hypertension secondary to PTSD: outcomes by year
| Year | Decisions | Granted | Denied | Remanded |
|---|---|---|---|---|
| 2018 | 383 | 13.8% | 24.3% | 57.2% |
| 2019 | 402 | 15.4% | 16.9% | 66.4% |
| 2020 | 445 | 11.2% | 23.6% | 63.1% |
| 2021 | 440 | 11.1% | 23.6% | 64.8% |
| 2022 | 341 | 18.5% | 12.0% | 68.0% |
| 2023 | 274 | 23.0% | 14.2% | 62.0% |
| 2024 | 264 | 20.8% | 15.2% | 64.0% |
| 2025 | 233 | 26.6% | 12.0% | 60.1% |
| 2026 | 97 | 33.0% | 12.4% | 53.6% |
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 | 593 | 87.5% | 22.5% | +65.0 pts |
| Favorable VA exam | 323 | 77.9% | 40.3% | +37.6 pts |
| Private medical opinion | 890 | 66.9% | 32.7% | +34.2 pts |
| Treating physician opinion | 173 | 69.6% | 46.2% | +23.5 pts |
| Combat service | 321 | 44.8% | 48.4% | −3.6 pts |
| Lay statement | 2,028 | 39.9% | 79.1% | −39.3 pts |
- The Board applied the benefit-of-the-doubt rule (38 CFR 3.102) in 79.8% of the decisions that granted hypertension.
- The Board found the veteran's statements credible in 21.9% 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 | 1,893 | 43.4% | 64.0% | −20.7 pts |
| Unfavorable VA exam | 2,280 | 45.4% | 67.2% | −21.8 pts |
Why the Board granted or denied hypertension
Most common reasons in grants
- Current diagnosis established63
- Service connection established43
- Caused by the service-connected disability36
- Aggravated by the service-connected disability22
- Secondary to PTSD9
- VA examiner: less likely than not related to service8
- Granted secondary to PTSD4
- Hypertension diagnosed4
Most common reasons in denials
- VA examiner: less likely than not related to service139
- No in-service complaints, treatment or diagnosis96
- Preponderance of the evidence against the claim64
- Service records negative or silent54
- No current diagnosis27
- No continuity of symptomatology22
- Current diagnosis established15
- Aggravated by the service-connected disability12
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
Secondary service connection granted; Substantial weight to private opinion; PTSD impacts heart and vascular function
Current diagnosis of hypertension established.; Obesity identified as intermediate step between MST/PTSD and hypertension.; Evidence supports obesity caused by MST and PTSD.
Private medical opinion found hypertension at least as likely as not secondary to PTSD.; Medical literature supports connection between PTSD and hypertension.; Presumption of soundness applies as hypertension did not clearly pre-exist service.
Denied
No evidence of in-service incurrence; Private opinion lacked probative value (speculative, correlational); No presumptive service connection (late onset)
No in-service symptoms or diagnosis of hypertension; First post-service treatment over 20 years after separation; VA examiner opinion found hypertension not related to PTSD
No in-service onset or treatment; VA exams found less likely than not related to toxic exposure; Private opinion lacked specific nexus to veteran's facts; No nexus to PTSD established
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 PTSD, 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 (2018–2026) and can contain errors. It is updated automatically as new decisions are added.