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High blood pressure — rated on documented diastolic and systolic readings and the need for continuous medication. This guide quotes the actual rating criteria from 38 CFR Part 4 for diagnostic code 7101, explains what the C&P examiner measures, covers the presumptive and secondary routes to service connection, and lists the reasons these claims come back denied — and how each gets fixed.
How the VA rates hypertension in 2026 — the exact criteria
These are the criteria a VA rater applies, quoted from the rating schedule (§ 4.104). Your rating is the highest level whose wording your evidence meets — and evidence that never uses these words tends to be rated at the bottom.
DC 7101 — Hypertensive vascular disease (hypertension and isolated systolic hypertension)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 60% | Diastolic pressure predominantly 130 or more |
| 40% | Diastolic pressure predominantly 120 or more |
| 20% | Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more |
| 10% | Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control |
Hypertension must be confirmed by readings taken two or more times on at least three different days. Hypertension means diastolic pressure predominantly 90 or greater; isolated systolic hypertension means systolic predominantly 160 or greater with diastolic under 90.
Hypertension is rated separately from hypertensive heart disease and other heart disease.
Honest ceiling: most land 10–20%.
What the C&P examiner measures
The examiner records blood-pressure readings and your history of readings and medication. The rating requires readings on at least three different days, so bring your own log or pharmacy/clinic printouts — a single normal reading at the exam does not defeat a documented history.
The questions that get at the rating criteria — answer them for yourself before the exam:
- Are you on blood pressure medication? If you stopped, would it go back up?
Service connection: presumptive, direct, or secondary
Hypertension is presumptive for Agent Orange exposure — added by the PACT Act in 2022 (38 CFR 3.309(e)) — and is a chronic disease under 3.309(a) if shown within one year of separation. It is also a well-recognized secondary to PTSD, sleep apnea and kidney disease.
Every service-connection claim has three legs: a current diagnosis (the C&P exam can supply it), an in-service event, injury, exposure or an already-connected condition, and a link between the two — which the VA's own examiner addresses at the exam for direct and secondary claims, and which the law supplies for presumptive ones. You do not need a private opinion to file; you need one only if the VA denies for lack of nexus, and a supplemental claim within one year keeps your effective date.
Secondary conditions veterans miss
Conditions that commonly develop because of this one can be service-connected on top of it, each with its own rating:
- Stroke secondary to hypertension — If HTN is service-connected and a stroke came AFTER — the VA is instructed to PRESUME the stroke is secondary. Active stroke rates 100%. If you have had a stroke or TIA, that is a claim.
What the medical literature says
Kibler J.L. et al., Behavioral Medicine 34(4):125-32 (2009) — Hypertension in relation to PTSD and depression in the US National Comorbidity Survey
PTSD is related to hypertension independent of depression. Why it matters: HTN secondary to service-connected MH.
NASEM, Veterans and Agent Orange: Update 11 (2018)
Moved hypertension to "sufficient evidence of association" with herbicide exposure — now presumptive for exposed veterans. Why it matters: Any AO-exposed vet with HTN: presumptive, no nexus needed.
Why hypertension claims get denied — and the fix
- Readings not confirmed on three different days — a home log or clinic printouts fix it.
- Rated 0 percent despite continuous medication because the pre-medication history of diastolic 100+ was never documented.
A denial is a grade on the evidence packet, not a verdict on you. Filed as a supplemental claim within one year, the fix keeps your original effective date.
Filing it right the first time
- Intent to File first. It locks your effective date for a year — back pay runs from that day, not from the day the package is ready.
- File everything at once. Every condition with a real symptom and a plausible route — direct, presumptive, secondary, increase — goes in one claim. The VA's duty to assist schedules the exam and pulls your records; a condition held back "for more evidence" only starts its clock later.
- Your statement in the criteria's words. A Statement in Support of Claim (VA Form 21-4138) that describes your worst days and your typical days using the language in the table above is the evidence the rater reads first.
- Your records. VA records through Blue Button, decision letters and code sheet from VA.gov, and private records from each doctor's office or patient portal — or a signed 21-4142 so the VA pulls them.
- Prepare for the exam. Know what the examiner measures (above) and answer honestly, including the bad days.
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See If You Qualify →Frequently asked questions
What is the VA rating for hypertension?
Hypertension is rated under diagnostic code 7101 (§ 4.104) at 10%, 20%, 40%, 60%. The percentage depends on which criteria in the rating schedule your evidence meets — the full table is on this page.
What is the highest VA rating for hypertension?
The highest schedular rating available is 60%. Typical grants land around 10%, but every case is decided on its own evidence.
Is hypertension a presumptive condition?
Hypertension is presumptive for Agent Orange exposure — added by the PACT Act in 2022 (38 CFR 3.309(e)) — and is a chronic disease under 3.309(a) if shown within one year of separation. It is also a well-recognized secondary to PTSD, sleep apnea and kidney disease.
Can hypertension be claimed as a secondary condition — or cause one?
Yes. Stroke secondary to hypertension. A secondary condition is rated on top of the primary one, and the VA's own C&P examiner can supply the connecting opinion.
Do I need a nexus letter for hypertension?
Not to file. The VA's duty to assist schedules a C&P exam where its own examiner addresses the connection, and presumptive conditions need no opinion at all. A private opinion becomes worth buying only if the VA denies for lack of nexus — a supplemental claim within one year keeps your original effective date.
Rating criteria verified against eCFR (38 CFR Part 4) — last reviewed 2026-09-19. Regulations change; confirm anything decision-critical at ecfr.gov.