Home › Conditions › Secondary claims › Heart Conditions ← Hypertension
A secondary claim is a condition caused or worsened by one the VA has already service-connected (38 CFR 3.310). The causation fight is already half-won — the VA agreed your hypertension came from service; the question is only whether it caused or aggravated the heart conditions. That's a medical question with a recognized answer.
The connection
Untreated or long-standing high blood pressure damages the heart and vessels — hypertensive heart disease, and elevated stroke risk, follow it. Notably: when hypertension is service-connected and a stroke comes later, VA guidance directs raters to treat the stroke as presumptively secondary. If you are an HTN-rated veteran who has had a stroke or TIA, that is a claim, and an active stroke rates at 100%.
How the VA rates heart conditions
General Rating Formula for Diseases of the Heart (DC 7005 coronary artery disease and most heart codes)
| Rating | Criteria (38 CFR Part 4 wording) |
|---|---|
| 100% | Workload of 3.0 METs or less results in heart failure symptoms |
| 60% | Workload of 3.1–5.0 METs results in heart failure symptoms |
| 30% | Workload of 5.1–7.0 METs results in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging) |
| 10% | Workload of 7.1–10.0 METs results in heart failure symptoms; or continuous medication required for control |
Heart failure symptoms include breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. One MET is the energy cost of standing quietly at rest.
METs testing is required in all cases except when medically contraindicated or when 100 percent can be assigned on another basis; when exercise testing cannot be done, the examiner may estimate the MET level with specific examples (§ 4.100).
Ischemic heart disease is presumptive for Agent Orange exposure (38 CFR 3.309(e)), and the PACT Act added hypertension itself to the Agent Orange list — so hypertensive heart disease secondary to a presumptive hypertension is a common chain.
Full criteria, exam and evidence guide: VA rating for Heart Conditions. And the anchor: VA rating for Hypertension.
What the claim needs — the three legs
- The anchor: service connection for the hypertension (see how that condition is rated). Not connected yet? File both in the same claim — the VA decides the anchor first, then the secondary against it.
- A current diagnosis of heart conditions — the VA rates diagnosed conditions. If you only have the symptoms, file them anyway: the C&P exam supplies the diagnosis, and a "no diagnosis" denial is repaired with a supplemental claim that keeps your date.
- The medical link. An opinion stating it is "at least as likely as not" that the hypertension caused or aggravated the heart conditions. The VA's own C&P examiner supplies this free in most cases; your own doctor can too. A paid independent opinion is the answer to a denial, not the first move.
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See If You Qualify →Frequently asked questions
Can I claim heart conditions secondary to hypertension?
Yes, if three things hold: the hypertension (or its equivalent) is service-connected, you have a current diagnosis of heart conditions, and a medical opinion connects the two. The connection described on this page is a recognized pathway raters see regularly.
Do I need to pay for a nexus letter for heart conditions secondary to hypertension?
Usually not. The VA's own C&P examiner can supply the connecting opinion at your exam for free, and your own treating doctor can also provide it. A paid independent opinion is worth buying only after a denial for lack of nexus — a supplemental claim within one year keeps the original effective date.
What if the primary condition isn't service-connected yet?
File them together in the same claim. The VA decides the primary first and then the secondary against it in the same decision; a secondary filed alone against a condition the VA has not connected fails. Filing both at once under one Intent to File protects the effective date for both.
Last reviewed 2026-09-19.