Home › Conditions › Secondary claims › Hypertension ← PTSD
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 ptsd came from service; the question is only whether it caused or aggravated the hypertension. That's a medical question with a recognized answer.
The connection
A sustained stress response keeps the sympathetic nervous system — and blood pressure — elevated, and the research literature on PTSD and hypertension is substantial. For a veteran with service-connected PTSD and a later hypertension diagnosis, secondary service connection is a recognized, regularly granted theory.
How the VA rates hypertension
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.
Full criteria, exam and evidence guide: VA rating for Hypertension. And the anchor: VA rating for PTSD, Depression and Anxiety.
What the claim needs — the three legs
- The anchor: service connection for the ptsd (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 hypertension — 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 ptsd caused or aggravated the hypertension. 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 hypertension secondary to ptsd?
Yes, if three things hold: the ptsd (or its equivalent) is service-connected, you have a current diagnosis of hypertension, 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 hypertension secondary to ptsd?
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.