The Department of Veterans Affairs recognizes several secondary conditions to hypertension, each with its own implications for veterans’ health and disability claims. Hypertension can affect the heart and arteries, cause kidney disease and damage blood vessels in the brain, eyes, etc. Over time, high blood pressure places strain on nearly every major organ system in the body.
Secondary conditions can either be caused directly by hypertension or significantly aggravated by its presence or the medications used to treat it. Many are disabling in their own right and may be granted separate VA ratings when appropriately documented and medically linked.
Chronic Kidney Disease
Hypertension is the second leading cause of chronic kidney disease. High blood pressure damages the blood vessels in the kidneys, impairing their ability to filter waste from the blood effectively. Veterans with kidney disease secondary to hypertension could get disability ratings of 30%, 60%, 80%, or 100%, depending on creatinine levels, dialysis requirements, and symptoms such as fatigue or weight loss.
How to Get VA Disability for Chronic Kidney Disease →
Sleep Apnea
Hypertension and sleep apnea have a well-documented bi-directional relationship, with each potentially exacerbating the other. Obstructive sleep apnea can increase blood pressure, while hypertension can worsen sleep quality. Sleep apnea can be rated at 0%, 30%, 50% (if CPAP is required), and 100% for chronic respiratory failure or tracheostomy under diagnostic code 6847.
VA Ratings for Sleep Apnea and Hypertension Explained →
Cardiovascular Conditions
Heart disease is a broad category that includes conditions such as coronary artery disease, heart failure, and arrhythmias. Hypertension is a major risk factor for developing secondary heart diseases, because it puts extra strain on the heart and arteries, contributes to plaque buildup, and leads to ischemic damage over time.
VA disability ratings for heart disease secondary to hypertension range from 10% to 100% depending on left ventricular ejection fraction (LVEF), METs level, and hospitalizations (DC 7005, 7006). See the VA Ratings for Heart Disease →
Heart Problems Secondary to Hypertension
- Hypertensive Heart Disease – includes complications such as left ventricular hypertrophy, heart failure and ischemic heart disease, all which are caused by prolonged high blood pressure.
- Cardiomyopathy – when it becomes more difficult for the heart to pump blood to the rest of the body. Hypertension can lead to hypertensive cardiomyopathy.
- Pulmonary Hypertension – a type of high blood pressure that affects the arteries in the lungs and the right side of the heart.
- Angina – this symptom of coronary artery disease causes chest pain due to reduced blood flow to the heart muscles.
Vascular Disorders and High Blood Pressure
Strokes (CVA)
A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting enough oxygen and nutrients. Because hypertension damages blood vessels in the brain, both ischemic and hemorrhagic strokes are an increased risk. Veterans with service-connected strokes are rated at 100% for 6 months post-stroke, then rated on residuals (e.g., paralysis, cognitive deficits, speech problems).
Aneurysms
High blood pressure can weaken the walls of the arteries, leading to aneurysms (bulges in the wall of an artery), which can rupture and cause life-threatening internal bleeding. Learn How the VA Rates Aortic Aneurysms →
Atherosclerosis
Atherosclerosis is when fat, cholesterol and other substances build up on artery walls, restricting blood flow. Hypertension can accelerate this process, which will increase the risk of heart attacks and strokes. See the VA Ratings for Atherosclerosis →
Peripheral Artery Disease (PAD)
This condition is caused by narrowed arteries due to hypertension-related atherosclerosis, leading to claudication and reduced limb function. Veterans can be rated under diagnostic code 7114 at 20%, 40%, 60%, or 100%. PAD Disability Ratings Explained →
Other Vascular Disorders Secondary to Hypertension
- Portal Hypertension-related Liver Disease: increased blood pressure in the portal venous system is linked to cirrhosis
- Hypertensive Encephalopathy: a condition where severely high blood pressure causes brain swelling and dysfunction, often leading to symptoms like headache, nausea, vomiting and altered mental status.
- Chronic Venous Insufficiency: when the veins in the legs cannot pump enough blood back to the heart, which can be worsened by hypertension.
- Vascular Dementia: cognitive decline caused by reduced blood flow to the brain, potentially rated by the VA under diagnostic code 9305.
Neurological and Mental Health Disorders
Peripheral Neuropathy Aggravated by Hypertension
Hypertension can worsen blood flow to the limbs and aggravate existing neuropathy or contribute to its development, especially in conjunction with diabetes. Peripheral neuropathy is rated from 10% to 40% depending on severity. How the VA Rates Peripheral Neuropathy →
Chronic Headaches
Hypertension can lead to vascular or tension headaches due to pressure changes in cranial vessels. VA ratings are 0%, 10%, 30%, or 50% under migraine criteria (DC 8100).
Cognitive Impairment
Hypertension causes white matter damage and reduced cerebral blood flow. Additionally, hypertension medications like beta blockers or diuretics can lead to cognitive slowing, dizziness, or depression. Mild neurocognitive disorder is rated from 10% to 100% under diagnostic code 9326, while cognitive decline (dementia) may be rated under diagnostic code 9305 – Major or mild vascular neurocognitive disorder.
Mental Health Disorders
Chronic illnesses like hypertension can lead to depression, anxiety, or adjustment disorders due to the limitations they impose on the veteran’s lifestyle, fear of future complications or medication side effects. These can be service-connected under 38 C.F.R. § 3.310(a) as secondary psychiatric conditions. Learn More About Mental Health Ratings →
Eyesight Issues
Hypertension is associated with diabetes complications, including retinopathy (chronic high blood pressure causes damage to retinal blood vessels). But severe or poorly controlled hypertension can also cause other retinal complications:
- Choroidopathy
- Optic neuropathy
- Transient vision loss (amaurosis fugax)
All these eye conditions are eligible for secondary service connection if they can be medically linked to high blood pressure.
Erectile Dysfunction
Hypertension damages small blood vessels, reducing penile blood flow. Some hypertension medications can also contribute to sexual dysfunction. While this condition only gets a 0% rating, it may qualify for Special Monthly Compensation (SMC-K) for loss of use of a creative organ. Erectile Dysfunction VA Disability Explained →
Gout
Gout is a form of arthritis caused by excess uric acid in the blood, which forms crystals in the joints. Hypertension and certain medications used to treat high blood pressure can increase the risk of developing the condition. See the VA Ratings for Gout →
Service Connecting Secondary Conditions Related to Hypertension
To establish a service connection for secondary conditions caused by hypertension, veterans must provide diagnoses for both conditions and a medical link (nexus) between the two.
- Primary Service-Connected Condition: You have a medical diagnosis of hypertension that is service-connected.
- Secondary Condition Diagnosis: You have a current diagnosis for the secondary condition (e.g., chronic kidney disease, sleep apnea, heart disease).
- Nexus Between Conditions: There is medical evidence linking the secondary condition to your service-connected hypertension. A nexus letter from a healthcare provider should state that it is at least as likely as not (50% or greater probability) that the veteran’s secondary condition is proximately due to or aggravated by service-connected hypertension.
There are many disabilities, from chronic kidney disease to sleep apnea, that can be linked to hypertension. Proper documentation, medical evidence from records, the C&P exam and other medical opinions, and a strong nexus letter are essential for establishing service connection and obtaining VA benefits for these secondary conditions. To learn more, check out the Hill & Ponton FREE ebook The Road to VA Compensation Benefits.
Content Reviewed by
Attorney Anne Linscott
Anne Linscott is an attorney at Hill & Ponton, P.A., dedicated to helping veterans secure the disability benefits they deserve. With a strong background in finance and law, Anne brings compassionate advocacy and a deep commitment to supporting those who have served.
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