Hypertension VA rating: the high blood pressure criteria

High blood pressure is rated on numbers, which makes it one of the most predictable conditions in the schedule. What is less predictable is service connection, and the rules there changed in 2022 for an entire generation of veterans.

Last reviewed October 2026 · Not legal advice, VA.gov always controls

VA rates hypertension, high blood pressure, under diagnostic code 7101, "hypertensive vascular disease," in 38 CFR § 4.104, at 10%, 20%, 40%, or 60%, set by the diastolic and systolic readings that predominate in your records. Continuous medication gives a 10% floor only with a history of diastolic readings predominantly 100 or more, and the diagnosis must be confirmed by readings taken on at least three different days.

The tiers

"Predominantly" means most of your readings, not your worst one. And the readings the VA weighs are the ones in the record, mainly clinic visits in your service, VA, and private treatment records, and the C&P exam. Someone whose pressure is well controlled on medication will have normal readings in the record, which is why the medication clause in the 10% tier exists. It is the floor for anyone who needed medication to get a diastolic-100 history under control, regardless of what the numbers say today.

Why controlled hypertension tops out at 10%

Modern treatment keeps blood pressure low, and the schedule rates the pressure, not the diagnosis. A veteran on two medications with readings around 130/85 is rated 10% on the medication floor only if the record also shows a history of diastolic pressure predominantly 100 or more; without that history, the rating is 0%, because § 4.31 assigns zero percent whenever a code's compensable criteria are not met. Either way, there is no path to 20% unless control fails. That is frustrating, but it is also a service-connected rating that establishes the foundation for what comes later, because hypertension is a common primary for secondary claims.

Service connection: three routes

Direct

The VA/DoD hypertension guideline notes evidence that hypertension is underdiagnosed and undertreated in the military population, so check the service treatment records, including the separation physical, for elevated readings. A diagnosis of hypertension during service, or a prescription for a blood pressure medication, is direct evidence. Readings that were elevated but never formally diagnosed still help: a nexus opinion can connect an in-service pattern to the post-service diagnosis. Hypertension is also a chronic disease under § 3.309(a), which lists cardiovascular-renal disease, including hypertension, so if it became manifest to a compensable degree (that is, the 10% level) within one year of separation, it is presumed service connected under § 3.307(a)(3), provided the veteran served 90 days or more of continuous active service during a war period or after December 31, 1946, as § 3.307(a)(1) requires.

Presumptive: Agent Orange

The PACT Act, signed on August 10, 2022, added hypertension to the list of conditions presumed to be caused by herbicide exposure, at 38 U.S.C. § 1116(a)(2)(M). Veterans who served in Vietnam or its offshore waters, in or near the Korean DMZ, at U.S. or Royal Thai bases in Thailand, or in the other locations and periods set out in §§ 1116, 1116A, and 1116B no longer need to prove a link. A diagnosis plus qualifying service is the claim. Veterans previously denied on this condition can file a supplemental claim; the presumptive conditions guide explains how. Hypertension is not on the burn-pit presumptive list, so post-9/11 veterans cannot use this route.

The presumption comes from the statute itself: VA's regulatory list at § 3.309(e) does not yet name hypertension, and the Board of Veterans' Appeals has granted these claims under § 1116 directly, though its decisions are non-precedential. The statute phased the presumption in, naming October 1, 2026 for most veterans, but a September 2022 VA decision memorandum applied it to every veteran's claim from the August 10, 2022 enactment date. For a veteran, a grant on this presumption cannot take effect earlier than that date, so an older pending claim may still need the direct or chronic-disease route argued as well.

Secondary

Hypertension is frequently claimed as secondary to other service-connected conditions, and it is one of the conditions where the medical literature gives a nexus opinion something substantial to stand on:

• Sleep apnea. The VA/DoD hypertension guideline lists obstructive sleep apnea as a risk factor for developing hypertension. See how the VA rates sleep apnea.
• PTSD and other mental health conditions. No presumption links these to hypertension, so the claim rests on an individualized medical opinion. The Board of Veterans' Appeals has granted hypertension as secondary to PTSD on the strength of a private provider's opinion, though its decisions are non-precedential.
• Kidney disease and diabetes, which the same guideline says can raise the risk of hypertension. Hyperthyroidism works differently: Note (2) to DC 7101 rates hypertension caused by hyperthyroidism as part of the thyroid condition, not as a separate rating.
• Medication. The guideline tells clinicians to check for NSAIDs and other prescription or over-the-counter medications that interfere with blood pressure control; a prescription history for a service-connected condition can support a secondary or aggravation theory.

For any of these, the opinion has to say the hypertension is at least as likely as not caused or aggravated by the named condition and explain the mechanism in your case. The secondary conditions guide covers what that letter needs.

Hypertension as a primary for other claims

Once hypertension is service connected, conditions that flow from it are claimable as secondaries: hypertensive heart disease (rated under DC 7007 on the METs workload that brings on symptoms, at 10, 30, 60, or 100 percent, and rated separately from it under Note (3) to DC 7101), chronic kidney disease, stroke residuals, hypertensive retinopathy, and erectile dysfunction from either the condition or the medication, which DC 7522 in § 4.115b rates at 0% but flags for review for SMC-K, the award for loss of use of a creative organ. A 10% hypertension rating that later supports a 30% or 60% heart rating is doing more work than its number suggests.

The exam

The hypertension DBQ records your readings, your medication, and your diagnosis history. The form has space for three current readings, which the examiner may take one after another at the same visit. Bring a printed log of home readings over the previous few months if you keep one, and your clinic readings. If you are on medication, make sure the examiner answers two DBQ questions: whether your treatment includes continuous medication, and whether you have a history of diastolic pressure predominantly 100 or more. A yes to both is what the 10% floor rests on.

The checklist

1. Confirmed readings on three different days, in the record.
2. A medication list with start dates.
3. In-service readings or diagnosis from your STRs, especially the separation physical.
4. For Agent Orange claims: proof of qualifying service location and dates.
5. For secondary claims: a nexus opinion naming the primary condition.
6. Any evidence of complications: echocardiogram, kidney labs, eye exam.

Sources

• 38 CFR § 4.104, Schedule of ratings: cardiovascular system: the DC 7101 hypertension tiers, the three-day confirmation rule in Note (1), hypertension from hyperthyroidism rated with the thyroid condition in Note (2), separate rating from heart disease in Note (3), and the METs formula used for hypertensive heart disease under DC 7007.
• 38 CFR § 4.31, Zero percent evaluations: a zero percent rating when a code's compensable criteria are not met.
• 38 CFR § 3.307(a)(1) and (a)(3), Presumptive service connection for chronic, tropical, or prisoner-of-war related disease, disease associated with exposure to certain herbicide agents, or disease associated with exposure to contaminants in the water supply at Camp Lejeune; wartime and service on or after January 1, 1947: the 90-day service requirement, and the one-year window for a chronic disease to reach 10% after separation.
• 38 CFR § 3.309(a) and (e), Disease subject to presumptive service connection: the chronic disease list that includes hypertension, and the herbicide list that does not yet name it.
• 38 U.S.C. § 1116(a)(2)(M) and (d), Presumptions of service connection for diseases associated with exposure to certain herbicide agents; presumption of exposure for veterans who served in certain locations: hypertension as an herbicide presumptive, the covered locations and dates, and, in the PACT Act § 404 notes, the phased-in applicability dates.
• 38 U.S.C. § 1120, Presumption of service connection for certain diseases associated with exposure to burn pits and other toxins: the burn pit presumptive list, which does not include hypertension.
• VA Hypertension Disability Benefits Questionnaire (updated July 11, 2024): what the examiner records, including three current readings, continuous medication, and a history of diastolic pressure predominantly 100 or more.
• Board of Veterans' Appeals, Citation Nr. A24000373 (Jan. 3, 2024): cites the September 20, 2022 VA memorandum that applies the hypertension presumption from the PACT Act's enactment date.