How the VA rates hypertension

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 August 2026 · Not legal advice, VA.gov always controls

Hypertension is rated under diagnostic code 7101, "hypertensive vascular disease," in 38 CFR § 4.104, the cardiovascular section. The tiers are set entirely by blood pressure readings, with one exception for medication.

The tiers

"Predominantly" means most of your readings, not your worst one. And the readings the VA counts are the ones in the record: clinic visits, the C&P exam, a home log if a provider has noted it. 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 most hypertension ratings are 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 and has 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

Elevated readings in service treatment records are common, especially at separation physicals. 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), 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.

Presumptive: Agent Orange

The PACT Act, signed in August 2022, added hypertension to the list of conditions presumed to be caused by herbicide exposure. Veterans with qualifying service in Vietnam, the Korean DMZ, Thailand air bases, and the other locations covered by § 3.309(e) no longer need to prove a link. A diagnosis plus qualifying service is the claim. This was the single largest expansion of presumptive hypertension claims in the history of the program, and 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.

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. Untreated obstructive sleep apnea is a well-documented contributor to hypertension. See how the VA rates sleep apnea.
• PTSD and other mental health conditions. The National Academies have found suggestive evidence of an association between PTSD and hypertension, and many claims succeed on this theory with an individualized opinion.
• Kidney disease, diabetes, and thyroid conditions, where the physiological link is direct.
• Medication. NSAIDs, some stimulants, and some psychiatric drugs raise blood pressure; 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, often far higher than the hypertension itself), chronic kidney disease, stroke residuals, hypertensive retinopathy, and erectile dysfunction from either the condition or the medication, which carries SMC-K. 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 examiner will take your pressure, usually once. 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 records that you require it for control, because that phrase is the 10% floor.

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.