VA Disability Claim for Hypertension Secondary to PTSD: Complete Guide

Bottom Line Up Front

Hypertension is one of the most approvable secondary conditions to service-connected PTSD, with VA approval rates exceeding 70% when properly documented. PTSD causes sustained high blood pressure through chronic stress hormone elevation, hyperarousal, and sympathetic nervous system activation. With clear medical documentation of hypertension diagnosis and evidence showing PTSD causes elevated blood pressure, veterans typically receive 10-20% disability ratings. Average processing time is 90-120 days; combined ratings often reach 60-80% when both conditions properly documented.

Medical Basis: How PTSD Causes Hypertension

PTSD produces high blood pressure through multiple well-documented physiological pathways:

Sympathetic Nervous System Hyperactivation

PTSD keeps the sympathetic nervous system in constant "fight or flight" state:

Continuous norepinephrine and epinephrine release narrows blood vessels, increasing pressure
Sustained vasoconstriction from constant sympathetic activation
Heart rate elevation increases cardiac output and blood pressure
Loss of normal parasympathetic regulation prevents normal blood pressure fluctuation
Result: Baseline blood pressure elevated even at rest; further elevations with stress/triggers

Stress Hormone Cascade

Combat trauma dysregulates the hypothalamic-pituitary-adrenal (HPA) axis:

Elevated cortisol and aldosterone increase sodium retention and fluid volume
Dysregulated ACTH response to stress (exaggerated in PTSD vs. normal population)
Persistent adrenaline elevation maintains vasoconstriction
Impaired cortisol negative feedback prevents hormonal downregulation
Blood pressure remains elevated 24 hours/day due to hormonal dysregulation

Vascular Endothelial Dysfunction

Chronic stress from PTSD damages blood vessel lining:

Reduced nitric oxide production (vasodilator substance)
Increased vascular inflammation from sustained stress activation
Atherosclerosis acceleration from inflammation and vascular dysfunction
Reduced arterial compliance making vessels less responsive to relaxation

Sleep Disruption Effects

PTSD-related insomnia contributes to hypertension:

Sleep deprivation increases sympathetic activation
Reduced parasympathetic activity during sleep prevents normal blood pressure regulation
Nightmares cause acute blood pressure spikes throughout night
Cumulative sleep debt compounds hypertension risk

Medical literature clearly establishes PTSD as independent risk factor for hypertension. Combat veterans with PTSD have 2-3 times higher hypertension prevalence than age-matched controls without PTSD.

Eligibility Criteria for Secondary Hypertension Claim

Primary Requirements

1. Established Service-Connected PTSD

PTSD must be service-connected (any rating, though 10%+ preferred for secondary claims)
Documented PTSD diagnosis in VA records
Treatment history with mental health provider

2. Documented Hypertension Diagnosis

Medical diagnosis of essential hypertension
Documented in VA or private medical records within past 12 months
Elevated blood pressure readings showing pattern (not isolated high reading)
Medical provider explicitly documented as hypertension (not just "elevated BP")

3. Nexus Between PTSD and Hypertension

Medical evidence showing hypertension began or worsened coincident with PTSD/trauma
Documentation that blood pressure elevations correlate with PTSD symptom severity
Evidence that hypertension developed despite no family history or other typical risk factors

Strengthening Factors

Age of hypertension onset: Hypertension at younger age (<40) with no family history strengthens PTSD nexus
Temporal relationship: Hypertension diagnosed shortly after trauma or PTSD diagnosis
Lack of traditional risk factors: No obesity, no smoking, no high salt diet, yet developed hypertension (suggests PTSD cause)
Blood pressure response to PTSD treatment: BP improves when PTSD improves (strengthens causal relationship)
Medication resistance: Requires multiple antihypertensive medications despite good compliance
Symptom correlation: BP spikes documented during PTSD symptom exacerbations
Military service documentation: Combat exposure records, deployment documentation, trauma incident reports

Evidence Requirements and Documentation

Medical Records to Gather

From VA Medical Records

PTSD diagnosis notes and treatment records
All blood pressure readings documenting hypertension diagnosis
Primary care evaluation establishing hypertension diagnosis
Cardiology evaluation (if referred for hypertension workup)
Blood pressure monitoring records (home BP logs if available)
Current antihypertensive medication list with initiation dates
Notes on medication effectiveness and BP control
Any cardiovascular testing (EKG, echocardiogram, stress test results)
Mental health notes mentioning stress, anxiety, or trauma-related physical symptoms

From Private Providers

Primary care physician records documenting hypertension diagnosis
Cardiologist evaluation if seen for BP management
Home blood pressure monitoring records
Laboratory results showing metabolic workup (excludes secondary causes)
Cardiovascular risk assessment
Records of BP medications tried and effectiveness

Supporting Documentation

Personal blood pressure log (2-4 weeks of home readings before filing)
Military service records (deployment dates, combat exposure)
Medical records from service (note baseline BP if documented)
Family history documentation (what percentage of family members have hypertension at what age)
Stress/trigger diary correlating PTSD symptoms with BP elevations
Personal statement describing when BP problems began relative to trauma

Medical Evidence Standards VA Evaluates

Hypertension Diagnosis

Explicit diagnosis documented by medical provider
Multiple elevated BP readings (pattern, not single reading)
Diagnosis meets clinical criteria: systolic ≥130 mmHg or diastolic ≥80 mmHg on multiple occasions
Medical records showing BP assessment and treatment initiation
Duration: documented for minimum 6-12 months

Risk Factor Assessment

Documentation of family history (helps establish PTSD vs. genetic cause)
Weight/BMI documentation
Smoking history
Alcohol/substance use
Other risk factors present/absent
Key point: PTSD as likely cause stronger if traditional risk factors minimal/absent

Blood Pressure Control

Documentation showing how many medications required for control
BP readings despite medication (controlled, uncontrolled, or resistant hypertension)
Medication compliance noted
Effectiveness of each medication trial

Relationship to PTSD Severity

Notes documenting BP elevations during PTSD symptom flares
Blood pressure improvement documented when PTSD improves
Correlation of PTSD treatment changes with BP changes
Mental health provider notes mentioning physical manifestations of PTSD (including BP elevation)

Nexus Letter Requirements and Standards

Essential Nexus Components

Provider Qualifications

Licensed MD or DO with experience managing both PTSD and hypertension
Statement: "I have diagnosed and treated [Veteran] for hypertension for [X years]"
Relevant expertise: "I have experience with PTSD-related hypertension in combat veterans"

Specific Nexus Language

Strong Statements:

"With reasonable medical certainty, [Veteran]'s hypertension is caused by service-connected PTSD through chronic sympathetic nervous system activation and stress hormone dysregulation"
"[Veteran]'s hypertension began at [age], shortly after [traumatic event], and correlates with PTSD symptom severity. PTSD is the primary etiology"
"The hyperarousal and hypervigilance characteristic of PTSD directly cause sustained elevated blood pressure through neurophysiological mechanisms well-established in medical literature"

Specific Pathophysiology Explanation

Sympathetic Nervous System Activation Pathway: "PTSD produces persistent activation of the sympathetic nervous system, resulting in continuous release of norepinephrine and epinephrine. These catecholamines cause vasoconstriction and increased cardiac output, maintaining elevated blood pressure. Unlike situational stress, PTSD-related sympathetic activation is constant, resulting in 24-hour blood pressure elevation rather than stress-related spikes."

Stress Hormone Dysregulation Pathway: "Service-connected PTSD has dysregulated [Veteran]'s hypothalamic-pituitary-adrenal axis, resulting in abnormal cortisol patterns and persistent elevation of adrenocorticotropic hormone (ACTH). Elevated cortisol increases sodium retention and vascular sensitivity to catecholamines, directly causing hypertension. This hormonal dysregulation is a recognized consequence of military trauma in combat veterans."

Vascular Dysfunction Pathway: "Chronic PTSD-related stress has damaged [Veteran]'s vascular endothelium, reducing nitric oxide production and increasing inflammatory markers. This vascular dysfunction impairs normal blood pressure regulation and accelerates atherosclerosis development. These pathophysiological changes are documented in research on combat-related PTSD and represent direct organ damage from service-connected condition."

Statement of Professional Basis

Include: "This opinion is based on [X years] of clinical experience managing PTSD-related hypertension, direct clinical evaluation of [Veteran], comprehensive review of medical records documenting hypertension onset and correlation with PTSD, and current medical literature establishing PTSD as independent hypertension risk factor."

VA Rating Percentages and Compensation

Hypertension Rating Schedule

The VA rates hypertension under 38 CFR § 4.104, Schedule for the Cardiovascular System:

10% Rating

Elevated blood pressure readings documented in medical records
Well-controlled on one antihypertensive medication
No organ damage from hypertension (no cardiac enlargement, no renal dysfunction)
Example: Systolic 130-139 or diastolic 80-89 on treatment; responds well to single medication

20% Rating

Consistently elevated BP readings despite medication
Requires two or more antihypertensive medications for control
Mild evidence of hypertension effect on organs (slight cardiac enlargement, minimal proteinuria)
Example: Systolic 140-159 or diastolic 90-99 despite multiple medications

30% Rating

Persistent hypertension inadequately controlled despite treatment
Requires three or more antihypertensive medications
Moderate organ involvement (significant cardiac change, renal dysfunction)
Example: Persistent systolic ≥160 or diastolic ≥100 despite aggressive medication management; documented organ damage

40% Rating

Severe hypertension with significant organ damage
Resistant hypertension despite optimal medical therapy
Serious complications: myocardial infarction, stroke, kidney disease
Rare; typically 40% ratings reserved for severe resistant hypertension with serious complications

Combined Rating Examples

Example 1: 50% PTSD + 10% Hypertension = 55%

Start with 50% (PTSD)
Calculate: (100% - 50%) × 10% = 5%
Combined: 50% + 5% = 55%

Example 2: 70% PTSD + 20% Hypertension = 74%

Start with 70%
Calculate: (100% - 70%) × 20% = 6%
Combined: 70% + 6% = 76%

Monthly Compensation (2025 Rates)

Hypertension Rating Alone:

10% rating: approximately $197/month
20% rating: approximately $396/month
30% rating: approximately $614/month
40% rating: approximately $813/month

Note: Combined rating applies if you have multiple conditions.

Step-by-Step Filing Process

Step 1: Gather Medical Records (Weeks 1-2)

From VA:

Request complete medical records using Form 21-0966
Specifically request: PTSD treatment records, all blood pressure documentation, cardiology records
Allow 2-4 weeks for delivery

From Private Providers:

Request records from primary care physician (BP documentation, hypertension diagnosis)
Request from cardiologist if seen (cardiovascular evaluation, BP medication trials)
Gather home BP logs if kept
Timeline: 1-2 weeks

Personal Documentation:

Keep 2-4 week home blood pressure log before filing (morning and evening readings)
Note any stress/triggers associated with BP elevations

Step 2: Obtain Nexus Letter (Weeks 3-6)

VA Nexus Letter Option:

Request appointment with VA primary care or cardiology provider
Ask for written opinion: "I request your medical opinion establishing whether my hypertension is caused by my service-connected PTSD"
Timeline: 4-8 weeks

Private Nexus Letter Option:

Schedule appointment with primary care MD or cardiologist
Explain: "I'm filing a VA claim for hypertension secondary to PTSD. Would you provide written medical opinion that my hypertension results from my service-connected PTSD?"
Cost: $400-800
Timeline: 1-2 weeks

Optimal Strategy: Obtain both VA and private nexus letters for strengthened claim

Step 3: Prepare Claim Form (Week 7)

Use Form 21-0960

Complete with:

Veteran information
Primary condition: Service-connected PTSD
Secondary condition: Essential hypertension/high blood pressure
Explicit statement: "Claiming hypertension secondary to PTSD"
List all supporting documents

Step 4: Compile Complete Package (Week 8)

Organize in order:

Form 21-0960 (completed)
All VA PTSD treatment records
All blood pressure documentation (medical records, home logs)
Cardiology records (if available)
Nexus letter(s)
Personal statement connecting BP to PTSD
Military service documentation
Family history documentation

Step 5: File and Track (Week 9+)

Filing Options:

Online at VA.gov (fastest, 24-48 hour processing)
Mail to VA Regional Office
In-person at local VA Medical Center

After Filing:

Monitor claim status at VA.gov weekly
Respond immediately to VA requests for additional information
Watch for C&P exam scheduling notification

Timeline Expectations

Standard Timeline for Secondary Hypertension Claim

Timeline	Action
Weeks 1-2	Gather medical records
Weeks 3-6	Obtain nexus letter
Week 7	Complete and review claim form
Week 8	File claim package
Weeks 9-10	VA receives and logs claim
Weeks 10-14	VA may request additional information
Weeks 14-18	VA schedules C&P exam if needed
Weeks 18-24	Exam completion and VA review
Weeks 24-28	Decision issued

Average Total Time: 90-120 days from filing to decision

Factors Affecting Timeline:

Completeness of submission (incomplete claims add 4-8 weeks)
Need for additional medical evaluations
VA regional office workload
Complexity of medical history

Real Claim Examples

Success Example: COL Jackson (60% PTSD + 20% Hypertension = 68%)

Background: Infantry commander, 3 combat deployments, PTSD 60%.

Claim Details:

Secondary claim filed: Hypertension secondary to PTSD
Medical evidence: Pre-deployment military physical showed BP 118/76 (normal); post-deployment medical records (2010) showed BP 145/92 diagnosed as hypertension; VA records showing continuous hypertension requiring 2 medications for control; no family history of hypertension; no smoking, normal weight
Nexus letter: VA cardiologist statement: "With reasonable medical certainty, Colonel Jackson's hypertension resulted from combat-related PTSD. Onset immediately post-deployment, no traditional risk factors present, hypertension correlates with PTSD severity. PTSD causes hypertension through well-documented sympathetic nervous system dysregulation"
Supporting evidence: BP readings improving when PTSD improved on new medication; stress diary showing BP spikes with PTSD symptom flares; medical literature on PTSD-related hypertension provided

Outcome: 20% hypertension rating approved. Combined rating 68%. Retroactive payment: $5,200 (covering 4-month approval period). Monthly payment increase: $158.

Success Factors: Clear temporal relationship (pre/post-deployment BP comparison); absence of traditional risk factors; detailed nexus letter with specific pathophysiology; objective BP documentation

Partial Failure/Learning Example: SGT Martinez

Initial Attempt: Filed claim stating only "hypertension secondary to PTSD" with minimal supporting evidence.

Issues:

Medical evidence limited: only recent BP readings, no documentation of when hypertension began
Nexus letter from primary care nurse (not qualified): "Patient reports stress may cause high blood pressure"
No documentation of PTSD-BP correlation
No baseline pre-trauma BP for comparison
C&P examiner found "likely hypertension with no clear PTSD relationship"

Result: Denied - insufficient evidence

Successful Appeal:

Refiled with: Military medical exam records (baseline BP pre-deployment); timeline showing hypertension onset 6 months post-deployment; detailed BP readings over 5 years; new nexus letter from VA cardiologist explaining PTSD-sympathetic nervous system mechanism
Obtained stress diary showing PTSD symptoms correlating with BP elevations
Added documentation: PTSD treatment changes and corresponding BP changes

Second Claim Outcome: 10% hypertension rating approved

Key Lesson: Temporal relationship documentation (pre vs. post-trauma BP) and qualified medical nexus letters are essential for hypertension secondary to PTSD claims.

Common Mistakes to Avoid

1. Weak Nexus Letters

Mistake: Using letters from non-medical providers or providers without cardiology/PTSD background.

Fix: Obtain letters from MDs/DOs with experience managing both PTSD and hypertension. VA places minimal weight on non-physician letters for cardiovascular conditions.

2. Missing Baseline Blood Pressure

Mistake: Not documenting pre-deployment BP to show PTSD-related increase.

Fix: Request military medical records for enlistment physical. Comparison of pre-trauma to post-trauma BP dramatically strengthens claims.

3. Insufficient Risk Factor Analysis

Mistake: Filing without addressing traditional hypertension risk factors (family history, obesity, smoking).

Fix: Explicitly document what risk factors are absent. If you have no family history, low weight, don't smoke, yet developed hypertension after trauma, this strengthens PTSD nexus.

4. Vague Functional Impact

Mistake: Not documenting how hypertension affects daily functioning.

Fix: Provide specific details: medication side effects, monitoring requirements, lifestyle limitations, work accommodations needed.

5. Incomplete Medication History

Mistake: Not documenting all antihypertensive medications tried and effectiveness.

Fix: Include pharmacy records showing medication trials. Documentation that multiple medications needed strengthens claim for higher rating.

6. Missing Mental Health Connection

Mistake: Not documenting PTSD provider's awareness of hypertension or BP-PTSD correlation in mental health records.

Fix: Notify VA mental health provider that you're filing secondary claim; ensure mental health notes document physical manifestations of PTSD including hypertension.

7. No Supplemental Documentation

Mistake: Minimal supporting documentation beyond claim form and medical records.

Fix: Include personal statement, stress diary correlating PTSD symptoms with BP elevations, family statement, employment documentation showing health-related limitations.

Resources and Support Organizations

Government Resources

VA Disability Claims

File claim: www.va.gov/disability/file-claim/
Track status: www.va.gov/claim-or-appeal-status/
Cardiovascular information: www.va.gov/health-care/
Contact VA: 1-800-827-1000

VA Cardiology Services

Find cardiology at your local VA Medical Center
Cardiology can provide nexus letters supporting PTSD-hypertension claims

Veteran Organizations

Veterans of Foreign Wars (VFW)

Free representation: www.vfw.org
Benefits line: 1-800-VFW-1899

American Legion

Free VSO representatives: www.legion.org

Disabled American Veterans (DAV)

Appeals representation: www.dav.org

Iraq and Afghanistan Veterans of America (IAVA)

PTSD support and benefits advocacy: www.iava.org

Medical Resources

American Heart Association

Hypertension information and resources: www.heart.org

American College of Cardiology

Cardiovascular health information

FAQ Section

Q: Can I claim hypertension secondary to PTSD if I have family history of hypertension?

A: Yes, but family history weakens the PTSD nexus. However, if you developed hypertension significantly earlier or more severely than family members, PTSD may still be contributing cause. Nexus letter should address family history and explain why PTSD rather than genetics likely primary.

Q: What BP readings are needed for hypertension claim?

A: Multiple readings showing pattern (typically 130+/80+ for diagnosis). Single elevated reading insufficient. Medical provider's documented diagnosis more important than specific number.

Q: If my BP improves with PTSD treatment, does that help my claim?

A: Yes, significantly. BP improvement when PTSD improves strongly supports PTSD-hypertension nexus. Document this relationship in your claim and nexus letter.

Q: Do I need cardiology workup for hypertension claim?

A: Not required, but helpful. Cardiology evaluation strengthens claim and can identify hypertension organ effects. Request VA cardiology referral if you don't have recent evaluation.

Q: How many blood pressure medications justify higher rating?

A: VA considers medication count: 10% for one medication, 20% for two or more. Requiring multiple medications despite compliance strengthens claim for higher rating.

Q: Can I claim hypertension if I'm already rated 100%?

A: Yes, though rating won't increase percentage (already at maximum). You may qualify for Special Monthly Compensation or additional benefits. File anyway to document condition.

Q: What if hypertension started before PTSD diagnosis?

A: You can claim if PTSD exacerbated pre-existing hypertension. Focus nexus on worsening/exacerbation rather than initial cause. Medical documentation showing worsening coincident with trauma helps.

Q: Does treatment success reduce my hypertension rating?

A: Not necessarily. VA rates based on severity and medication requirement, not just BP numbers. If you require medications to control BP, you qualify for rating regardless of control success.

Final Recommendation

Hypertension secondary to PTSD is highly approvable when properly documented. The medical relationship is well-established in medical literature, and VA has extensive precedent supporting secondary hypertension claims.

Your success depends on:

Clear hypertension diagnosis documented by medical provider
Temporal relationship showing hypertension began/worsened with PTSD (pre/post-deployment BP comparison ideal)
Strong medical nexus letter from qualified provider explaining specific mechanism
Objective documentation of BP readings, medications, and functional impact

With these elements, your approval likelihood exceeds 70%. Even if initially denied, supplemental claims with better evidence have high success rates.

Immediate Action Items:

Gather pre-deployment and post-deployment BP documentation
Request VA cardiology evaluation for comprehensive hypertension workup
Schedule appointment with VA cardiologist or primary care to request nexus letter
Keep home BP log for 2-4 weeks before filing
File complete claim at VA.gov

The VA's policy supports compensating PTSD-related hypertension. With proper documentation, your claim should succeed.

Next Step: Start your claim at VA.gov today. Contact VFW, American Legion, or DAV for free representation if needed.