Hypertension Secondary to PTSD

If your PTSD is service connected and you have high blood pressure, you can claim the hypertension as secondary to the PTSD. Large studies of veterans and of civilians link PTSD to new hypertension over time. But high blood pressure has many other causes, such as age, weight, smoking and family history, so the medical opinion has to explain why PTSD matters in your case. This page covers what the research shows, how VA decides the claim, how hypertension is rated, and what a nexus letter has to say.

Can PTSD cause hypertension?

The research shows a consistent link over time in large groups, with a few signals about why. It does not prove that PTSD caused one veteran's high blood pressure, and one large genetic study found mixed results.

• A study of 194,319 post-9/11 veterans in VA care (Burg and colleagues, Psychosomatic Medicine, 2017) found that PTSD was tied to new hypertension over a median of 2.4 years, with hazard ratios from 1.12 to 1.30. PTSD treatment lowered that risk: the hazard ratio was 1.44 for untreated PTSD and 1.20 for treated PTSD.
• In the Millennium Cohort, a large group of service members followed over time (Howard and colleagues, Journal of Hypertension, 2020), PTSD was tied to higher odds of hypertension (adjusted odds ratio 1.54) among 38,734 participants. Combat exposure, sleeping less than six hours, being overweight and having obesity were also tied to higher odds.
• Among 47,514 civilian women followed for 22 years in the Nurses' Health Study II (Sumner and colleagues, Psychological Medicine, 2016), the risk of new hypertension rose modestly with the number of PTSD symptoms. Women with six or seven symptoms had the highest risk (hazard ratio 1.20). Higher body mass index and antidepressant use accounted for 30% and 21% of the link.
• A laboratory study of 14 veterans with combat-related PTSD and 14 matched controls (Park and colleagues, Journal of Physiology, 2017) found that the veterans with PTSD had stronger sympathetic nerve and blood pressure responses during mental stress, weaker baroreflex control at rest, and more inflammation.
• A 2017 review (Edmondson and von Känel, Lancet Psychiatry) concluded that PTSD is a risk factor for new cardiovascular disease, with many candidate mechanisms still being sorted out.
• Not every study agrees. A 2021 analysis of 72,224 trauma-exposed people across 11 studies (Sumner and colleagues, Frontiers in Neuroscience) found mixed results. With the largest study included, PTSD symptoms went with lower systolic and higher diastolic pressure; without it, there was a borderline link with higher systolic pressure and no link with diastolic pressure. The authors called for more research.

The paths these studies point to are an overactive stress response, weight gain and medicines. A careful opinion names the one that fits your records and acknowledges what the research does not settle.

How VA decides hypertension secondary to PTSD

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected PTSD caused the hypertension, at least as likely as not.
• Aggravated by. Your hypertension is aggravated by your service-connected PTSD, meaning it would be less severe but for the PTSD (M21-1 V.ii.2.D). VA rates only the part above the baseline level of the hypertension before the aggravation, so the opinion should describe that baseline.

The claim needs three things in the file: a confirmed hypertension diagnosis, service-connected PTSD, and a medical opinion linking the two with reasoning. Confirmation has its own rule. Note 1 to Diagnostic Code 7101 requires readings taken two or more times on at least three different days, and defines hypertension as diastolic pressure predominantly 90 or greater. Isolated systolic hypertension means systolic pressure predominantly 160 or greater with diastolic pressure below 90.

When weight gain is the link

In the Nurses' Health Study II, higher body mass index accounted for 30% of the link between PTSD symptoms and new hypertension. VA does not treat obesity as a disability on its own, but VA's General Counsel (VAOPGCPREC 1-2017) allows it to be a middle step: the PTSD or its medication caused weight gain, the weight gain was a substantial factor in causing the hypertension, and the hypertension would not have happened without the weight gain. The Court of Appeals for Veterans Claims built on that framework in Walsh v. Wilkie (2020). An opinion on this theory has to answer all three parts.

When a PTSD medicine is part of the picture

In the same study, antidepressant use accounted for 21% of the link. For one antidepressant, venlafaxine, a 1998 analysis of 3,744 patients treated for depression (Thase, Journal of Clinical Psychiatry) found that venlafaxine raised diastolic blood pressure in a dose-dependent way that was clinically significant only above 300 mg a day. It did not worsen control in patients who already had high blood pressure. If a medicine is part of your theory, the opinion should name the drug, the dose and the dates.

VA rating for hypertension secondary to PTSD

Hypertension secondary to PTSD is rated the same way as any hypertension, under Diagnostic Code 7101:

• 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 a minimum rating for a history of diastolic pressure predominantly 100 or more that requires continuous medication for control

The 10 percent minimum matters for veterans on medication. If your readings before treatment were predominantly 100 or more diastolic and you now need continuous medication, the minimum applies even when your current readings are controlled. The hypertension VA rating page explains why the higher levels are hard to reach once treatment brings readings down.

VA rates hypertension separately from PTSD, and Note 3 to DC 7101 rates it separately from heart disease as well. The PTSD and hypertension ratings combine under 38 CFR § 4.25, larger rating first. A 70 percent PTSD rating and a 10 percent hypertension rating combine to 73, because the 10 percent takes its share of the remaining 30. VA rounds 73 down to 70 percent, so in that case the combined rating does not change.

The C&P exam for hypertension secondary to PTSD

VA usually orders an exam or a medical opinion for this claim. The examiner is asked whether your hypertension is at least as likely as not caused by your PTSD and, separately, whether the PTSD aggravated it. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013).

What the examiner looks at:

• Your blood pressure history against the three-day rule in Note 1 to DC 7101
• When the hypertension was diagnosed compared with the onset and treatment of your PTSD
• Your readings before medication, which decide the 10 percent minimum
• Your weight history and any medicine that may have caused weight gain or raised blood pressure
• Other risk factors, such as age, smoking, alcohol use, family history, and other conditions in your file such as sleep apnea or diabetes

In Board decision A25088795 (October 2025), the Board granted hypertension secondary to PTSD on a private opinion that reviewed the treatment records and the medical literature and discussed at length how the veteran's PTSD symptoms related to the hypertension. It gave the VA opinions no weight because none addressed aggravation and their reasoning was inadequate. Board decisions are not precedential, but they show what the Board accepts. Watch for an opinion that says PTSD raises blood pressure only briefly during stress, then stops. That does not deal with the long-term studies above, and it skips aggravation. The Board section below shows how the Board ruled on these appeals.

If your PTSD also led to sleep apnea, see sleep apnea secondary to PTSD. If both conditions are in your file, the opinion should address both. Migraines secondary to PTSD has its own page too. C&P exam prep can help you get ready for the exam.

Why hypertension secondary to PTSD claims get denied

The gaps that lead to a denial are the same ones § 3.310 and DC 7101 point to:

• The readings in the file do not meet the three-day rule, so the hypertension is not confirmed.
• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• An opinion blames age, weight or family history without asking whether the PTSD or its medication caused the weight gain.
• A private opinion states a conclusion with no reasoning, or does not address the other risk factors in your file.
• No opinion addresses aggravation.

Nexus letter for hypertension secondary to PTSD

A strong nexus letter for this claim does six things:

1. States that the doctor reviewed your records, including your blood pressure history, your PTSD treatment and your medication list.
2. Gives an opinion on causation: your hypertension is at least as likely as not caused by your service-connected PTSD.
3. Gives a separate opinion on aggravation: your hypertension is aggravated by your service-connected PTSD, meaning it would be less severe but for the PTSD, and describes the baseline, such as your readings and medication needs before the worsening.
4. Explains the reasoning in plain medical terms and cites the research, including the mixed genetic findings.
5. Deals with your other risk factors directly. If weight is part of the picture, it answers the three weight gain questions above.
6. Names any PTSD medicine that is part of the theory, with the dose and the dates.

Where these opinions break down is predictable: no rationale, a conclusion with no reasoning behind it, an incomplete review of the records, or silence on the other causes of high blood pressure in your file. Raven Nexus can organize your records and the research into a draft for your doctor to review.

Questions veterans ask about hypertension secondary to PTSD

Can hypertension be secondary to PTSD?

Yes. VA can grant hypertension secondary to service-connected PTSD under 38 CFR § 3.310 when PTSD caused it or made it worse. Large veteran studies tie PTSD to new hypertension, and a medical opinion has to apply that research to your records.

What is the VA rating for hypertension secondary to PTSD?

The same as any hypertension under Diagnostic Code 7101: 10, 20, 40 or 60 percent, based mainly on diastolic readings. The rating combines with your PTSD rating under 38 CFR § 4.25.

Can I get 10 percent if my blood pressure is controlled on medication?

Yes, if your history shows diastolic pressure predominantly 100 or more and you require continuous medication for control. That is the minimum rating under DC 7101.

Will a 10 percent hypertension rating raise my combined rating?

Sometimes. With a 70 percent PTSD rating, a 10 percent rating combines to 73 and rounds back to 70. With other ratings in the mix, it can push the total past a rounding line.

Can my PTSD medication raise my blood pressure?

Some can. A 1998 analysis found venlafaxine raised diastolic pressure in a dose-dependent way that was clinically significant above 300 mg a day, so the opinion should look at your drug and dose.

Sources

• 38 CFR § 3.310, secondary service connection; M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.104, Diagnostic Code 7101, hypertensive vascular disease, and its notes; 38 CFR § 4.25, combined ratings table.
• VA General Counsel Precedent Opinion 1-2017 (VAOPGCPREC 1-2017), obesity as an intermediate step; Walsh v. Wilkie, 32 Vet. App. 300 (2020).
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• Burg MM, Brandt C, Buta E, et al. Risk for Incident Hypertension Associated With Posttraumatic Stress Disorder in Military Veterans and the Effect of Posttraumatic Stress Disorder Treatment. Psychosomatic Medicine. 2017;79(2):181-188. PMID 27490852.
• Howard JT, Stewart IJ, Kolaja CA, et al. Hypertension in military veterans is associated with combat exposure and combat injury. Journal of Hypertension. 2020;38(7):1293-1301. PMID 31990903.
• Sumner JA, Kubzansky LD, Roberts AL, et al. Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women. Psychological Medicine. 2016;46(15):3105-3116. PMID 27534802.
• Park J, Marvar PJ, Liao P, et al. Baroreflex dysfunction and augmented sympathetic nerve responses during mental stress in veterans with post-traumatic stress disorder. Journal of Physiology. 2017;595(14):4893-4908. PMID 28503726.
• Edmondson D, von Känel R. Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry. 2017;4(4):320-329. PMID 28109646.
• Sumner JA, Maihofer AX, Michopoulos V, et al. Examining Individual and Synergistic Contributions of PTSD and Genetics to Blood Pressure: A Trans-Ethnic Meta-Analysis. Frontiers in Neuroscience. 2021;15:678503. PMID 34248484.
• Thase ME. Effects of venlafaxine on blood pressure: a meta-analysis of original data from 3744 depressed patients. Journal of Clinical Psychiatry. 1998;59(10):502-508. PMID 9818630.
• Board of Veterans' Appeals citation A25088795 (October 15, 2025, granted). Board decisions are not precedential.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.