Hypertension Under 38 CFR: Ratings, Service Connection, C&P Exam

The VA hypertension rating falls at 10, 20, 40, or 60 percent under Diagnostic Code 7101 in 38 CFR § 4.104, and the tier is decided almost entirely by the numbers on your blood pressure readings.¹ Before any rating applies, though, you have to establish that your hypertension is connected to your military service.

The Four Rating Tiers

For VA purposes, hypertension means diastolic pressure (the bottom number) predominantly 90 or greater. Isolated systolic hypertension is a separate recognized category: systolic pressure predominantly 160 or greater with diastolic staying below 90. Both are rated under the same diagnostic code.¹

The tiers, with monthly compensation for a single veteran with no dependents as of December 1, 2025:

60 percent — diastolic pressure predominantly 130 or more. $1,435.02 per month. This is the highest rating available for hypertension alone.²
40 percent — diastolic pressure predominantly 120 or more. $795.84 per month.²
20 percent — diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more. $356.66 per month.²
10 percent — diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more, or a history of diastolic pressure predominantly 100 or more with continuous medication required for control. $180.42 per month.²

Veterans with a spouse, children, or dependent parents receive higher amounts at the 30 percent level and above.

What “Predominantly” Means and the Three-Day Rule

The word “predominantly” carries real weight in the criteria. Not every reading has to hit the threshold; the majority of them do. Adjudicators look at the overall pattern in your medical records rather than isolated spikes.¹

Before any rating attaches, the diagnosis has to meet an evidentiary standard. Your blood pressure must be measured two or more times on at least three different days.¹ One high reading at one appointment is not enough. The three-day requirement confirms the elevated pressure is persistent, not a response to stress or pain in the moment.

Existing medical records can satisfy the requirement. If your treatment history already contains enough documented readings taken on separate days, no new appointments are needed. Veterans without that documentation are typically sent to a Compensation and Pension exam to gather it.

The 10 Percent Rating on Continuous Medication

The 10 percent tier catches the largest number of veterans, and the third pathway is the reason. If your medication is working well enough that your current readings look normal, you can still qualify at 10 percent as long as the record shows your diastolic pressure previously hit 100 or above before the medication brought it down.¹ The VA treats the need for lifelong medication as a disability in itself.

Your records need to show the medication is prescribed on an ongoing basis. Short-term or as-needed prescriptions for spikes will not qualify. This is also where claims most often stall: if pre-medication readings were never well documented in your service treatment records or early post-service records, proving that historical diastolic threshold becomes difficult. A C&P exam where the examiner specifically addresses medication history can help.

Establishing Service Connection

Meeting the blood pressure numbers gets you nothing on its own. You have to link the hypertension to your service, and there are three ways to do it.

Direct Service Connection

A direct claim needs three things: a current diagnosis, evidence of an in-service event or condition that caused it, and a medical opinion (called a nexus) linking the two. A doctor must state, with a supporting rationale, that your current hypertension is at least as likely as not caused by something that happened during service. Blood pressure that was normal at enlistment and elevated at separation strengthens the claim considerably.

Presumptive Service Connection Under the PACT Act

Some veterans skip the nexus requirement entirely. The PACT Act added hypertension to the list of Agent Orange presumptive conditions, so veterans who served in qualifying locations during specified periods and later develop hypertension are presumed to have a service-connected condition.³

Qualifying service locations and dates:

Republic of Vietnam, January 9, 1962, through May 7, 1975, including service aboard vessels in Vietnam’s inland waterways or within 12 nautical miles of shore
Thailand, any U.S. or Royal Thai military base, January 9, 1962, through June 30, 1976
Laos, December 1, 1965, through September 30, 1969
Cambodia, Mimot or Krek in Kampong Cham Province, April 16, 1969, through April 30, 1969
Guam or American Samoa, January 9, 1962, through July 31, 1980
Johnston Atoll, January 1, 1972, through September 30, 1977
Korean DMZ, September 1, 1967, through August 31, 1971

Veterans who had contact with C-123 aircraft carrying Agent Orange traces, or who tested, transported, or stored Agent Orange, also qualify.³ With a presumptive claim, you need only the diagnosis and proof of qualifying service.

Secondary Service Connection

If your hypertension was caused or worsened by another condition that is already service-connected, you can claim it as a secondary disability under 38 CFR § 3.310. The regulation covers two scenarios: the secondary condition was proximately caused by the service-connected disability, or the service-connected disability aggravated it beyond its natural progression.⁴

The most common secondary claim for hypertension involves PTSD, where chronic stress and the physiological effects of untreated or undertreated PTSD contribute to sustained blood pressure elevation. You need a current hypertension diagnosis, an existing service-connected PTSD rating, and a nexus letter from a qualified provider explaining the connection.

For aggravation claims, the VA requires a baseline showing how severe the hypertension was before the service-connected condition began worsening it. The rating reflects only the degree of worsening above that baseline.⁴

Separate Ratings for Hypertension and Heart Disease

This is where claims often get confused. Note 3 to Diagnostic Code 7101 directs adjudicators to evaluate hypertension separately from hypertensive heart disease and other heart conditions.¹ If you have hypertension and a heart condition such as coronary artery disease, you should receive separate ratings, not a single combined one.

The anti-pyramiding rule under 38 CFR § 4.14 still applies, which prohibits rating the same symptom or functional limitation under two different codes.⁵ Hypertension and heart disease usually produce distinct symptoms — elevated blood pressure readings on one side, reduced cardiac output or exercise tolerance on the other — so separate evaluations are appropriate as long as they don’t overlap.

What to Expect at the C&P Exam

If the VA needs more information to decide your claim, it will schedule a Compensation and Pension exam. The clinician follows the Hypertension Disability Benefits Questionnaire and will record at least three blood pressure readings, review your medical history, ask whether you take continuous medication, and assess whether the condition affects your ability to work.⁶

One question tends to catch veterans off guard. The examiner will specifically ask whether you have a history of diastolic pressure predominantly 100 or more. That single notation drives eligibility for the 10 percent continuous-medication rating, so bring any records showing elevated readings from service or shortly after separation. You should be seated comfortably with back and feet supported during each measurement. No lab work is required for a hypertension diagnosis; the VA diagnoses it solely through blood pressure readings.⁶

1
eCFR. 38 CFR 4.104 – Schedule of Ratings, Cardiovascular System
2
U.S. Department of Veterans Affairs. Current Veterans Disability Compensation Rates
3
U.S. Department of Veterans Affairs. Agent Orange Exposure and Disability Compensation
4
eCFR. 38 CFR 3.310 – Disabilities That Are Proximately Due to, or Aggravated by, Service-Connected Disease or Injury
5
eCFR. 38 CFR 4.14 – Avoidance of Pyramiding
6
U.S. Department of Veterans Affairs. Hypertension Disability Benefits Questionnaire