How to file a VA hypertension claim — the Agent Orange presumption, direct and secondary routes, and how DC 7101 rates it
High blood pressure can be service-connected four ways: as an Agent Orange presumptive condition added by the PACT Act for veterans with presumed herbicide exposure (Vietnam and the added locations); as a chronic disease that appeared to a compensable degree within one year of separation (38 CFR 3.307 and 3.309(a), "cardiovascular-renal disease, including hypertension"); directly, when it was diagnosed in service; or secondary to a service-connected condition with a medical opinion under 38 CFR 3.310. VA rates it under 38 CFR 4.104, diagnostic code 7101, from 10% to 60% based on predominant diastolic and systolic readings, and the diagnosis must be confirmed by readings taken two or more times on at least three different days. File on VA Form 21-526EZ.
What you'll need
- VA Form 21-526EZ
- Medical records with the diagnosis and blood pressure readings taken on at least three different days, and your current medication list
- For the Agent Orange route: service records showing service in a presumptive location and period
- For a secondary claim: the rating decision for the primary condition and a medical opinion linking the two
- A free accredited representative (CVSO or VSO)
Step-by-step
Step 1: Pick the route to service connection
Agent Orange presumptive: the PACT Act added hypertension to the Agent Orange list, so a veteran with presumed exposure — service in the Republic of Vietnam (January 9, 1962 – May 7, 1975), on certain Thailand bases (1962–1976), in Laos (1965–1969), at Mimot or Krek, Cambodia (April 1969), on Guam, American Samoa or their waters (1962–1980), on Johnston Atoll (1972–1977), in the Korean DMZ (September 1, 1967 – August 31, 1971), or other presumptive exposure — needs only the diagnosis. One-year presumption: hypertension that reached a compensable level within one year after separation is presumed service-connected as a chronic disease. Direct: diagnosed or treated in service. Secondary: caused or aggravated by a service-connected condition, with a physician's opinion explaining the link. Hypertension is not a Gulf War or burn-pit presumptive.
Reference: https://www.va.gov/resources/the-pact-act-and-your-va-benefits/
Step 2: Meet VA's definition and gather the readings
Under DC 7101, Note 1, hypertension means diastolic pressure predominantly 90 or greater, and isolated systolic hypertension means systolic pressure predominantly 160 or greater with diastolic under 90; either must be confirmed by readings taken two or more times on at least three different days. Gather clinic records that show readings over time (VA and private), the date of diagnosis, and when medication started and at what doses. A home blood pressure log can supplement, but the claim exam and clinic records are what VA rates on.
Step 3: File VA Form 21-526EZ
File online, by mail to the Claims Intake Center (PO Box 4444, Janesville, WI 53547-4444), in person or through a free accredited representative, naming the condition and the route (for example "hypertension — Agent Orange presumptive" or "hypertension secondary to service-connected [condition]"). If VA denied hypertension before August 10, 2022 and you have presumed Agent Orange exposure, file a Supplemental Claim (VA Form 20-0995) so VA reviews it under the new presumption.
Reference: https://www.va.gov/disability/file-disability-claim-form-21-526ez/
Step 4: The claim exam
VA will usually schedule an exam that takes blood pressure readings and reviews your history and medications. Bring your medication list and any log. Tell the examiner what your readings were before treatment started, because the minimum 10% level under DC 7101 is tied to a history of diastolic readings predominantly 100 or more plus the need for continuous medication.
Step 5: How DC 7101 rates hypertension
10% — diastolic predominantly 100 or more, or systolic predominantly 160 or more, or the minimum for a veteran with a history of diastolic readings predominantly 100 or more who requires continuous medication for control; 20% — diastolic predominantly 110 or more, or systolic predominantly 200 or more; 40% — diastolic predominantly 120 or more; 60% — diastolic predominantly 130 or more. Hypertension is rated separately from hypertensive heart disease and other heart conditions (Note 3). If service connection is granted but the readings do not meet the 10% criteria, VA assigns a 0% (noncompensable) rating under 38 CFR 4.31, which still counts as service connection.
Critical tips
- Vietnam-era veterans who were denied hypertension before the PACT Act should file a Supplemental Claim — the presumption now applies.
- Conditions that medical evidence links to service-connected hypertension (for example hypertensive heart disease or kidney disease) are separate secondary claims under 38 CFR 3.310 with their own ratings.
- A 0% rating still establishes service connection and can be increased later if readings or medication needs change.
- A county veterans service officer can file the claim for free: warriorsfund.org/find-cvso.
- In crisis: dial 988 then press 1, or text 838255.