Nexus Letter for Hypertension Secondary to PTSD: What the VA Looks For

High blood pressure is one of the most common diagnoses among veterans — and one of the most commonly denied when claimed as secondary to PTSD. The medical link is well described: post-traumatic stress disorder keeps the body's fight-or-flight response switched on, with sustained surges of adrenaline and cortisol that, over years, are associated with elevated blood pressure. But the VA does not grant claims on general medical principles. It grants them on evidence in your file, explained by a physician in language the rating system recognizes. That is the job of a nexus letter.

What "secondary service connection" means for hypertension

A secondary claim under 38 CFR § 3.310 does not argue that hypertension began in service. It argues that a condition the VA has already service-connected — here, PTSD — caused your hypertension or aggravated it beyond its natural course. Aggravation matters: even where hypertension has other contributors such as age, weight, or family history, a physician can still opine that PTSD made it measurably worse. (Veterans with Agent Orange or other presumptive exposures may have a separate, direct path; a secondary claim is often the route when no presumption applies.)

The four things a strong nexus letter must address

• A confirmed hypertension diagnosis, with the blood pressure readings that support it documented in your records — not a single elevated reading at one appointment.
• Your service-connected PTSD: the rating, the history, and the symptoms documented over time.
• A medical rationale connecting the two. This is where most letters fail. A conclusory sentence is not a rationale. The opinion has to engage your specific records — treatment notes, medication history, the timeline of both conditions — and tie them to peer-reviewed literature on PTSD, sustained sympathetic activation, and cardiovascular risk.
• The right legal standard. The VA asks whether the connection is "at least as likely as not" — a 50 percent or greater probability. An opinion that hedges below that threshold, or that never states it, gives the rater nothing to grant on.

Why the author's credentials matter

Hypertension sits squarely inside internal medicine. A rater weighing a cardiovascular opinion will notice who signed it. Opinions from Hart Causation and Claims are personally authored by Dr. John H. Hart, Jr., M.D., an ABIM board-certified internist and retired Air Force Reserve Lieutenant Colonel who served as a Senior Flight Surgeon — a physician who has managed hypertension clinically and understands military service from the inside.

The practice prepares independent medical opinions only: no DBQs, no examinations, and no diagnosis or treatment. Records are exchanged through HIPAA-compliant communication via SimplePractice, most opinions are delivered in 10–14 business days (72-hour rush available), and flat fees run $1,500–$3,500 depending on complexity. If the records cannot support a favorable opinion, you will be told so directly — before you commit.