A hypertension nexus letter for your VA claim, from your blood pressure history

What the clinician looks for in your blood pressure records

High blood pressure is a condition of numbers over time, so the clinician's review for the $500 fee starts with the readings: when they were taken, how high they were, and when a diagnosis or medication followed.

• Repeated blood pressure readings taken on different days, not a single high reading at one visit.
• The diagnosis of hypertension and the date it was first made, and when medication was started.
• Readings from service: sick call visits, annual physicals, dental visits, pre-deployment and separation exams. Elevated readings in service matter even if no one called them hypertension at the time.
• Readings from the first years after discharge, which can bridge the gap between service and a later diagnosis.
• Other service-connected conditions in your records that bear on blood pressure, such as kidney disease or sleep apnea, and long-term medications taken for a service-connected physical condition.
• Where you served. If your records show service where VA presumes Agent Orange exposure, the claim may not need a nexus letter at all; see the questions below.

Common service-connection routes for hypertension

Direct service connection under 38 CFR 3.303 rests on the readings. When your service records show blood pressure creeping up, and the post-service records show it kept climbing to a diagnosis, a clinician may find the hypertension began in service even though the diagnosis came later.

Secondary service connection under 38 CFR 3.310 has a few physical routes a clinician may consider: hypertension caused or made worse by service-connected kidney disease, by service-connected sleep apnea, or by long-term use of a medication taken for a service-connected physical condition, such as some anti-inflammatory pain relievers that can raise blood pressure. Each needs records showing the condition or the medication came first.

Hypertension is also on VA's list of conditions presumed connected to Agent Orange exposure. A presumptive claim does not depend on a nexus letter, so if that list covers your service, check that route first.

Is there a DBQ for hypertension?

Yes. VA's public Hypertension DBQ covers it. Commander Health completes it for a flat $200, or with the nexus letter for $550. The licensed clinician completes and signs it only when your records hold the blood pressure readings, the diagnosis and the treatment history the form asks for.

VA rates hypertension on the readings, so the DBQ is only as good as the record of them. If recent readings are missing, the screen says so before you pay, and VA may still order its own exam.

What it is not

• Physical conditions only: Commander Health does not write PTSD or other mental health opinions, or secondary opinions that run through a mental health condition.
• Not an exam or an appointment. There are no calls or video visits; the clinician works from your records, and any follow-up comes by email.
• Not a filing service. Commander Health does not file claims and is not a VSO, a law firm, or a VA-accredited representative. Free help filing a claim is available from a VA-accredited Veterans Service Organization.
• Not a guarantee. Clinical review never guarantees an outcome. A clinician signs only if your records support the opinion, and VA decides the claim.

Frequently asked questions

My blood pressure was a little high in service but never diagnosed. Does that help?

It can. A clinician looks at the pattern of readings in service and after, and may find the condition began in service even if the diagnosis came later. The clinician signs the $500 letter only if your records support it.

My readings are normal now because I take medication. Is that a problem?

No. The readings from before treatment, and the record that medication was needed, show the condition. Upload the older records as well as the recent ones.

Do I need a nexus letter if I was exposed to Agent Orange?

Maybe not. Hypertension is on VA's Agent Orange presumptive list, so if your service qualifies, VA can connect it without a medical opinion on cause. A nexus letter matters more when no presumption applies.

Can hypertension be secondary to my service-connected sleep apnea?

A clinician may consider that route under 38 CFR 3.310 when your records show the sleep apnea came first. The opinion follows your records and the medical literature.