How the Board ruled on heart disease claims, 2021–2025

Heart disease (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

47.1% granted of 2,516 decided cases (margin of error 45.2–49.1%). 1,186 granted, 1,330 denied, 3,163 sent back to VA (remanded, not decided), 562 dismissed.

What convinced the Board in granted cases

• The Board granted when a private, treating, or VA doctor gave a favorable opinion backed by a review of the record, an examination, medical research, or long-term care of the veteran. (4 of 9 decisions read; e.g. 21075361, 21044151, 21052321)
• Many grants turned on proving herbicide exposure, often through the veteran's credible account of duties near Thai air base perimeters or on aircraft, which made heart disease presumptively service-connected. (6 of 9 decisions read; e.g. A21011044, A21010782, 22041145)
• The Board also credited consistent statements from the veteran or family that heart problems or related duties dated back to service. (2 of 9 decisions read, few decisions; e.g. 21052321, 21044151)

Common reasons in denied cases

• The Board denied when no doctor had linked the heart condition to service and only the veteran's own belief about the cause was offered, which was not competent medical evidence. (5 of 11 decisions read; e.g. 21067245, 22001713, A25011207)
• Claims failed when the heart condition first appeared many years after service, with no in-service heart problems and no proven herbicide exposure. (5 of 11 decisions read; e.g. A24050181, 21021316, 22000236)
• The Board relied on VA opinions that reviewed the full record, considered the veteran's contentions, and explained other risk factors or why service did not cause or worsen the condition. (3 of 11 decisions read; e.g. 24003451, 21059878, A24050181)

See the full answer, year by year →

Heart disease (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

48.2% granted of 575 decided cases (margin of error 44.1–52.3%). 277 granted, 298 denied, 627 sent back to VA (remanded, not decided), 44 dismissed.

What convinced the Board in granted cases

• The Board granted when herbicide exposure was presumed or found (Vietnam, Thailand base perimeters, Korea, or a stateside base) and the veteran had coronary artery disease, which is on the presumptive list. (7 of 9 decisions read; e.g. A21014949, A24049420, 22054593)
• When the dispute was whether the veteran truly had ischemic heart disease, the Board found the evidence balanced, gave little weight to a VA exam that gave no rationale, or credited the veteran's report of a doctor's diagnosis. (3 of 9 decisions read; e.g. 22051060, 22001995, 21029909)
• Credible lay accounts, buddy statements, maps and photos about where the veteran worked outweighed an incomplete VA exposure memo, and a negative VA opinion did not defeat the presumption once exposure was shown. (2 of 9 decisions read, few decisions; e.g. A21014949, 21046888)

Common reasons in denied cases

• The Board denied when no medical opinion linked the heart condition to service, and the veteran's or family's own belief about the cause was not accepted as medical evidence. (6 of 12 decisions read; e.g. 21022956, 21009173, 23045553)
• The Board found the veteran was not in Vietnam, its waters, or near the Korean DMZ, so the herbicide presumption did not apply. (4 of 12 decisions read; e.g. A25020762, A23000092, A21003146)
• Other claims failed because there was no ischemic heart disease diagnosis, or the condition (such as atrial fibrillation) or the exposure (Camp Lejeune water, radiation) was not covered by a presumption, and a VA opinion found no link. (5 of 12 decisions read; e.g. 21072343, 21037329, 21042042)

See the full answer, year by year →

Heart disease secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

48.1% granted of 457 decided cases (margin of error 43.6–52.7%). 220 granted, 237 denied, 753 sent back to VA (remanded, not decided), 42 dismissed.

What convinced the Board in granted cases

• The Board credited private opinions citing medical literature on the link, such as PTSD or depression raising heart disease risk, often with no probative contrary opinion. (4 of 11 decisions read; e.g. 23035286, 21005763, 21011541)
• VA examiners' own favorable opinions, such as heart disease being a complication of service-connected hypertension, supported many grants. (5 of 11 decisions read; e.g. 21041236, 22019098, 23052024)
• The Board granted even when heart disease had several causes, if the service-connected condition or its treatment, such as NSAIDs, was a contributing factor. (3 of 11 decisions read; e.g. 23052024, 24026579, 21011541)

Common reasons in denied cases

• Reasoned VA opinions found no link, for example explaining that varicose veins and coronary disease have different causes, and they went unrebutted. (4 of 12 decisions read; e.g. A23021302, A21012660, 21070799)
• Only the veteran's own belief linked the heart condition to service or an exposure, which is not competent medical evidence. (4 of 12 decisions read; e.g. 21060626, 22054670, 21070799)
• There was no current heart diagnosis apart from hypertension, despite the veteran's belief that one existed. (3 of 12 decisions read; e.g. 24026302, 21045562, A21012660)

See the full answer, year by year →

Heart disease secondary to hypertension

Secondary (caused or worsened by a service-connected condition)

66.4% granted of 107 decided cases (margin of error 57.0–74.6%). 71 granted, 36 denied, 120 sent back to VA (remanded, not decided), 9 dismissed.

What convinced the Board in granted cases

• The Board credited private medical opinions explaining that long-standing high blood pressure caused heart changes such as cardiomyopathy or left ventricular thickening. (3 of 6 decisions read; e.g. 21030930, A24055292, 23028602)
• Negative VA opinions lost weight when they relied on inaccurate facts, such as wrongly treating hypertension as not service-connected, or failed to address the secondary question. (3 of 6 decisions read; e.g. 23040231, 21047565, 23028602)
• In some grants a VA examiner's own opinion or rationale described the heart condition as a known complication of hypertension. (2 of 6 decisions read, few decisions; e.g. 21041236, 23040231)

Common reasons in denied cases

• The claim failed because hypertension itself was not service-connected, so a heart condition could not be granted as secondary to it. (5 of 12 decisions read; e.g. 22021656, 21076499, A24003549)
• A reasoned VA opinion found no link and went unrebutted, or the only private opinion gave no reasoning at all. (4 of 12 decisions read; e.g. A25017120, 21075209, 21058310)
• There was no diagnosed heart disability apart from the hypertension, and lay reports of chest pain or palpitations could not supply a diagnosis. (3 of 12 decisions read; e.g. A21003022, 22020178, 22035879)

See the full answer, year by year →

Heart disease secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

49.2% granted of 61 decided cases (margin of error 37.1–61.4%). 30 granted, 31 denied, 103 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion cited studies linking PTSD to heart disease and applied them to the veteran's own history, with a clear rationale based on the record. (5 of 10 decisions read; e.g. A24000215, A23020500, 23018251)
• Private or treating doctors' opinions carried significant weight when based on examining and treating the veteran, including one explaining that PTSD aggravated heart disease caused by service-connected hypertension. (4 of 10 decisions read; e.g. A21002419, 21030930, 23031088)
• Negative VA opinions lost weight when they rested on an inaccurate factual premise, were inadequate, or never considered a later favorable opinion in the record. (3 of 10 decisions read; e.g. A25016718, 23031088, A24019894)

Common reasons in denied cases

• Most denials rested on thorough VA opinions, based on the file and medical literature, finding PTSD was not shown to cause or worsen the heart condition, often pointing to cholesterol or other risk factors instead. (8 of 10 decisions read; e.g. A21009129, 24025843, 22018895)
• Favorable opinions or notes that said PTSD 'may' or had 'the potential' to worsen the heart condition were treated as speculative, and general articles not tied to the veteran's history carried little weight. (3 of 10 decisions read; e.g. 21020187, 21048175, 22037184)
• Some claims failed because testing showed no current heart disorder, and the veteran's own belief about the cause was not competent medical evidence. (3 of 10 decisions read; e.g. 23004741, 23026221, 23052716)

See the full answer, year by year →

Heart disease secondary to diabetes

Secondary (caused or worsened by a service-connected condition)

43.6% granted of 39 decided cases (margin of error 29.3–59.0%). 17 granted, 22 denied, 46 sent back to VA (remanded, not decided), 3 dismissed.

What convinced the Board in granted cases

• The Board granted when a VA examiner's own opinion said diabetes contributed to the heart condition, or when competing opinions that both discussed the record and medical literature were evenly balanced. (2 of 8 decisions read, few decisions; e.g. A23005037, 22031220)
• Several grants found that probative medical evidence showed the heart condition was caused or worsened by diabetes, often together with service-connected hypertension, without the excerpt showing the reasoning. (4 of 8 decisions read; e.g. 21012920, 22003254, A21015070)

Common reasons in denied cases

• Many denials found no current heart disability during the appeal period, or none apart from a hypertension-related condition. (4 of 12 decisions read; e.g. 22053190, A23021183, 21016469)
• Many denials failed because diabetes itself was not service-connected, so nothing could be granted as secondary to it. (4 of 12 decisions read; e.g. 24007258, A23000995, 21053504)
• Where a heart condition existed, thorough VA opinions found it was not caused or worsened by diabetes, for example attributing it to hypertension instead. (3 of 12 decisions read; e.g. 22016325, 21003163, 24003665)

See the full answer, year by year →

Heart disease secondary to depression / psychiatric disorder

Secondary (caused or worsened by a service-connected condition)

Small sample: 28 decided cases, too few for a reliable percentage. 13 granted, 15 denied, 60 sent back to VA (remanded, not decided), 3 dismissed.

See the full answer, year by year →

Heart disease secondary to sleep apnea

Secondary (caused or worsened by a service-connected condition)

Small sample: 23 decided cases, too few for a reliable percentage. 16 granted, 7 denied, 43 sent back to VA (remanded, not decided), 1 dismissed.

See the full answer, year by year →

Heart disease secondary to asthma / COPD / lung condition

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 6 granted, 4 denied, 32 sent back to VA (remanded, not decided), 1 dismissed.

See the full answer, year by year →