Note: Use of the term “hypertension” in reports or in VA guidance will most often be used as a synonym for any type of hypertensive vascular disease. b. Blood Pressure Readings Required for SC Subject to the exception below, service connection (SC) for hypertensive vascular disease requires current blood pressure readings (obtained during the claim period) which meet the regulatory definition of either hypertension, or isolated systolic hypertension. Exception: Current readings meeting the regulatory standards for the definitions above are not required if the competent evidence shows a diagnosis of hypertension or isolated systolic hypertension, currently controlled by (or asymptomatic with) medication, and a past competent diagnosis was made in service based on manifestation of blood pressure readings to a compensable degree within the presumptive period as provided in and , or secondary to a service-connected (SC) disability. Notes: When SC is established based on the exception above (where current readings do not meet the regulatory definitions), the disability percentage will be either 0 percent or 10 percent, depending on whether or not the predominant diastolic pressure was 100 or more before symptoms were controlled with medication as provided in . A disability first clearly diagnosed after service can be SC under when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. References: For more information on the concept of competent evidence and policies on evaluating the competency of evidence, see M21-1, Part III, Subpart iv, 5. the multiple blood pressure readings confirmation requirement see, M21-1, Part III, Subpart iv, 4.E.1.c considering a diagnosis of pre-hypertension, see M21-1, Part III, Subpart iv, 4.E.1.d, and considering predominant blood pressure readings in evaluation of hypertensive vascular disease, see M21-1, Part III, Subpart iv, 4.E.1.e. c. The Multiple Blood Pressure Readings In addition to the definitional requirements for a diagnosis of hypertension or isolated systolic hypertension , Note 1 provides a second criterion that must be met for a diagnosis to be acceptable.
f. Considering Long Term Effects of Hypertension Hypertension may exist for years without causing symptoms so increase the cardiac load as to result in hypertrophy of the cardiac muscle or cardiac dilation and decompensation, if sufficiently severe, and cause arteriosclerosis of uneven distribution that often involves the vessels of one organ to a greater degree than those of the rest of the body, in cases where hypertension is long-standing. If the hypertension is of sufficient degree to cause significant impairment of circulation to the organ, symptoms will manifest in accordance with the organ involved, and degree of impairment. g. Definition: Arteriosclerotic Heart Disease Arteriosclerotic heart disease, also diagnosed as ischemic heart disease (IHD) and coronary artery disease (CAD), is a disease of the heart caused by the diminution of blood supply to the heart muscle due to narrowing of the cavity of one or both coronary arteries due to the accumulation of fatty material on the inner lining of the arterial wall. h. Documentation Required to Support a Diagnosis of Arteriosclerotic Heart Disease For rating purposes, a diagnosis of arteriosclerotic heart disease must be documented by objective testing. Objective tests include, but are not limited to electrocardiogram (ECG or EKG) findings treadmill exercise testing (with or without a thallium scan),or cardiac catheterization and angiography. Note: The actual test results do not need to be of record if the evidence indicates that the diagnosis was rendered by a competent medical professional and based on the results of an objective test. Important: Symptoms of chest pain alone are not sufficient to support a clinical diagnosis of arteriosclerotic heart disease for rating purposes. As chest pain is a symptom of multiple disabilities, the diagnosis arteriosclerotic heart disease must be supported with objective documentation. i. Requirement for Documentation of Cardiac Hypertrophy, According to , objective evidence must show the following information for rating purposes when evaluating the cardiovascular conditions listed under whether cardiac hypertrophy is present whether cardiac dilatation is present, and