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The Department of Veterans Affairs (VA) proposes to remove Note (1) under diagnostic code (DC) 7101 pertaining to hypertensive vascular disease (hypertension and isolated systolic hypertension). This proposed revision would ensure that VA’s Schedule for Rating Disabilities (VASRD) aligns with current medical understanding of hypertension and remove an unintended barrier to service connection, facilitating appropriate awards of service connection for our nation’s veterans.

Statement of Need:

Similar to 2900-AQ72, 2900-AQ73, and 2900-AQ82, this proposed rule will update the VASRD to incorporate medical advancements that have occurred since the last revision, update current medical terminology, and provide clear evaluation criteria for hypertensive vascular disease (hypertension and isolated systolic hypertension).

Summary of the Legal Basis:

38 U.S.C. 1155. VA will revise 38 CFR 4.104 and Diagnostic Code (DC) 7101, which sets forth the criteria for hypertension.

Alternatives:

VA cannot update the VASRD through non-regulatory action. VA could choose to leave the VASRD criteria as is, but failure to update the notes under DC 7101 would leave outdated medical standards for hypertension in place. One of VA’s main objectives for the VASRD is to ensure it accurately reflects medical advancements and improved technology. Since VA cannot accomplish this goal through non-regulatory action, failure to pursue a regulatory update does not align to VA’s objectives. VA also considered replacing the definition of hypertension in DC 7101 with the currently accepted definition from the American Heart Association (AHA). While this approach would satisfy VA’s goal of ensuring the criteria aligns to current medical standards, it would require VA to continuously update DC 7101 following any updates to AHA’s definition of hypertension, which could lead to confusion. Since there is no regulatory need for VA to maintain a hypertension definition within the VASRD, complete removal is the most effective approach to ensure accurate claims processing.

Anticipated Costs and Benefits:

The total budgetary impact is estimated to be $348.8 million over five years and $357.5 million over 10 years.

Risks:

By processing claims for compensation benefits using outdated criteria, VA risks overcompensating or undercompensating Veterans for these service-connected conditions.