Citation Nr: 21000596 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 17-16 218 DATE: January 5, 2021 ORDER Entitlement to service connection for obstructive sleep apnea (OSA) is denied. Entitlement to service connection for an acquired psychiatric condition is denied. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric condition, is denied. FINDINGS OF FACT 1. The evidence of record is against finding that the Veteran’s OSA occurred in, or is the result of, his period of active duty service. 2. The evidence of record is against finding that the Veteran was diagnosed with an acquired psychiatric disorder during service, had an acquired psychiatric condition that superimposed itself on an in-service personality disorder, or was diagnosed with a psychosis within one year after separation. 3. The evidence of record is against finding that the Veteran’s preexisting hypertension experienced in-service worsening, and the Veteran otherwise is not service connected for any acquired psychiatric condition. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for OSA are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for entitlement to an acquired psychiatric are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a) (c), 3.384, 4.9, 4.127. 3. The criteria for entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric condition, are not met. 38 U.S.C. §§ 1110, 1111, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.304(b), 3.306, 3.310, 3.322. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1963 to July 1964. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The issues on appeal were previously before the Board in June 2020 decision. At the time, the issue of service connection for diabetes mellitus, type II, was denied; while the issues that are the subject of this appeal were remanded for development as described below. It is acknowledged that the issue of service connection for diabetes mellitus, type II was included on the subsequent September 2020 Supplemental Statement of the Case (SSOC); however, this was in error and may not be considered by the Board herein. In regard to the issues on appeal, the Board reopened, on the basis of new and material evidence, the claims for an acquired psychiatric condition and hypertension. Those claims, as well as the one for OSA, were remanded for additional development. With respect to OSA, VA was to obtain an addendum opinion and, if necessary, schedule the Veteran for an examination, to assess whether the Veteran’s in-service complaints of snoring and daytime tiredness, as well as experiencing problems with phlegm, were related to his current condition. For the psychiatric claim, a VA examination was required to assess the nature and etiology of any current diagnosis. The Board recognized that the Veteran has a preexisting personality disorder, so the examiner also was to answer whether a superimposed psychiatric condition developed during service and persisted into the present. As hypertension is argued as secondarily related to a psychiatric condition, adjudication of the hypertension issue hinged on the development for the psychiatric claim. In August 2020, VA afforded the Veteran the necessary examinations and obtained the appropriate medical opinions (discussed more fully below). Thus, VA substantially has complied with the Board’s prior remand directives, and adjudication now may proceed. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). To establish service connection, there must exist medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); 38 C.F.R. § 3.303(a). In rendering a decision on appeal, the Board must analyze the competency, credibility, and probative value of the evidence, account for the evidence that it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Buchanan v. Nicholson, 451 F.3d 1331, 1335–37 (Fed. Cir. 2006). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall resolve all reasonable doubt in favor of the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102. 1. Entitlement to service connection for OSA is denied. The Veteran alleges that his OSA manifested during service, claiming that he experienced problems with phlegm, snoring, and daytime tiredness. He also asserts that his snoring was so loud that other soldiers did not want to share a room with him. See Tr. 3–4. The Veteran’s service treatment records (STRs) show that he checked the box for “frequent trouble sleeping” on his June 1962 pre-enlistment examination report. Despite this, he did not claim sleep difficulties during his August 1963 induction examination. The remainder of the STRs similarly are absent for complaints or diagnoses of OSA, to include the May 1964 separation examination report. The first reference to OSA does not appear until decades after the Veteran’s discharge from active duty. A June 1997 private treatment record from Dr. M.B. contains an assessment of “probable obstructive sleep apnea.” Recent VA medical center (VAMC) and private medical records show that the Veteran has been diagnosed with OSA and uses a CPAP machine to manage his condition. None of the Veteran’s treating physicians, however, have authored an opinion indicating that this condition manifested during his period of active duty or linking it to events in service. Various private treatment records received after the Board’s remand also verify that the Veteran currently has a diagnosis of OSA. An August 2020 VA examination report noted physical examination of the Veteran and review of the claims file and recited the Veteran’s complaints and medical history. The report confirms the Veteran’s sleep apnea. In opining that the Veteran’s condition was not related to service, the examiner stated the following: The first true mention of sleep difficulties by a treating physician found in the records is from 1997, [approximately] 33 years s/p military service discharge. Other records found regarding difficulty sleeping are not likely relevant as the claimant [a]t that time suffered from sinus congestion. Once that was treated with antihistamine, his sleeping difficulties resolved. The Board recognizes that the Veteran currently suffers from OSA, so the first element of service connection has been established. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). The Veteran has testified that he experienced problems with phlegm, snoring, and daytime tiredness during service. The Veteran is competent to report symptoms capable of lay observation, so the Board finds the Veteran’s testimony credible on this point, which satisfies the second element of service connection. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007); Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). Turning to the third element of service connection, however, the Board finds the evidence of record insufficient. The August 2020 examiner noted that the first diagnosis of sleep apnea did not appear for more than three decades after the Veteran’s service. Other records asserting problems sleeping, prior to a formal diagnosis of sleep apnea, were, in the examiner’s words, “irrelevant,” as those symptoms were tied to sinus congestion and relieved with antihistamines. Based on this information, the examiner believes that the Veteran’s sleep apnea is less likely than not related to his in-service accounts of snoring, daytime tiredness, and experiences with phlegm. While the Veteran believes that these in-service symptoms are related to his current diagnosis, he is not competent to render such a complex medical opinion. See Jandreau, 492 F. 3d at 1377. As the only competent and credible medical opinion of record, uncontradicted by the other competent and credible evidence of record, the Board affords the August 2020 VA opinion considerable probative value. Thus, the third element of service connection has not been established. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). Because the evidence of record does not support the Veteran’s claim for entitlement to service connection for OSA, the Veteran’s appeal is denied. The Board is unable to find an approximate balance of the positive and negative evidence submitted to warrant for the Veteran a favorable decision. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53; 38 C.F.R. §§ 3.102, 3.303(a). 2. Entitlement to service connection for an acquired psychiatric condition is denied. The Veteran seeks entitlement to service connection for an acquired psychiatric condition, claiming that he was diagnosed with schizophrenia in service. See November 16, 2007, VA Form 21-4138. For certain chronic diseases, including psychoses, a presumption of service connection arises if the disease is manifested to a degree of ten percent within one year following discharge from service. When a chronic disease is not shown to have manifested to a compensable degree within one year after service, there is required, under 38 C.F.R. § 3.303(b), a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331, 1336 (Fed. Cir. 2013); 38 C.F.R. § 3.303(b), 3.307(a)(3), 3.309(a). For VA compensation purposes, the term “psychosis” means: a Brief Psychotic Disorder; Delusional Disorder; Psychotic Disorder Due to Another Medical Condition; Other Specified Schizophrenia Spectrum and Other Psychotic Disorder; Schizoaffective Disorder; Schizophrenia; Schizophreniform Disorder; and Substance/Medication-Induced Psychotic Disorder. 38 C.F.R. § 3.384. While service connection may be granted for an additional disability superimposed on top of a personality disorder, personality disorders themselves are not considered diseases for which service connection may be granted. 38C.F.R. §§3.303(c), 4.9, 4.127; VAOPGCPREC 82-90 (July 18, 1990). The Veteran’s STRs show that he claimed a family history of mental illness on his June 1962 pre-enlistment examination report. There was, however, no evidence of a diagnosed psychiatric disorder at the time of induction. The Veteran did not claim any mental health difficulties during his August 1963 induction examination. In March 1964, the Veteran was admitted for psychiatric treatment. Initial diagnoses included schizoid personality disorder and schizophrenic reaction. These later were replaced by a diagnosis of passive aggressive reaction. A May 1964 psychiatric examination report indicates that the Veteran initially was referred for hospitalization because “he had been observed making bizarre movements, gestures, talking to himself, and appearing not to be in contact with his surroundings.” The division psychiatrist initially diagnosed him with schizophrenic reaction. The Veteran thought that these symptoms were brought on by a desire to return home, saying he “just couldn’t make it” in the military. He claimed that he had felt “perturbed” since enlistment, having once fired two shots into the underbrush while serving on guard duty. Based on the results of the evaluation, the military psychiatrist diagnosed the Veteran with a passive aggressive reaction. He went on to say that the Veteran suffered from a “characterologic problem” not amenable to treatment by further military psychotherapy, retraining, reclassification, or punishment. Thus, separation from service was recommended. The Veteran’s May 1964 separation examination reflects a diagnosis of “passive-aggressive personality.” In June 1964, the psychiatrist who performed the earlier mental health evaluation wrote a report describing the diagnosis as “[p]assive aggressive reaction, chronic, moderate . . .” and indicating that the Veteran’s condition was “part of a character and behavior disorder due to deficiencies in emotional and personality development.” There are no further indications of a psychiatric disorder until decades after separation. In March 2008, W.T., a private licensed practical nurse, wrote that she has been assisting in the Veteran’s treatment since the mid-1980s. At the time he first presented for treatment, he was already on medications for his psychiatric disorder. He then was diagnosed with passive aggressive personality disorder and schizophrenia. A May 2015 disability benefits questionnaire (DBQ) completed by Dr. C.W., a private educational psychologist, reflects an in-person evaluation. The Veteran was noted to have been divorced three times, with a history of explosive personality behavior and alcohol abuse. The examiner also documented symptoms of anxiety, suspiciousness, mild memory loss, difficulty understanding complex commands, and difficulty establishing and maintaining effective relationships. Based on these findings, the examiner diagnosed the Veteran with panic disorder without agoraphobia, schizoid personality disorder, and alcohol dependence (in remission). Although it was not possible to differentiate symptoms attributable to each of these conditions, the examiner determined that they impacted each other negatively. As such, the Veteran’s psychiatric impairments were found to result in occupational and social impairment due to mild or transient symptoms. In May 2015, Dr. M.B., the Veteran’s private treating physician, submitted a letter stating that “it is at least as likely as not that [his]... personality disorder could be linked to the time he served in the military.” An August 2020 VA examination report noted mental examination of the Veteran and review of the claims file and recited the Veteran’s complaints and medical history. The VA psychologist noted that the Veteran currently does not meet the standards for any psychiatric condition recognized by the DSM-5. In the “Relevant Mental Health History” Section of the report, the examiner provided the following: When asked to describe his psychiatric symptoms, the claimant exhibited difficulty plausibly describing them. He reported “I’m very schizophrenic.” He was asked to elaborate on this and he added “I’m always thinking somebody doing something to me.” I continued to ask him to describe this and it developed that the claimant likes things to be in a certain place in his house. He wants things arranged in a certain way and doesn’t like things to be messy or out of order and he’s always fussing at his wife about this and she says “you crazy.” At this point the claimant informed me “I don’t think I’m crazy.” I confirmed that when the claimant says that he thinks people try to do something to him, he is expressing irritation and frustration with his wife for not putting things up the way he thinks they should be put up. The claimant said that at some point in the past, he heard a voice telling him to “slap the fire out of someone.” This was such a vague statement. I asked him what happened? He said “I slapped them.” I said “what happened next?” He responded “you know what happened next.” I said no I really didn’t. What happened next? He said “well we got into it.” I asked him who the person was and he responded “oh just someone.” I found it completely implausible that the claimant could remember that he heard a voice telling him to slap someone but didn’t remember when it happened or who it was he slapped. The claimant was asked if he was having any mood disturbance. He reported that he had mood swings, which he described as getting irritated with his wife. The claimant was asked about anxiety symptoms. What he described was that he’s frustrated easily and often impatient. No plausible symptoms of psychosis were reported either currently or historically. Absolutely no schizoid personality disorder symptoms were reported. No recognizable symptoms of any psychiatric disorder was reported, other than that the claimant appears to have been recovering from alcoholism for 30 years. He denied current suicidal or homicidal ideation. The only noted psychiatric symptom was impaired abstract thinking. In opining that the Veteran’s in-service personality disorder did not superimpose itself onto a psychiatric disability during service, she stated: Claimant does not meet diagnostic criteria for schizophrenia, panic disorder or alcohol dependence. He did not describe a history or symptoms consistent with schizophrenia or panic disorder. He had developed alcohol dependence such that he required inpatient hospitalization in 1990, 26 years after he was discharged from the service. He did not report having any alcohol abuse issues during his time in the service. It is less likely than not that he has any acquired psychiatric condition developed during his time in the service and persisting to the present. The Board notes that there is conflicting medical evidence regarding whether the Veteran currently has a diagnosed psychiatric condition. While the VA psychologist believes that the Veteran currently does not have a psychiatric condition, Dr. C.W. diagnosed, in May 2015, the Veteran with schizophrenia and panic disorder. Thus, the Board finds that, despite the Veteran’s current mental state, he has satisfied the first element of service connection. See Romanowsky, 26 Vet. App. at 293; McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim); 38 C.F.R. § 3.303(a). As noted above, presumptive service connection can be awarded if a psychosis develops within a year form service. STRs reveal that the Veteran had only a personality disorder during service, and the relevant post-service medical evidence show a diagnosis of schizophrenia as early as 2008. As that diagnosis was not rendered within one year from separation from service, the application of presumptive service connection for a chronic condition is not applicable. See 38 C.F.R. § 3.307(a)(3), 3.309(a). There also is no evidence to suggest that the Veteran experienced symptoms of a psychosis from service into the present. The evidence suggests that, at the earliest, the Veteran began receiving psychiatric care in the mid-1980s. This is more than two decades after separation from service. Thus, the application of presumptive service connection based on continuity of symptomatology also is inapplicable. See 38 C.F.R. § 3.303(b). Returning to the principles of direct service connection, the Board acknowledges that the Veteran was diagnosed with a personality disorder during service. While that disorder itself is not subject to compensation, see 38 C.F.R. §§ 3.303(c), 4.9, 4.127, it nevertheless establishes the second element for service connection. See Romanowsky, 26 Vet. App. at 293; 38 C.F.R. § 3.303(a). With respect to the third element of service connection, the Board finds that the evidence of record is insufficient. The August 2020 examiner noted that the Veteran did not develop a psychiatric condition that began during service and extended into the present. Rather, that examiner is of the opinion that the Veteran has no psychiatric diagnosis altogether. The Veteran has alleged that he developed schizophrenia during service. The record, however, reflects that he was diagnosed with a personality disorder, and he otherwise is not competent to render a complex medical opinion as to whether that personality disorder superimposed itself onto a separate psychiatric condition during service. See Jandreau, 492 F. 3d at 1377. Dr. M.B. stated that “it is at least as likely as not that [the Veteran’s]... personality disorder could be linked to the time he served in the military,” but that statement provides little to the Board. Stating that it is as least as likely as not that X could be linked to Y is circuitous. Dr. M.B. starts with a positive statement and then casts doubt on it. Furthermore, there is no supporting rationale associated with Dr. M.B.’s opinion. On the other hand, the VA examiner provides a definitive, unwavering statement backed by a supporting rationale. Thus, the Board affords more probative value to the August 2020 VA examiner than it does Dr. M.B. Thus, the third element of service connection has not been established. Because the evidence of record does not support the Veteran’s claim for entitlement to service connection for an acquired psychiatric condition, the Veteran’s appeal is denied. The Board is unable to find an approximate balance of the positive and negative evidence submitted to warrant for the Veteran a favorable decision. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53; 38 C.F.R. §§ 3.102, 3.303(a). 3. Entitlement to service connection for hypertension, to include as secondary to an acquired psychiatric condition, is denied. The Veteran has asserted that his hypertension is secondarily related to a diagnosis of schizophrenia he received while in service. See March 18, 2008, VA Form 21-4138. To establish secondary service connection, a veteran must provide evidence of (1) a current, non-service-connected disability, (2) a current service-connected disability, and (3) evidence that the non-service-connected disability is either (i) proximately due to or the result of a service-connected disability or (ii) aggravated (increased in severity) beyond natural progression by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 446 (1995); 38 C.F.R. § 3.310. Under VA law, hypertension must be verified by readings taken two or more times on at least three different days. Hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. 38 C.F.R. § 4.104, DC 7101 Note (1). The evidence of record verifies that the Veteran currently has hypertension. Because the Board herein finds that the Veteran neither was diagnosed with schizophrenia in service nor developed an acquired psychiatric condition that was superimposed on his in-service personality disorder, the elements for secondary service connection legally cannot be established. Thus, a claim for benefits via this route must be denied. See Allen, 7 Vet. App. at 446; 38 C.F.R. § 3.310. The Veteran per se does not allege that his hypertension began prior to service and therein was aggravated; however, the evidence of record raises this possibility. While this previously was discussed in the prior decision, the Board will address it again for completion’s sake. A veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). An indication of past disorder or disability by a veteran on a report of medical history is not enough to prevent the presumption of soundness from attaching. Gray v. Nicholson, 21 Vet. App. 104 (2006). When no preexisting condition is noted upon entry into service, the veteran is presumed to have been sound upon entry. The burden then falls on the government to rebut the presumption of soundness by clear and unmistakable evidence that the veteran’s disability was both preexisting and not aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any ‘increase in disability [was] due to the natural progress of the’ preexisting condition. 38 U.S.C. § 1153. If this burden is met, then the veteran is not entitled to service-connected benefits. However, if the government fails to rebut the presumption of soundness under section 1111, the veteran’s claim is one for service connection. This means that no deduction for the degree of disability existing at the time of entrance will be made if a rating is awarded. Wagner v. Principi, 370 F. 3d 1089, 1096 (Fed. Cir. 2004) (citing 38 C.F.R. § 3.322). With respect to the clear and unmistakable burden there is a wealth of caselaw regarding what does and does not constitute aggravation. Temporary or intermittent flare-ups during service of a pre-existing injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted to symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). Evidence of the Veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). The recurrence of pre-service symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002). If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder has not been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1998). Where a disability or disease is noted at the time of enlistment, a veteran is not presumed sound as to that disability. A veteran’s preexisting injury or disease, however, will be presumed to have been aggravated by active service where there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. 38 C.F.R. § 3.306(b). “The clear-and-unmistakable-evidence standard is an ‘onerous’ one... and requires that the no-aggravation result be ‘undebatable.’” Cotant v. Principi, 17 Vet. App. 116, 131 (2003). The veteran bears the initial burden of establishing that a worsening of a disability or disease occurred in service. If the veteran is successful, the presumption of aggravation attaches, and the burden shifts to the VA to demonstrate by clear and unmistakable evidence that any worsening is attributable to the natural progression of the disability. On the other hand, if a preexisting disorder is noted upon entry into service, the veteran cannot bring a claim for service connection for that disorder, but the veteran may bring a claim for service-connected aggravation of that disorder. In that case section 1153 applies and the burden falls on the veteran to establish aggravation. See Jensen v. Brown, 19 F.3d 1413, 1417 (Fed. Cir. 1994). If the presumption of aggravation under section 1153 arises, the burden shifts to the government to show a lack of aggravation by establishing “that the increase in disability is due to the natural progress of the disease.” 38 U.S.C. § 1153; see also 38 C.F.R. § 3.306; Jensen, 19 F.3d at 1417.” Wagner, 370 F. 3d at 1096. STRs reflect the existence of “moderate labile essential hypertension” during his June 1962 pre-enlistment examination. Despite this, his August 1963 induction examination report contains no indication of hypertension. Indeed, the Veteran affirmatively denied previous issues with blood pressure during that evaluation. A military psychiatric examination report from May 1964 shows that the Veteran was hypertensive while sitting. Although the military psychiatrist recommended medication and salt restriction to manage the Veteran’s hypertension, this condition was noted to improve with removal from stressful situations. That same month, he was started on medication and a salt-restricted diet. The Veteran’s May 1964 separation examination reflects a diagnosis of “mild, essential, labile hypertension;” his blood pressure was measured at 160/100. The pre-induction examination notes a diagnosis of moderate labile hypertension, so the Veteran cannot be presumed sound upon entry into service for his hypertension. Nevertheless, the presumption of aggravation will assume that any in-service worsening of the Veteran’s hypertension was caused by service, unless proven to be caused by the natural progression of hypertension, entitling him to benefits. In the aggravation context, the burden of establishing in-service worsening falls to the Veteran; if such a fact is proven, the burden then shifts to VA to establish, if possible, that the aggravation is attributable to the natural progression of the condition and not due to service. If VA cannot meet its burden, then the Veteran is entitled to benefits. The Board does not find that the presumption of aggravation arises because the Veteran has not shown in-service worsening of his hypertension. As noted above, the Veteran’s hypertension was described, pre-induction, as moderate. At the time of separation, his hypertension was described by the examiner as “mild.” This evidence clearly shows that, if anything, the Veteran’s hypertension improved during service and did not experience worsening. Therefore, the Board finds that Veteran’s preexisting hypertension did not worsening during service and that any implied claim for such is denied. See 38 U.S.C. § 1153; Wagner, 370 F.3d at 1096. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Trevor T. Bernard, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.