Citation Nr: 21030730
Decision Date: 05/19/21	Archive Date: 05/19/21

DOCKET NO. 20-06 984
DATE: May 19, 2021

ORDER

Entitlement to compensation under 38 U.S.C. § 1151 for increased thirst is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for short term memory impairment is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for left foot swelling is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for right foot swelling is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for left hand swelling is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for right hand swelling is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for vision changes is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for weakness is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for elevated blood pressure is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for renal insufficiency (claimed as a diabetic kidney disorder) is denied.

Entitlement to compensation under 38 U.S.C. § 1151 for supraventricular arrythmia (claimed as elevated heart rate) is denied.

FINDING OF FACT

The Veteran's treatment by Department of Veterans Affairs (VA) physicians did not result in additional disability leading to a July 2016 private hospitalization, to include increased thirst, short-term memory impairment, swelling of the bilateral hands and feet, vision changes, weakness, elevated blood pressure, renal insufficiency, or supraventricular arrythmia.

CONCLUSIONS OF LAW

1.  The criteria for compensation for increased thirst, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

2.  The criteria for compensation for short term memory impairment, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

3.  The criteria for compensation for left foot swelling, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

4.  The criteria for compensation for right foot swelling, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

5.  The criteria for compensation for left hand swelling, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

6.  The criteria for compensation for right hand swelling, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

7.  The criteria for compensation for vision changes, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

8.  The criteria for compensation for weakness, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

9.  The criteria for compensation for elevated blood pressure, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

10.  The criteria for compensation for renal insufficiency, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

11.  The criteria for compensation for supraventricular arrythmia, pursuant to 38 U.S.C. § 1151, are not met. 38 U.S.C. § 1151, 5107; 38 C.F.R. §§ 3.102, 3.361.

REASONS AND BASES FOR FINDING AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from September 1964 to April 1965.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In February 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. 

Law and Analysis

A veteran who suffers disability resulting from hospital care or medical or surgical treatment provided by a VA employee or in a VA facility is entitled to compensation for the additional disability in the same manner as if such additional disability were service-connected if the additional disability was not the result of willful misconduct and was proximately caused by carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing that treatment, or an event not reasonably foreseeable. 38 U.S.C. § 1151(a)(1)(A), (B); 38 C.F.R. § 3.361(a)-(d); Viegas v. Shinseki, 705 F.3d 1374, 1377-78 (Fed. Cir. 2013). The purpose of the statute is to award benefits to those veterans who were disabled as a result of VA treatment or vocational rehabilitation. 38 U.S.C. § 1151(a).

First, there must be evidence of additional disability, as shown by comparing the veteran's condition before and after the VA medical care in question. 38 C.F.R. § 3.361(b). To determine whether a veteran has an additional disability, VA compares the veteran's condition immediately before the beginning of the hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT) program upon which the claim is based to the veteran's condition after such care, treatment, examination, services, or program has stopped. VA considers each body part or system separately. The additional disability must not be the result of the veteran's willful misconduct. 38 U.S.C. § 1151(a); 38 C.F.R. § 3.361(c)(3). Moreover, additional disability caused by a veteran's failure to follow properly given medical instructions is not caused by hospital care, medical or surgical treatment, or examination. 38 C.F.R. § 3.361(c)(3).

Second, the additional disability must be caused by hospital care, medical or surgical treatment, examination, training and rehabilitation services, or CWT program furnished the veteran by VA. 38 C.F.R. § 3.361(c). In order for additional disability to be compensable under 38 U.S.C. § 1151, the additional disability must have been actually caused by, and not merely coincidental to, hospital care, medical or surgical treatment, or medical examination furnished by a VA employee or in a VA facility. Merely showing that a veteran received care, treatment, or examination and that the veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). 

Hospital care, medical or surgical treatment, or examination cannot cause the continuance or natural progress of a disease of injury for which the care or treatment was furnished unless VA's failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). The factual elements necessary to support a claim under section 1151 based on failure to diagnose or treat a preexisting condition may vary with the facts of each case and the nature of the particular injury and cause alleged by the claimant. As a general matter, however, entitlement to benefits based on such claims would ordinarily require a determination that: (1) VA failed to diagnose and/or treat a preexisting disease or injury; (2) a physician exercising the degree of skill and care ordinarily required of the medical profession reasonably should have diagnosed the condition and rendered treatment; and (3) the veteran suffered disability or death which probably would have been avoided if proper diagnosis and treatment had been rendered. VAOPGCPREC 5-2001 (Feb. 5, 2001); see also Roberson v. Shinseki, 607 F.3d 809, 817 (Fed. Cir. 2010).

Third, the proximate cause of the disability, as opposed to a remote contributing cause, must be: (1) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the hospital care, medical or surgical treatment, or examination; or (2) an event that was not reasonably foreseeable. 38 U.S.C. § 1151(a)(1); 38 C.F.R. § 3.361(d).

To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part in furnishing hospital care, medical or surgical treatment, or examination was the proximate cause of a veteran's additional disability or death, it must be shown that the hospital care, medical or surgical treatment, or examination caused the veteran's additional disability or death; and (i) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (ii) VA furnished the hospital care, medical or surgical treatment, or examination without the veteran's informed consent. Determinations of whether there was informed consent involve consideration of whether the health care providers substantially complied with the requirements of 38 C.F.R. § 17.32. 38 C.F.R. § 3.361(d)(1).

Regarding reasonable foreseeability, whether the proximate cause of a veteran's additional disability or death was an event not reasonably foreseeable is in each claim to be determined based on what a reasonable health care provider would have foreseen. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. In determining whether an event was reasonably foreseeable, VA will consider whether the risk of that event was the type of risk that a reasonable health care provider would have foreseen or disclosed in connection with the informed consent procedures of 38 C.F.R. § 17.32. 38 C.F.R. § 3.361(d)(2); Schertz v. Shinseki, 26 Vet. App. 362, 367-69 (2013).

Thus, section 1151 contains two causation elements a veteran's disability must not only be caused by the hospital care or medical treatment he or she received from VA, but also must be proximately caused by the VA's fault or an unforeseen event. 38 U.S.C. § 1151(a)(1). 

The Veteran contends that her medications prescribed by her treating VA primary care physician, Dr. B., and/or as a result of cortisone injections by her treating VA orthopedist, Dr. E., resulted in a hospitalization at a private hospital for supraventricular tachycardia (SVT), acute kidney injury, and hyperglycemia on July 18, 2016. In a July 2017 notice of disagreement form, the Veteran indicated that she was allergic to prescribed Cipro. She has claimed that the VA physicians' treatment was negligent and that she has the following additional disabilities as a result of the prescribed medication and cortisone injections: increased thirst, short-term memory impairment, swelling of the bilateral feet and hands, vision changes, weakness, elevated blood pressure, renal insufficiency, and supraventricular arrythmia. See December 2016 claim, February 2017 Veteran statement, July 2017 notice of disagreement forms, February 2021 hearing transcript.

The record shows that the Veteran called the VA Telephone Advice Program (TAP) line on February 16, 2016, and related that she might have a urinary tract infection (UTI). On February 17, 2016, Dr. B. evaluated the Veteran for a possible UTI. At that time, the Veteran complained of increased frequency and urgency for three days with no dysuria or fever or chills. She stated that she had UTIs once per year. Dr. B. noted that the Veteran had urinary tract symptoms and a possible UTI. He offered the Veteran a urinalysis prior to prescribing her medication, but the Veteran declined due to transportation issues. He prescribed the Veteran Nitrofurantoin, specifically the brand name Macrobid, an antibiotic to treat UTIs. 

On February 23, 2016, the Veteran called the VA TAP line and told the TAP nurse that she was being treated with Nitrofurantoin for a bladder infection and that she threw up three times after taking the medication the previous night. She also requested a call back from Dr. B. to discuss whether her recently prescribed medication had sulphur in it. The same day, Dr. B. followed-up with the Veteran and noted that she did not tolerate Macrobid. The Veteran informed him that she took over four days' worth of the antibiotic. He told the Veteran to stop taking the medication and to report any symptoms following the weekend. On February 24, 2016, Dr. B. informed the Veteran that she should have taken enough of the antibiotics to resolve the UTI, so it was okay to stop taking it. He also instructed the Veteran to follow-up with a urinalysis to determine if the infection had resolved. 

On March 4, 2016, following lab results showing that the Veteran's urine samples showed a continued UTI, Dr. B.'s nurse, L.M., attempted to contact the Veteran to determine if she could safely take Cipro for treatment of her UTI. On March 8, 2016, the Veteran left a voicemail for L.M. and indicated that she had a "bad reaction" to Cipro in the past and requested an alternate medication for the treatment of her UTI. The same day, L.M. called the Veteran to determine if she was allergic to Cipro. She noted that the Veteran was sensitive to Cipro despite a listed allergy to Cipro with a reaction of nausea and vomiting. During the call, the Veteran did not remember having an allergy to Cipro. Rather, she stated that she had a hard time with antibiotics. The Veteran indicated that she was willing to try Cipro with the understanding that if she had any side effects, she was to stop the medication and call the TAP line. Thereafter, she was prescribed 500 milligrams of Cipro once daily. 

Approximately two hours later, on March 8, 2016, the Veteran called the VA TAP line again and reported that she was prescribed Cipro in 2009 or 2010 and "it felt like someone was pulling the skin off [of her] legs and feet." The nurse that took the call looked in the Veteran's chart and saw that Cipro was listed as an allergy that caused the Veteran nausea and vomiting. In the encounter note, the nurse reported, "Medication should not have been given to [V]eteran. [Primary care] needs to [follow-up] with the [V]eteran to address her concerns and provide an alternate medication." A few hours later, Dr. B. responded to the TAP call note. In his March 8, 2016 note, he noted that the Veteran had a long list of medications that she was "allergic" to, including penicillin and Legaquin; however, antibiotic susceptibility test results showed otherwise. He indicated that his nurse called and asked the Veteran to confirm that her reaction to Cipro was just vomiting as documented in her record and to ask if she would be willing to retry it since other medication choices were not practical. He noted that the Veteran stated that she did not even remember have reacted to Cipro at all and that she would be willing to try it. After the Veteran received the prescription, she immediately remembered that she had reacted to it before and called Dr. B. She indicated that a single dose caused her right lower leg flesh to "feel like it was about to fall off" in the past and that she never took another dose. Dr. B. reported that the Veteran came to the clinic and that they discussed other treatment options. He related that they agreed on a prescription for Azithromycin (Z-pack) and that she had taken Z-packs without reaction several times before. In an addendum note, Dr. B. responded directly to the nurse who took the Veteran's call on the VA TAP line and requested that she call the rest of the team or her supervisor before making another statement inferring that the physician had mistakenly prescribed the medication as there may be hidden explanations.

In a March 17, 2016, VA treatment note, the Veteran stated that she believed that she finished her antibiotic on March 12, 2016. She was advised to have a repeat urinalysis to determine whether her UTI had resolved. There was no further treatment for the UTI documented in the record.

A review of the record also shows that the Veteran had a history of receiving corticosteroid or cortisone injections in both hips and knees. Prior to her July 2016 private hospitalization, she received corticosteroid injections in both knees and hips on April 14, 2016. In an associated injection procedure note, Dr. E. noted that the Veteran tolerated the procedure well. Notably, throughout the record, the Veteran reported that her blood sugar increased for a period of seven to ten days following her corticosteroid injections and that she took more insulin than prescribed during that time. See May 2015, October 2015, January 2016, February 2016, March 2016, April 2016, May 2016, July 2016 VA treatment notes. In an August 2015 VA nutrition telephone note, a VA dietician noted that the Veteran was noncompliant with her blood glucose regimen. She specifically indicated that the Veteran was "NOT willing to work on adjusting doses of fast acting [Aspart] with her evening meal and NPH at bedtime." The dietician reminded the Veteran of the danger of going low with her blood glucose due to taking NPH three times daily against the advice of her nurse, physician, and dietician. The Veteran verbalized understanding of the dangers of going low but stated that "if going into a coma overnight is the way I'm supposed to go, that is the way I'm supposed to go." The dietician again cautioned the Veteran to continue to check her blood glucose levels regularly and to be very cautious with her insulin dosing if she insisted on continuing to take NPH three times daily as she has in the past.

On June 20, 2016, the Veteran called the VA TAP line to report that she was passing blood in her stools. She indicated that the blood was bright red and that she took stool softeners at night. She denied any abdominal pain and stated that she had a small amount of bright red blood upon wiping.

In response to the TAP note, on June 20, 2016, Dr. B.'s nurse, L.M., indicated that she spoke with the Veteran concerning her call. The Veteran stated that there had been blood on the toilet paper every time she wiped after a bowel movement for "the last two months." She denied any bright red blood in the toilet. She denied hard stools or bearing down. She also denied any dizziness, lightheadedness, or orthostasis. The same day, Dr. B. noted that the Veteran had blood on wiping for two months and that her last VA colonoscopy in 2012 revealed no piles. He indicated that the Veteran agreed to hemorrhoidal therapies for one week and that she would call for an examination if she had no improvement.

On July 18, 2016, the Veteran called the VA TAP line and stated that she was having issues having a bowel movement and that she was also having difficulty standing up. The Veteran explained that she had anal bleeding and that she called Dr. B. who asked if she wanted to come into the clinic for evaluation or if she wanted him to send some medication. She asked him to send medication. Dr. B. sent stool softeners that did not work, so he subsequently sent the Veteran suppositories. She stated that the suppositories finally worked, but her heart began racing. She said that she had weakness and she was unable to stand since she used the suppository. She requested a call back from Dr. B. to come in for an evaluation. Subsequent notes showed that Dr. B. called the Veteran twice, but she did not answer the phone. He indicated that he would call again.

On July 18, 2016, the Veteran presented to a private emergency room with weakness in her legs, especially standing and walking. She reported an onset several days ago. She denied any chest pain or shortness of breath. She also denied any heart palpitations despite being found to have a heart rate of 190 during the triage process. The emergency department provider noted that the Veteran had an acute kidney injury, hyperglycemia, and SVT. He noted that the Veteran was found to be in SVT upon arrival to the emergency room and that she converted to a sinus rhythm after identical dosed at 6 and 12 mg IV. He indicated that the Veteran's heart rate had remained in the 90s since medication was given. 

In a July 18, 2016, history and physical note from the private hospital, an internist noted that the Veteran had a prior medical history of type II diabetes mellitus and she was evaluated in the emergency department for an inability to stand up. She denied any chest pain or dizziness, and she denied any focal weakness, but she stated that she fell out of bed the night before and that she was unable to ambulate well. She indicated that her heart was racing, and she had some dyspnea. In the emergency room, she had a heart rate of 189 and an EKG showed SVT that required two doses of adenosine to resolve. She had a normal sinus rate following the medication. An ECG showed that sinus rhythm had replaced atrial fibrillation noted in early ECG from emergency room. The physician noted that the Veteran's principal problem was an acute kidney injury and she had active problems of SVT, type II diabetes mellitus, elevated liver function tests, and thrush. The physician ordered slow rate hydration and directed that renal function or liver function tests be followed. She also ordered A1c checks as the Veteran took insulin on a sliding scale. She prescribed Cardizem for heart rate control and stopped the Veteran's previous prescription Atenolol. An echocardiogram was ordered. She also prescribed nystatin for the Veteran's oral thrush. 

On July 22, 2016, the Veteran was discharged to home to follow-up with her VA primary care physician. Her heart rate was controlled, and she was stable. 

On July 19, 2016, L.M. indicated that she was contacted by a nurse at the private hospital for a list of the Veteran's medications. The nurse related that the Veteran presented to the emergency room complaining that she felt "off balance" every time that she tried to walk. A monitor revealed SVT with a heart rate in the 190s. The Veteran was admitted to the ICU, given Adenosine, and converted to a normal sinus rhythm. She remained in a normal sinus rhythm and the nurse anticipated that the Veteran would be transferred to the step-down unit or discharged home.

In a July 22, 2016, VA pharmacy note, a pharmacist reported that she had an in-depth conversation with the Veteran, who indicated that she had just been discharged from the hospital and that she had written prescriptions in her possession. The pharmacist spoke to L.M. in an attempt to expedite medical record retrieval from the Veteran's recent private hospitalization in order to provide a prompt resolution to the Veteran's medication needs.

In a subsequent VA treatment note dated on July 22, 2016, L.M. indicated that the Veteran presented as an unscheduled triage to the primary care clinic with a request for an outside prescription. L.M. noted that records from the private hospital were received and reviewed and that the medications were ordered as prescribed. She also indicated that the Veteran's cholesterol medication was changed to Atorvastatin from Simvastatin due to a potential drug interaction with Diltiazem. The Veteran was instructed to pick-up her medications at the pharmacy. In an addendum, L.M. noted that while explaining to the Veteran that she had to discontinue Zocor/Simvastatin and take Lipitor instead to avoid a possible drug interaction with Diltiazem, she stated, "I told Dr. K. I CAN'T take Lipitor. Why do you keep trying to give it to me?" L.M. explained to the Veteran that she was unaware that the Veteran had problems with Lipitor in the past and that she would inform Dr. B. of the same. L.M. discussed with Dr. B. and Lipitor was discontinued. An appointment was made with Dr. B. on July 27, 2016, to discuss medications and a safe alternative for Zocor. Records indicate that the Veteran presented to her primary care follow-up on July 27, 2016.

In May 2017, the Veteran was afforded a VA examination in connection with her claims. The VA examiner noted that the Veteran was diagnosed with SVT on July 18, 2016. She also noted that the Veteran had a diagnosis of renal insufficiency. The examiner indicated that the Veteran presented to a private emergency room in SVT with a heart rate of approximately 190 and acute onset renal insufficiency in the context of SVT that responded to IV hydration. The examiner noted that the Veteran contended that being prescribed hydrocortisone cream per her rectum and cortisone injections in her knees led to hospitalization and renal damage. The examiner opined that the Veteran's contentions that treatment by her primary care physician, Dr. B., and her orthopedist, Dr. E., led to her hospitalization for symptomatic SVT and renal damage in unfounded upon review of the available medical records. She stated that hydrocortisone cream was appropriately prescribed for the Veteran's rectal complaints. Of note, the examiner pointed out that the record shows that the Veteran requested a refill of this medication which was originally issued for a 14-day supply; therefore, the examiner felt that one would assume that the Veteran was deriving benefit from the cream. The examiner also noted that the record ascertains years that the Veteran received musculoskeletal corticosteroid injections and that the Veteran requested repeat injections shortly after her July 2016 hospitalization. The examiner acknowledged that corticosteroids can certainly cause a wide range of side effects, but records showed that the Veteran had tolerated the injections well throughout the years, other than elevated blood sugar readings for a short period following her injections. The examiner concluded her opinion with the following:

In my professional opinion, the timing of the symptoms [related to] SVT/RI occurrence/hospitalization to the administration of the hydrocortisone cream and injections was more likely than not a matter of coincidence. Review of medical literature does not support this class of drug as a common etiology for SVT or renal insufficiency. Records show veteran was symptomatic for at least 2 days, and likely this was [due to the] SVT. Her SVT resolved with treatment, and her renal function returned back to baseline with treatment and IV hydration.

In reaching the opinions as to the claimed disabilities from treatment by VA physicians that the Veteran contends led to a July 2016 hospitalization, the May 2017 VA examiner performed an examination of the Veteran. The examiner also reviewed the pertinent evidence in the claims file, including the Veteran's treatment records and her contentions. The Board finds that this opinion addresses the central medical issues in this case, is based on an analysis of the evidence and current medical understanding and is therefore entitled to probative weight. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (an examination is not rendered inadequate where the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion"); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record).

In summary, the most probative evidence (including consideration of the lay statements) does not establish that any additional disability was caused by the VA treatment. If the Board finds that there is no "actual causation," it is unnecessary to address the next step of proximate causation (i.e., negligence and reasonable foreseeability). That is, because the evidence of record does not demonstrate additional disability caused by VA treatment, examination, or surgery, the analysis need not advance to the question of proximate cause, including negligence and reasonable foreseeability. Mangham v. Shinseki, 23 Vet. App. 284, 287-88 (2009) (citing Loving v. Nicholson, 19 Vet. App. 96, 101 (2005)); see also 38 U.S.C. § 1151(a)(1); 38 C.F.R. § 3.361(d).

The Board has considered the Veteran's statements, including her competent reports of observable symptomatology such as increased thirst, short-term memory impairment, swelling of the extremities, vision changes, weakness, increased blood pressure, renal insufficiency, and SVT. In fact, during the February 2021 hearing, the Veteran was unable to articulate that any of these disabilities had increased in severity due to her VA treatment and July 2016 hospitalization. Rather, she reported that she had increased thirst while she was hospitalized and the record shows that she was treated with IV hydration. She indicated that she had problems with short-term memory and that she was "not quite the person" that she was "supposed to be." She was unable to tell the undersigned how her short-term memory had worsened. The Veteran stated that her vision had decreased for years. The record shows that the Veteran had prescription changes for her glasses, but nothing indicated that her visual impairment was related to medications prescribed by Dr. B. or cortisone shots administered by Dr. E. The Veteran reported that she fell after she took the suppository and continued falling after she was discharged from the hospital. The Veteran also stated that she was on blood pressure medication for 25 to 30 years, but she was unable to explain how it worsened since she was prescribed the suppository. 

Nevertheless, as to the question of whether the Veteran actually has additional disability for purposes of § 1151 benefits, even assuming that he is competent to opine on this medical matter, the Board finds that the May 2017 VA examiner's opinions are more probative, as they were provided by a medical professional with knowledge, training, and expertise and are supported by rationale based on such knowledge. The VA examiner reviewed the claims file and considered the Veteran's reported history and lay statements.

As a preponderance of the evidence is against finding additional disability due to the Veteran's treatment by VA physicians did not result in additional disability leading to a July 2016 hospitalization, the criteria of 38 U.S.C. § 1151 are not met.

 

 

J. B. FREEMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Osegueda, 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.