Citation Nr: 25005705 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 17-06 778 DATE: April 25, 2025 ORDER Entitlement to compensation for residuals of left shoulder surgery under 38 U.S.C. § 1151 is denied. FINDING OF FACT The Veteran's residuals of left shoulder surgery is not related to treatment or lack of treatment rendered in August 2008 surgery by a Department of Veterans Affairs (VA) Medical Center and was not proximately due to carelessness, lack of proper skill, error in judgment, or similar instance of fault by VA in furnishing reasonable care; or, that the additional disability was not due to an event not reasonably foreseeable in furnishing the Veteran's VA surgical treatment. CONCLUSION OF LAW The criteria for entitlement to compensation for residuals of left shoulder surgery under 38 U.S.C. § 1151 have not been met. 38 U.S.C. §§ 1151, 5107; 38 C.F.R. §§ 3.102, 3.361. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1968 to April 1970, including service in the Republic of Vietnam. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board denied the claim for compensation under the provisions of 38 U.S.C. § 1151 for residuals of left shoulder surgery in an April 2022 decision. The Veteran subsequently appealed this decision to the Court of Appeals for Veterans Claims (Court). Pursuant to a December 2022 Joint Motion for Partial Remand, the parties agreed to vacate the April 2022 Board decision as to the instant claim as the Board failed to address a reasonably raised theory of entitlement. The Board remanded the instant matter for additional development in May 2023. The Board remanded the instant matter to the Agency of Original Jurisdiction (AOJ) for additional development. in May 2023 and December 2023. Specifically, this matter was remanded to the AOJ to obtain quality assurance review of the records associated with the treatment and left shoulder surgery performed at the Tampa VA Medical Center from August 6, 2008 to present, and to confirm that the Veteran's complete VA treatment records related to the August 2008 surgical procedure, to include nurses' notes, have been obtained and associated with the record on appeal. The requested records have been associated with the record. The Board therefore finds that the AOJ has substantially complied with its previous remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Board notes that additional evidence, namely VA treatment records, were associated with the claims file after the issuance of the November 2024 Supplemental Statement of the Case. The Veteran waived AOJ consideration of this additional evidence and requested that the Board proceed with adjudication of his appeal in a January 2025 submission. In addition, the Veteran's representative waived initial AOJ of the evidence associated with the record after the issuance of the November 2024 Supplemental Statement of the Case in the March 2024 Informal Hearing Presentation. The Board will therefore proceed with its adjudication. 1. Entitlement to compensation for residuals of left shoulder surgery under 38 U.S.C. 1151 is denied. As noted in the December 2023 Board remand, the Veteran continues to seek entitlement to compensation under 38 U.S.C. § 1151 for left shoulder surgery performed by a VA Medical Center in August 2008. Specifically, the Veteran and his representative contend that the Veteran suffered a mid-surgery stroke and other additional disabilities as due to the carelessness, negligence, lack of proper skill, error in judgment, or a similar instance of fault on the part of VA treatment providers, as well as arguing that the additional disabilities were the result of an event not reasonably foreseeable in the course of VA treatment. See November 2023 Appellate Brief. 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. § 3.301(c)(3). Second, the additional disability must be caused by hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy program furnished the veteran by VA. 38 C.F.R. § 3.361(c). 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). 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. 38 C.F.R. § 3.361(c)(1); Loving v. Nicholson, 19 Vet. App. 96, 99-100 (2005); Sweitzer v. Brown, 5 Vet. App. 503, 505 (1993). That is, the additional disability must have been the result of injury that was part of the natural sequence of cause and effect flowing directly from the actual provision of "hospital care, medical or surgical treatment, or examination" furnished by VA and such additional disability must be directly caused by that VA activity. Loving, 19 Vet. App. at 101. 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). Thus, 38 U.S.C. § 1151 contains two causation elements -an additional disability must not only be "caused by" the hospital care or medical treatment received from VA, but also must be "proximate[ly] cause[d]" by the VA's "fault" or an unforeseen "event." 38 U.S.C. § 1151(a)(1). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Turning to the evidence, postoperative surgery note shows left shoulder rotator cuff decompression. In October 2008, the Veteran was noted to complain of left shoulder pain, status post-surgery in August 2008. The severity was noted to be such that caused the Veteran issues with sleep. See October 2008 VA Medical Treatment Records. Upon further inquiry, the Veteran reported that he was doing well after decompression and was mobilizing well until he heard a pop and began to experience difficulty lifting shoulders. Id. In a September 2009 statement, the Veteran reported that during the initial surgery in August 2008, it was found that he did not have a torn rotator cuff, with significant drilling of the left shoulder with some bone removal. he was involved in a motor vehicle accident with a strike on the driver's side and received another surgery with a private medical service provider in March 2009 to mitigate some of the damage caused by the previous surgery. The Board notes that in a March 2017 VA Surgical Information Notes submitted with the Veteran's assertions on it, the physician noted no evidence of full-thickness tear in the rotator cuff musculature, although there was some surface delamination, which was in contradistinction to the preoperative Magnetic Resonance Imaging (MRI) scan which was suggestive of a full thickness tear. Turning to the question of whether there is an etiological relationship between the Veteran's claimed left shoulder surgery residuals and his August 2008 surgical procedure at a VA medical center, the Board notes that the record contains above etiology opinions which must be considered and weighed. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993). When faced with conflicting medical opinions, the Board may favor one medical opinion over the other. See Evans v. West, 12 Vet. App. 22, 30 (1998). The Board will consider each of these opinions below. The Veteran first attended a VA examination in December 2009. The examiner opined that the surgery was completed appropriately with appropriate studies which were complete. The examiner explained that studies are never 100 percent, but the surgery itself was done appropriately, with needed decompression and repair completed in appropriate manner. The examiner found that the Veteran having some residual nonuse of the shoulder was not a consequence of any negligence, carelessness, lack of proper skill, error, and judgment or similar incident of fault in the part of the VA hospital. However, the January 2019 Board decision found the examination inadequate as the VA examiner did not address the corrective shoulder surgery performed by the private medical provider; this opinion is therefore afforded little, if any, probative weight. In January 2020, the Veteran was provided a medical opinion regarding the etiology of the claimed residuals of left shoulder surgery. The examiner opined that the claimed residuals of left should surgery was less likely than not due to carelessness, negligence, lack of skill, or similar incidence of fault on the part of the attending VA personnel. In support of this opinion, the examiner explained that the Veteran had a left shoulder surgery in 2007 and a revision in August 2008. The examiner noted that the Veteran's complaints of bilateral upper extremities numbness in the pointer finger and thumb started in 2007 with shoulder and arm weakness and numbness down the side, as well as twitchy right eye and right sided facial numbness going on since 2007 immediately after the left shoulder surgery. The examiner explained that the Veteran likely experienced small vessel lacunar stroke 2/2 small vessel ischemia not seen on the MRI scan that probably occurred during the left shoulder surgery in 2007. Thus, the examiner explained this had to do more with adverse sequelae due to stroke and peripheral neuropathy, which does not represent wrongdoing on the part of the VA. With regards to whether the claimed residuals of left shoulder surgery resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider, the VA examiner opined that such was less likely than not. In support of this opinion, the examiner explained that the Veteran more likely than not had a stroke during left shoulder surgery that caused his symptoms. An addendum medical opinion was obtained in the same month which sought opinions on carelessness, negligence, lack of proper skill, error in judgment, or a similar instance of fault on the part of the VA treatment providers in rendering left shoulder surgery. The examiner opined that the Veteran's residuals of left shoulder surgery were less likely than not the result of carelessness, negligence, lack of proper skill, error in judgment, or a similar instance of fault on the part of the VA treatment providers. In support of this opinion, the examiner opined that the Veteran underwent a left shoulder arthroscopic subacromial decompression with acromioplasty on August 6, 2008. During the surgery, the examiner noted that the left shoulder was not found to have the full thickness tear which was suggested in the pre-surgery MRI scan and that the surgeon did confirm surface delamination of the rotator cuff which was consistent with partial thickness tear. The examiner noted that the surgeon noted the wound was copiously irrigated and the wound was closed. The examiner further noted that a few months post-surgery, the Veteran complained of increased pain and evaluated by MRI scan in November 2008, which showed post-surgical changes limiting evaluation of the rotator cuff, but the heterogeneity and thickening of the distal supraspinatus tendon, which the examiner attributed to tendinopathy, small amount of fluid in the joint space and subacromial/deltoid bursa, and mild degenerative hypertrophy of the acromioclavicular joint with mild mass effect on the supraspinatus muscle/tendon. As such, the examiner found that Veteran underwent a second surgery from a private medical service provider in 2009 based on his belief that there were errors to the first surgery which the VA examiner explained as being speculative. The examiner noted that the surgery performed in March 2009 was left shoulder arthroscopic SLAP repair, left shoulder arthroscopic subacromial decompression with acromioplasty, left shoulder arthroscopic glenohumeral joint limited debridement, left shoulder arthroscopy with a partial synovectomy of the glenohumeral joint. The examiner noted that the private orthopedic surgeon noted no negligence or that the second surgery was due to errors from the first, although the private surgeon did remark on the worsened condition which again, the VA examiner noted as speculative. With regards to the Veteran's report of having left extremity tremor secondary to residuals of nerve damage from the first surgical procedure, the examiner noted that the medical records did not support this assertion; rather, immunosuppressants can increase and/or cause tremors, which the Veteran is taking. The examiner ultimately opined that everything was done appropriately, as visualized damage was decompressed and repaired in an appropriate manner. The Veteran's experience of some residual nonuse of the shoulder was not a consequence of negligence, carelessness, lack of proper skill, error, or judgment or similar incident of fault on the part of the VA hospital. However, the September 2021 Board decision found the examination inadequate as the VA examiner did not address the corrective shoulder surgery performed by the private medical provider; this opinion is therefore afforded little, if any, probative weight. Based on the September 2021 remand directives, an addendum VA medical opinion was obtained in November 2021. The examiner opined that based on the record dated May 2, 2008, the Veteran was noted with full thickness partial width non-retracted tear of the distal anterior supraspinatus tendon as shown by the MRI scan. The examiner noted that the Veteran underwent surgery for a left shoulder condition on August 6, 2008, but was found to have no thickness tear on the left shoulder during the operation by the surgeon operating on the Veteran. Instead, the examiner noted that the surgeon observed surface delamination of the rotator cuff, consistent with partial thickness tear. The VA examiner confirmed a signature for informed consent on July 21, 2008 for rotator cuff - tear repair, chronic (repair of chronic rotator cuff tear) shoulder - acromionectomy (partial complete) (acromionectomy (partial complete)). Based on the July 2008 consent for the left shoulder, the examiner noted that it is clear that the performed surgery was within the scope of the informed consent. The examiner also explained that the Veteran underwent another surgery on March 11, 2009 for left shoulder arthroscopic slap repair, left shoulder arthroscopic subacromial decompression with acromioplasty, left shoulder arthroscopic glenohumeral joint limited debridement, left shoulder arthroscopy with a partial synovectomy of the glenohumeral joint which is another condition although involving the same joint. The examiner also explained that the two surgeries were unrelated. Thus, the examiner opined that it is less likely than not that the Veteran has acquired any additional left shoulder disability as a result of the August 2008 surgery. The examiner also added that as there is no noted additional disability resulting from the August 2008 surgery, it is less likely than not that any additional disability was the result of the carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the VA's part or was an event not reasonably foreseeable. The examiner ultimately explained that the Veteran's assertion that surgeon performed unnecessary procedure by removing bone and tissue from his shoulder, there is not enough medical evidence to support the claim, and such assertion is speculative. The examiner instead explained that the glenohumeral joint limited debridement, left shoulder arthroscopy with a partial synovectomy of the glenohumeral joint limited debridement, left shoulder arthroscopy with a partial synovectomy of the glenohumeral joint was not done during the August 2008 surgery but during the March 2009 private surgery instead. The April 2022 Board decision found the November 2021 VA examiner's opinion adequate and denied the claim. The December 2022 Joint Motion for Partial Remand vacated the Board's April 2022 decision and remanded the matter to the Board for further adjudication. Specifically, the parties agreed that the Board errored in finding that the November 2021 VA medical opinion was probative in denying the claim of entitlement for residuals of left shoulder surgery and directed the Board to address whether the Veteran is entitled to compensation for residuals of left shoulder surgery due to a stroke during left shoulder surgery, and to obtain a medical opinion addressing whether the stroke was a reasonably foreseeable event associated with the left shoulder surgery. The August 2023 VA examiner reviewed the files and provided an opinion. The examiner opined that review of VA diagnosis and treatment showed that both were appropriate and timely, with accepted appropriate protocols being followed. The examiner opined that the standard of care was met in this case, and opined that it is less likely than not that the claimed condition as caused by or became worse as a result of VA treatment, carelessness, negligence, lack of skill, similar incidence of fault on the part of the attending VA personnel or additional disability which resulted from an event that could not have reasonably been foreseen by a reasonable healthcare provider and/or failure on the part of the VA to timely diagnose and/or properly treat the claimed disease or disability allowed the disease or disability to continue to progress. The examiner reported that there were no additional disabilities that can be confirmed as being due to the Veteran's August 2008 left shoulder surgery. In support of this opinion, the examiner explained that the examiner agreed with the January 2020 medical opinion that the VA actions, including pre-operative, intraoperative, and post-operative, were appropriate and timely with no residuals attributable ot any VA negligence or carelessness. The examiner explained that the MRI scan taken prior to the surgery revealed full thickness tear of rotator cuff on the left shoulder. The examiner reasoned that the Veteran was given options ot wait on intervention or to proceed with surgery to resolve the suspected left rotator cuff tear and impingement syndrome of left shoulder and that the Veteran opted to proceed with the left shoulder surgery, with full discussion of risk s of the surgery being documented in the claims file. The examiner noted that the Veteran underwent the surgery in August 2008 and the full rotator cuff tear was not found during the surgery, but instead, the surgeon visually confirmed significant osteophytes and impingement at the time of the surgery. The examiner also explained that MRI scan is not a perfect imaging modality, thus initial pre-operative diagnosis of full thickness rotator cuff tear, not confirmed intraoperative, are not entirely unexpected or rare. Regardless of the MRI results, the examiner noted that the surgery continued and alleviated the Veteran's left shoulder impingement, which was a decompression with no bone removal which would be integral to the joint itself and/or its function and the surgeon only shaved and smoothed the osteophytes to improve shoulder function. The examiner noted that the Veteran initially did well after the surgery as noted by the October 2008 VA treatment notes, which indicated that the Veteran was doing well until he heard a pop and experienced a difficulty lifting his shoulder and that MRI scan results performed in November 2008 was inconclusive. The examiner noted that the Veteran then sought private consultation and asserted that the photos from the repeated surgery in 2009 show nerve damage, inflammation, infection, and bone loss, the examiner opined that none of such symptoms were visible in the photos. The August 2023 VA examiner further explained that nerve damage does not appear on standard photograph, infection was not visible and not mentioned in the private orthopedic surgery notes. The examiner noted that the noted "glenoid synovitis," which is indicative of inflammation on area of the shoulder, could not be pinpointed to a specific when or why as it was not observed during the August 2008 surgery. However, the examiner reasoned that the retrospective assumption of inflammation being caused by the August 2008 surgery based on the noted glenoid synovitis during the March 2009 surgery was not reasonable and the bone loss was also not evident, as the photos showed smooth bone which was appropriate and expected the August 2008 decompression surgery. In fact, the examiner noted that as the 2009 left shoulder surgery included drilling into bone and rasping/burring bone to decompress as well, the bone effects would be evident after the 2009 surgery and not the 2008 surgery. The examiner also noted that the private orthopedics operative record did not mention and prior surgical damage and/or infection to the left shoulder joint and noted "normal" articular surface. As to other claimed disabilities to include left upper extremity numbness including in his fingers, the examiner attributed this to cervical disc disease and degenerative joint disease noted in the 2011 and 2014 electromyography (EMG) as well as the cervical spine MRI scan in 2010 and 2014 rather than from the shoulder surgeries. The examiner explained that the Veteran was actually improving post-August 2008 surgery and any new left shoulder conditions developed after the August 2008 left shoulder does not establish that the new conditions were caused by the August 2008 surgery; rather, it shows a progression of the Veteran's underlying degenerative processes which resulted in tears and inflammations identified during the March 2009 left shoulder surgery. Therefore, the examiner opined that the August 2008 left shoulder surgery did not then result in any additional disability. With regards to the claimed stroke mid-surgery, the August 2023 VA examiner referenced the only documentation dated in June 2011 and that this was the only time the Veteran was evaluated, and no other provider, including other neurologists ever found or diagnosed the Veteran with stroke. The examiner also explained that the Veteran's neurological examinations since June 2011 have not supported the left hemisensory loss described by the June 2011 neurologist, and more importantly, the Veteran's symptoms can be explained by other conditions. The examiner noted that the VA neurologist also made the assessment that the Veteran suffered a stroke during surgery based solely on the Veteran's reports of experiencing symptoms after the initial left shoulder surgery at the VA. However, the examiner noted that the Veteran's neurological symptoms are not noted until 2011 despite having other neurological assessments prior to this time. The examiner also noted that the 2011 neurologist referenced a left shoulder surgery in 2007 and 2008 rather than 2008 and 2009, rendering the VA neurologist's assessments uncertain with regards to applicable time periods. The examiner noted that the VA neurologist's comments that the Veteran experienced new neurological symptom after each surgery also lessens the credibility of the VA neurologist's opinion as to whether the stroke occurred during the 2008 VA surgery or during the 2009 private surgery, and that the opinion is more likely to be speculative. As no other neurologist diagnosed the Veteran with stroke, and given the Veteran's widely varying self-reported history of neurological symptoms over time or have findings with other clear etiologies unrelated to the 2008 left shoulder surgery at the VA, the examiner opined that it cannot be reasonably established that the Veteran has ever had a stroke or a mid-surgery stroke during the surgery. Therefore, the VA examiner opined that it is less likely as not that the additional disabilities were the result of an event not reasonably foreseeable in the course of the VA treatment. The August 2023 VA examiner also reemphasized that it is less likely like as not that failure on the part of the VA to timely diagnosed and/or properly treat the claimed left shoulder condition allowed the disease or disability to continue to progress. In support of this opinion, the examiner referenced the claims file, which showed that the VA providers immediately evaluated the Veteran with an orthopedic consult and left shoulder MRI scan when the Veteran presented with left shoulder symptoms in May 2008, all pre-operative evaluations and clearances were completed prior to the August 2008 surgery, and when the Veteran complained of a "pop" in October 2008, an MRI was performed in November 2008 which showed an inconclusive result. The examiner noted that the Veteran then sought private consultation, for which the VA no longer held responsibility for the outcomes. Therefore, the examiner opined that there was no failure on the part of the VA. The Board assigns high probative weight to the August 2023 VA opinion. The examiner reviewed the Veteran's medical history and claims file, and offered a medical opinion backed up by a clear and concise rationale that addressed the pertinent questions at issue. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion"); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In light of the foregoing, the Board finds that the evidence is against finding that the Veteran incurred residuals of a left shoulder surgery as a result of the treatment performed at a VA Medical Center in 2008. In this regard, the August 2023 VA examiner opined that the Veteran's left shoulder damage was less likely than not the result of the treatment or lack of treatment performed at a VA Medical Center in 2008. Rather, the examiner explained that his left shoulder damage was more likely a condition that resulted from progression of underlying degenerative processes which resulted in tears and inflammation that was observed during the March 2009 private surgery. The Veteran's experience of numbness was secondary to the 2011 cervical spine condition, and the Veteran likely did not have stroke mid-surgery. Additionally, the Board finds that the Veteran's claim cannot prevail under the remaining criteria set forth under 38 U.S.C. § 1151. The most probative evidence of record fails to establish that the Veteran incurred left shoulder damage from the treatment or lack of treatment performed in 2008 as a result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA. The Board finds the medical opinion of the VA examiner of significant probative value. The evidence is against a finding that there was a causal relationship between the VA medical treatment provided and the Veteran's left shoulder damage, and the competent medical evidence established that there was no fault on the part of VA in the treatment provided. The threshold (and dispositive in this case) factor is the lack of a nexus between the VA treatment provided and the Veteran's claimed disability. In fact, the August 2023 VA examiner opined that the medical conditions from which the Veteran experiences are less likely than not to have been caused by carelessness, negligence, lack of proper skill, error in judgment or similar instance of fault on the part of VA. This opinion is by a medical professional competent to provide such an opinion, cited supporting factual data, and explained the underlying rationale which cites to current medical knowledge; hence, it is probative evidence in this matter. The Board finds the examiner's opinion probative as it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, supra. There is no contrary probative opinion of record. The Board considered the Veteran's statements made in support of his claim. In certain instances, lay statements may serve to support findings related to the occurrence of lay-observable events or the presence of disability, or symptoms of disability, susceptible of lay observation. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); see Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). However, the Veteran is not competent to state that any residuals of a left shoulder surgery is etiologically related to any VA carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA's part during treatment or lack of treatment in 2008. It is not shown that the Veteran is otherwise qualified through specialized education, training or experience to offer a medical etiological opinion. Thus, the Veteran's assertions are outweighed by the August 2023 VA opinion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (holding that the Board is prohibited from substituting its own medical judgment in place of the pinions of competent medical professionals). There is no other medical evidence of record showing that the Veteran has residuals of left shoulder surgery that was caused by VA treatment in 2008, and the Board may not accept unsupported lay speculation with regard to medical issues. Accordingly, the Board finds that compensation under 38 U.S.C. § 1151 for residuals of a left shoulder surgery is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Audrey Kim, 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.