Citation Nr: 19162002 Decision Date: 08/09/19 Archive Date: 08/09/19 DOCKET NO. 16-34 047 DATE: August 9, 2019 REMANDED Entitlement to service connection for lymphadenopathy and lymphadenitis of the left lower extremity, also claimed as left leg edema, is remanded. REASONS FOR REMAND The appellant served on active duty in the United States Army from March 1986 to April 1986. His discharge was characterized as an Entry Level Status discharge for failing to meet the procurement medical fitness standards. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 1986 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) which denied entitlement to service connection for lymphadenopathy and lymphadenitis on the basis that the disability preexisted service and was not aggravated therein. The appellant appeared before the undersigned Veterans Law Judge at a videoconference hearing in February 2019. A transcript of that hearing has been added to the record on appeal. The appellant contends that his left leg lymphadenopathy and lymphadenitis, which began many years prior to his entry onto active duty and which was treated with surgery in July 1985, was aggravated beyond its normal progression by his active duty service. He asserts that long periods of marching, standing, and running caused an increase in his underlying disability, as evidenced by his seeking medical attention in April 1986 for left leg pain and swelling. After a review of the evidence of record, the Board finds that further development is necessary prior to adjudicating this claim. In developing this claim, VA provided the appellant with a medical examination in May 2016, at which time an opinion was rendered that the appellant’s disability was not as likely as not aggravated by his service because there was no evidence of him seeking treatment while on active duty. However, the Board notes that this is inconsistent with the evidence of record discussed by the examiner which noted that in April 1986, while still on active duty, the appellant sought medical treatment for symptoms of his lymphadenopathy, to include swelling in his left leg. The Board further notes that the examiner did not address the appellant’s lay contentions that the rigors of basic training were the cause of his recurrence of symptoms, and that these demonstrated an increase in his level of disability. As such, the Board finds the May 2016 VA examination inadequate. On remand, the RO should seek a medical opinion addressing whether the symptoms of left leg pain and swelling the appellant experienced in April 1986, while on active duty, were a temporary or intermittent flare-up of the underlying disease, or whether these symptoms revealed a worsening of the underlying condition beyond its natural progress. See Davis v. Principi, 276 F.3d. 1341, 1346-46 (Fed. Cir. 2002) ([E]vidence of temporary flare-ups symptomatic of an underlying preexisting condition, alone, is not sufficient for a non-combat veteran to show increased disability under 38 U.S.C. § 1153 unless the underlying condition is worsened); see also Maxson v. West, 12 Vet. App. 453, 458 (1999) (citing Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991)), aff’d 230 F.3d 1330 (Fed. Cir. 2000). The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the symptoms of left leg pain and swelling the Veteran experienced in April 1986 were indicative of an increase (worsening) of the appellant’s preexisting underlying left leg lymphadenopathy and lymphadenitis or whether these symptoms of pain and swelling were a temporary, intermittent, or regular flare-up of the underlying disease. If the examiner finds that these symptoms of left leg pain and swelling from April 1986 are indicative of a worsening of the appellant’s underlying lymphadenopathy and lymphadenitis, the examiner should provide an opinion as to whether the increase in the appellant’s underlying lymphadenopathy and lymphadenitis was not clearly and unmistakably due to the natural progress of the disease. The examiner must consider the relevant evidence of record, including the service treatment records and the appellant’s lay statements that his symptoms in April 1986 were caused by significant physical exertion during basic training. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kleponis, 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.