Citation Nr: 21074840 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 18-37 655 DATE: December 16, 2021 REMANDED Entitlement to an increased rating in excess of 20 percent for left lower extremity lymphedema is remanded. Entitlement to an initial compensable rating for lymphedema of the testicles is remanded. REASONS FOR REMAND The Veteran served in the United States Air Force from September 1963 to July 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by a VA Regional Office (RO). By way of background, these appeals stem from the Veteran's July 31, 2015, claim seeking an increased rating for his left lower extremity lymphedema, and his October 1, 2015, claim seeking service connection for lymphedema of the testicles. The issues have been appropriately characterized as an increased rating of the left lower extremity lymphedema, and an "initial" rating for lymphedema of the testicles appropriately. The Veteran testified before the undersigned in a Board hearing in October 2021 and the hearing transcript is of record. As an aside, the Board notes that during the October 2021 Board hearing, the Veteran raised possible contentions for service connection for medical conditions secondary to his lymphedema in his left lower extremity and testicles, to include cellulitis, hydroceles, and hernia. The Veteran filed separate claims for these conditions in June 2018 and June 2019. Subsequently, service connection for cellulitis as secondary to left lower extremity lymphedema was denied in an August 2018 rating decision and was not appealed. The claim for hydroceles as secondary to lymphedema of the testicles was denied in an October 2019 rating decision and also has not been appealed. Lastly, a rating decision has not as of yet been issued by the AOJ regarding service connection for hernia. Therefore, these claims are not properly before the Board and will not be further addressed in this decision. 1.Entitlement to an increased rating in excess of 20 percent for left lower extremity lymphedema is remanded. 2. Entitlement to an initial compensable rating for lymphedema of the testicles is remanded. The Veteran contends that he experiences worsened symptoms from his left lower extremity and testicular lymphedema. The Board finds the evidence of record is insufficient to resolve the Veteran's claims. During the October 2021 Board hearing, the Veteran testified that his testicles swell every day and are painful. He also testified to suffering from cellulitis in his left leg as a result of his lymphedema with a history of hospitalization and prescribed antibiotics. The swelling in his left leg has gotten so bad that the skin has turned red, it is about twice the size of his left leg, and his doctors have advised him to watch for recurrence of cellulitis. See October 2021 Board hearing P. 7-8. Lastly, the Veteran testified to having to "stay off [my] feet more than normal to elevate to try to move the fluid off [my legs]. See id. P. 13. The Veteran has been afforded several VA examinations over the course of the appeal, which have been variable regarding the severity of his two conditions and certainly in contrast with the Veteran's 2021 testimony. In particular, the Veteran was last afforded VA examinations in October 2019 to determine the severity of his lymphedema. The examiners, however, noted that the Veteran's testes were normal and that there was no change in the Veteran's left lower extremity condition noting only symptoms of pain and swelling. The Veteran has been afforded other VA examinations during the period on appeal for his testicular lymphedema in May 2018 and August 2019. The May 2018 VA examiner noted that the Veteran's testes were abnormal during physical examination. However, in August and again in October 2019 the examiners noted that his testes were normal however the diagnosis of lymphedema of the testes remained. Furthermore, the earlier May 2018 examiner noted that the Veteran's testicular condition would negatively impact his functional impairment. In contrast, the 2019 examiners noted no functional impact. In order to afford the Veteran reasonable doubt, the Board finds a remand is necessary to ascertain whether there has been a change in the current severity of either of his conditions and for the examiner to comment and attempt to resolve the discrepancies found in the record throughout the appeal period. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from September 2019 to the Present. 2. After the above development has been completed, schedule the Veteran for a VA examination before an appropriate examiner to determine the current severity of the Veteran's left lower extremity lymphoedema, to include any and all residuals. The examiner shall be provided the entire claims file and this remand for review. The examiner should provide a full description of the Veteran's disability and residuals and discuss all signs and symptoms necessary for evaluating the Veteran's left lower extremity lymphedema and residuals under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any functional, social, and occupational effects due to his disability. The examiner is directed to consider the Veteran's lay statements of symptom worsening. Regarding the Veteran's left lower extremity lymphoedema, to include any and all residuals, the examiner should consider and address the Veteran's testimony that his left leg swelling has gotten to the point that this left leg is twice the size of his right leg with red coloration of the skin and cellulitis. The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. To the extent possible, the examiner is also asked to resolve the apparent discrepancies in the record throughout the appeal period found between the examinations in May 2018, August 2019, October 2019, and the Veteran's October 2021 testimony before the Board regarding the severity of his condition. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Schedule the Veteran for a VA examination before an appropriate examiner to determine the current severity of the Veteran's lymphoedema of the testicles, to include any and all residuals. The examiner shall be provided the entire claims file and this remand for review. The examiner should provide a full description of the Veteran's disability and residuals and discuss all signs and symptoms necessary for evaluating the Veteran's lymphoedema of the testicles and residuals under the rating criteria for the entire period on appeal beginning July 2014 to the present. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any functional, social, and occupational effects due to his disability during the entire appeal period. The examiner is directed to consider the Veteran's lay statements of symptom worsening. Regarding the Veteran's lymphoedema of the testicles, to include any and all residuals, the examiner should consider and address the Veteran's testimony that his testicles swell "all day every day" and are painful. The examiner must provide a complete rationale for any opinion expressed, based on the examiner's clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. To the extent possible, the examiner is also asked to resolve the apparent discrepancies in the record throughout the appeal period found between the examinations in May 2018, August 2019, October 2019, and the Veteran's October 2021 testimony before the Board regarding the severity of his condition. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. F. Minnitte, Attorney Advisor 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.