Citation Nr: 21011887 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 20-25 537 DATE: March 2, 2021 REMANDED Entitlement to an initial compensable rating for chronic lymphocytic leukemia (CLL) associated with herbicide exposure (claimed as cancer lymph nodes) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1966 to February 1969. This matter is on appeal from a January 2019 rating decision. He testified before the undersigned Veterans Law Judge at a January 2021 Board hearing. Procedurally, the Veteran was granted service connection for chronic lymphocytic leukemia (CLL) and was assigned a noncompensable rating by a January 2019 rating decision. The Veteran filed a timely Notice of Disagreement, arguing for a higher rating. Medical records show that the Veteran initially exhibited signs of abnormal white blood cell count in February 2017 and was ultimately diagnosed with chronic lymphoid leukemia disease in March 2017. However, his hemoglobin and platelets were within normal range. His BCR-ABL was also normal. A CT scan completed in March 2017 showed no lymphadenopathy or splenomegaly. In October 2018, the Veteran denied any weight loss, night sweats, fever, or infection, but did complain of enlarged neck on the left side. In November 2018, VA treatment records showed that he complained of swollen glands in his neck area. At his November 2018 VA examination, the examiner noted that the Veteran’s leukemia is in active status but was asymptomatic. He did not require continuous medication for control of a hematologic or lymphatic condition, including anemia or thrombocytopenia. While his treatment is completed, he was in watchful waiting status. He does not have anemia or thrombocytopenia. He did not have polycythemia vera, sickle cell anemia, or other complications. His laboratory testing showed hemoglobin at 14.4, hematocrit at 42.1, red blood cells count at 4.38, white blood cell count at 15.9, and his platelet count was adequate. Medical treatment records in December 2018 noted that the Veteran had multiple subcentimeter retroperitoneal and mesenteric lymph nodes, with bilateral inguinal lymph nodes measuring up to 11 mm short axis right. By April 2019, private treatment records from Touchstone Medical Imaging showed multiple enlarged hypoechoic lymph nodes of the neck bilaterally, with the largest one on the right measuring 3.2 cm by 2.4 cm, 2.1 by 1.9 cm, and 3 cm by 2.7 cm. The largest ones on the left measured at 2.8 cm by 1.7 cm, 2.3 cm by 1.8 cm, and 2.2 by 2 cm. In his January 2020 Notice of Disagreement, the Veteran asserted that his condition had remained stable in the past. However, new medical records show that his lymph nodes have since enlarged. More recently, he experiences night sweats, extreme tiredness, bone aches, and enlarged lymph nodes all over his body. He is required to undergo blood tests on a monthly basis and visits a doctor very three months. At his January 2021 Board hearing, the Veteran testified that he had only been receiving his leukemia treatment from VAMC and that he currently experiences residual symptoms, pain, fatigue, shortness of breath, lack of oxygen, and teeth pain. In reviewing the record, the Board finds that a remand is warranted to afford the Veteran a new VA examination to determine the current severity of his leukemia. The more recent April 2019 private imaging tests revealed that the Veteran’s lymph nodes have clearly enlarged compared to his 2018 readings. Moreover, the Veteran has described physical symptoms highly suggestive of worsening. Thus, on remand, a new VA examination should be scheduled for the Veteran. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records pertaining to the Veteran’s treatment of his service-connected leukemia. 2. Schedule the Veteran a new VA examination to assess the current severity of the Veteran’s leukemia. The VA examiner should also consider and address the Veteran’s reported symptoms such as residual symptoms, anemia, night sweats, body pains, fatigue, shortness of breath and teeth pain. The VA examiner must review the claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. The examiner should address the December 2018 and April 2019 treatment records indicating the Veteran’s enlarged lymph nodes, and clearly state whether the Veteran’s leukemia is active and what treatment, if any, he receives and the dates for such treatment. All necessary tests and studies should be accomplished, and all clinical findings reported in detail. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Yeh, 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.