LLE® Certification

Lymphedema Lower Extremity

The purpose of LLE certification is to demonstrate a candidate’s proficiency and mastery of essential knowledge and skills in Lymphedema Lower Extremity Management. It promotes consumer protection and confers peer and public recognition to those individuals who prove proficient in their practice.

Eligibility for Certification

Applicants for the NAWCO LLE certification must meet all of the following criteria:

LLE Certification Eligibility Requirements:

  • Active unrestricted license as a Registered Nurse, Licensed Practical/Vocational Nurse, Nurse Practitioner, Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Physician or Physician Assistant.
  • Have practiced the equivalent of 1 year full-time in the past five years as a Registered Nurse, Licensed Practical/Vocational Nurse, Nurse Practitioner, Physical Therapist, Physical Therapist Assistant, Occupational Therapist, Physician or Physician Assistant. Payment of required exam fees.

Education Requirements:

  1. Successful graduate of Norton “Edema Solutions for Wound Specialists” course and 30 contact hours of NAWCO *approved wound or lymphedema training courses. Click here for information about Norton School, -or-
  2. Current, active certification as a Certified Lymphedema Therapist (CLT) and 22 contact hours of NAWCO approved wound care courses, -or-
  3. LANA certification and 22 contact hours of NAWCO approved wound care courses.
  4. Receive passing score on the NAWCO LLE Examination.

*Approved Lymphedema and Wound Education providers:

  1. Academy of Lymphatic Studies
  2. Norton School of Lymphatic Therapy
  3. Klose Training Lymphedema Certification
  4. Pacific Therapy Education
  5. Wound Care Education Institute


Upon successful completion of the LLE Certification examination, candidates may use the initials LLE, Lymphedema Lower Extremity Certified, to designate their status. Credentials are awarded for a five (5) year period following obtaining a passing score on the examination.

Upon expiration of the credentialing term, LLEs are required to recertify with the NAWCO to maintain their credentials “LLE”.

Certification Certificate

The NAWCO will award an official numbered certificate to all candidates upon passing the NAWCO LLE Certification examination, denoting status as LLE, Lymphedema Lower Extremity Certified.

Scope of Practice

The LLE provides direct patient lymphedema and edema care in acute, outpatient, long-term care and home care settings. The LLE plays an important role as a direct care provider, educator and resource for optimum patient outcomes in lymphedema and edema management associated with wounds. The LLE scope of practice is performed in accordance with legislation code as determined by each respective professional state regulatory board.

Lymphedema Lower Extremity and edema management includes the identification, assessment, management, prevention, and continuing evaluation of patients with signs and symptoms of swelling related to lymphatic and or venous failure, which includes but is not limited to primary lymphatic dysplasia and all other forms of secondary lymphatic trauma.

Lymphedema Lower Extremity, edema and wound management is a specialized area that focuses on overall skin care and promotion of an optimal wound environment through reduction of edema and lymphedema. This therapeutic approach includes intensive rehabilitative interventions followed by education in self-care measures to prevent disease progression.

Lymphedema Lower Extremity and edema management requires the skills of the interdisciplinary team that includes the physician, nurse, LLE, dietitian, physical therapist, occupational therapist, social worker, and other health care disciplines or providers depending upon each individual patient assessment. The physician or other advanced practice provider is the leader of the interdisciplinary care team. As such, Lymphedema Lower Extremity and edema management care plans must always be prescribed by the physician or other advanced practice provider.

Content of Examination

The LLE Certification examination is an objective, multiple choice test consisting of up to 110 questions with a total testing time of two (2) hours.
The questions for the LLE Certification examination are prepared by teams of Subject Matter Experts (SMEs). The examination questions are written to assess cognitive levels of knowledge, comprehension, application and analysis related to lymphedema lower extremity and edema management.

Review of Examinations

For security reasons, examination materials are not available for review. Neither the testing corporation nor the NAWCO will discuss specific questions on any of the examinations. Comments about questions should be directed in writing to the NAWCO Certification Committee. The NAWCO will review comments relating to the exam but will not make a written response to comments.

Candidates who believe their examination results were improperly recorded or their examination graded inaccurately may request that their examination be hand scored. To request examination hand scoring, candidates should complete a signature form available from the NAWCO website. This request must be postmarked no later than 100 days after the test administration date.

Examination Disclosure

The examination questions remain solely the property of the NAWCO. These materials are confidential and are not to be shared with any person or agency for any reason.

Retesting Policy

If you are unsuccessful in passing the examination, you will receive instructions and a re-examination application by US mail from the National Alliance of Wound Care and Ostomy.

Candidates who take the LLE Certification examination and are unsuccessful may retake the examination for a total of three (3) additional re-examination attempts within two (2) years of the date of approval for the examination. After four (4) attempts, you would be required to wait for a period of one (1) year prior to taking the exam again.

Candidates who allow the two (2) year time limit to expire, but who do not exhaust the four (4) exam attempts, are not required to wait one (1) year prior to reapplying to take the exam again. However, all unsuccessful candidates must meet all eligibility requirements in order to retake the examination. Candidates are encouraged to self-study during this time.

Unsuccessful candidates are not eligible for any refunds.


NAWCO strictly protects the security of your personal information and honors your choices for its intended use. We carefully protect your data from loss, misuse, unauthorized access or disclosure, alteration, or destruction. Though we make every effort to preserve user privacy, we may need to disclose personal information when required by law wherein we have a good-faith belief that such action is necessary to comply with a current judicial proceeding, a court order, or legal process. If we are required by law to release your confidential information, you will be notified by email at the address we have on file, unless prohibited by law. Otherwise, your personal information is never shared outside the company without your permission. Inside the company, data is stored in password-controlled servers with limited access. NAWCO does not release information to anyone as to whether a particular candidate has applied or what their exam results were. Anyone may obtain basic certification information including name, city, state, original certification date, current certification date, certification expiration date, and certification status by using the credential verification feature on the home page of our website: www.nawccb.org. If a certificant wishes NAWCO to verify his or her certification status in writing for an employer, a request signed by the certificant must first be received by the NAWCO office.


Certification is awarded for a five (5) year period following successful passing of the examination. Upon expiration of the credentialing term, LLEs are required to recertify with the NAWCO to maintain their credentials. Details of the recertification options will be mailed to successful candidates within one year of expiration of credential. They may also be accessed at the NAWCO website: www.nawccb.org.


Individuals may appeal decisions regarding eligibility, examination results, and disciplinary matters made by the NAWCO certification program by submitting a written letter of appeal to the NAWCO Certification Committee within 30 days of the NAWCO decision or action that is being appealed. Certificants may request a copy of the appeal policy by contacting the NAWCO office.

References for Study

The following reference list may be helpful in preparing for the examination. This list does not attempt to include all the acceptable references available, nor is the examination based solely on these sources. The NAWCO does not sponsor or endorse any one reference over another. Some of the references can be accessed online, while others are available at local book stores.

Key items:

  1. Edema Solutions for Wound Specialists Course Workbook. Norton School of Lymphatic Therapy
  2. Foeldi’s Textbook of Lymphology, M. Foeldi, E. Foeldi, Elsevier, 3rd Edition December 2012.