Citation Nr: 21067884 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 17-39 939 DATE: November 5, 2021 REMANDED Entitlement to a rating in excess of 10 percent for avascular necrosis of the left first metatarsal is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2002 to August 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In a July 2017 substantive appeal, the Veteran requested a hearing at the Board's Washington, DC, offices. The Board scheduled a September 2019 central office hearing and informed the Veteran of the hearing in an August 2019 letter. The Veteran failed to appear at the scheduled hearing. The hearing request is accordingly considered withdrawn. An additional VA examination is required. A December 2014 VA examination of the Veteran's foot indicated that the Veteran experienced flare-ups that impacted the function of her foot but did not include a description of the symptoms on flare-up. Additionally, the VA examination noted a radiology report that reported "Early degenerative arthritic changes are present at the first MTP joint." The VA examination determined that this "is not a continuation or eventuality of any avascular necrosis identified in the past" but did not provide a rationale to explain this finding. Moreover, as the Veteran initiated her claim informally after processing of another claim had begun, she did not receive formal notice consistent with VA's duties, and such should be supplied on remand. 38 U.S.C. § 5103; 38 C.F.R. § 3.156. Accordingly, the matter is REMANDED for the following action: 1. Provide notice to the Veteran regarding the requirements necessary to substantiate a claim for an increased rating. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected avascular necrosis of the left first metatarsal. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Then, readjudicate the claim. If the benefit sought remains denied, issue a supplemental statement of the case and return the matter to the Board, if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. Ripplinger, 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.