Skin Conditions — VA Disability Ratings

How Skin Conditions conditions are rated

The skin schedule at 38 CFR §4.118 covers dermatitis and eczema, psoriasis, acne, skin infections, skin cancers, hair loss, scars, and disfigurement of the head, face and neck, under diagnostic codes 7800 through 7833. Systemic therapy is treatment given by any route "other than the skin" (§4.118(a)). Two or more skin conditions may be combined "only if separate areas of skin are involved"; where they share an area, only the highest evaluation is used (§4.118(b)).

Many skin diseases, including dermatitis or eczema (DC 7806) and psoriasis (DC 7816), are rated under the General Rating Formula for the Skin. The 10, 30 and 60 percent levels are each met by "at least one of" their criteria: the share of the entire body or of exposed areas affected, or the systemic therapy required over the past 12-month period. 60% applies to more than 40 percent, or "constant or near-constant systemic therapy." 30% applies to 20 to 40 percent, or systemic therapy for "a total duration of 6 weeks or more, but not constantly." 10% applies to at least 5 but less than 20 percent, or intermittent systemic therapy totaling less than 6 weeks. 0% applies when lesions cover less than 5 percent and no more than topical therapy was required.

Except for DC 7824, the formula also allows the rater to "rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability." Some codes carry no table of their own: cutaneous leishmaniasis (DC 7808) is rated as disfigurement, scars or dermatitis, and benign skin neoplasms (DC 7819) as disfigurement, scars or impairment of function. Acne, chloracne, urticaria, vitiligo, hair loss and hyperhidrosis have criteria of their own.

Scars and other disfigurement of the head, face or neck are rated under DC 7800 at 10, 30, 50 or 80 percent. The levels count "characteristics of disfigurement," or visible or palpable tissue loss with gross distortion or asymmetry of features such as the nose, eyes or lips. Note (1) lists eight characteristics, such as a scar 5 or more inches long. One characteristic is 10%, and six or more is 80%. The rater is to consider "unretouched color photographs" (Note (3)), and pain, instability, or muscle or nerve residuals are evaluated separately and combined (Note (4)).

Scars elsewhere on the body are rated by area under DCs 7801 and 7802. DC 7801 covers scars "associated with underlying soft tissue damage," from 10% at 6 square inches to 40% at 144 square inches or more. DC 7802 covers scars without that damage at one level, 10% for 144 square inches or more. For both, the body has six zones, and a separate evaluation "may be assigned for each affected zone." DC 7804 counts scars that are "unstable or painful": 10% for one or two, 20% for three or four, 30% for five or more, with 10 percent added if any is both. A scar rated under DC 7800, 7801, 7802 or 7805 may also be rated under DC 7804 (Note (3)). DC 7805 sends any other disabling effect of a scar to an appropriate code.

Skin cancers are rated as scars, disfigurement or impairment of function. Treatment that goes beyond the skin, such as systemic chemotherapy, brings 100% from the onset of treatment, with a mandatory VA examination six months after it ends (DCs 7818 and 7833). Under the General Rating Formula, because the therapy criteria look back 12 months, pharmacy records showing how long each course lasted, and dated photographs of a flare, can matter more than one examination on a quiet day.