Chloracne — VA Disability Rating Criteria (DC 7829)

Diagnostic Code 7829 · 38 CFR §4.118

What Is It?

Chloracne is an acne-like eruption caused by exposure to chlorinated aromatic compounds, above all the dioxin TCDD that contaminated the herbicides sprayed in Vietnam. It is not ordinary acne. It produces dense fields of straw-colored cysts and comedones, characteristically on the cheeks and behind the ears, around the eyes and along the jaw, and it can extend to the armpits, groin and torso. It appears within weeks to months of a heavy exposure, and it can persist or recur for years afterward, leaving pitted scarring behind. Chloracne was one of the first conditions the VA recognized as presumptively linked to herbicide exposure, and it remains one of the small number of herbicide presumptives that carry a manifestation deadline: it must have appeared to a compensable degree within a year of the last exposure. Two things follow from that. Veterans who developed it in Vietnam or shortly after coming home have a straightforward presumptive route. Veterans who developed acneform disease later, or from other chemical exposures — solvent and fuel work, burn-pit smoke, industrial degreasers, firefighting — are outside the presumption but not outside the code, because DC 7829 rates severe acne generally, not only acne caused by dioxin.

Rating Criteria

Evidence Needed

The criteria distinguish two things and the evidence has to speak to both. The first is depth: the whole 0 percent row is superficial acne — comedones, papules, pustules — of any extent, so a record describing blackheads and whiteheads, however widespread, establishes a noncompensable evaluation. What earns a compensable rating is DEEP acne, meaning deep inflamed nodules and pus-filled cysts, and that word needs to be in the dermatology note. The second is location, which is scored in an unusual order: deep acne on less than 40 percent of the face and neck, or anywhere on the body outside the intertriginous areas, is 10 percent; deep acne in the intertriginous areas — the axilla, the anogenital region, the skin folds of the breasts, or between the digits — is 20 percent regardless of extent; and deep acne on 40 percent or more of the face and neck is 30 percent. So the file needs a dermatologist to record which areas are involved by name, and a percentage for the face and neck. Dated photographs from active outbreaks are important because the condition fluctuates and the scarring outlasts the lesions. For the presumptive route, the evidence is service in a location and period covered by the herbicide presumption, plus records showing the chloracne appeared to a compensable degree within a year of the last exposure. For a direct claim on another exposure, the evidence is the exposure history, the MOS and duty records supporting it, and a medical opinion.

C&P Exam Tips

Ask the examiner to use the regulation's own vocabulary, because two words carry the whole evaluation. The first is deep: deep inflamed nodules and pus-filled cysts, as against superficial comedones, papules and pustules. An examination that records "acne" without that distinction leaves a rater with the 0 percent row as the safe choice. The second is intertriginous, and it is worth raising unprompted — deep acne in the axilla, the anogenital region, the skin folds of the breasts, or between the digits is 20 percent on its own, without any extent requirement, and an examiner focused on the face may never look. Ask for a percentage figure for the face and neck rather than a description, since 40 percent is the threshold between 10 and 30 percent. Bring photographs from active periods, because chloracne comes and goes while the pitted scarring stays. Point out the scarring explicitly and describe any disfigurement — depression or elevation of the surface, hypo- or hyperpigmentation, the measured area affected — since DC 7829 provides for evaluating the condition as disfigurement of the head, face or neck under DC 7800, or as scars, where that is the predominant disability, and DC 7800 reaches 80 percent where DC 7829 stops at 30.

How to File

File under DC 7829 with dermatology records that use the words deep acne, name the involved areas including any intertriginous involvement, and give a percentage for the face and neck. For the presumptive route, attach the service records establishing herbicide exposure — service in the Republic of Vietnam, in the covered Thailand and Korean DMZ locations and periods, or in the other locations the presumption now reaches — together with the medical evidence showing the chloracne appeared to a degree of 10 percent or more within one year of your last exposure. Where the condition appeared later, or where the exposure was to something other than herbicides, the presumption does not apply but direct service connection remains open on an exposure history plus a medical nexus opinion, and it is worth filing on that basis rather than not filing. Where the acne is a side effect of medication prescribed for a service-connected condition, file as secondary. If the lasting problem is scarring rather than active lesions, read the alternative instruction in DC 7829 carefully: the code provides for evaluating the condition as disfigurement of the head, face or neck under DC 7800, or as scars under DC 7801, 7802, 7804 or 7805, depending on the predominant disability. Where the scarring is the predominant disability, ask for the evaluation under DC 7800 and give the rater the measurements that code requires.

Common Mistakes

The first mistake is missing the one-year window and stopping there. Chloracne is one of the few herbicide presumptives that must have become manifest to a degree of 10 percent or more within a year after the last date of exposure, so a veteran who developed acneform disease in 1985 cannot use the presumption. What is often missed is that this does not end the claim: direct service connection is still available on evidence of the exposure and a medical opinion linking it to the condition, and it is a real route rather than a technicality. The second mistake is letting the record say "acne" and nothing more, when the difference between superficial and deep lesions is the difference between 0 percent and a compensable rating. The third is never mentioning the intertriginous areas — deep acne in the armpits, the groin, the breast folds or between the digits is 20 percent on its own, and examiners looking at a face do not find it. The fourth is the most common misunderstanding on this page: assuming a DC 7800 disfigurement rating simply adds on top of the DC 7829 rating. It does not work that way. DC 7829 provides for evaluating the condition as disfigurement or as scars depending on the predominant disability — an alternative, not an addition — and 38 CFR 4.14 prohibits evaluating the same disability under several diagnoses. The right move where the scarring is worse than the active acne is to argue that the disfigurement is the predominant disability and ask for the evaluation there, since DC 7800 reaches 80 percent.

Frequently Asked Questions

Is chloracne always connected to Agent Orange?

It is the classic marker of dioxin exposure, which is why it was among the first conditions the VA recognized as presumptively linked to herbicide exposure, but it is not exclusive to it. Chloracne is caused by chlorinated aromatic compounds generally, and severe acneform disease from other chemical exposures is rated under the same code. DC 7829 rates the acne, not the cause; the cause is what the service-connection half of the claim is about.

What is the one-year rule for chloracne?

38 CFR 3.307(a)(6)(ii) provides that the herbicide-associated diseases must have become manifest to a degree of 10 percent or more at any time after service — except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy must have become manifest to a degree of 10 percent or more within a year after the last date the veteran was exposed to an herbicide agent in service. Those three are the only herbicide presumptives carrying that deadline. Missing it removes the presumption; it does not remove direct service connection.

What is the difference between deep and superficial acne here?

It is the entire difference between a compensable and a noncompensable rating. The regulation defines superficial acne as comedones, papules and pustules — blackheads, whiteheads and ordinary pimples — and assigns 0 percent to it at any extent. Deep acne is defined as deep inflamed nodules and pus-filled cysts, and only deep acne reaches 10, 20 or 30 percent. If your dermatology records describe your condition only as "acne," ask for a note that states whether the lesions are deep nodulocystic.

Why is acne in the armpits or groin rated higher than acne on the arms?

Because the regulation says so directly. Deep acne affecting the intertriginous areas — the axilla of the arm, the anogenital region, skin folds of the breasts, or between the digits — is 20 percent, with no extent threshold attached, while deep acne on other non-facial areas is 10 percent. Skin folds rub, stay damp, and heal badly, and the schedule reflects that. It is easy to overlook because the examination tends to concentrate on the face, so raise it yourself if those areas are involved.

Can I get more than 30 percent?

Not under DC 7829, which stops at 30 percent. But the code itself provides an alternative: it may instead be evaluated as disfigurement of the head, face, or neck under DC 7800, or as scars under DC 7801, 7802, 7804 or 7805, depending upon the predominant disability. DC 7800 reaches 80 percent and is scored on the eight characteristics of disfigurement — scar length and width, surface contour, adherence, texture, color, missing underlying tissue, and induration. Where years of cystic chloracne have left the face pitted and discolored, the disfigurement is often the predominant disability and the evaluation belongs under DC 7800. Note that this is a choice between codes for the same manifestation rather than two ratings added together.

My chloracne has cleared up but the scarring is permanent. What do I claim?

Claim the scarring, and claim it as the predominant disability. Active chloracne comes and goes; the pitted, discolored scarring it leaves behind does not, and it is what most veterans are living with decades later. DC 7829 expressly allows the condition to be evaluated as disfigurement of the head, face or neck under DC 7800 or as scars under the scar codes where that reflects the predominant disability. Give the rater what DC 7800 needs: measurements of the affected area, and which of the eight characteristics of disfigurement are present. Photographs matter more here than anywhere else on this page.