Diseases of Keratinization (Ichthyosis, Keratoderma) — VA Rating (DC 7824)
Diagnostic Code 7824 · 38 CFR §4.118
What Is It?
Diseases of keratinization are disorders in which the skin's outer layer forms abnormally — too thick, too adherent, or shed incorrectly. DC 7824 covers the group: the ichthyoses, which produce dry, plate-like scaling over large areas; Darier disease, with its greasy crusted papules in the seborrheic areas; and the palmoplantar keratodermas, which thicken the skin of the palms and soles until it cracks. Most of these are genetic and present from childhood, which raises a question veterans should understand rather than fear. A condition that existed before service is not automatically excluded: under 38 CFR §3.306, service connection is available for aggravation where a preexisting condition worsened beyond its natural progression during service, and the presumption of soundness at §3.304(b) means that unless the condition was noted on the entrance examination, the VA bears the burden of proving both that it preexisted and that it was not aggravated. DC 7824 is rated on the General Rating Formula for the Skin — coverage or systemic therapy duration.
Rating Criteria
| Rating | Criteria |
|---|---|
| 60% | Characteristic lesions involving more than 40 percent of the entire body, or more than 40 percent of exposed areas affected; or, constant or near-constant systemic therapy required over the past 12-month period. This is the maximum schedular evaluation under the General Rating Formula for the Skin. |
| 30% | Characteristic lesions involving 20 to 40 percent of the entire body, or 20 to 40 percent of exposed areas affected; or, systemic therapy required for a total duration of six weeks or more, but not constantly, over the past 12-month period. |
| 10% | Characteristic lesions involving at least 5 percent but less than 20 percent of the entire body, or at least 5 percent but less than 20 percent of exposed areas affected; or, intermittent systemic therapy — including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs — required for a total duration of less than six weeks over the past 12-month period. |
| 0% | No more than topical therapy required over the past 12-month period, and characteristic lesions involving less than 5 percent of the entire body or less than 5 percent of exposed areas affected. |
Evidence Needed
The entrance examination is a document worth obtaining first, because it determines who carries the burden on a preexisting condition. Beyond that: a dermatology diagnosis naming the specific disorder, and where relevant genetic testing. For the rating, body-surface-area figures — which are typically high in the ichthyoses, since scaling is generalized — and a complete systemic therapy record, particularly oral retinoids such as acitretin and isotretinoin, which are the mainstay of treatment and are systemic therapy under 38 CFR §4.118(a). Service treatment records showing flares, worsening, or treatment during service are the aggravation evidence. Photographs document extent. Where palms and soles are involved, records of painful fissures, difficulty walking, and inability to grip belong in the file, because those support a separate functional evaluation.
C&P Exam Tips
Ask for total body and exposed-area percentages; the ichthyoses frequently exceed the 20 to 40 percent range that supports 30 percent and sometimes the 40 percent line that supports 60. Give the oral retinoid history in weeks over the past twelve months — continuous acitretin is constant systemic therapy and satisfies the 60 percent criterion on the therapy path alone. If your palms or soles are involved, this is the part of the exam to press: describe the fissures, show them, and describe what they prevent — gripping tools, standing a full shift, walking on hard ground. That functional loss is routed through DC 7805 to a musculoskeletal evaluation and is the most commonly missed element of a keratinization claim. Report secondary infections in cracked skin.
How to File
File on VA Form 21-526EZ naming the specific disease — ichthyosis vulgaris, X-linked ichthyosis, Darier disease, palmoplantar keratoderma — under DC 7824. If the condition predates service, frame the claim as aggravation under 38 CFR §3.306 and attach the entrance examination together with service treatment records showing worsening. Attach the dermatology diagnosis, body-surface-area documentation, photographs, and the systemic retinoid history with durations. Claim functional limitation of the hands or feet separately through DC 7805, and claim recurrent secondary skin infections under DC 7820.
Common Mistakes
The most damaging mistake is assuming a genetic condition cannot be service-connected and never filing. Aggravation of a preexisting condition is compensable under 38 CFR §3.306, and the presumption of soundness places the burden on the VA when the condition was not noted at entry — a veteran whose ichthyosis was manageable in civilian life and became severe under field conditions, protective gear, and desert climate has a real aggravation claim. The second mistake is not counting oral retinoid therapy, which is systemic and often continuous. The third is treating palmoplantar involvement as merely cosmetic when deep fissures genuinely limit gripping and walking, and that limitation is separately ratable. The fourth is an exam in winter or after heavy emollient use, which understates the extent.
Frequently Asked Questions
Can I claim ichthyosis if I was born with it?
Yes, on an aggravation theory. 38 CFR §3.306 provides for service connection where a preexisting condition worsened beyond its natural progression during service, and the presumption of soundness at §3.304(b) means that if the condition was not noted on your entrance examination, the VA must prove by clear and unmistakable evidence both that it preexisted service and that it was not aggravated. Service treatment records showing flares or worsening are the core evidence.
Do oral retinoids count as systemic therapy?
Yes, and they are named directly in the General Rating Formula alongside corticosteroids, phototherapy, biologics, PUVA, and other immunosuppressive drugs. Acitretin and isotretinoin taken by mouth are administered by a route other than the skin and therefore qualify under 38 CFR §4.118(a). Continuous retinoid therapy over the past twelve months meets the constant-or-near-constant criterion for 60 percent independently of body coverage.
How is palmoplantar keratoderma rated?
The skin disease itself is rated under DC 7824 on the General Rating Formula, but the palms and soles are a small share of body surface area, so coverage rarely drives the rating. The value is in function: deep painful fissures that limit gripping or walking are a disabling effect not considered by the skin codes, and DC 7805 routes that to the appropriate musculoskeletal evaluation. Claim it by name and describe the specific tasks it prevents.
Does military service make ichthyosis worse?
It commonly does, and the mechanisms are well understood. Low humidity and desert heat strip moisture from skin that already retains it poorly; frequent washing with harsh field soap removes the lipid barrier; occlusive protective gear and body armor trap sweat and cause maceration and secondary infection; and limited access to emollients during field duty interrupts the only effective daily management. Documenting those conditions supports an aggravation claim.