Malignant Skin Neoplasms, Non-Melanoma (Basal & Squamous Cell) — VA Rating (DC 7818)
Diagnostic Code 7818 · 38 CFR §4.118
What Is It?
DC 7818 covers malignant skin neoplasms other than malignant melanoma — overwhelmingly basal cell carcinoma and squamous cell carcinoma, the two most common cancers of any kind in the United States. Veterans get them at high rates, and for identifiable reasons: sustained sun exposure in the field, service in high-ultraviolet environments, and in some cohorts documented exposures to arsenic, ionizing radiation, or coal tar derivatives. The critical thing to understand about this code is that it assigns no percentage of its own. It instructs the rater to evaluate the condition as disfigurement of the head, face, or neck (DC 7800), as scars (DC 7801, 7802, 7804, or 7805), or on impairment of function — whichever fits the actual residual. There is a 100 percent provision, but it is narrower than most veterans expect: it applies only when the malignancy requires therapy comparable to that used for systemic malignancies — systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. The regulation states plainly that if treatment is confined to the skin, the 100 percent provisions do not apply.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Assigned from the date of onset of treatment where the malignancy requires therapy comparable to that used for systemic malignancies — systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. A mandatory VA examination follows six months after completion of that antineoplastic treatment, and any resulting change is subject to 38 CFR §3.105(e). If there has been no local recurrence or metastasis, the evaluation is then based on residuals. If treatment is confined to the skin, the 100 percent provision does not apply. |
| 0% | DC 7818 carries no rating table of its own. Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC 7801, 7802, 7804, or 7805), or impairment of function — whichever reflects the actual residual. A fully excised lesion leaving only a small, non-tender, non-disfiguring scar is noncompensable; facial excisions frequently produce a compensable DC 7800 evaluation, and painful or unstable surgical scars are compensable under DC 7804 regardless of size. |
Evidence Needed
Because the evaluation comes from the residuals, the evidence has to describe the residuals. Pathology reports establish the diagnosis and the type; operative reports establish how extensive the treatment was, which is what decides whether the 100 percent provision is even in play. For the durable rating you need measured dimensions of every surgical scar, dated photographs — particularly of the face, where DC 7800 scores eight specific characteristics of disfigurement — and documentation of any tenderness or breakdown. Mohs surgery and wide local excision on the face frequently leave contour depression, texture change, and pigment loss covering more than six square inches, each of which is a scored characteristic. Service records or a nexus opinion tying sun exposure, radiation, or chemical exposure to the malignancy support service connection.
C&P Exam Tips
The exam that matters is the scars examination, not a cancer examination. Ask the examiner to complete the full DC 7800 characteristics of disfigurement for every head, face, or neck excision site — surface contour depressed on palpation, adherent to underlying tissue, hypo- or hyper-pigmented in an area exceeding six square inches, abnormal texture in an area exceeding six square inches, missing underlying soft tissue, indurated and inflexible skin. Each characteristic counts, and eight of them are listed. Have every scar measured. Report any scar that is tender to palpation or that breaks down, because DC 7804 pays 10 percent for one or two such scars at any size. If a nerve was sacrificed during excision, report the numbness and its distribution.
How to File
File on VA Form 21-526EZ naming the specific malignancy — basal cell carcinoma or squamous cell carcinoma — and the body sites involved. Describe the in-service exposure: sustained sun exposure, latitude and duty environment, or any documented radiation or chemical exposure. Attach pathology and operative reports, dated photographs, and measured scar dimensions. Claim the residuals expressly as separate issues: disfigurement under DC 7800, scars under DC 7801 through 7805, and any nerve or functional loss under the appropriate code. If treatment involved more than skin-confined surgery, claim the 100 percent provision by name and give the treatment dates.
Common Mistakes
The most common and most disappointing mistake is expecting a rating for the cancer itself. Basal and squamous cell carcinoma treated by excision or Mohs surgery are usually cured, and once cured there is no active disease to rate — the compensation lives entirely in the residual scarring and disfigurement, and a veteran who does not claim those receives 0 percent. The second mistake is misreading the 100 percent provision; the regulation excludes treatment confined to the skin, so routine Mohs surgery does not trigger it no matter how many procedures were required. The third is not photographing and measuring facial scars, which is where the real rating usually is. The fourth is failing to claim each new lesion as it arises — these cancers recur, and each new excision adds scarring. The fifth is never claiming at all because the cancer was "just" a basal cell.
Frequently Asked Questions
Why did I get 0 percent for skin cancer?
Because DC 7818 rates residuals, not the diagnosis. If the lesion was excised, has not recurred, and left a small scar that is neither painful nor disfiguring, there is nothing left for the schedule to compensate. The rating comes from what the treatment left behind. The productive response is to claim the residuals specifically — measured scars, facial disfigurement characteristics, tenderness, numbness — rather than to appeal the cancer diagnosis itself.
When does the 100 percent rating apply?
Only when the skin malignancy requires therapy comparable to that used for systemic malignancies: systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. It runs from the date treatment begins, with a mandatory VA examination six months after that treatment ends. The regulation states expressly that if treatment is confined to the skin, the provision does not apply — which excludes most basal and squamous cell cases.
Is skin cancer presumptive for Agent Orange or burn pits?
Non-melanoma skin cancer is not on the Agent Orange presumptive list, and it is not among the PACT Act burn-pit presumptives. Service connection is available on a direct basis, and sun exposure during service is the most commonly successful theory, supported by duty environment, MOS, and a nexus opinion. Veterans with documented ionizing-radiation exposure should look at the radiation-exposed veteran provisions at 38 CFR §3.309(d) and §3.311, which do cover certain skin cancers.
Can I claim each new skin cancer separately?
You do not need a new service-connection grant for each lesion once the condition is service-connected, but you should file for an increased evaluation as new excisions add scarring and disfigurement. Each procedure leaves another scar, and scar ratings accumulate — additional painful scars move you up the DC 7804 tiers, and additional facial excisions add characteristics of disfigurement under DC 7800.