Old World Leishmaniasis ("Baghdad Boil") — VA Rating (DC 7808)
Diagnostic Code 7808 · 38 CFR §4.118
What Is It?
Old World leishmaniasis is a parasitic skin disease caused by Leishmania species (most commonly L. major and L. tropica in the Middle East) and transmitted by the bite of infected sandflies. The classic presentation, well documented among veterans who deployed to Iraq, Afghanistan, Kuwait, and surrounding regions, is a slow-growing painless ulcer on exposed skin — face, neck, forearms, lower legs — that begins as a small red papule and gradually enlarges, crusts over, and leaves a depressed scar after months of healing. Service members nicknamed it the "Baghdad boil," and the Department of Defense recognized cutaneous leishmaniasis as a deployment-acquired condition during the OEF/OIF era. Beyond the cosmetic disfigurement, the lesions can become secondarily infected, can leave permanent scars on exposed areas, and in a small percentage of cases can recur or progress to mucocutaneous disease involving the nose, mouth, and throat. DC 7808 itself assigns no percentage — 38 CFR §4.118 lists it as a routing code, and the evaluation is taken from whichever code fits what the disease actually left behind.
Rating Criteria
| Rating | Criteria |
|---|---|
| See pathways | DC 7808 (leishmaniasis, Old World, cutaneous) carries no percentage column of its own under 38 CFR §4.118. The instruction printed beside the code is to rate as disfigurement of the head, face, or neck (DC 7800), as scars (DC 7801, 7802, 7804, or 7805), or as dermatitis (DC 7806), depending upon the predominant disability. In practice that means: facial, head, or neck disfigurement from healed lesions is evaluated on the characteristics of disfigurement under DC 7800, which reaches 80 percent; scars elsewhere on the body go to DC 7801 (deep and nonlinear), DC 7802 (superficial and nonlinear), DC 7804 (unstable or painful) or DC 7805 (other effects of scars); and active or recurring disease is evaluated under DC 7806, whose General Rating Formula for the Skin runs 0, 10, 30 and 60 percent on percentage of body or exposed area affected and on how long systemic therapy was required in the past 12 months. Ratings from different codes for distinct residuals are combined under 38 CFR §4.25 where they do not overlap. |
Evidence Needed
A confirmed diagnosis from a dermatologist or infectious disease specialist is the anchor. Confirmation is typically by skin biopsy showing the amastigote forms of the parasite on histopathology, by PCR identification of the Leishmania species, or by culture from a fresh lesion. Photographs of active lesions and of healed scars document the extent and the cosmetic residuals. Records of antiparasitic treatment (miltefosine, sodium stibogluconate, amphotericin B, paromomycin) demonstrate the management burden. Deployment records establishing time in an endemic region — Iraq, Afghanistan, Kuwait, Saudi Arabia, parts of North Africa, Southwest Asia generally — close the nexus. The Department of Defense leishmaniasis screening program produced records on many service members that can be obtained through the National Personnel Records Center.
C&P Exam Tips
Bring the biopsy report, the PCR or species identification if available, photographs of the original lesions and current scars, and the treatment history. Because DC 7808 has no percentages of its own, the examination is really deciding which code the evaluation comes from — so document both sides: percentage of body and of exposed area affected plus systemic-therapy duration (the DC 7806 route), and the location, size, and character of every residual scar (the DC 7800 and 7801-7805 routes). If the residual lesions are on the face, head, or neck, ask the examiner to describe them against the characteristics of disfigurement, because DC 7800 reaches 80 percent where the dermatitis formula stops at 60. If you have had multiple recurrences or any mucocutaneous involvement, list every episode with dates and treatments. Describe the functional and emotional impact of visible scars, particularly on social interaction and employment.
How to File
File VA Form 21-526EZ listing Old World leishmaniasis under DC 7808. Attach the biopsy or PCR confirmation, deployment records to an endemic region, treatment history, and photographs of active and healed lesions. If facial or neck scarring is significant, request separate evaluation under DC 7800. File mucocutaneous disease, mental health residuals from disfigurement, and any chronic skin infection residuals as separate secondary claims where they apply.
Common Mistakes
Filing without species confirmation, leaving the diagnosis open to challenge years after the original infection Treating DC 7808 as the only applicable code when facial scarring justifies separate DC 7800 evaluation Missing the recurrence pattern by not documenting every lesion episode with dates Letting cosmetic-disfigurement secondaries (depression, anxiety, social impact) go unclaimed when they are well established in the literature for visible-skin diseases
Frequently Asked Questions
Is leishmaniasis presumptive for OEF/OIF veterans?
Leishmaniasis is not on the formal presumptive list under the PACT Act in the same way as some respiratory cancers, but the Department of Defense and VA have long recognized deployment to endemic regions as the standard nexus pathway. Service connection runs through the deployment records plus the diagnosis. Some veterans with disseminated or visceral leishmaniasis have been service-connected on broader exposure theories under the burn pit and toxic-exposure framework.
What if my lesion healed years ago and only left scars?
Healed lesions still support service connection, and the rating shifts to the scar criteria. Small scars in unexposed areas may produce a 0% or 10% rating under DC 7808 alone. Significant facial or neck scars open the DC 7800 disfigurement code, which can produce ratings from 10% to 80% depending on the number and character of disfiguring features. Photographs of the current scars and a dermatology consult drive the evaluation.
Can leishmaniasis recur years after the initial infection?
Yes. The parasite can persist in skin tissue and lymph nodes for years, and reactivation can occur particularly with immunosuppression — chemotherapy, organ transplant medications, HIV. A new lesion in a veteran with a history of cutaneous leishmaniasis is treated as a recurrence of the original disease, which strengthens the case for ongoing service connection and supports rating increases when the new lesions are extensive.