Papulosquamous Disorders (Lichen Planus, PRP) — VA Rating (DC 7822)
Diagnostic Code 7822 · 38 CFR §4.118
What Is It?
Papulosquamous disorders are diseases that produce raised bumps (papules) topped with scale (squame). DC 7822 is the residual code for the ones not listed separately in the schedule: lichen planus, pityriasis rubra pilaris, parapsoriasis, pityriasis lichenoides, and — importantly — mycosis fungoides, which is not a benign rash at all but the most common form of cutaneous T-cell lymphoma. Psoriasis has its own code at DC 7816. Lichen planus is the one veterans encounter most; it produces intensely itchy purple polygonal papules on the wrists, ankles, and lower back, often with lacy white patches inside the mouth, and it is associated with hepatitis C and with a range of medications. DC 7822 is rated under the General Rating Formula for the Skin, driven by body surface area involved or by the duration of systemic therapy over the past twelve months. The most important practical point about this code is diagnostic rather than procedural: a persistent scaly patch diagnosed as parapsoriasis or eczema that never quite clears deserves a biopsy, because early mycosis fungoides is routinely mistaken for both.
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
A biopsy is more valuable here than in most skin claims, both because the papulosquamous diseases look alike clinically and because mycosis fungoides is in the differential. Dermatology notes should record which disease is diagnosed and on what basis. For the rating itself: body-surface-area percentages for total body and exposed areas during an active period, and a complete systemic therapy history with durations — phototherapy and PUVA count, as do oral corticosteroids, retinoids such as acitretin, methotrexate, and biologics. Photographs during a flare document coverage. If lichen planus is the diagnosis, hepatitis C serology belongs in the file given the recognized association, and for veterans that association can open an entirely separate and more valuable claim. Oral involvement should be documented by a dentist or oral medicine specialist.
C&P Exam Tips
Ask for both percentages — total body and exposed areas — and remember that the higher figure drives the rating, so visible involvement on the wrists, hands, and ankles matters. Bring flare photographs. State phototherapy sessions and their date range explicitly: light-based treatment including PUVA is named in the General Rating Formula as qualifying systemic therapy, and veterans routinely fail to mention it because it does not feel like medication. Give oral corticosteroid and retinoid courses in weeks. If you have oral lichen planus, ask that mucosal involvement be documented and mention any pain with eating or acidic foods. If the diagnosis has been uncertain or shifting over years, ask directly whether a biopsy has ruled out cutaneous T-cell lymphoma.
How to File
File on VA Form 21-526EZ naming the specific disorder — lichen planus, pityriasis rubra pilaris, parapsoriasis — under DC 7822. Attach the biopsy report, dermatology notes, flare photographs with body-surface-area estimates, and a systemic therapy log including phototherapy dates. If lichen planus is the diagnosis, get hepatitis C testing and, if positive, file that as its own claim. If the disorder is drug-induced by a medication prescribed for a service-connected condition, file it as secondary. Claim any residual scarring or post-inflammatory pigment change under the scar codes.
Common Mistakes
The most serious mistake in this code is not diagnostic humility: mycosis fungoides is a lymphoma that spends years masquerading as eczema or parapsoriasis, and a patch that has been treated as a rash for a decade without clearing should be biopsied. That is a medical point before it is a claims point, but it is also worth many multiples of a skin rating. The second mistake is omitting phototherapy from the treatment history — it is expressly named in the criteria as qualifying therapy and is almost always forgotten. The third is not pursuing the hepatitis C association with lichen planus, which can open a far more significant claim. The fourth is the ordinary one: an exam during remission with no flare photographs, producing a body-surface-area figure that does not reflect the disease.
Frequently Asked Questions
Is lichen planus rated under DC 7822?
Yes. Lichen planus is a papulosquamous disorder not listed separately in the schedule, so it falls under DC 7822 and is rated on the General Rating Formula for the Skin — body-surface-area involvement or systemic therapy duration over the past twelve months. Oral lichen planus should be documented too; mucosal disease is painful, affects eating, and supports the overall severity picture.
Does light therapy count toward the rating?
Yes. The General Rating Formula expressly names phototherapy, photochemotherapy, and PUVA among the qualifying systemic therapies, alongside corticosteroids, retinoids, biologics, and other immunosuppressive drugs. Veterans frequently omit light treatment from the history because it does not feel like a drug. Record the date range and frequency of your sessions — a course running six weeks or more meets the 30 percent criterion on its own.
What is mycosis fungoides doing in a skin code?
Mycosis fungoides is cutaneous T-cell lymphoma, and in its early stages it presents as flat scaly patches indistinguishable from eczema or parapsoriasis — which is why it is grouped with the papulosquamous disorders. If it is diagnosed, it should be developed as a malignancy claim, not merely a skin claim, since active lymphoma carries a 100 percent evaluation under the hemic and lymphatic codes during treatment.
Is lichen planus connected to hepatitis C?
There is a well-recognized association, and it matters for veterans in two directions. If you have lichen planus, hepatitis C testing is worth requesting. If you have service-connected hepatitis C, lichen planus may be secondarily service-connected under 38 CFR §3.310. Hepatitis C itself is rated under DC 7354 and is frequently a considerably more valuable claim than the skin condition.