Scarring Alopecia — VA Disability Rating (DC 7830)

Diagnostic Code 7830 · 38 CFR §4.118

What Is It?

Scarring alopecia — cicatricial alopecia — is permanent hair loss caused by destruction of the hair follicle itself. Once the follicle is replaced by scar tissue, the hair does not come back, which is what separates it from alopecia areata and from ordinary pattern baldness. The causes veterans encounter include discoid lupus erythematosus, lichen planopilaris, central centrifugal cicatricial alopecia, folliculitis decalvans, dissecting cellulitis of the scalp, and physical trauma — burns, blast injuries, and surgical scars from head wounds. Traction alopecia from years of tightly regulated hairstyles can also progress to scarring, which is a recognized occupational pattern. DC 7830 rates the condition on one measurement: the percentage of the scalp affected. Nothing turns on symptoms or treatment. The schedular ceiling is 20 percent, which is modest, and the code should always be read alongside DC 7800, because scalp scarring is scarring of the head and may produce a higher evaluation on the characteristics of disfigurement.

Rating Criteria

Evidence Needed

The rating is a percentage of scalp, so the record needs that percentage stated as a number. Dermatology notes, scalp photographs from multiple angles, and where available trichoscopy or a scalp biopsy — which distinguishes scarring from non-scarring alopecia by showing follicular destruction and fibrosis — are the core. The biopsy matters more than it might seem, because DC 7830 applies only to scarring alopecia; non-scarring hair loss falls under DC 7831 with a much lower ceiling. Where the cause is an underlying disease, document it: discoid lupus, lichen planopilaris, and dissecting cellulitis are each separately ratable. Where the cause is trauma or burn, the operative and treatment records establish it. Photographs before and after are persuasive for showing progression.

C&P Exam Tips

Ask the examiner to state the percentage of scalp affected as a specific figure and to photograph the scalp from the top, back, and both sides. Twenty percent and forty percent are the thresholds, so an estimate rendered as "patchy hair loss" is not usable — press for a number. Ask separately that the DC 7800 characteristics of disfigurement be completed for the scarred scalp, measuring areas of abnormal texture, adherence, contour depression, and pigment change, since those may produce a higher evaluation than the 20 percent ceiling here. If an underlying inflammatory disease is still active, make sure it is documented as active and named, and describe any pain, burning, or itching of the scalp.

How to File

File on VA Form 21-526EZ as scarring alopecia or cicatricial alopecia under DC 7830, stating the estimated percentage of scalp involved. In the same claim, claim disfigurement of the head, face, or neck under DC 7800 for the scarred areas, and file the underlying cause as its own issue — discoid lupus under DC 7809, lichen planopilaris under DC 7822, dissecting cellulitis under DC 7820. If the hair loss followed a head injury, burn, or surgery for a service-connected condition, file it as secondary and name the primary. Attach the biopsy, photographs, and dermatology records.

Common Mistakes

The most frequent mistake is having the hair loss recorded without the scalp percentage, which leaves the rater estimating from a photograph or defaulting low. The second is not distinguishing scarring from non-scarring alopecia; DC 7830 pays up to 20 percent and DC 7831 pays a maximum of 10 percent and only with loss of all body hair, so the biopsy that establishes follicular destruction is worth obtaining. The third is never claiming under DC 7800, which rates disfigurement of the head, face, or neck up to 80 percent and covers the scalp. The fourth is claiming the hair loss without claiming the disease that caused it, when discoid lupus or lichen planopilaris carries its own evaluation. The fifth is dismissing traction alopecia from regulation hairstyles, which is a documented occupational cause and progresses to permanent scarring.

Frequently Asked Questions

How much scalp loss do I need for a rating?

At least 20 percent of the scalp for a 10 percent evaluation, and more than 40 percent for the maximum 20 percent evaluation. Below 20 percent of the scalp, DC 7830 is noncompensable. Because the thresholds are numeric, the single most useful thing you can do is get the affected percentage stated as a number in the examination report rather than described qualitatively.

What is the difference between DC 7830 and DC 7831?

DC 7830 covers scarring alopecia, where the follicle is destroyed and the loss is permanent, and it is rated by percentage of scalp up to 20 percent. DC 7831 covers alopecia areata, an autoimmune non-scarring hair loss where the follicle survives, and it pays 10 percent only with loss of all body hair and 0 percent when loss is limited to the scalp and face. A scalp biopsy is what reliably distinguishes them.

Can I get a higher rating under the disfigurement code?

Often, yes. The scalp is part of the head, so scarring alopecia can be evaluated under DC 7800 as disfigurement of the head, face, or neck, which scores eight characteristics — including abnormal texture, adherence to underlying tissue, and hypo- or hyper-pigmentation in an area exceeding six square inches — and reaches 80 percent. Ask expressly for the characteristics of disfigurement to be examined and measured.

Is hair loss from wearing a helmet compensable?

Where it produces documented traction alopecia that has progressed to scarring, it can be. Traction alopecia from sustained tension on the hair — tight regulation hairstyles, and the friction and pressure of helmets and headgear worn for long periods — is a recognized cause, and prolonged traction destroys follicles permanently. The claim needs a dermatology diagnosis, ideally biopsy-supported, plus evidence of the duty conditions that caused it.