Tuberculosis Luposa (Lupus Vulgaris) — VA Disability Rating (DC 7811)
Diagnostic Code 7811 · 38 CFR §4.118
What Is It?
Tuberculosis luposa — lupus vulgaris — is cutaneous tuberculosis: a chronic infection of the skin by Mycobacterium tuberculosis that produces slowly expanding reddish-brown plaques, classically on the face and neck. Untreated it is destructive, eroding cartilage of the nose and ears and leaving disfiguring scars and contractures that can persist for decades after the infection itself is cured. It is rare in the United States but remains a live risk for veterans who served in high-prevalence regions, and it can appear years after exposure. The rating mechanism for DC 7811 is unlike anything else in the skin schedule: the code contains no criteria of its own and instead directs that the condition be rated under 38 CFR §4.88c or §4.89, whichever is appropriate — the schedules for inactive nonpulmonary tuberculosis. Under §4.88c, which governs veterans entitled after 19 August 1968 and therefore essentially everyone filing today, a 100 percent evaluation runs for one year following the date of inactivity, after which residuals are rated under whichever body systems they affect. §4.89 is the older graduated schedule preserved for those whose entitlement arose before that date.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Under 38 CFR §4.88c: a 100 percent evaluation for one year following the date of inactivity of the tuberculous process. (§4.89 applies instead — with its own graduated schedule of reducing evaluations — where entitlement arose prior to 19 August 1968.) |
| 0% | After the §4.88c period expires, DC 7811 itself carries no evaluation. Rate residuals under the specific body system or systems affected — disfigurement of the head, face, or neck (DC 7800), scars (DC 7801, 7802, 7804, or 7805), limitation of function, or the appropriate organ-system code. A veteran with no residuals receives 0 percent; a veteran with facial destruction may receive a substantial evaluation under DC 7800. |
Evidence Needed
The diagnosis needs to be documented as tuberculosis, not merely as a chronic skin lesion: skin biopsy showing caseating granulomas, mycobacterial culture or PCR from the lesion, and a positive tuberculin skin test or interferon-gamma release assay. The date of inactivity matters enormously, because the §4.88c 100 percent period is measured from it — treatment completion records and the physician statement declaring the process inactive are the documents that fix that date. For the residual rating, which is where most veterans actually live, you need what the disease left behind: dated photographs of facial and neck scarring, measured dimensions of each disfigured area, documentation of tissue or cartilage loss, and any limitation of motion from contracture. Service records placing you in a high-prevalence region support the nexus.
C&P Exam Tips
Come to the exam clear that this is a two-part evaluation and say so. First, establish the date of inactivity and whether the one-year §4.88c period was ever assigned — many veterans were never given it because the claim was filed long after treatment. Second, and more important for a long-settled infection, direct the examination toward residuals: ask the examiner to complete the DC 7800 characteristics of disfigurement for every facial or neck lesion, measuring each area and recording contour depression, texture, pigment change, and any missing tissue. If cartilage was lost from the nose or ear, that is visible tissue loss and it drives the disfigurement rating hard. Report any contracture that limits motion and any nasal obstruction from structural damage.
How to File
File on VA Form 21-526EZ as tuberculosis luposa or cutaneous tuberculosis under DC 7811, and state the date the disease was declared inactive so the §4.88c period can be considered. File the residuals as separate issues in the same claim — disfigurement of the head, face, or neck under DC 7800, scars under DC 7801 through 7805, nasal obstruction or breathing impairment under the respiratory codes, and any limitation of motion from contracture under the appropriate musculoskeletal code. Attach the biopsy, culture or PCR results, treatment records, the inactivity determination, and dated photographs.
Common Mistakes
The central mistake is expecting the General Rating Formula for the Skin to apply. It does not — DC 7811 routes to the nonpulmonary tuberculosis schedules, and a claim argued in terms of body surface area and systemic therapy is arguing criteria that do not govern. The second mistake is treating the case as closed once the infection is cured, when the real compensation for a long-inactive cutaneous tuberculosis lies entirely in the residuals, and DC 7800 disfigurement of the head, face, or neck reaches 80 percent. The third is failing to pin down the date of inactivity, which is what the §4.88c one-year period runs from. The fourth is not claiming functional residuals — nasal obstruction from destroyed cartilage, ectropion from facial contracture, restricted neck motion — each of which is separately ratable under its own body system.
Frequently Asked Questions
Why is cutaneous TB not rated like other skin conditions?
Because the schedule treats it as tuberculosis first and a skin disease second. DC 7811 carries no criteria of its own and directs the rater to 38 CFR §4.88c or §4.89 — the schedules for inactive nonpulmonary tuberculosis. Those schedules provide a period at 100 percent following inactivity and then rate whatever the disease left behind under the affected body systems.
What does §4.88c actually provide?
A 100 percent evaluation for one year following the date of inactivity of the tuberculous process, after which residuals are rated under the specific body system or systems affected. It applies to veterans whose entitlement arose after 19 August 1968, which covers essentially everyone filing now. §4.89 preserves an older graduated schedule for entitlement arising before that date.
What happens after the 100 percent period ends?
The evaluation is based entirely on residuals. For lupus vulgaris that usually means facial and neck disfigurement rated under DC 7800, scars under DC 7801 through 7805, and any functional loss — nasal obstruction, eyelid malposition, restricted neck motion — under the code for the affected system. This is where the durable rating comes from, and it is worth developing carefully.
Can I still claim this decades after treatment?
Yes. There is no time limit on filing a VA disability claim, and the residuals of lupus vulgaris are permanent. The one-year §4.88c period may be long past, but the disfigurement and functional loss are current disabilities and are rated on their present severity. The effective date will generally run from the date of claim rather than from the original infection.