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SKIN CONDITIONS SECTION
Current Section: Skin Conditions
Table of Contents

Skin Conditions

Skin Conditions

Overview of VA Skin Condition Ratings

Skin conditions affect the largest organ of the body and can range from minor irritations to severe, debilitating disorders. Military service can lead to skin conditions through environmental exposures, chemical contact, extreme weather conditions, infections, or as secondary effects of other service-connected conditions. This section explains how the VA rates skin conditions and provides detailed guidance for the most common conditions.

General Rating Principles for Skin Conditions

The VA rates most skin conditions based on several factors:

  • Percentage of body affected: Both exposed areas (face, neck, hands) and total body surface area
  • Required treatments: Topical treatments, systemic medications, or other therapies needed
  • Frequency and duration of flare-ups: How often symptoms occur and how long they last
  • Impact on daily activities: How the condition affects your ability to work and perform daily tasks
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Exposed vs. Total Body Surface Area

When rating skin conditions, the VA considers both:

  • Exposed areas: Face, neck, and hands (approximately 20% of total body surface area)
  • Total body surface area: The entire skin surface

For example, a skin condition affecting 5% of exposed areas might only affect 1% of total body surface area. The VA will use whichever percentage results in a higher rating.

Presumptive Service Connection for Skin Conditions

Certain skin conditions may qualify for presumptive service connection based on specific exposures:

Presumptive Conditions by Exposure

Agent Orange Exposure

For veterans who served in Vietnam, certain areas of Thailand, or other specified locations:

  • Chloracne or other acneform disease similar to chloracne (must manifest to a degree of 10% or more within one year of exposure)
  • Porphyria cutanea tarda (must manifest to a degree of 10% or more within one year of exposure)
Gulf War Illness

For veterans who served in Southwest Asia during the Gulf War:

  • Undiagnosed skin symptoms (rashes, lesions, etc.)
  • Medically unexplained chronic multisymptom illness with skin symptoms
Camp Lejeune Contaminated Water

For veterans who served at Camp Lejeune for at least 30 days between August 1953 and December 1987:

  • Adult leukemia
  • Aplastic anemia and other myelodysplastic syndromes

Dermatitis and Eczema

Dermatitis and eczema are inflammatory skin conditions characterized by itchy, red, swollen, and cracked skin. Military service can trigger or worsen these conditions through exposure to harsh environments, chemicals, stress, or as allergic reactions to equipment or materials.

Establishing Service Connection for Dermatitis/Eczema

To establish service connection for dermatitis or eczema, you need:

  1. Diagnosis of dermatitis or eczema by a qualified medical professional
  2. Evidence of onset during service or evidence of a service-connected condition that caused or aggravated your skin condition
  3. Medical nexus linking your current skin condition to service or to another service-connected condition
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Secondary Service Connection

Dermatitis and eczema can be secondary to other service-connected conditions, including:

  • PTSD or other mental health conditions (stress can trigger or worsen skin conditions)
  • Diabetes (can cause skin changes and increased susceptibility to infections)
  • Medication side effects (many medications can cause skin reactions)

If you have one of these service-connected conditions, you may be able to establish service connection for your skin condition as secondary to that condition.

VA Rating Criteria for Dermatitis/Eczema

Dermatitis and eczema are rated under Diagnostic Code 7806 based on the percentage of body affected and required treatments:

60%
More than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period

Evidence for 60% Rating:

  • Medical documentation showing more than 40% of entire body affected, or
  • Medical documentation showing more than 40% of exposed areas (face, neck, hands) affected, or
  • Prescription records showing constant or near-constant use of systemic therapy (oral or injectable medications) during the past 12 months
  • Medical records documenting severe dermatitis/eczema
  • Photographs showing extent of skin condition
  • Evidence of significant impact on daily activities and work
30%
20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period

Evidence for 30% Rating:

  • Medical documentation showing 20-40% of entire body affected, or
  • Medical documentation showing 20-40% of exposed areas affected, or
  • Prescription records showing systemic therapy for 6 weeks or more (but not constantly) during the past 12 months
  • Medical records documenting moderately severe dermatitis/eczema
  • Photographs showing extent of skin condition
  • Evidence of moderate impact on daily activities
10%
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 such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period

Evidence for 10% Rating:

  • Medical documentation showing 5-20% of entire body affected, or
  • Medical documentation showing 5-20% of exposed areas affected, or
  • Prescription records showing intermittent systemic therapy for less than 6 weeks during the past 12 months
  • Medical records documenting mild to moderate dermatitis/eczema
  • Photographs showing extent of skin condition
  • Evidence of mild impact on daily activities
0%
Less than 5 percent of the entire body or less than 5 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period

Evidence for 0% Rating:

  • Medical documentation showing less than 5% of entire body affected
  • Medical documentation showing less than 5% of exposed areas affected
  • Prescription records showing only topical treatments (creams, ointments) during the past 12 months
  • Medical records documenting mild dermatitis/eczema
  • Evidence of minimal impact on daily activities
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Johnson v. McDonald Court Decision

In 2016, the U.S. Court of Appeals for Veterans Claims ruled in Johnson v. McDonald that topical corticosteroids (steroid creams and ointments) should be considered "systemic therapy" for VA rating purposes, even though they are applied directly to the skin rather than taken orally or by injection.

This means that if you use prescription-strength corticosteroid creams or ointments for your skin condition, you may qualify for a higher rating based on the frequency and duration of use, even if the affected area is small.

However, in 2017, the Federal Circuit partially reversed this decision, clarifying that topical treatments applied to the skin, including topical corticosteroids, are not automatically considered systemic therapy. The court held that systemic therapy refers to treatment affecting the body as a whole, while topical therapy refers to treatment applied directly to the skin.

Despite this reversal, if your topical corticosteroid is prescribed in a manner that affects the body as a whole (e.g., high-potency steroids used over large areas that can be absorbed systemically), you may still qualify for a higher rating.

Building a Strong Dermatitis/Eczema Claim

Evidence Checklist for Dermatitis/Eczema Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Dermatitis/Eczema Claim Tip

Take photographs of your skin condition during flare-ups, making sure to include a ruler or other size reference in the image. These visual records can be powerful evidence of the extent and severity of your condition, especially since the VA examiner may not see your condition during a flare-up. Include photos of both exposed areas (face, neck, hands) and non-exposed areas to show the full extent of the condition.

Scars

Scars are permanent marks on the skin resulting from wounds, burns, surgeries, or skin conditions. Military service often involves injuries that can lead to scarring, and scars can also result from treatments for service-connected conditions.

Establishing Service Connection for Scars

To establish service connection for scars, you need:

  1. Evidence of scars documented by a medical professional
  2. Evidence of the injury, burn, surgery, or skin condition during service that caused the scars, or evidence that the scars resulted from treatment for a service-connected condition
  3. Medical nexus linking your current scars to the in-service event or to treatment for a service-connected condition
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Secondary Service Connection for Scars

Scars are often secondary to other service-connected conditions, particularly when they result from:

  • Surgeries to treat service-connected conditions
  • Complications of service-connected conditions (e.g., diabetic ulcers that leave scars)
  • Treatment for service-connected skin conditions

If your scars resulted from treatment for a service-connected condition, you should file for secondary service connection.

VA Rating Criteria for Scars

Scars are rated under several diagnostic codes based on their location, size, and characteristics:

Scars of the Head, Face, or Neck (DC 7800)

80%
With visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement

Evidence for 80% Rating:

  • Medical documentation of visible or palpable tissue loss
  • Evidence of gross distortion or asymmetry of three or more features or paired sets of features, or
  • Documentation of six or more characteristics of disfigurement
  • Photographs showing the scars and disfigurement
  • Medical opinion about the severity of disfigurement
50%
With visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement

Evidence for 50% Rating:

  • Medical documentation of visible or palpable tissue loss
  • Evidence of gross distortion or asymmetry of two features or paired sets of features, or
  • Documentation of four or five characteristics of disfigurement
  • Photographs showing the scars and disfigurement
  • Medical opinion about the severity of disfigurement
30%
With visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement

Evidence for 30% Rating:

  • Medical documentation of visible or palpable tissue loss
  • Evidence of gross distortion or asymmetry of one feature or paired set of features, or
  • Documentation of two or three characteristics of disfigurement
  • Photographs showing the scars and disfigurement
  • Medical opinion about the severity of disfigurement
10%
With one characteristic of disfigurement

Evidence for 10% Rating:

  • Documentation of one characteristic of disfigurement
  • Photographs showing the scar
  • Medical opinion about the disfigurement
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Characteristics of Disfigurement

The eight characteristics of disfigurement for rating purposes are:

  1. Scar 5 or more inches (13 or more cm) in length
  2. Scar at least 1/4 inch (0.6 cm) wide at widest part
  3. Surface contour of scar elevated or depressed on palpation
  4. Scar adherent to underlying tissue
  5. Skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 sq cm)
  6. Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square inches (39 sq cm)
  7. Underlying soft tissue missing in an area exceeding 6 square inches (39 sq cm)
  8. Skin indurated and inflexible in an area exceeding 6 square inches (39 sq cm)

Scars Not of the Head, Face, or Neck (DC 7801-7805)

Scars on other parts of the body are rated based on whether they are:

  • Deep and nonlinear (DC 7801)
  • Superficial and nonlinear (DC 7802)
  • Unstable or painful (DC 7804)
  • Causing other disabling effects (DC 7805)
40%
Deep and nonlinear scars covering an area or areas of 144 square inches (929 sq cm) or greater

Evidence for 40% Rating:

  • Medical documentation of deep scars (associated with underlying tissue damage)
  • Measurements showing scars cover 144 square inches or more
  • Photographs showing the scars
  • Medical opinion about the depth and size of scars
30%
Deep and nonlinear scars covering an area or areas of at least 72 square inches (465 sq cm) but less than 144 square inches (929 sq cm)

Evidence for 30% Rating:

  • Medical documentation of deep scars
  • Measurements showing scars cover 72-144 square inches
  • Photographs showing the scars
  • Medical opinion about the depth and size of scars
20%
Deep and nonlinear scars covering an area or areas of at least 12 square inches (77 sq cm) but less than 72 square inches (465 sq cm)

Evidence for 20% Rating:

  • Medical documentation of deep scars
  • Measurements showing scars cover 12-72 square inches
  • Photographs showing the scars
  • Medical opinion about the depth and size of scars
10%
Deep and nonlinear scars covering an area or areas of at least 6 square inches (39 sq cm) but less than 12 square inches (77 sq cm)

Evidence for 10% Rating:

  • Medical documentation of deep scars
  • Measurements showing scars cover 6-12 square inches
  • Photographs showing the scars
  • Medical opinion about the depth and size of scars

Unstable or Painful Scars (DC 7804)

30%
Five or more scars that are unstable or painful

Evidence for 30% Rating:

  • Medical documentation of five or more unstable or painful scars
  • Description of pain or instability associated with each scar
  • Photographs showing the scars
  • Medical opinion about the pain or instability of scars
20%
Three or four scars that are unstable or painful

Evidence for 20% Rating:

  • Medical documentation of three or four unstable or painful scars
  • Description of pain or instability associated with each scar
  • Photographs showing the scars
  • Medical opinion about the pain or instability of scars
10%
One or two scars that are unstable or painful

Evidence for 10% Rating:

  • Medical documentation of one or two unstable or painful scars
  • Description of pain or instability associated with each scar
  • Photographs showing the scars
  • Medical opinion about the pain or instability of scars
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Key Terms

Deep scar: A scar associated with underlying soft tissue damage

Superficial scar: A scar not associated with underlying soft tissue damage

Unstable scar: A scar where, for any reason, there is frequent loss of covering of skin over the scar

Linear scar: A scar that is line-like, not wide or deep

Nonlinear scar: A scar that is wide, deep, or has an irregular shape

Building a Strong Scar Claim

Evidence Checklist for Scar Claims

Required Medical Evidence
Military Records
Supporting Statements
Additional Evidence (if applicable)
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Scar Claim Tip

For painful scars, be specific about the type and frequency of pain in your personal statement. Describe how the pain affects your daily activities, whether certain movements or activities trigger the pain, and any treatments you use to manage the pain. This detailed information helps establish the severity of your symptoms beyond what might be observed during a brief C&P exam.

Case Study: Successful Scar Claim

Veteran Profile

Army veteran who served in Afghanistan and sustained injuries from an IED explosion.

Condition

Multiple scars on face, neck, and arms from shrapnel injuries and subsequent surgeries.

Symptoms & Presentation
  • Facial scar measuring 7 inches in length and 0.5 inches in width
  • Surface contour of facial scar depressed on palpation
  • Facial scar adherent to underlying tissue
  • Three painful scars on right arm
  • One unstable scar on neck with frequent breakdown of skin
  • Deep scars on arms covering approximately 15 square inches
  • Limited range of motion in right arm due to scarring
Evidence Submitted
  • Service treatment records documenting IED injury and multiple surgeries
  • Purple Heart award documentation
  • Medical records with detailed measurements and descriptions of all scars
  • Photographs of all scars with ruler for size reference
  • Statement from dermatologist about characteristics of disfigurement
  • Personal statement describing pain and functional limitations
  • Statement from spouse about observed pain and skin breakdown
  • Documentation of psychological impact of facial disfigurement
  • Range of motion testing showing limitation due to arm scars
Outcome

The veteran was awarded multiple ratings for different scars:

  • 30% for facial scars under DC 7800 (three characteristics of disfigurement)
  • 20% for painful scars under DC 7804 (three painful scars)
  • 10% for unstable scar under DC 7804 (one unstable scar, with additional 10% added because it was both unstable and painful)
  • 20% for deep scars on arms under DC 7801 (15 square inches)
  • 10% for limitation of motion of right arm under DC 7805 (referring to appropriate musculoskeletal code)

These separate ratings were combined using VA's combined ratings table for a significant overall disability rating.

Key Takeaways
  1. Detailed measurements and photographs were crucial for accurate rating
  2. The veteran received separate ratings for different types of scars affecting different body areas
  3. The VA correctly applied the note that an additional 10% is added when a scar is both unstable and painful
  4. Functional limitations caused by scars were rated under the appropriate diagnostic code
  5. The comprehensive documentation of all scar characteristics ensured proper rating under multiple diagnostic codes

See Also

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