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Rating Schedule for The Skin

Your outermost layer of armor.

Terms to Know

  • Exposed areas: Areas of skin that are not usually covered by clothing

    • Head;

    • Neck; and

    • Hands.

  • Topical Therapy: Any treatment applied directly to the skin, regardless of the type of drug.

  • Systemic Therapy: Any treatment that is injected, or taken by mouth, through the nose, or butt.

    • This includes, but is not limited to:

      • Biologics

      • Corticosteroids

      • Photochemotherapy

      • Photochemotherapy, Psoralen with long-wave Ultraviolet-A light (PUVA)

      • Phototherapy

      • Retinoids

      • Other immunosuppressive drugs.

IMPORTANT NOTES:

  • As of August 13, 2018, medications that are applied to the skin, including topical corticosteroids or immunosuppressives, are NOT considered systemic for Department of Veterans Affairs (VA) purposes! Yes, even if the use of said medications is continuous!

  • If the treatment for your service-connected skin condition results in permanent damage to clothing you may be entitled to a yearly Clothing allowance of around $1,000.

Estimating Skin Surface Area and Percentages of Total Body

These are the estimated figures the VA uses when determining how much of your total body is affected.

NOTE:

  • Estimates are applied equally to both males and females.

  • * = Body location is considered exposed.

  • **= These are the estimates for one limb, NOT both!

  • ***= Body location is considered exposed and these are the estimates for one limb, NOT both!

Body Location Area Size % of Total Body
Front of Head* 92 in2 3.5%
Back of Head* 92 in2 3.5%
Front of Neck* 26 in2 1%
Back of Neck* 26 in2 1%
Front of Torso 343 in2 13%
Back of Torso 343 in2 13%
Front of Upper Arm** 53 in2 2%
Back of Upper Arm** 53 in2 2%
Front of Forearm** 40 in2 1.5%
Back of Forearm** 40 in2 1.5%
Back of Hand/Fingers*** 33 in2 1.25%
Palm of Hand/Fingers*** 33 in2 1.25%
Genitalia 26 in2 1%
Left Butt Cheek 66 in2 2.5%
Right Butt Cheek 66 in2 2.5%
Front of Thigh** 125 in2 4.75%
Back of Thigh* 125 in2 4.75%
Front of Calf** 92 in2 3.5%
Back of Calf** 92 in2 3.5%
Top of Foot/Toes** 46 in2 1.75%
Bottom of Foot/Toes** 46 in2 1.75%
Total Exposed skin 368 in2 14%
Total Skin 2,636 in2 100%

Example: Calculating Estimated Skin Surface Area and Percentages of Total Body

1. Identify which area(s) of skin are affected.

  • In the above example:

    • Front of Torso and Genitalia are affected.

2. Shape off sections of affected skin, so you can measure the area. If the area has does not allow for a single square/rectangle/triangle. Then you will need to make several shapes to get a more accurate estimate.

3. Find the area of your shapes. Time to take off your socks and do some math! Measure the area(s) of the affected skin.

  • In our pictured example:

    • Front of Torso is 7"x8" so area is 56 in².

    • Genitalia is 5"x5" so area is 25 in².

Math Reminders

  • Square and rectangles: width times length.

  • Right angle triangle: width times length then divide the area by 2.

    • So if the length and width are 2" and 5" multiply to get an area of 10 in² then divide the area by 2 to get a final area of 5 in².

4. Add your areas per body section If your skin condition is made up of multiple shapes, add those areas together per Body section.

  • In our pictured example:
    We did not have multiple areas of the same body sections affected. So no work for us to do here.

    • Total Front of Torso: 56 in².

    • Total Genitalia: 25 in².

5. Calculate total area of exposed skin Remember, the body sections considered exposed are:

  • Front of Head;

  • Back of Head;

  • Front of Neck;

  • Back of Neck;

  • Back of Hand/Fingers; and

  • Palm of Hand/Fingers.

Add up the areas of all exposed body sections then divide by 368in2. Now multiply that answer by 100 to get a percentage of exposed skin that is affected.

If your combined exposed area was 120 in². We would do 120/368 to get 0.3260. Then multiply 0.3260 by 100 to get 32.60%.

Giving us a total area of exposed skin of 32.6%.

  • However, in our pictured example: We did not have any areas of exposed skin.

6. Calculate total area of affected skin

Add up all the areas of all body sections then divide by 2636in². Now multiply that answer by 100 to get a percentage of total skin that is affected.

  • In our pictured example:

    • Total Front of Torso: 56 in² + Total Genitalia: 25 in² = 81 in²

    • 81 in² /2636 in² = 0.0307 times 100 = 3.07%

    • Percentage of Total Body affected is 3.07%

With the percentages of total body and possibly exposed skin. You can now use the General rating formula to determine your rating.

General Rating Formula For The Skin

Most conditions are rated under this general rating formula.

IMPORTANT NOTES:

Rating
 Description
0%
 Requires the use of topical medications at least once over a 12-month period, or the lesions cover less than 5% of total body, or less than 5% of exposed areas.
10% Lesions cover 5 to 19% of total body or 5 to 19% of exposed areas; or if it requires the use of systemic therapy for a total of less than 6 weeks over a 12-month period.
30% Lesions cover 20 to 40% of total body or 20 to 40% of exposed areas; or if it requires the use of systemic therapy for a total of 6 weeks or more over a 12-month period.
60% Lesions cover more than 40% of total body or more than 40% of exposed areas; or if it requires the constant or near-constant use of systemic therapy for a 12-month period.

PYRAMIDING NOTES:

Single Ratings

  • Single condition that affects multiple areas of skin.

  • Multiple conditions that affect the SAME areas of skin - the Veteran will get a single rating (the highest of the conditions).

  • Skin conditions and scars caused by those conditions CANNOT be rated separately unless stated otherwise.

  • If medication usage is the basis of a rating; then all skin conditions that are treated by the SAME medication will be lumped together.

Multiple Ratings

Can be given if:

  • Each condition has a clear and distinct diagnosis AND each condition affects a DIFFERENT areas of skin.

RATER NOTE:

  • If assigning the Veteran a single ratings per condition instead of multiple would be more advantageous the VA will do so.

7806 Dermatitis or Eczema

7822 Papulosquamous Disorders Not listed Elsewhere

Skin conditions that cause hard and scaly bumps.

This includes but is not limited to:

  • Lichen planus

  • Lymphomatoid papulosus

  • Mycosis fungoides

  • Pityriasis lichenoides et varioliformis acuta (PLEVA)

  • Pityriasis rubra pilaris (PRP)

  • Plaque parapsoriasi (large or small)

Rated under the General rating formula.

Skin Discoloration

7823 Vitiligo

A disease that causes the loss of skin color in blotches.

Rating
 Description
0%
 No exposed areas affected.
10% Exposed areas affected.

7826 Primary Cutaneous Vasculitis

Cutaneous vasculitis is a group of disorders in which there are inflamed blood vessels in the skin. This causes the skin to turn red or purple due to bleeding under the skin.

IMPORTANT NOTES:

  • If the Veteran can get rated higher under Disfigurement or Scars. They will be rated under one of those schedules instead of this one.

  • If this condition is caused by something like medications, infections, cancers, etc. It CANNOT be rated under this schedule.

  • Episode is defined as a period in which symptoms became active. Critically, you MUST go to your doctor in order to get them documented. Otherwise the episode will NOT count!

Rating
 Description
10%
 1-3 episodes a year that required systemic medications to suppress the immune system (steroids, cyclosporine, etc.) to control; OR no episodes due to continuous use of systemic medication for control.
30% 4 or more episodes a year that required systemic medications to suppress the immune system for control.
60% Episodes are regular and consistent and are not properly controlled by systemic medications to suppress the immune system.

7807 New World (American) Mucocutaneous Leishmaniasis

Parasitic skin infection originating form the bite of an American sandfly.

Skin Infections

7808 Old World Cutaneous Leishmaniasis (Oriental Sore)

Parasitic skin infection originating from the bite of a European, Asian or African sandfly.

7811 Tuberculosis Luposa (Lupus Vulgaris)

Tuberculosis that affects the skin.

7813 Dermatophytosis

Fungal infection that causes ring-shaped red and swollen patches on the skin.

Depending where on the body the fungus affects the body it has a different name:

  • Head - Tinea corporis

  • Chin (beard area) - Tinea barbae

  • Shoulder and back - Tinea Versicolor

  • Body - Ringworm

  • Nails - Tinea unguim (onychomycosis)

  • Groin (jock itch) - Tinea cruris

  • Feet - Tinea pedis

Rated under the General rating formula.

7827 Erythema Multiforme (Toxic Epidermal Necrolysis (TEN))

Erythema Multiforme - a skin infection characterized by bulls-eye-shaped lesions.

Toxic Epidermal Necrolysis - a severe skin infection that results in the skin peeling off and blistering.

IMPORTANT NOTE:

  • Episode is defined as a period in which symptoms became active. Critically, you MUST go to your doctor in order to get them documented. Otherwise the episode will NOT count!

Rating
 Description
10%
 1-3 episodes of mouth, hands, of feet involvement (but don’t impair their functions) a year that required systemic medications to suppress the immune system (immunosuppressives, antihistamines, or sympathomimetics) to control; OR no episodes due to continuous use of systemic medication for control.
30% 4 or more episodes of mouth, hands, or feet involvement (but don’t impair their functions) a year that required systemic medications to suppress the immune system for control.
60% Episodes involve the mouth, hands, or feet (and DO impair their functions) are regular and consistent and are NOT properly controlled by systemic medications to suppress the immune system.

7820 Infections of the Skin Not Listed Elsewhere

Autoimmune Disorders

7815 Bullous Disorders

A rare skin condition causing large, fluid-filled blisters.

These disorders include:

  • Benign chronic familial pemphigus (Hailey-Hailey)

  • Bullous pemphigoid

  • Dermatitis herpetiformis

  • Epidermolysis bullosa acquisita

  • Pemphigus foliaceous

  • Pemphigus vulgaris

  • Porphyria cutanea tarda

Rated under the General rating formula.

7816 Psoriasis

A condition in which skin cells build up and form scales and itchy, dry patches.

Common Secondary Conditions

7809 Discoid Lupus Erythematosus (DLE)

Chronic autoimmune disease that affects the skin.

PYRAMIDING NOTE:

  • If lupus affects other parts of the body, it can be rated under Systematic lupus erythematosus instead. The Veteran would keep the higher of the 2 ratings.

Rated under the General rating formula.

7821 Cutaneous Manifestations of Collagen-vascular Diseases Not Listed Elsewhere

This includes but is not limited to:

  • Calcinosis cutis

  • Dermatomyositis

  • Scleroderma

  • Subacute cutaneous lupus erythematosus

Rated under the General rating formula.

7824 Diseases of Keratinization

Usually result in the development extensive, scaling of the skin, which can appear red.

Examples of diseases include but are not limited to:

  • Darier's disease

  • Icthyoses

  • Palmoplantar keratoderma

Rated under the General rating formula.

7828 Acne (Pimples)

Skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. It causes whiteheads, blackheads or pimples.

IMPORTANT NOTE:

  • If the Veteran's symptoms are best represented under Disfigurement or Scars. They will be rated under one of those schedules instead of this one.

Conditions affecting the Pores and Hair

Rating
 Description
0%
 Superficial acne (comedones, papules, pustules) of any extent.
10% Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40% of the face and neck; OR deep acne affecting non-intertriginous areas of the body (other than the face and neck).
30% Deep acne affecting 40% or more of the face and neck.

7829 Chloracne

Acne-like eruption of blackheads, cysts, and pustules associated with exposure to certain chemical compounds, such as chlorinated dioxins and dibenzofurans.

IMPORTANT NOTE:

  • If the Veteran's symptoms are best represented under Disfigurement or Scars. They will be rated under one of those schedules instead of this one.

Rating
 Description
0% Moderate.
10% Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40% of the face and neck; OR deep acne affecting non-intertriginous areas of the body (other than the face and neck).
20% Deep acne affecting the intertriginous areas (arm pit, the anogenital region, skin folds of the breasts, or between fingers and toes)
30% Deep acne affecting 40% or more of the face and neck.

7830 Scarring Alopecia

Group of hair loss disorders that create permanent destruction of hair follicles by scar tissue formation in the skin.

Rating
 Description
0%
 Affects less than 20% of the scalp.
10% Affects 20-40% of the scalp.
20% Affects more than 40% of the scalp.

7831 Alopecia Areata

Hair loss that starts with one or more circular bald patches that may overlap.

PYRAMIDING NOTE:

Rating
 Description
0% Loss of hair limited to scalp and face.
10% Loss of ALL body hair.

Loss of Eyebrows

  • Click HERE for information.

Loss of Eyelashes

  • Click HERE for information.

Male Pattern Baldness (Androgenetic Alopecia)

VA will NOT service-connect this condition as it is genetic or developmental in nature.

7832 Excessive Sweating (Hyperhidrosis)

Abnormally excessive sweating involving the extremities, underarms, and face, usually unrelated to body temperature or exercise.

Rating
 Description
0% Able to handle paper or tools after therapy.
30% Unable to handle paper or tools because of moisture, AND unresponsive to therapy.

7817 Erythroderma

Term used to describe intense and usually widespread reddening of the skin due to inflammatory skin disease.

PYRAMIDING NOTE:

  • This condition is commonly secondary to another condition. As such, if the symptoms are accounted for under another schedule they CANNOT be used to produce a rating under this schedule! Otherwise, you can get a rating under this schedule.

NOTE:

  • Treatment failure is defined as either disease progression, or less than a 25% reduction in the extent and severity of disease after 4 weeks of prescribed therapy, as documented by medical records.

Miscellaneous Skin Conditions

Rating
 Description
0% Topical treatments are used over the past 12-months.
10% For a total period of less than 6 weeks over the past 12-months any of the following therapies were done: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy.
30% For a total period of 6 weeks or more over the past 12-months any of the following therapies were done: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy.
60% No current treatment due to a documented history of treatment failure with 1 treatment regimen.
100% Most of the skin is affected WITH symptoms such as weight loss, fever, or low protein levels in the blood AND one of the following situations exist: 1. No current treatment due to a documented history of treatment failure with 2 or more treatment regimens. 2. Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy is required over the past 12-months.

7825 Chronic Hives (Urticaria)

Red, itchy welts that result from a skin reaction.

NOTE:

  • For the purposes of this schedule chronic means: the hives must occur at least twice per week for at least 6 weeks without any treatments.

Rating
 Description
10%
 Requires first line treatment (antihistamines) for control.
30% Requires second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control.
60% Requires third line treatment for control (e.g., plasmapheresis, immunotherapy, immunosuppressives) due to ineffectiveness with first and second line treatments.

Scars

A growth of tissue marking the spot where skin has healed after an injury.

7800 Scars and Disfigurement Involving the Head, Face, or Neck

Rated either on visible or palpable disfigurement or upon the additive effect of scars (characteristics of disfigurement).

In terms of disfigurement the VA considers the following locations:

  • Cheeks

  • Chin

  • Ears

  • Eyes (and eyelids)

  • Forehead

  • Mouth (and lips)

  • Nose

Characteristics of Disfigurement:

  • Scar is 5 or more inches (13 or more cm.) in length.

  • Scar at least 1/4 inch (0.6 cm.) wide at widest part.

  • Scar is attached to underlying tissue (makes the skin hard to move).

  • Scar surface sinks or raises when pushed.

  • Skin is abnormally white or dark in an area exceeding six square inches (39 cm²).

  • Skin texture is abnormal (irregular, shrunken, shiny, scaly, etc.) in an area exceeding six square inches (39 cm²).

  • Underlying soft tissue missing in an area exceeding six square inches (39 cm²).

  • Skin is hard and inflexible in an area exceeding six square inches (39 cm²).

NOTES:

  • Remember, calculate area using ALL the scars from the head, face, and neck.

    • However, multiple scars CANNOT be added together to meet the width of scarring requirement!

PYRAMIDING NOTES:

If the Veteran experiences any of the following they CAN receive a separate rating for the condition.

Rating
 Description
10% 1 characteristic of disfigurement.
30% 1 location is disfigured; OR there are 2-3 characteristics of disfigurement.
50% 2 locations are disfigured; OR there are 4-5 characteristics of disfigurement.
80% 3 or more locations are disfigured; OR there are at least 6 characteristics of disfigurement.

Scars NOT Involving the Head, Face, or Neck

PYRAMIDING NOTES:

  • The body is divided into SIX different areas. Each area can have their scars rated separately.

  • However, if the Veteran would get a higher rating by combining the scar sizes from all the different areas instead of doing the above. This will be done instead.

  • If the Veteran has combinations of deep and superficial scars in an area(s). Those scars WILL be given separate ratings.

  • If a scar causes Range of motion issues, a separate rating for that impairment CAN be granted!

Bilateral Factor:

Body Section Area
Torso (front) 1
Back 2
Left arm 3
Right arm 4
Left leg 5
Right leg 6

7801 Deep Scars (Underlying Soft Tissue Damage)

There is damage to the soft tissue under the skin.

Rating
 Description
10% 6-11.99 in2 (39-77 cm2).
20% 12-71.99 in2 (78-465 cm2).
30% 72-143.99 in2 (465-929 cm2).
40% 144 in2 (929 cm2) or more.

7802 Superficial Scars

Only affects the skin, not the tissues under the skin.

Rating
 Description
10% 144 in2 (929 cm2) or more.

7804 Painful or Unstable Scars

Unstable scars for the purposes of this schedule means - there is frequent loss of covering of skin over the scar.

PYRAMIDING NOTE:

  • The Veteran CAN receive a rating for the scar itself AND if it is painful or unstable!

IMPORTANT NOTES:

  • For VA purposes, self-reports of pain are NOT good enough! The examiner MUST note that the scars are painful when touched to be counted!

  • If at least once scar is BOTH painful AND unstable. The Veteran's rating under this schedule is increased by 10% (normal math)!

Rating
 Description
10% 1-2.
20% 3-4.
30% 5 or more.

7805 All other Scars

  • Rated under the scar diagnostic code which best captures the impairment.

Cancer and Tumors

Common residuals:

7818 Cancer (Malignant Neoplasms - NOT including Melanoma)

IMPORTANT NOTE:

  • UNLESS, the cancer requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. Then it is rated as follows:

Rating
 Description
?%
 Rated on residuals.
100% For 6 months after treatments stop and the cancer goes dormant.
100% While active.

7833 Cancer (Malignant Melanoma)

Causes dark patches to form on the skin.

IMPORTANT NOTE:

  • UNLESS, the cancer requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. Then it is rated as follows:

Rating
 Description
?%
 Rated on residuals.
100% For 6 months after treatments stop and the cancer goes dormant.
100% While active.

7819 Tumor (Benign Neoplasm)

Has no rating in and of itself.

However, if the Veteran suffers residual symptoms due to the presence of the tumor(s) or any treatments used to deal with them. Those may be rated.

If the Human papillomavirus (HPV) causes warts, those warts will be rated under this schedule. That said, HPV itself would not otherwise get service-connected. However, if there is a Medical opinion that your in-service HPV led to cancer, then that cancer CAN get service connected!

Disability Benefits Questionnaire (DBQs)

To get an idea of how a C&P exam will be conducted it is recommended that the Veteran look at the applicable DBQ.

Veteran's may ask a physician to complete a DBQ on their behalf to submit with their claim. For more information on DBQs click HERE.

Having Trouble Finding Your Condition?

  • Click HERE to view the Master Condition List.

References