Psoriasis & Eczema: How VA Rates Chronic Dermatitis Under 38 CFR 4.118

Psoriasis (DC 7816) and eczema or dermatitis (DC 7806) represent two of the most prevalent chronic inflammatory skin conditions claimed by veterans. In 38 CFR 4.118, the VA rates both conditions using the shared General Rating Formula for the Skin. This formula establishes evaluation tiers of 0%, 10%, 30%, and 60% based on either the percentage of body surface area affected or the duration and type of medical therapy required over the preceding 12-month period.

Modern dermatological management relies heavily on advanced systemic medications, including biologic immunomodulators like dupilumab, adalimumab, infliximab, ustekinumab, and oral immunosuppressives like methotrexate or cyclosporine. Under 38 CFR 4.118, requiring systemic immunosuppressive therapy for a total of 6 weeks or more in the past 12-month period independently satisfies the criteria for a 60% rating. Under VA adjudicative law, if a veteran's skin is clear solely because of continuous biologic therapy, the veteran remains entitled to the 60% rating because discontinuing therapy would result in severe symptom recurrence.

Chronic inflammatory skin disorders frequently trigger disabling secondary conditions. Psoriatic arthritis (DC 5002) develops in approximately 30 percent of psoriasis patients, causing peripheral joint pain, swelling, and spinal stiffness that is evaluated separately from the skin disability. In addition, intractable pruritus, chronic sleep fragmentation, and cosmetic disfigurement frequently cause secondary depression, anxiety, or somatic symptom disorder, which can be claimed under 38 CFR 3.310.

Veterans exposed to environmental hazards, burn pits, or toxic chemicals during military service may establish direct or presumptive service connection for chronic skin disorders. Chloracne is a recognized presumptive condition for veterans with herbicide (Agent Orange) exposure. In addition, particulate matter, jet fuels, and industrial solvents encountered during deployments frequently initiate or aggravate chronic contact dermatitis and eczema.

Because skin conditions are evaluated over a rolling 12-month lookback period, maintaining comprehensive pharmacy records is vital. Veterans should retain pharmacy records showing monthly biologic self-injections or oral immunosuppressive refills, clinic visit logs for in-office infusions or phototherapy sessions, and treatment notes from private or VA dermatologists confirming the ongoing medical necessity of systemic management.