Skin Conditions & Scars C&P Exam: What VA Looks For

The VA separates skin evaluations into two distinct clinical instruments: the Scars / Disfigurement Disability Benefits Questionnaire and the Skin Diseases (other than scars) Disability Benefits Questionnaire. Modern VA examination procedures identify these forms by their formal clinical titles rather than historical administrative form numbers. If a veteran suffers from both surgical scars and an underlying inflammatory skin condition like psoriasis or dermatitis, the examiner must complete both questionnaires to assess each disability independently without violating pyramiding rules.

During a scar examination under 38 CFR 4.118, the examiner uses a metric or inch ruler to measure the exact length and width of each individual scar, calculating total surface area in square inches. The examiner assesses whether the scar is superficial (DC 7802) or deep (DC 7801), defined by attachment to underlying subcutaneous tissue, fascia, or muscle. For scars on the head, face, and neck (DC 7800), the examiner records the presence of eight specific characteristics of disfigurement, including length greater than five inches, depression, elevation, abnormal texture, abnormal pigmentation, tissue loss, distortion of facial features, and adherence.

When evaluating active inflammatory skin diseases like dermatitis, eczema, or psoriasis, the examiner calculates the percentage of body surface area affected using the clinical Rule of Nines. The examiner distinguishes between the percentage of the entire body affected versus the percentage of exposed areas affected (defined specifically as the head, face, neck, and hands). This distinction is critical because involvement of exposed surfaces triggers compensable ratings at significantly lower percentage thresholds under the General Rating Formula for the Skin.

The General Rating Formula for the Skin assigns ratings based either on body surface area or on the duration of medical therapy required over the preceding 12 months. The examiner must review pharmacy records to establish whether the veteran required systemic immunosuppressive therapy (such as oral corticosteroids, methotrexate, cyclosporine, or biologic agents like dupilumab or adalimumab) for 6 weeks or more (qualifying for 60%) or for 2 to 6 weeks (qualifying for 30%). For veterans managed with constant or intermittent topical medications for at least 6 weeks, the examiner documents topical regimens supporting a 10% rating.

Because dermatological conditions fluctuate in severity, an in-person exam may occur during a temporary remission. Veterans should assemble longitudinal medical records documenting severe flare-ups, including clear dated color photographs, dermatology clinic visit notes, biopsy pathology reports, and pharmacy records proving ongoing prescription fills. RatingScope never advises veterans to alter clinical descriptions or exaggerate symptoms; bringing objective documentation ensures the examiner records a complete and accurate historical picture of disability severity.