VA General Rating Formula for the Skin: 38 CFR 4.118 Guide

The General Rating Formula for the Skin in 38 CFR 4.118 governs a wide array of dermatological diagnostic codes, such as dermatitis (DC 7806), psoriasis (DC 7816), and other chronic dermatoses. The schedule establishes two independent evidentiary pathways for rating: physical body surface area involvement, or the duration of prescription medication required over the previous 12-month period. Under 38 CFR 4.7, the veteran is entitled to whichever pathway results in the higher disability evaluation. A veteran whose skin appears relatively clear due to aggressive biologic therapy can still achieve a maximum rating based on medication dependency.

The maximum schedular evaluation under the General Rating Formula is 60%. A veteran qualifies for this tier by meeting either of two benchmarks: having more than 40% of the entire body or more than 40% of exposed areas affected by active disease; OR requiring systemic immunosuppressive therapy (such as oral corticosteroids, biologic injections, methotrexate, cyclosporine, or extensive phototherapy) for a total of 6 weeks or more during the past 12-month period. Documented pharmacy fill records confirming at least 6 weeks of systemic medication establish entitlement regardless of current physical presentation.

A 30% rating is assigned when the disease involves 20% to 40% of the entire body, or 20% to 40% of exposed areas; OR when systemic immunosuppressive therapy has been required for a total of 2 to 6 weeks during the past 12-month period. This tier commonly applies to veterans experiencing seasonal flare-ups or episodic exacerbations managed with short courses of systemic steroids or targeted immune modulators.

A 10% rating is granted when the condition involves 5% to 20% of the entire body or 5% to 20% of exposed areas; OR when the veteran requires constant or intermittent topical medication (such as prescription topical corticosteroids, calcineurin inhibitors, or retinoids) for at least 6 weeks in the past 12 months. If active lesions cover less than 5% of the body or exposed areas and continuous therapy is not required, a 0% non-compensable rating is assigned. Establishing a 0% service-connected rating preserves access to free VA prescription medications.

The regulation specifically defines exposed areas as the head, face, neck, and hands. Because lesions on exposed surfaces create substantial social, occupational, and cosmetic impairment, the required square footage to reach compensable tiers is dramatically lower than for the rest of the body. For example, severe dermatitis localized entirely to the hands and face that covers over 40% of those exposed surfaces qualifies for the full 60% evaluation, even though it represents only a small fraction of the veteran's total body surface area.