Understanding Skin Conditions and Ratings
The skin, as the largest organ in the body, plays a vital role in protection, sensation, and regulation of body functions. Skin conditions can range from minor irritations to severe disorders that significantly impair daily life. These conditions are evaluated and rated based on the degree of disability they cause, the treatments required, and their physical manifestations such as scars or rashes. Ratings under the VA Schedule for Rating Disabilities (VASRD) focus on functional loss, the extent of the affected area, and the severity of symptoms. Non-linear scars, linear scars, dermatitis, and autoimmune-related skin conditions each have specific criteria for evaluation. Some skin disorders may also lead to secondary impairments like nerve damage, pain, or loss of function, which can be rated separately. Accurate measurement, medical documentation, and classification of the condition ensure that veterans receive appropriate compensation for their service-connected disabilities.
The Skin: Scars and Conditions
Non-Linear Scars of the Body
Non-linear scars are patches rather than thin lines. Each body part affected by a non-linear scar is rated separately. The six areas of the body for separate ratings are:
- Right arm
- Left arm
- Right leg
- Left leg
- Front of the torso
- Back of the torso
The front and back of the torso are divided by the midline along the side of the body. The neck and head are rated separately under Code 7800.
Measurement of Non-Linear Scars
- Measure the length (top-to-bottom) and width (side-to-side) of the scar, and multiply them to calculate the area.
- If the scar curves, divide it into sections, measure each section, calculate their areas, and add them together.
Ratings for Non-Linear Scars
- Code 7801: Deep, non-linear scars (damage to soft tissues under the skin).
- 40%: 144 in² or more.
- 30%: Between 72 in² and 144 in².
- 20%: Between 12 in² and 72 in².
- 10%: Between 6 in² and 12 in².
- Code 7802: Superficial, non-linear scars (affects only the skin).
- 10%: 144 in² or more.
- 0%: Less than 144 in².
Linear Scars of the Body
- Code 7805: Linear scars are lines (not necessarily straight). They are not ratable by themselves but are rated based on limitations they cause. For example:
- A scar limiting elbow motion may be rated under “limited motion of the elbow.” Final code: 7805-3400 (linear scar rated as elbow limitation).
- Code 7805: Linear scars are lines (not necessarily straight). They are not ratable by themselves but are rated based on limitations they cause. For example:
Key Steps in the Skin Conditions
Common Skin Conditions
- Code 7806: Dermatitis/Eczema
- 60%: Affects 40%+ of the body or exposed areas OR requires constant systemic therapy (e.g., methotrexate, steroids) over the past 12 months.
- 30%: Affects 20%-40% of the body or exposed areas OR requires systemic therapy for 6+ weeks within 12 months.
- 10%: Affects 5%-20% of the body or exposed areas OR requires systemic therapy for <6 weeks within 12 months.
- 0%: Affects <5% of the body or exposed areas OR requires only topical treatment.
- Code 7809: Lupus
- Rated as dermatitis (7806) or scars (7801), depending on presentation.
- If affecting other parts of the body, it is rated as systematic lupus erythematosus (6350). Cannot receive ratings under both.
Fungal and Autoimmune Conditions
- Code 7813: Dermatophytosis (Ringworm)
- Rated as dermatitis (7806) or scars (7801).
- Code 7815: Bullous Disorders
- Blistering conditions rated similarly to psoriasis (7816).
- Code 7816: Psoriasis
- Causes redness, scaling, and other skin abnormalities.
- Ratings:
- Same as dermatitis (7806) for affected areas or required treatments.
- Code 7821: Cutaneous Manifestations of Collagen-Vascular Diseases
- Collagen-related skin conditions like psoriasis.
- Rated similarly to psoriasis (7816) or scars (7801).
Other Skin Disorders
- Code 7820: Infections of the Skin
- Rated as dermatitis (7806) or scars (7801).
- Code 7822: Papulosquamous Disorders
- Hard, scaly bumps rated as dermatitis (7806) or scars (7801).
- Code 7824: Diseases of Keratinization
- Affects keratin production, causing skin to harden.
- Ratings:
- 60%: Affects the whole body, requiring constant oral/injected medications.
- 30%: Affects whole body, requiring oral/injected medications for 6+ weeks.
- 10%: Affects some areas, requiring oral/injected medications for <6 weeks.
- 0%: Requires only topical treatments.
- Code 7825: Chronic Hives
- 60%: Severe episodes (4+/year) uncontrolled by treatment.
- 30%: Severe episodes (4+/year) controlled by systemic medications.
- 10%: Episodes (4+/year) controlled by swelling medications.
- Code 7826: Primary Cutaneous Vasculitis
- Red/purple skin due to blood vessel issues.
- Ratings:
- 60%: At least 4 debilitating episodes/year uncontrolled by treatment.
- 30%: At least 4 debilitating episodes/year controlled by systemic medications.
- 10%: 1-3 episodes controlled by systemic medications.
- Code 7827: Erythema Multiforme/Toxic Epidermal Necrolysis (TENs)
- Causes skin detachment and organ failure.
- 60%: Severe episodes (4+/year) uncontrolled by treatment.
- 30%: Episodes (4+/year) controlled by systemic medications.
- 10%: 2-3 episodes controlled by medications.
- Code 7828: Acne
- 30%: Deep acne affects 40%+ of the face/neck.
- 10%: Deep acne affects <40% of the face/neck or areas beyond.
- 0%: Superficial acne.
- Code 7829: Chloracne
- Acne caused by dioxin exposure.
- Rated similarly to acne (7828).
Important Notes
- Conditions may overlap in symptoms and effects; however, only the rating that provides the highest benefit can be applied.
- If scars or conditions cause other impairments (e.g., nerve damage), those impairments may be rated separately.
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