**The Skin**

4.118 Schedule of ratings---skin 4.118-1

**§4.118 Schedule of ratings---skin.**

A veteran who VA rated under diagnostic codes 7800, 7801, 7802, 7803,
7804, or 7805 before October 23, 2008 can request review under
diagnostic codes 7800, 7801, 7802, 7804, and 7805, irrespective of
whether the veteran's disability has increased since the last review. VA
will review that veteran's disability rating to determine whether the
veteran may be entitled to a higher disability rating under diagnostic
codes 7800, 7801, 7802, 7804, and 7805. A request for review pursuant to
this rulemaking will be treated as a claim for an increased rating for
purposes of determining the effective date of an increased rating
awarded as a result of such review; however, in no case will the award
be effective before October 23, 2008.

Rating

**7800** Burn scar(s) of the head, face, or neck; scar(s) of the head,
face, or neck due to other

causes; or other disfigurement of the head, face, or neck:

With visible or palpable tissue loss and either gross distortion or

asymmetry of three or more features or paired sets of features

(nose, chin, forehead, eyes (including eyelids), ears (auricles),

cheeks, lips), or; with six or more characteristics of disfigurement 80

With visible or palpable tissue loss and either gross distortion or

asymmetry of two features or paired sets of features (nose, chin,

forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or;

with four or five characteristics of disfigurement 50

With visible or palpable tissue loss and either gross distortion or

asymmetry of one feature or paired set of features (nose, chin,

forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or;

with two or three characteristics of disfigurement 30

With one characteristic of disfigurement 10

> **Note (1)**: The 8 characteristics of disfigurement, for purposes of
> evaluation under §4.118, are:

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

Scar at least one-quarter inch (0.6 cm.) wide at widest part.

Surface contour of scar elevated or depressed on palpation.

Scar adherent to underlying tissue.

Skin hypo-or hyper-pigmented in an area exceeding six square

inches (39 sq. cm.).

Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in

an area exceeding six square inches (39 sq. cm.).

Underlying soft tissue missing in an area exceeding six square

inches (39 sq. cm.).

Skin indurated and inflexible in an area exceeding six square

inches (39 sq. cm.).

> **Note (2)**: Rate tissue loss of the auricle under DC 6207 (loss of
> auricle) and anatomical loss of the eye under DC 6061 (anatomical loss
> of both eyes) or DC 6063 (anatomical loss of one eye), as appropriate.
>
> **Note (3)**: Take into consideration unretouched color photographs
> when evaluating under these criteria.
>
> **Note (4):** Separately evaluate disabling effects other than
> disfigurement that are associated with individual scar(s) of the head,
> face, or neck, such as pain, instability, and residuals of associated
> muscle or nerve injury, under the appropriate diagnostic code(s) and
> apply § 4.25 to combine the evaluation(s) with the evaluation assigned
> under this diagnostic code.
>
> **Note (5):** The characteristic(s) of disfigurement may be caused by
> one scar or by multiple scars; the characteristic(s) required to
> assign a particular evaluation need not be caused by a single scar in
> order to assign that evaluation.

With visible or palpable tissue loss and either gross distortion or

asymmetry of three or more features or paired sets of features

(nose, chin, forehead, eyes (including eyelids), ears (auricles),

cheeks, lips), or; with six or more characteristics of disfigurement 80

**7801** Burn scar(s) or scar(s) due to other causes, not of the head,
face, or neck, that are deep and

nonlinear:

Area or areas of 144 square inches (929 sq. cm.) or greater 40

Area or areas of at least 72 square inches (465 sq. cm.) but less than

144 square inches (929 sq. cm.) 30

Area or areas of at least 12 square inches (77 sq. cm.) but less than

72 square inches (465 sq. cm.) 20

Area or areas of at least 6 square inches (39 sq. cm.) but less than

12 square inches (77 sq. cm.) 10

> **Note (1):** A deep scar is one associated with underlying soft
> tissue damage.
>
> **Note (2):** If multiple qualifying scars are present, or if a single
> qualifying scar affects more than one extremity, or a single
> qualifying scar affects one or more extremities and either the
> anterior portion or posterior portion of the trunk, or both, or a
> single qualifying scar affects both the anterior portion and the
> posterior portion of the trunk, assign a separate evaluation for each
> affected extremity based on the total area of the qualifying scars
> that affect that extremity, assign a separate evaluation based on the
> total area of the qualifying scars that affect the anterior portion of
> the trunk, and assign a separate evaluation based on the total area of
> the qualifying scars that affect the posterior portion of the trunk.
> The midaxillary line on each side separates the anterior and posterior
> portions of the trunk. Combine the separate evaluations under § 4.25.
> Qualifying scars are scars that are nonlinear, deep, and are not
> located on the head, face, or neck.

**7802** Burn scar(s) or scar(s) due to other causes, not of the head,
face, or neck, that are superficial and nonlinear:

Area or areas of 144 square inches (929 sq. cm.) or greater 10

> **Note (1):** A superficial scar is one not associated with underlying
> soft tissue damage.
>
> **Note (2):** If multiple qualifying scars are present, or if a single
> qualifying scar affects more than one extremity, or a single
> qualifying scar affects one or more extremities and either the
> anterior portion or posterior portion of the trunk, or both, or a
> single qualifying scar affects both the anterior portion and the
> posterior portion of the trunk, assign a separate evaluation for each
> affected extremity based on the total area of the qualifying scars
> that affect that extremity, assign a separate evaluation based on the
> total area of the qualifying scars that affect the anterior portion of
> the trunk, and assign a separate evaluation based on the total area of
> the qualifying scars that affect the posterior portion of the trunk.
> The midaxillary line on each side separates the anterior and posterior
> portions of the trunk. Combine the separate evaluations under § 4.25.
> Qualifying scars are scars that are nonlinear, superficial, and are
> not located on the head, face, or neck.

**7804** Scar(s), unstable or painful:

Five or more scars that are unstable or painful 30

Three or four scars that are unstable or painful 20

One or two scars that are unstable or painful 10

> **Note (1):** An unstable scar is one where, for any reason, there is
> frequent loss of covering of skin over the scar.
>
> **Note (2):** If one or more scars are both unstable and painful, add
> 10 percent to the evaluation that is based on the total number of
> unstable or painful scars.
>
> **Note (3):** Scars evaluated under diagnostic codes 7800, 7801, 7802,
> or 7805 may also receive an evaluation under this diagnostic code,
> when applicable.

**7805** Scars, other (including linear scars) and other effects of
scars evaluated under diagnostic

codes 7800, 7801, 7802, and 7804:

Evaluate any disabling effect(s) not considered in a rating provided
under diagnostic

codes 7800-04 under an appropriate diagnostic code.

**7806** Dermatitis or eczema.

More than 40 percent of the entire body or more than 40 percent of

exposed areas affected, or; constant or near-constant systemic therapy

such as corticosteroids or other immunosuppressive drugs required

during the past 12-month period 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed areas

affected, or; systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of six weeks

or more, but not constantly, during the past 12-month period 30

At least 5 percent, but less than 20 percent, of the entire body, or at

least 5 percent, but less than 20 percent, of exposed areas affected,

or; intermittent systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of less than

six weeks during the past 12-month period 10

Less than 5 percent of the entire body or less than 5 percent of exposed

areas affected, and; no more than topical therapy required during the

past 12-month period 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars

(DC's 7801, 7802, 7803, 7804, or 7805), depending upon the

predominant disability.

**7807** American (New World) leishmaniasis (mucocutaneous, espundia):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801,

7802, 7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the

predominant disability.

**Note**: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301
(visceral

leishmaniasis).

**7808** Old World leishmaniasis (cutaneous, Oriental sore):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the
predominant

disability.

**Note**: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301
(visceral

leishmaniasis).

**7809** Discoid lupus erythematosus or subacute cutaneous lupus
erythematosus:

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the

predominant disability. Do not combine with ratings under DC 6350.

**7811** Tuberculosis luposa (lupus vulgaris), active or inactive:

Rate under §§4.88c or 4.89, whichever is appropriate.

**7813** Dermatophytosis (ringworm: of body, tinea corporis; of head,
tinea capitis; of

feet, tinea pedis; of beard area, tinea barbae; of nails, tinea unguium;
of

inguinal area (jock itch), tinea cruris):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the
predominant

disability.

**7815** Bullous disorders (including pemphigus vulgaris, pemphigus
foliaceous, bullous

pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita,
benign

chronic familial pemphigus (Hailey-Hailey), and porphyri cutanea tarda):

More than 40 percent of the entire body or more than 40 percent of

exposed areas affected, or; constant or near-constant systemic therapy

such as corticosteroids or other immunosuppressive drugs required

during the past 12-month period 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed

areas affected, or; systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of six weeks or

more, but not constantly, during the past 12-month period 30

At least 5 percent, but less than 20 percent, of the entire body, or at

least 5 percent, but less than 20 percent, of exposed areas affected,

or; intermittent systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of less than

six weeks during the past 12-month period 10

Less than 5 percent of the entire body or exposed areas affected, and;

no more than topical therapy required during the past 12-month

period 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars

(DC's 7801, 7802, 7803, 7804, or 7805), depending upon the predominant

disability.

**7816** Psoriasis:

More than 40 percent of the entire body or more than 40 percent

of exposed areas affected, or; constant or near-constant systemic

therapy such as corticosteroids or other immunosuppressive drugs

required during the past 12-month period 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed

areas affected, or; systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of six weeks

or more, but not constantly, during the past 12-month period 30

At least 5 percent, but less than 20 percent, of the entire body, or at

least 5 percent, but less than 20 percent, of exposed areas affected,

or; intermittent systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of less than

six weeks during the past 12-month period 10

Less than 5 percent of the entire body or exposed areas affected, and;

no more than topical therapy required during the past 12-month

period 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars

(DC's 7801, 7802, 7803, 7804, or 7805), depending upon the predominant

disability.

**7817** Exfoliative dermatitis (erythroderma):

Generalized involvement of the skin, plus systemic manifestations

(such as fever, weight loss, and hypoproteinemia), and; constant or

near-constant systemic therapy such as therapeutic doses of

corticosteroids, immunosuppressive retinoids, PUVA (psoralen

with long-wave ultraviolet-A light) or UVB (ultraviolet-B light)

treatments, or electron beam therapy required during the past

12-month period 100

Generalized involvement of the skin without systemic manifestations,

and; constant or near-constant systemic therapy such as therapeutic

doses of corticosteroids, immunosuppressive retinoids, PUVA (psoralen

with long-wave ultraviolet-A light) or UVB (ultraviolet-B light)

treatments, or electron beam therapy required during the past

12-month period 60

Any extent of involvement of the skin, and; systemic therapy such

as therapeutic doses of corticosteroids, immunosuppressive retinoids,

PUVA (psoralen with long-wave ultraviolet-A light) or UVB

(ultraviolet-B light) treatments, or electron beam therapy required

for a total duration of six weeks or more, but not constantly, during

the past 12-month period 30

Any extent of involvement of the skin, and; systemic therapy such

as therapeutic doses of corticosteroids, immunosuppressive retinoids,

PUVA (psoralen with long-wave ultraviolet-A light) or UVB

(ultraviolet-B light) treatments, or electron beam therapy required

for a total duration of less than six weeks during the past 12-month

period 10

Any extent of involvement of the skin, and; no more than topical

therapy required during the past 12-month period 0

**7818** Malignant skin neoplasms (other than malignant melanoma):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or7805), or impairment of function.

**Note**: If a skin malignancy 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,

a 100-percent evaluation will be assigned from the date of onset of
treatment,

and will continue, with a mandatory VA examination six months following

the completion of such antineoplastic treatment, and any change in
evaluation

based upon that or any subsequent examination will be subject to the

provisions of §3.105(e) of this chapter. If there has been no local
recurrence

or metastasis, evaluation will then be made on residuals. If treatment
is

confined to the skin, the provisions for a 100-percent evaluation do not

apply.

**7819** Benign skin neoplasms:

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or 7805), or impairment of function.

**7820** Infections of the skin not listed elsewhere (including
bacterial, fungal, viral,

treponemal and parasitic diseases):

Rate as disfigurement of the head, face, or neck (DC 7800), scars (DC's
7801, 7802,

7803, 7804, or 7805), or dermatitis (DC 7806), depending upon the
predominant

disability.

**7821** Cutaneous manifestations of collagen-vascular diseases not
listed elsewhere

(including scleroderma, calcinosis cutis, and dermatomyositis):

More than 40 percent of the entire body or more than 40 percent of

exposed areas affected, or; constant or near-constant systemic therapy

such as corticosteroids or other immunosuppressive drugs required

during the past 12-month period 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed

areas affected, or; systemic therapy such as corticosteroids or

other immunosuppressive drugs required for a total duration of six

weeks or more, but not constantly, during the past 12-month period 30

At least 5 percent, but less than 20 percent, of the entire body, or at

least 5 percent, but less than 20 percent, of exposed areas affected,

or; intermittent systemic therapy such as corticosteroids or other

immunosuppressive drugs required for a total duration of less than

six weeks during the past 12-month period 10

Less than 5 percent of the entire body or exposed areas affected, and;

no more than topical therapy required during the past 12-month

period 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant

disability.

**7822** Papulosquamous disorders not listed elsewhere (including lichen
planus, large or

small plaque parapsoriasis, pityriasis lichenoides et varioliformis
acuta

(PLEVA), lymphomatoid papulosus, and pityriasis rubra pilaris (PRP)):

More than 40 percent of the entire body or more than 40 percent of

exposed areas affected, and; constant or near-constant systemic

medications or intensive light therapy required during the past

12-month period 60

20 to 40 percent of the entire body or 20 to 40 percent of exposed

areas affected, or; systemic therapy or intensive light therapy required

for a total duration of six weeks or more, but not constantly, during

the past 12-month period 30

At least 5 percent, but less than 20 percent, of the entire body, or at

least 5 percent, but less than 20 percent, of exposed areas affected,

or; systemic therapy or intensive light therapy required for a total

duration of less than six weeks during the past 12-month period 10

Less than 5 percent of the entire body or exposed areas affected, and;

no more than topical therapy required during the past 12-month

period 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant

disability.

**7823** Vitiligo:

With exposed areas affected 10

With no exposed areas affected 0

**7824** Diseases of keratinization (including icthyoses, Darier's
disease, and palmoplantar

keratoderma):

With either generalized cutaneous involvement or systemic

manifestations, and; constant or near-constant systemic medication,

such as immunosuppressive retinoids, required during the past

12-month period 60

With either generalized cutaneous involvement or systemic

manifestations, and; intermittent systemic medication, such as

immunosuppressive retinoids, required for a total duration of six

weeks or more, but not constantly, during the past 12-month period 30

With localized or episodic cutaneous involvement and intermittent

systemic medication, such as immunosuppressive retinoids, required

for a total duration of less than six weeks during the past 12-month

period 10

No more than topical therapy required during the past 12-month period 0

**7825** Urticaria:

Recurrent debilitating episodes occurring at least four times during the

past 12-month period despite continuous immunosuppressive therapy 60

Recurrent debilitating episodes occurring at least four times during the

past 12-month period, and; requiring intermittent systemic

immunosuppressive therapy for control 30

Recurrent episodes occurring at least four times during the past

12-month period, and; responding to treatment with antihistamines or

sympathomimetics 10

**7826** Vasculitis, primary cutaneous:

Recurrent debilitating episodes occurring at least four times during the

past 12-month period despite continuous immunosuppressive therapy 60

Recurrent debilitating episodes occurring at least four times during the

past 12-month period, and; requiring intermittent systemic

immunosuppressive therapy for control 30

Recurrent episodes occurring one to three times during the past

12-month period, and; requiring intermittent systemic

immunosuppressive therapy for control 10

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

**7827** Erythema multiforme; Toxic epidermal necrolysis:

Recurrent debilitating episodes occurring at least four times during the

past 12-month period despite ongoing immunosuppressive therapy 60

Recurrent episodes occurring at least four times during the past

12-month period, and; requiring intermittent systemic

immunosuppressive therapy 30

Recurrent episodes occurring during the past 12-month period that

respond to treatment with antihistamines or sympathomimetics, or;

one to three episodes occurring during the past 12-month period

requiring intermittent systemic immunosuppressive therapy 10

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

**7828** Acne:

Deep acne (deep inflamed nodules and pus-filled cysts) affecting 40

percent or more of the face and neck 30

Deep acne (deep inflamed nodules and pus-filled cysts) affecting less

than 40 percent of the face and neck, or; deep acne other than on the

face and neck 10

Superficial acne (comedones, papules, pustules, superficial cysts) of

any extent 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

**7829** Chloracne:

Deep acne (deep inflamed nodules and pus-filled cysts) affecting 40

percent or more of the face and neck 30

Deep acne (deep inflamed nodules and pus-filled cysts) affecting less

than 40 percent of the face and neck, or; deep acne other than on the

face and neck 10

Superficial acne (comedones, papules, pustules, superficial cysts) of

any extent 0

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars
(DC's

7801, 7802, 7803, 7804, or 7805), depending upon the predominant
disability.

**7830** Scarring alopecia:

Affecting more than 40 percent of the scalp 20

Affecting 20 to 40 percent of the scalp 10

Affecting less than 20 percent of the scalp 0

**7831** Alopecia areata:

With loss of all body hair 10

With loss of hair limited to scalp and face 0

**7832** Hyperhidrosis:

Unable to handle paper or tools because of moisture, and

unresponsive to therapy 30

Able to handle paper or tools after therapy 0

**7833** Malignant melanoma:

Rate as scars (DC's 7801, 7802, 7803, 7804, or 7805), disfigurement of
the head, face,

or neck (DC 7800), or impairment of function (under the appropriate body
system).

**Note**: If a skin malignancy 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,

a 100-percent evaluation will be assigned from the date of onset of
treatment,

and will continue, with a mandatory VA examination six months following

the completion of such antineoplastic treatment, and any change in
evaluation

based upon that or any subsequent examination will be subject to the

provisions of §3.105(e). If there has been no local recurrence or
metastasis,

evaluation will then be made on residuals. If treatment is confined to
the

skin, the provisions for a 100-percent evaluation do not apply.

(Authority: 38 U.S.C. 1155)

\[29 FR 6718, May 22, 1964, as amended at 34 FR 5063, Mar. 11, 1969; 40
FR 42540, Sept. 15, 1975; 43 FR 45262, Oct. 2, 1978; 67 FR 49596, July
31, 2002; 67 FR 58448, Sept. 16, 2002; 68 FR 62889, Oct. 9, 2002; 73 FR
54710, Sept. 23, 2008\]

**Supplement *Highlights* references**: 30(2), 31(2), 45(2).

Reserved