Custom Federal Regulations Service™

**This is supplemental material**

**for Book C of your set of**

**Federal Regulations**

Title 38, Part 4

*Schedule for Rating Disabilities*

**Veterans Benefits Administration**

Supplement No. 31

Covering period of *Federal Register* issues

through September 22, 2002

Copyright © 2002 Jonathan Publishing

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> **GENERAL INSTRUCTIONS**

Custom Federal Regulations Service™

**Supplemental Materials for *Book C***

**Code of Federal Regulations**

**Title 38, Part 4**

***Schedule for Rating Disabilities***

**Veterans Benefits Administration**

**Supplement No. 31**

25 September 2002

Covering the period of Federal Register issues

through September 22, 2002

When **Book C** was originally prepared, it was current through final
regulations published in the *Federal Register* of 24 March 1992. These
supple­mental materials are designed to keep your regulations up to date.
You should file the attached pages immediately, and record the fact that
you did so on the *Supplement Filing Record* which is at page C-8 of
Book C, *Schedule for Rating Disabilities*.

> **To ensure accuracy and timeliness of your materials,**
>
> **it is important that you follow these simple procedures:**
>
> 1\. Always file your supplemental materials immediately upon receipt.
>
> 2\. Before filing, always check the Supplement Filing Record (page
> C-8) to be sure that all prior supplements have been filed. If you are
> missing any supple­ments, contact the Veterans Benefits Administration
> at the address listed on page C-2.
>
> 3\. After filing, enter the relevant information on the Supplement
> Filing Record sheet (page C-8)---the date filed, name/initials of
> filer, and date through which the *Federal Register* is covered.
>
> 4\. If as a result of a failure to file, or an undelivered supplement,
> you have more than one supplement to file at a time, be certain to
> file them in chronological order, lower number first.
>
> 5\. Always retain the filing instructions (simply insert them at the
> back of the book) as a backup record of filing and for reference in
> case of a filing error.
>
> 6\. Be certain that you *permanently discard* any pages indicated for
> removal in the filing instructions in order to avoid confusion later.

To execute the filing instructions, simply remove *and throw away* the
pages listed under *Remove These Old Pages,* and replace them in each
case with the corres­pond­ing pages from this supplement listed under *Add
These New Pages*. Occasionally new pages will be added without removal
of any old material (reflecting new regulations), and occasionally old
pages will be removed with­out addition of any new material (reflecting
rescinded regulations)---in these cases the word *None* will appear in
the appropriate column.

> **FILING INSTRUCTIONS**

**Book C, Supplement No. 31**

**September 25, 2002**

*Remove these Add these Section(s)*

*[old pages]{.underline} [new pages]{.underline} [Affected]{.underline}*

**Do not file this supplement until you confirm that**

**all prior supplements have been filed**

4.71a-25 to 4.71a-28 4.71a-25 to 4.71a-28 §4.71a

4.118-1 to 4.118-10 4.118-1 to 4.118-10 §4.118

**Be sure to complete the**

***Supplement Filing Record* (page C-8)**

**when you have finished filing this material.**

> **HIGHLIGHTS**

**Book C, Supplement No. 31**

**September 25, 2002**

***Supplement* Highlights *references***: Where substantive changes are
made in the text of regulations, the paragraphs of *Highlights* sections
are cited at the end of the relevant section of text. Thus, if you are
reading §3.263, you will see a note at the end of that section which
reads: "Supplement *Highlights* references---6(2)." This means that
paragraph 2 of the *Highlights* section in Supplement No. 6 contains
information about the changes made in §3.263. By keeping and filing the
*Highlights* sections, you will have a reference source explaining all
substantive changes in the text of the regulations.

***Supplement frequency***: This Book C (*Schedule for Rating
Disabilities*) was originally supplemented four times a year, in
February, May, August, and November. Beginning 1 August 1995,
supplements will be issued *every month* during which a final rule
addition or modification is made to the parts of Title 38 covered by
this book. Supplements will be numbered consecutively as issued.

**Modifications in this supplement include the following:**

1\. On 22 August 2002, the VA published a final rule, effective 23
September 2002, to amend that portion of the *Schedule for Rating
Disabilities* that addresses intervertebral disc syndrome in order to
clarify the criteria to ensure that veterans diagnosed with this
condition meet uniform criteria and receive consistent evaluations.
Change:

• In §4.71a, revised diagnostic code 5293.

2\. On 16 September 2002, the VA published a correction to a final rule
originally published on 31 July 2002 concerning the *Schedule for Rating
Disabilities* section dealing with *The Skin*. The corrections were
non-substantive in nature. Changes:

• In §4.118, corrected diagnostic codes 7802, 7807-7809, 7811, 7813,
7818-7820, and 7833.

**5292** Spine, limitation of motion of, lumbar:

Severe 40

Moderate 20

Slight 10

**5293** Intervertebral disc syndrome:

Evaluate intervertebral disc syndrome (preoperatively or
postoperatively) either on

the total duration of incapacitating episodes over the past 12 months or
by combining under §4.25 separate evaluations of its chronic orthopedic
and

neurologic manifestations along with evaluations for all other
disabilities,

whichever method results in the higher evaluation.

With incapacitating episodes having a total duration of at least six
weeks

during the past 12 months 60

With incapacitating episodes having a total duration of at least four
weeks

but less than six weeks during the past 12 months 40

With incapacitating episodes having a total duration of at least two
weeks

but less than four weeks during the past 12 months 20

With incapacitating episodes having a total duration of at least one
week

but less than two weeks during the past 12 months 10

**Note (1)**: For purposes of evaluations under 5293, an incapacitating
episode is a period of acute signs and symptoms due to intervertebral
disc syndrome that requires bed rest prescribed by a physician and
treatment by a physician. "Chronic orthopedic and neurologic
manifestations" means orthopedic and neurologic signs and symptoms
resulting from intervertebral disc syndrome that are present constantly,
or nearly so.

**Note (2)**: When evaluating on the basis of chronic manifestations,
evaluate orthopedic disabilities using evaluation criteria for the most
appropriate orthopedic diagnostic code or codes. Evaluate neurologic
disabilities separately using evaluation criteria for the most
appropriate neurologic diagnostic code or codes.

**Note (3):** If intervertebral disc syndrome is present in more than
one spinal segment, provided that the effects in each spinal segment are
clearly distinct, evaluate each segment on the basis of chronic
orthopedic and neurologic manifestations or incapacitating episodes,
whichever method results in a higher evaluation for that segment.

**5294** Sacro-iliac injury and weakness:

**5295** Lumbosacral strain:

Severe; with listing of whole spine to opposite side, positive

Goldthwaite's sign, marked limitation of forward bending in

standing position, loss of lateral motion with osteo-arthritic

changes, or narrowing or irregularity of joint space, or some

of the above with abnormal mobility on forced motion 40

With muscle spasm on extreme forward bending, loss of lateral

spine motion unilateral, in standing position 20

With characteristic pain on motion 10

With slight subjective symptoms only 0

**[The Skull]{.smallcaps}**

Rating

**5296** Skull, loss of part of, both inner and outer tables:

With brain hernia 80

Without brain hernia:

Area larger than size of a 50-cent piece or 1.140 in2 (7.355 cm2 ) 50

Area intermediate 30

Area smaller than the size of a 25-cent piece

or 0.716 in2 (4.619 cm2 ) 10

Note: Rate separately for intracranial complications.

**[The Ribs]{.smallcaps}**

Rating

**5297** Ribs, removal of:

More than six 50

Five or six 40

Three or four 30

Two 20

One or resection of two or more ribs without regeneration 10

**Note (1):** The rating for rib resection or removal is not to be
applied with ratings for purulent pleurisy, lobectomy, pneumonectomy or
injuries of pleural cavity.

**Note (2):** However, rib resection will be considered as rib removal
in thoracoplasty performed for collapse therapy or to accomplish
obliteration of space and will be combined with the rating for lung
collapse, or with the rating for lobectomy, pneumonectomy or the
graduated ratings for pulmonary tuberculosis.

**[The Coccyx]{.smallcaps}**

Rating

**5298** Coccyx, removal of:

Partial or complete, with painful residuals 10

Without painful residuals 0

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

\[29 FR 6718, May 22,1964, as amended at 34 FR 5062, Mar. 11, 1969; 40
FR 42536, Sept. 15, 1975; 41 FR 11294, Mar. 18, 1976; 43 FR 45350, Oct.
2, 1978; 51 FR 6411, Feb. 24, 1986; 61 FR 20439, May 7, 1996; 64 FR
32410, June 17, 1999; 67 FR 48785, July 26, 2002; 67 FR 54349, Aug. 22,
2002\]

**Supplement *Highlights* references**: 16(1), 26(2), 30(1), 31(1).

# Table II

**[Ratings for Multiple Losses of Extremities with Dictator's Rating
Code and 38 CFR Citation]{.smallcaps}**

Impairment of other extremity

+---------+---------+---------+---------+---------+---------+---------+
| Imp     | Ana     | Ana     | Ana     | Ana     | Ana     | Ana     |
| airment | tomical | tomical | tomical | tomical | tomical | tomical |
| of one  | loss or | loss or | loss or | loss or | loss    | loss    |
| ex      | loss of | loss of | loss of | loss of | near    | near    |
| tremity | use     | use     | use     | use     | s       | hip     |
|         | below   | below   | above   | above   | houlder | (pre    |
|         | elbow   | knee    | elbow   | knee    | (pre    | venting |
|         |         |         | (pre    | (pre    | venting | use of  |
|         |         |         | venting | venting | use of  | pros    |
|         |         |         | use of  | use of  | pros    | thesis) |
|         |         |         | pros    | pros    | thesis) |         |
|         |         |         | thesis) | thesis) |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     | M Codes | L Codes | M 1/2   | L 1/2   | N Code  | M Code  |
| tomical | M-1 a,  | L-1 d,  | Code    | Code    | N-3, 38 | M-3 c,  |
| loss or | b,      | e, f,   | M-5,    | L-2 c,  | CFR     | 38 CFR  |
| loss of |         |         |         |         | 3       | 3.3     |
| use     | or c,   | or g,   | 38 CFR  | 38 CFR  | .350(f) | 50(f)(1 |
| below   | 38 CFR  | 38 CFR  | 3.350(f | 3       | (1)(xi) | )(viii) |
| elbow   | 3.350(c | 3       | )(1)(x) | .350(f) |         |         |
|         | )(1)(i) | .350(b) |         | (1)(vi) |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     | 3       | L Codes | L 1/2   | L 1/2   | M Code  | M Code  |
| tomical | .350(b) | L-1 a,  | Code    | Code    | M-3 b,  | M-3 a,  |
| loss or |         | b,      | L-2 b,  | L-2 a,  |         |         |
| loss of |         |         |         |         | 38 CFR  | 38 CFR  |
| use     |         | or c,   | 38 CFR  | 38 CFR  | 3       | 3       |
| below   |         | 38 CFR  | 3.350(f | 3       | .350(f) | .350(f) |
| knee    |         | 3.350   | )(1)(i) | .350(f) | (1)(ii) |         |
|         |         | (       |         | (1)(iv) |         |         |
|         |         | 1)(iii) |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         | N Code  | M Code  | N 1/2   | M 1/2   |
| tomical |         |         | N-1,    | M-2 a,  | Code    | Code    |
| loss or |         |         |         |         | N-4     | M-4 c,  |
| loss of |         |         | 38 CFR  | 38 CFR  |         |         |
| use     |         |         | 3.35    | 3       | 38 CFR  | 38 CFR  |
| above   |         |         | 0(d)(1) | .350(c) | 3       | 3       |
| elbow   |         |         |         | (       | .350(f) | .350(f) |
| (pre    |         |         |         | 1)(iii) | (1)(ix) |         |
| venting |         |         |         |         |         | (1)(xi) |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         | M Code  | M 1/2   | M 1/2   |
| tomical |         |         |         | M-2 a,  | Code    | Code    |
| loss or |         |         |         |         | M-4 b,  | M-4 a,  |
| loss of |         |         |         | 38 CFR  |         |         |
| use     |         |         |         | 3       | 38 CFR  | 38 CFR  |
| above   |         |         |         | .350(c) | 3       | 3       |
| knee    |         |         |         | (1)(ii) | .350(f) | .350(f) |
| (pre    |         |         |         |         |         |         |
| venting |         |         |         |         | (       | (1)(v)  |
| use of  |         |         |         |         | 1)(vii) |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         |         | O Code  | N Code  |
| tomical |         |         |         |         | O-1,    | N-2 b,  |
| loss    |         |         |         |         |         |         |
| near    |         |         |         |         | 38 CFR  | 38 CFR  |
| s       |         |         |         |         | 3       | 3       |
| houlder |         |         |         |         | .350(e) | .350(d) |
| (pre    |         |         |         |         | (1)(i)  | (3)     |
| venting |         |         |         |         |         |         |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+
| Ana     |         |         |         |         |         | N Code  |
| tomical |         |         |         |         |         | N-2 a,  |
| loss    |         |         |         |         |         |         |
| near    |         |         |         |         |         | 38 CFR  |
| hip     |         |         |         |         |         | 3       |
| (pre    |         |         |         |         |         | .350(d) |
| venting |         |         |         |         |         | (2)     |
| use of  |         |         |         |         |         |         |
| pros    |         |         |         |         |         |         |
| thesis) |         |         |         |         |         |         |
+---------+---------+---------+---------+---------+---------+---------+

Note: Need for aid attendance or permanently bedridden qualifies for
subpar. L. Code L-1 h, i (38 CFR 3.350(b)). Paraplegia with loss of use
of both lower extremities and loss of anal and bladder sphincter control
qualifies for subpar. O. Code O-2 (38 CFR 3.350(e)(2). Where there are
additional disabilities rated 50% or 100%, or anatomical or loss of use
of a third extremity see 38 CFR 3.350(f)(3), (4), or (5). (Authority: 38
U.S.C. 1115)

**The Skin**

4.118 Schedule of ratings---skin 4.118-1

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

Rating

**7800** 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.

**7801** Scars, other than head, face, or neck, that are deep or that
cause limited motion:

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

Area or areas exceeding 72 square inches (465 sq. cm.) 30

Area or areas exceeding 12 square inches (77 sq. cm.) 20

Area or areas exceeding 6 square inches (39 sq. cm.) 10

**Note (1)**: Scars in widely separated areas, as on two or more
extremities or on

anterior and posterior surfaces of extremities or trunk, will be
separately

rated and combined in accordance with §4.25 of this part.

**Note (2)**: A deep scar is one associated with underlying soft tissue
damage.

**7802** Scars, other than head, face, or neck, that are superficial and
that do not cause

limited motion:

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

**Note (1)**: Scars in widely separated areas, as on two or more
extremities or on

anterior and posterior surfaces of extremities or trunk, will be
separately

rated and combined in accordance with §4.25 of this part.

**Note (2)**: A superficial scar is one not associated with underlying
soft tissue

damage.

**7803** Scars, superficial, unstable 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)**: A superficial scar is one not associated with underlying
soft tissue

damage.

**7804** Scars, superficial, painful on examination 10

**Note (1)**: A superficial scar is one not associated with underlying
soft tissue

damage.

**Note (2)**: In this case, a 10-percent evaluation will be assigned for
a scar on the

tip of a finger or toe even though amputation of the part would not
warrant a

compensable evaluation.

(See §4.68 of this part on the amputation rule.)

**7805** Scars, other; Rate on limitation of function of affected part.

**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)

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

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