#### § 4.118 Schedule of ratings—skin.

(a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.

(b) Two or more skin conditions may be combined in accordance with § 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.

| | 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. | |
| 7801 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage: | |
| 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):* For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk | |
| *Note (2):* A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code | |
| 7802 Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage: | |
| Area or areas of 144 square inches (929 sq. cm.) or greater | 10 |
| *Note (1):* For the purposes of DCs 7801 and 7802, the six (6) zones of the body are defined as each extremity, anterior trunk, and posterior trunk. The midaxillary line divides the anterior trunk from the posterior trunk | |
| *Note (2):* A separate evaluation may be assigned for each affected zone of the body under this diagnostic code if there are multiple scars, or a single scar, affecting multiple zones of the body. Combine the separate evaluations under § 4.25. Alternatively, if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code | |
| 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; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804: | |
| Evaluate any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code | |
| General Rating Formula For The Skin For DCs 7806, 7809, 7813-7816, 7820-7822, and 7824: | |
| At least one of the following | 60 |
| Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or | |
| Constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period | 60 |
| At least one of the following | 30 |
| Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period | |
| At least one of the following | 10 |
| Characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or | |
| At least 5 percent, but less than 20 percent, of exposed areas affected; or | |
| Intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period | |
| No more than topical therapy required over the past 12-month period and at least one of the following | 0 |
| Characteristic lesions involving less than 5 percent of the entire body affected; or | |
| Characteristic lesions involving less than 5 percent of exposed areas affected | |
| Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability. This rating instruction does not apply to DC 7824 | |
| 7806 Dermatitis or eczema. | |
| Evaluate under the General Rating Formula for the Skin | |
| 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 disabililty | |
| **Note:** Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral leishmaniasis). | |
| 7809 Discoid lupus erythematosus. | |
| Evaluate under the General Rating Formula for the Skin | |
| *Note:* 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 (onychomycosis); of inguinal area (jock itch), tinea cruris; tinea versicolor). | |
| Evaluate under the General Rating Formula for the Skin | |
| 7815 Bullous disorders (including pemphigus vulgaris, pemphigus foliaceous, bullous pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, benign chronic familial pemphigus (Hailey-Hailey), and porphyria cutanea tarda). | |
| Evaluate under the General Rating Formula for the Skin | |
| *Note:* Rate complications and residuals of mucosal involvement (ocular, oral, gastrointestinal, respiratory, or genitourinary) separately under the appropriate diagnostic code | |
| 7816 Psoriasis. | |
| Evaluate under the General Rating Formula for the Skin | |
| *Note:* Rate complications such as psoriatic arthritis and other clinical manifestations (*e.g.,* oral mucosa, nails) separately under the appropriate diagnostic code | |
| 7817 Erythroderma: | |
| Generalized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following | 100 |
| Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA (psoralen with long-wave ultraviolet-A light), UVB (ultraviolet-B light) treatments, biologics, or electron beam therapy required over the past 12 month period; or | |
| No current treatment due to a documented history of treatment failure with 2 or more treatment regimens | 100 |
| Generalized involvement of the skin without systemic manifestations and one of the following | |
| Constant or near-constant systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy required over the past 12-month period; or | |
| No current treatment due to a documented history of treatment failure with 1 treatment regimen | 60 |
| Any extent of involvement of the skin, and any of the following therapies required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy | 30 |
| Any extent of involvement of the skin, and any of the following therapies required for a total duration of less than 6 weeks over the past 12-month period: systemic therapy such as therapeutic doses of corticosteroids, other immunosuppressive drugs, retinoids, PUVA, UVB treatments, biologics, or electron beam therapy | 10 |
| Any extent of involvement of the skin, and no more than topical therapy required over the past 12-month period | 0 |
| *Note:* Treatment failure is defined as either disease progression, or less than a 25 percent reduction in the extent and severity of disease after four weeks of prescribed therapy, as documented by medical records | |
| 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, or 7805), 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). | |
| Evaluate under the General Rating Formula for the Skin | |
| 7821 Cutaneous manifestations of collagen-vascular diseases not listed elsewhere (including scleroderma, calcinosis cutis, subacute cutaneous lupus erythematosus, and dermatomyositis). | |
| Evaluate under the General Rating Formula for the Skin | |
| 7822 Papulosquamous disorders not listed elsewhere (including lichen planus, large or small plaque parapsoriasis, pityriasis lichenoides et varioliformis acuta (PLEVA), lymphomatoid papulosus, mycosis fungoides, and pityriasis rubra pilaris (PRP)). | |
| Evaluate under the General Rating Formula for the Skin | |
| 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). | |
| Evaluate under the General Rating Formula for the Skin | |
| 7825 Chronic urticaria: | |
| For the purposes of this diagnostic code, chronic urticaria is defined as continuous urticaria at least twice per week, off treatment, for a period of six weeks or more | |
| Chronic refractory urticaria that requires third line treatment for control (e.g., plasmapheresis, immunotherapy, immunosuppressives) due to ineffectiveness with first and second line treatments | 60 |
| Chronic urticaria that requires second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control | 30 |
| Chronic urticaria that requires first line treatment (antihistamines) for control | 10 |
| 7826 Vasculitis, primary cutaneous: | |
| Persistent documented vasculitis episodes refractory to continuous immunosuppressive therapy | 60 |
| All of the following | 30 |
| Recurrent documented vasculitic episodes occurring four or more times over the past 12-month period; and | |
| Requiring intermittent systemic immunosuppressive therapy for control | 30 |
| At least one of the following | 10 |
| Recurrent documented vasculitic episodes occurring one to three times over the past 12-month period, and requiring intermittent systemic immunosuppressive therapy for control; or | |
| Without recurrent documented vasculitic episodes but requiring continuous systemic medication for control | |
| Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability | |
| 7827 Erythema multiforme; Toxic epidermal necrolysis: | |
| Recurrent mucosal, palmar, or plantar involvement impairing mastication, use of hands, or ambulation occurring four or more times over the past 12-month period despite ongoing immunosuppressive therapy | 60 |
| All of the following | 30 |
| Recurrent mucosal, palmar, or plantar involvement not impairing mastication, use of hands, or ambulation, occurring four or more times over the past 12-month period; and
requiring intermittent systemic therapy | |
| At least one of the following | 10 |
| One to three episodes of mucosal, palmar, or plantar involvement not impairing mastication, use of hands, or ambulation, occurring over the past 12-month period AND requiring intermittent systemic therapy; or | |
| Without recurrent episodes, but requiring continuous systemic medication for control | |
| Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability | |
| *Note:* For the purposes of this DC only, systemic therapy may consist of one or more of the following treatment agents: immunosuppressives, antihistamines, or sympathomimetics | |
| 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) of any extent | 0 |
| Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 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 the intertriginous areas (the axilla of the arm, the anogenital region, skin folds of the breasts, or between digits) | 20 |
| Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck; or deep acne affecting non-intertriginous areas of the body (other than the face and neck) | 10 |
| Superficial acne (comedones, papules, pustules) of any extent | 0 |
| Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 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)

[67 FR 49596, July 31, 2002; 67 FR 58448, 58449, Sept. 16, 2002; 73 FR 54710, Oct. 23, 2008; 77 FR 2910, Jan. 20, 2012; 83 FR 32597, July 13, 2018; 83 FR 38663, Aug. 7, 2018]