38 C.F.R. § 4.118 Schedule of ratings—skin.
Title 38 - Pensions, Bonuses, and Veterans' Relief
(Authority: 38 U.S.C. 1155) [67 FR 49596, July 31, 2002; 67 FR 58448, 58449, Sept. 16, 2002]
Title 38: Pensions, Bonuses, and Veterans' Relief
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings
The Skin
§ 4.118 Schedule of ratings—skin.
------------------------------------------------------------------------ Rating------------------------------------------------------------------------7800 Disfigurement of the head, face, or neck: With visible or palpable tissue loss and either gross 80 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...................... With visible or palpable tissue loss and either gross 50 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........................... With visible or palpable tissue loss and either gross 30 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........................... 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 60 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..................................................... 20 to 40 percent of the entire body or 20 to 40 percent of 30 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................ At least 5 percent, but less than 20 percent, of the entire 10 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................................... Less than 5 percent of the entire body or less than 5 0 percent of exposed areas affected, and; no more than topical therapy required during the past 12-month period... 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 disabililty................................................ 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 porphyria cutanea tarda): More than 40 percent of the entire body or more than 40 60 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..................................................... 20 to 40 percent of the entire body or 20 to 40 percent of 30 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................ At least 5 percent, but less than 20 percent, of the entire 10 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................................... Less than 5 percent of the entire body or exposed areas 0 affected, and; no more than topical therapy required during the past 12-month period................................... 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 60 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..................................................... 20 to 40 percent of the entire body or 20 to 40 percent of 30 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................ At least 5 percent, but less than 20 percent, of the entire 10 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................................... Less than 5 percent of the entire body or exposed areas 0 affected, and; no more than topical therapy required during the past 12-month period................................... 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 100 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....................................... Generalized involvement of the skin without systemic 60 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....................................... Any extent of involvement of the skin, and; systemic therapy 30 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................................... Any extent of involvement of the skin, and; systemic therapy 10 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..................................................... Any extent of involvement of the skin, and; no more than 0 topical therapy required during the past 12-month period...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): 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 60 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..................................................... 20 to 40 percent of the entire body or 20 to 40 percent of 30 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................ At least 5 percent, but less than 20 percent, of the entire 10 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................................... Less than 5 percent of the entire body or exposed areas 0 affected, and; no more than topical therapy required during the past 12-month period................................... 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 60 percent of exposed areas affected, and; constant or near- constant systemic medications or intensive light therapy required during the past 12-month period................... 20 to 40 percent of the entire body or 20 to 40 percent of 30 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.. At least 5 percent, but less than 20 percent, of the entire 10 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.................. Less than 5 percent of the entire body or exposed areas 0 affected, and; no more than topical therapy required during the past 12-month period................................... 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.............................. 07824 Diseases of keratinization (including icthyoses, Darier's disease, and palmoplantar keratoderma): With either generalized cutaneous involvement or systemic 60 manifestations, and; constant or near-constant systemic medication, such as immunosuppressive retinoids, required during the past 12-month period............................ With either generalized cutaneous involvement or systemic 30 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................................... With localized or episodic cutaneous involvement and 10 intermittent systemic medication, such as immunosuppressive retinoids, required for a total duration of less than six weeks during the past 12-month period...................... No more than topical therapy required during the past 12- 0 month period...............................................7825 Urticaria: Recurrent debilitating episodes occurring at least four 60 times during the past 12-month period despite continuous immunosuppressive therapy.................................. Recurrent debilitating episodes occurring at least four 30 times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control Recurrent episodes occurring at least four times during the 10 past 12-month period, and; responding to treatment with antihistamines or sympathomimetics.........................7826 Vasculitis, primary cutaneous: Recurrent debilitating episodes occurring at least four 60 times during the past 12-month period despite continuous immunosuppressive therapy.................................. Recurrent debilitating episodes occurring at least four 30 times during the past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control Recurrent episodes occurring one to three times during the 10 past 12-month period, and; requiring intermittent systemic immunosuppressive therapy for control...................... 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 60 times during the past 12-month period despite ongoing immunosuppressive therapy.................................. Recurrent episodes occurring at least four times during the 30 past 12-month period, and; requiring intermittent systemic immunosuppressive therapy.................................. Recurrent episodes occurring during the past 12-month period 10 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......................... 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) 30 affecting 40 percent or more of the face and neck.......... Deep acne (deep inflamed nodules and pus-filled cysts) 10 affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck.................. Superficial acne (comedones, papules, pustules, superficial 0 cysts) of any extent....................................... 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) 30 affecting 40 percent or more of the face and neck.......... Deep acne (deep inflamed nodules and pus-filled cysts) 10 affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck.................. Superficial acne (comedones, papules, pustules, superficial 0 cysts) of any extent....................................... 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................. 07831 Alopecia areata: With loss of all body hair.................................. 10 With loss of hair limited to scalp and face................. 07832 Hyperhidrosis: Unable to handle paper or tools because of moisture, and 30 unresponsive to therapy.................................... Able to handle paper or tools after therapy................. 07833 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.------------------------------------------------------------------------
