{"data":{"id":"us/38-cfr-4.118","jurisdiction":"us","citation":"38 CFR 4.118","heading":"Schedule of ratings—skin.","body":"(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.\n(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.\nRating\n7800 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:\nWith 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\nWith 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\nWith 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\nWith one characteristic of disfigurement 10\nNote (1): The 8 characteristics of disfigurement, for purposes of evaluation under § 4.118, are:\nScar 5 or more inches (13 or more cm.) in length.\nScar at least one-quarter inch (0.6 cm.) wide at widest part.\nSurface contour of scar elevated or depressed on palpation.\nScar adherent to underlying tissue.\nSkin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.).\nSkin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.).\nUnderlying soft tissue missing in an area exceeding six square inches (39 sq. cm.).\nSkin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).\nNote (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.\nNote (3): Take into consideration unretouched color photographs when evaluating under these criteria.\nNote (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.\nNote (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.\n7801 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:\nArea or areas of 144 square inches (929 sq. cm.) or greater 40\nArea or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.) 30\nArea or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.) 20\nArea or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.) 10\nNote (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\nNote (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\n7802 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:\nArea or areas of 144 square inches (929 sq. cm.) or greater 10\nNote (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\nNote (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\n7804 Scar(s), unstable or painful:\nFive or more scars that are unstable or painful 30\nThree or four scars that are unstable or painful 20\nOne or two scars that are unstable or painful 10\nNote (1): An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar.\nNote (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\nNote (3): Scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable\n7805 Scars, other; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804:\nEvaluate any disabling effect(s) not considered in a rating provided under diagnostic codes 7800-04 under an appropriate diagnostic code\nGeneral Rating Formula For The Skin For DCs 7806, 7809, 7813-7816, 7820-7822, and 7824:\nAt least one of the following 60\nCharacteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or\nConstant 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\nAt least one of the following 30\nCharacteristic 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\nAt least one of the following 10\nCharacteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or\nAt least 5 percent, but less than 20 percent, of exposed areas affected; or\nIntermittent 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\nNo more than topical therapy required over the past 12-month period and at least one of the following 0\nCharacteristic lesions involving less than 5 percent of the entire body affected; or\nCharacteristic lesions involving less than 5 percent of exposed areas affected\nOr 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\n7806 Dermatitis or eczema.\nEvaluate under the General Rating Formula for the Skin\n7807 American (New World) leishmaniasis (mucocutaneous, espundia):\nRate 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\nNote: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral leishmaniasis).\n7808 Old World leishmaniasis (cutaneous, Oriental sore):\nRate 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\nNote: Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral leishmaniasis).\n7809 Discoid lupus erythematosus.\nEvaluate under the General Rating Formula for the Skin\nNote: Do not combine with ratings under DC 6350\n7811 Tuberculosis luposa (lupus vulgaris), active or inactive:\nRate under §§ 4.88c or 4.89, whichever is appropriate\n7813 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).\nEvaluate under the General Rating Formula for the Skin\n7815 Bullous disorders (including pemphigus vulgaris, pemphigus foliaceous, bullous pemphigoid, dermatitis herpetiformis, epidermolysis bullosa acquisita, benign chronic familial pemphigus (Hailey-Hailey), and porphyria cutanea tarda).\nEvaluate under the General Rating Formula for the Skin\nNote: Rate complications and residuals of mucosal involvement (ocular, oral, gastrointestinal, respiratory, or genitourinary) separately under the appropriate diagnostic code\n7816 Psoriasis.\nEvaluate under the General Rating Formula for the Skin\nNote: Rate complications such as psoriatic arthritis and other clinical manifestations (e.g., oral mucosa, nails) separately under the appropriate diagnostic code\n7817 Erythroderma:\nGeneralized involvement of the skin with systemic manifestations (such as fever, weight loss, or hypoproteinemia) AND one of the following 100\nConstant 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\nNo current treatment due to a documented history of treatment failure with 2 or more treatment regimens 100\nGeneralized involvement of the skin without systemic manifestations and one of the following\nConstant 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\nNo current treatment due to a documented history of treatment failure with 1 treatment regimen 60\nAny 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\nAny 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\nAny extent of involvement of the skin, and no more than topical therapy required over the past 12-month period 0\nNote: 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\n7818 Malignant skin neoplasms (other than malignant melanoma):\nRate as disfigurement of the head, face, or neck (DC 7800), scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment of function\nNote: 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.\n7819 Benign skin neoplasms:\nRate as disfigurement of the head, face, or neck (DC 7800), scars (DC's 7801, 7802, 7803, 7804, or 7805), or impairment of function\n7820 Infections of the skin not listed elsewhere (including bacterial, fungal, viral, treponemal, and parasitic diseases).\nEvaluate under the General Rating Formula for the Skin\n7821 Cutaneous manifestations of collagen-vascular diseases not listed elsewhere (including scleroderma, calcinosis cutis, subacute cutaneous lupus erythematosus, and dermatomyositis).\nEvaluate under the General Rating Formula for the Skin\n7822 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)).\nEvaluate under the General Rating Formula for the Skin\n7823 Vitiligo:\nWith exposed areas affected 10\nWith no exposed areas affected 0\n7824 Diseases of keratinization (including icthyoses, Darier's disease, and palmoplantar keratoderma).\nEvaluate under the General Rating Formula for the Skin\n7825 Chronic urticaria:\nFor 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\nChronic refractory urticaria that requires third line treatment for control (e.g., plasmapheresis, immunotherapy, immunosuppressives) due to ineffectiveness with first and second line treatments 60\nChronic urticaria that requires second line treatment (e.g., corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone) for control 30\nChronic urticaria that requires first line treatment (antihistamines) for control 10\n7826 Vasculitis, primary cutaneous:\nPersistent documented vasculitis episodes refractory to continuous immunosuppressive therapy 60\nAll of the following 30\nRecurrent documented vasculitic episodes occurring four or more times over the past 12-month period; and\nRequiring intermittent systemic immunosuppressive therapy for control 30\nAt least one of the following 10\nRecurrent documented vasculitic episodes occurring one to three times over the past 12-month period, and requiring intermittent systemic immunosuppressive therapy for control; or\nWithout recurrent documented vasculitic episodes but requiring continuous systemic medication for control\nOr rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability\n7827 Erythema multiforme; Toxic epidermal necrolysis:\nRecurrent 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\nAll of the following 30\nRecurrent 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\nAt least one of the following 10\nOne 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\nWithout recurrent episodes, but requiring continuous systemic medication for control\nOr rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability\nNote: For the purposes of this DC only, systemic therapy may consist of one or more of the following treatment agents: immunosuppressives, antihistamines, or sympathomimetics\n7828 Acne:\nDeep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck 30\nDeep 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\nSuperficial acne (comedones, papules, pustules) of any extent 0\nOr rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability\n7829 Chloracne:\nDeep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck 30\nDeep 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\nDeep 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\nSuperficial acne (comedones, papules, pustules) of any extent 0\nOr rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability\n7830 Scarring alopecia:\nAffecting more than 40 percent of the scalp 20\nAffecting 20 to 40 percent of the scalp 10\nAffecting less than 20 percent of the scalp 0\n7831 Alopecia areata:\nWith loss of all body hair 10\nWith loss of hair limited to scalp and face 0\n7832 Hyperhidrosis:\nUnable to handle paper or tools because of moisture, and unresponsive to therapy 30\nAble to handle paper or tools after therapy 0\n7833 Malignant melanoma:\nRate 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)\nNote: 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.","path":["Title 38—Pensions, Bonuses, and Veterans' Relief","CHAPTER I—DEPARTMENT OF VETERANS AFFAIRS","PART 4—SCHEDULE FOR RATING DISABILITIES","Subpart B—Disability Ratings"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-38.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:25:50Z","sha256":"843fd348f1a05e234d89c42ab9af27c4536c080f6eac5f6f565ea20f32942fe8","source_id":"us-cfr","stale":true,"prev":"us/38-cfr-4.117","next":"us/38-cfr-4.119"},"notice":"GroundRules: Original legal text. Not legal advice."}