Pseudofolliculitis Barbae (Razor Bumps) VA Rating
What Is Pseudofolliculitis Barbae?
Pseudofolliculitis barbae (PFB), also referred to as razor bumps, is a chronic skin condition that affects follicular and perifollicular skin and can cause inflammation. It is characterized by itchy papules, pustules, and post-inflammatory hyperpigmentation.
While this condition can occur anywhere on the body, it most commonly affects the beard area, neck, and scalp and often results in multiple scars. According to the National Institute of Health, PFB occurs more frequently in men with tight curly hair, especially among men of African descent.
Pseudofolliculitis barbae is usually caused by ingrown hairs due to hair removal (e.g., shaving). In some cases, PFB can also develop due to other underlying skin conditions.
In mild to moderate cases, certain grooming techniques or topical creams can be effective. However, in more severe cases, PFB is best treated with laser therapy.
Pseudofolliculitis Barbae and Veterans
In the 1960s and 70s, the United States Military saw a significant increase in the prevalence of pseudofolliculitis barbae among its service members. Around 45 percent of black men in the armed forces developed the condition due to the mandatory “clean-shaven” policy in the military. PFB was reported less frequently in Asian, Hispanic, and Caucasian service members.
PFB continues to impact service members and veterans to this day. According to a study conducted by the National Library of Medicine, “career black enlistees are likely to under-report the severity of their disease [pseudofolliculitis barbae] and not seek medical help, possibly because of fear of continuous harassment and inability to be promoted by their superiors.”
Although the U.S. Navy recently announced a new grooming policy for individuals with PFB, the clean-shaven military policy continues to negatively affect many service members in different branches of the military.
Service Connection for Pseudofolliculitis Barbae
The Department of Veterans Affairs (VA) offers disability benefits to veterans with service-connected pseudofolliculitis barbae. Veterans can demonstrate that their PFB is related to their military service in one of the following ways:
Direct Service Connection
Generally, to establish direct service connection for VA compensation purposes, veterans must show evidence of the following three things:
- An in-service event, injury, or illness;
- A current diagnosis of a disabling condition by a medical professional; and
- A nexus, or link, between the in-service event and current disability.
To meet these three elements, veterans can use medical evidence showing that their condition developed during military service. Veterans can also use lay statements from fellow servicemembers to confirm that they experienced symptoms of pseudofolliculitis barbae during service.
Secondary Service Connection
Veterans who developed pseudofolliculitis barbae as a result of another service-connected condition may qualify for VA disability benefits on a secondary basis. To qualify for secondary service connection, veterans must have:
- A current diagnosis of a service-connected disabling condition by a medical professional; and
- A nexus, or link, between the service-connected condition and the secondary condition.
Additionally, if the veteran developed a secondary condition to PFB, such as a mental health disorder, they may also be eligible for secondary service-connected benefits.
Presumptive Service Connection
Presumptive service connection is another way for veterans to pursue entitlement to VA disability benefits. Here, VA has determined that certain conditions are presumed service-connected if the veteran meets certain criteria. Presumptive service connection means that veterans do not have to provide a medical nexus.
For example, Gulf War veterans with chronic skin conditions or with chronic undiagnosed skin disorders can be eligible for presumptive service connection at any time if the condition can be rated at 10 percent or higher.
Pseudofolliculitis Barbae VA Disability Rating
Once service connection is established, VA will assign a pseudofolliculitis barbae VA rating. VA typically rates pseudofolliculitis barbae under VA rating code 38 CFR § 4.118, the General Rating Formula for the Skin. However, VA may also rate pseudofolliculitis barbae based on disfiguring or painful scars.
General Rating Formula for the Skin
Many skin conditions are rated based on the amount of skin affected. VA’s rating schedule proposes two ways to determine this: calculations and estimations. Skin area calculations measure the surface area (in inches squared) of affected skin whereas skin area estimations look at the percentage of affected skin.
Using the General Rating Formula for the Skin, pseudofolliculitis barbae may be assigned one of the following ratings:
- 60 percent – “At least one of the following: 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.”
- 30 percent – “At least one of the following: characteristic lesions involving 20-40 percent of the entire body, or 20-40 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.”
- 10 percent – “At least one of the following: 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.”
- 0 percent – “No more than topical therapy required over the past 12-month period and at least one of the following: 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.”
Here, VA defines systemic therapy as any treatment that is injected or taken by mouth, through the nose, or anally. This includes, but is not limited to, the treatments listed within the rating criteria. VA defines topical therapy as any treatment applied directly to the skin, regardless of the type of drug.
VA Ratings for Scars
Veterans who have scars on the head, face, or neck due to their pseudofolliculitis barbae are rated based on skin loss and how many facial features have been disfigured.
VA typically assigns one of the following two ratings under 38 CFR §4.118, diagnostic code 7800, to pseudofolliculitis barbae scars:
- 30 percent – “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.”
- 10 percent – “With one characteristic of disfigurement.”
C&P Exams and VA DBQ for Pseudofolliculitis Barbae
After submitting a claim for pseudofolliculitis barbae, VA may request that the veteran attend a Compensation and Pension (C&P) exam, in which a VA examiner will evaluate their condition. VA uses C&P exams to gather more evidence on a veteran’s claimed condition before issuing a decision and assigning a rating. Most commonly, C&P exams are used to (1) confirm or deny service connection, and/or (2) establish the severity of a veteran’s disability.
During this process, the VA examiner may complete a Disability Benefits Questionnaire (DBQ). DBQs are supposed to help speed the processing of claims for service-connected compensation and give veterans more control over the disability claims process. While veterans can access DBQ forms online, they cannot fill them out themselves.
Veterans can also have their private health care provider complete a DBQ on their behalf. The streamlined forms use check boxes and standardized language so that the disability evaluation can be filled out quickly and correctly. Specifically, healthcare providers will “check a box” next to descriptions that most accurately depict the disability in question.
When attending a C&P exam or filling out a VA DBQ for pseudofolliculitis barbae, it essential that you are as honest as possible about your symptoms with the health care provider. It is also beneficial to ask your private physician to support their DBQ answers with a written explanation even if the form does not require it.
Did VA Deny Your Claim for Pseudofolliculitis Barbae?
If the Department of Veterans Affairs denied your claim for pseudofolliculitis barbae, Chisholm Chisholm & Kilpatrick LTD may be able to help you secure the compensation you deserve. We offer free consultations for veterans looking for assistance with their appeals. Call CCK today at 800-544-9144 to schedule your complimentary case review.
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