Psoriasis VA Disability Ratings and Benefits Explained

What is Psoriasis?

Psoriasis is a common skin condition that is categorized as an immune-mediated disease, meaning it is caused by dysfunction of the immune system.  Psoriasis can cause swelling in the body as well as raised plaques or scaly patches on the skin.

An overactive immune system can increase the speed of skin cell growth.  Usually, skin cells grow and die off monthly.  With psoriasis, skin cells can do this in as little as three or four days.  However, once the cells die, they do not shed, but rather stay on the surface of the skin.  This is what creates the psoriasis plaques or patches.  These patches can be extremely itchy, as well as have a burning or stinging sensation.  Psoriasis can occur anywhere on the body, but commonly affects the back of the knees, crook of the elbows, and the scalp.

Symptoms

• Itchiness
• Burning
• Stinging
• Scabs
• Bleeding
• Swollen and stiff joints

Risk Factors

Currently, the exact cause of psoriasis is unknown, although genetics may play a role.  Some triggers may aggravate symptoms and worsen the condition.  These triggers can include:

• Stress
• Injury, specifically to the skin
• Hormonal changes
• Increased alcohol consumption
• Smoking
• Some medications, such as ibuprofen, ACE inhibitors, and lithium
• Throat infections
• Some weather conditions, such as cold and dry weather
• Additional immune disorders, such as HIV
• Certain exposures

Importantly, psoriasis is not contagious, meaning that it does not spread from person to person.  Additionally, psoriasis can cause or aggravate other conditions such as:

• Arthritis
• Eye injections
• Diabetes
• High blood pressure
• Heart disease
• Celiac disease
• Sclerosis
• Crohn’s disease
• Mental health conditions like anxiety and depression

Diagnosing Psoriasis

A dermatologist’s expert opinion may be necessary to diagnose psoriasis.  There are multiple forms of psoriasis, meaning that a dermatologist can identify which form of psoriasis a person may have.

Forms of Psoriasis

• Plaque Psoriasis—This type of psoriasis is most common, and affects around 80 percent of people with psoriasis. Plaques, or scaly raised patches, can form anywhere on the body and commonly in the knees, elbows, and scalp.
• Guttate Psoriasis—Guttate psoriasis can occur after an infection of strep throat. A person may develop papules, or round spots that are raised.  They can appear on the arms, legs, torso, face, ears, and scalp.
• Inverse Psoriasis—People diagnosed with inverse psoriasis often have smooth skin, as opposed to the scaly, raised bumps typical of psoriasis. The smooth skin may be inflamed and reddened.  This form usually occurs in folds in the skin, like the underarm areas and genitals.  Inverse psoriasis is often very itchy and painful and worsened by sweat.
• Pustular Psoriasis—This form of psoriasis is categized by pustules, or pus-filled bumps, which may be surrounded by swollen or reddened skin.
• Erythrodermic Psoriasis—A rarer form of psoriasis, erythrodermic psoriasis can cause the skin to shed in large sheets. It usually affects the whole body and can cause severe itching, changes in heart rate, and nail changes.

Treating Psoriasis

There are multiple methods of treatment which may be used to treat psoriasis and alleviate symptoms.  Such treatment can include:

• Topical treatments—Topical treatments like creams and ointments can be applied directly to the skin to alleviate itch, swelling, and pain.
• Phototherapy—Light therapy which can use ultraviolet light to treat the skin.
• Systemic treatment—Oral medications or injections which can work throughout the whole body.

VA Service Connection for Psoriasis

To be granted VA service connection for psoriasis, you must first meet the elements of service connection:

• An in-service event, injury, or illness;
• A current diagnosis by a medical professional; and
• A medical nexus, or link, between your in-service event, injury, or illness and your current diagnosis.

The most crucial part of a claim for service connection for psoriasis will be to connect the psoriasis diagnosis to the veteran’s military service.  There are multiple ways this may be done:

Primary Service Connection—This form of service connection can be achieved if there is evidence that the veteran’s service directly caused their psoriasis.

Secondary Service Connection—This form of service connection can be achieved if the veteran’s psoriasis was developed as a result of another service-connected condition.  This could also apply if a veteran’s service-connected psoriasis caused them to develop another condition, in which case that second condition may be eligible for secondary service connection.  An example of this would be if a service-connected injury, such as a gash or cut or a scar, caused psoriasis.

Presumptive Service Connection—In some instances, the connection between a veteran’s psoriasis and their service may be presumptive, meaning that the burden of proof is not on the veteran to indicate that their service caused their psoriasis.  Usually, in order to qualify for this form of service connection, a veteran will need to have served in a specific location and time period.  An example of this may be if a veteran was exposed to Agent Orange and went on to develop psoriasis.

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Compensation and Pension (C&P) Exams for Psoriasis

Once a claim has been filed, VA may request a Compensation and Pension exam, or C&P exam.  This exam will usually be performed by a VA physician or VA contracted physician who may physically examine the veteran, as well as ask questions regarding the veteran’s military service, their psoriasis, or symptoms of their psoriasis.

To schedule a C&P exam, VA will usually call the veteran or send them a letter.  As such, it is crucial to ensure that VA has the veteran’s most up-to-date contact information.  If VA does not have the current contact information, the veteran might miss a C&P request.  Failure to attend an exam, or to reschedule a missed exam, could result in the denial of a veteran’s claim.

Prior to the exam, the examiner should review the veteran’s c-file.  The c-file will usually contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and military service records.

The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim.  A Disability Benefits Questionnaire is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities.  The veteran may also have their private doctor fill out a DBQ for them.  In the case of psoriasis, a dermatologist who regularly treats the veteran for their psoriasis may fill out a DBQ for the veteran to provide insight to VA.

How Does VA Rate Psoriasis?

VA rates skin conditions under 38 CFR § 4.118, Diagnostic Codes 7800-7833.  Psoriasis is listed under Diagnostic Code 7816.  Several skin conditions are rated based on the amount of skin that is affected.  VA’s rating schedule proposes two ways to determine this: calculations and estimations.

Skin area calculations take into account the surface area in inches squared that is affected whereas skin area estimations take into account the percentage of skin that is affected.  However, scars on the head, face, or neck are rated based on skin loss and how many facial features have been disfigured.

On the other hand, disability ratings for scars on areas of the body other than the head, face, or neck are generally based on the size of the scar.

The General Rating Formula for the Skin is included in 38 CFR § 4.118 and is used to rate the majority of skin conditions:

• “60% – at least one of the following: characteristic lesions involving more than 40% of the entire body or more than 40% 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% – at least one of the following: characteristic lesions involving 20-40% of the entire body, or 20-40% 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% – at least one of the following: characteristic lesions involving at least 5%, but less than 20%, of the entire body affected, or at least 5% but less than 20%, 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 fewer than 6 weeks over the past 12-month period
• 0% – 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% of the entire body affected; or characteristic lesions involving less than 5% 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.

For psoriasis, any complications that arise from the condition, such as psoriatic arthritis, are rated separately under their appropriate diagnostic code.

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Military Burn Pit Exposure and Psoriasis

Military burn pits are large areas of land in which the military and its contractors incinerated all waste generated by military bases, including plastics, medical waste, rubber, human waste, and more.

The U.S. Military used burn pits as part of their waste disposal protocol in places such as Iraq and Afghanistan in the post-9/11 era.  While the practice was effective in reducing large quantities of waste, burn pits emitted plumes of toxic smoke.  This was especially problematic in places such as the Middle East, as the desert wind carried the smoke for miles.

Many U.S. Military veterans have suffered health consequences from burn pit exposure.  Most of the negative effects involve temporary ailments of the respiratory system, though limited evidence suggests a link between burn pit exposure and the long-term deterioration of lung health.

These burn pits were used extensively throughout the Middle East and have affected veterans who served in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn.

Research continues to be done to link burn pit exposure to a variety of different conditions, such as cancers and respiratory conditions, but in order to fully understand the harm caused by military burn pits, much more research will need to be conducted.  However, research has indicated that one of the known chemical compounds released by burn pits includes the dioxin called TCDD which was also found in Agent Orange.

Some veterans who were exposed to military burn pits may have gone on to develop psoriasis, psoriatic arthritis, or both.  This has led many veterans who were exposed to these pits and have psoriasis or psoriatic arthritis to seek VA disability benefits.

While VA does acknowledge certain conditions as being eligible for presumptive service connection if the veteran can prove exposure to Agent Orange, VA has not established a presumption for veterans exposed to burn pits.  Since there is no presumption, VA adjudicates burn pit claims on a case-by-case basis.

VA does not have a consistent approach to deciding these claims, so lay evidence from veterans is key to winning burn pit claims. Often, VA does not have a way of proving veterans were near burn pits, so statements from the veteran themselves or buddy statements can help verify exposure.

New Proposed Burn Pit Legislation 2021

As of 2021, there are several major bills currently pending in Congress, that deal with the toxic exposure caused by burn pits.  These bills include:

• Conceding Our Veterans’ Exposure Now and Necessitating Training Act (COVENANT)
• Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
• Veterans Burn Pit Exposure Recognition Act
• Toxic Exposure in the American Military Act (TEAM)

If passed, any of these bills would offer much-needed relief to veterans suffering the toxic effects of burn pit exposure.

Call CCK Today for a Free Case Evaluation With the VA Disability Team at Chisholm Chisholm & Kilpatrick LTD

If you have previously been denied monthly VA disability benefits for your psoriasis, the veterans’ advocates at Chisholm Chisholm & Kilpatrick LTD may be able to assist you.  We are committed to helping veterans receive the benefits they deserve. For a free case evaluation, call us today at (800) 544-9144.