What is Chloracne?
Chloracne is a rare skin condition consisting of blackheads, cysts, and nodules, which has been linked directly to dioxin exposure. It is a well-established, long-term effect of exposure to TCDD or dioxin, a contaminant found in Agent Orange. More so, it is currently the only skin disorder that is consistently reported to be associated specifically with Agent Orange and other herbicides. Generally speaking, acne forms from overactive glands in the skin that produce and release oils. In regards to chloracne, the toxic chemicals resulting from exposure concentrate in these glands, break down slowly, and change the skin glands into cysts. Symptoms of chloracne include excessive oiliness of the skin and the appearance of numerous blackheads, often accompanied by fluid-filled cysts and dark body hair. In mild cases, the blackheads may be limited to the area around the eyes, extending along the temples to the ears. However, in severe cases, the blackheads may also appear in other places, including the cheek bone area, other facial areas, behind the ears, and along the arms. While mild cases of chloracne typically fade slowly after exposure or disappear altogether, more severe cases may persist for years after the exposure and lead to open sores and permanent scars.
Presumptive Service Connection for Chloracne due to Agent Orange Exposure
VA presumes chloracne in veterans is related to their exposure to Agent Orange or other herbicides during military service. When the disease appears within one year of exposure to Agent Orange to a degree of 10 percent disabling by VA’s rating regulations, service connection is awarded. VA mandates the one-year period after exposure because dioxin-associated chloracne presents shortly after exposure. Therefore, there is no risk of new cases occurring long after service in Vietnam, or such cases would not be related to Agent Orange exposure. Chloracne is rated as follows under 38 CFR § 4.118, Schedule of ratings – Skin using Diagnostic Code (DC) 7829:
- “30% – deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck
- 20% – 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)
- 10% – 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)
- 0% – superficial acne (comedones, papules, pustules) of any extent.”
Chloracne can also be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DC’s 7801, 7802, 7804, or 7805) depending upon the predominant disability.
How Did VA Determine Chloracne is Associated with Agent Orange Exposure?
As a requirement of the Agent Orange Act of 1991, the Institute of Medicine (IOM) must submit a report every two years, at a minimum, that reviews and summarizes the link between exposure to herbicides during service in Vietnam and certain diseases. The IOM concluded in its 1994 report on “Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam” as well as in its 2014 update and previous updates, that there is a positive association between chloracne and exposure to dioxin in Agent Orange.