VA Updates Disability Rating Schedule Related to Skin Conditions
In August 2018, VA made updates to all 15 body systems included in the Veterans Affairs Schedule for Rating Disabilities to reflect modern medicine more accurately and provide clearer rating decisions. In doing so, VA made changes to how it evaluates conditions related to the skin. Although no conditions were removed from the new rating schedule for skin conditions, several diagnostic codes were restructured or revised. Importantly, claims pending prior to August 13, 2018 will be considered under both the old and new rating criteria, and whichever is more favorable will be applied. Overall, under the new rating schedule for skin conditions, VA broadly aims to distinguish between conditions that affect a large portion of the body, or the entire body, and conditions that are localized or require localized treatment.
How to Avoid Pyramiding When Rating Skin Conditions
Skin conditions are often difficult to categorize because each condition can have many different causes and symptoms. As such, veterans often run into problems with pyramiding – the VA term for rating the same disability, or same manifestation (i.e. symptom) of a disability, twice. However, multiple ratings for skin conditions can be given as long as each condition has a clear and distinct diagnosis and each condition affects a different area of skin. For a single condition that affects different skin areas, a single rating is given under that condition and takes into account all affected areas. For multiple conditions that affect the same area, VA will only rate the one that gives the higher rating.
How VA Rates Skin Conditions
VA rates skin conditions under 38 CFR § 4.118, Diagnostic Codes 7800-7833. A number of 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 less 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.
Theories of Service Connection for Skin Conditions
Direct service connection is a very common to pursue when trying to obtain VA disability benefits. To establish direct service connection for a skin condition, veterans will need to demonstrate the following:
- A current diagnosis of a skin condition
- An in-service event, injury, or illness related to the skin condition
- A medical nexus linking the current, diagnosed skin condition to the in-service event, injury or illness
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 veterans fall under certain criteria. Presumptive service connection means that veterans do not have to provide a medical nexus linking their condition to their time in service. Examples of presumptive service connection for skin conditions include the following:
- Veterans who were exposed to herbicide agents while serving in Vietnam and developed chloracne and/or porphyria cutanea tarda within one year of exposure to a degree of 10 percent disabling are afforded presumptive service connection.
- Gulf War veterans with chronic skin conditions (e.g. dermatitis) 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.