Skin conditions: eczema, psoriasis and the exam

How VA rates skin conditions

38 CFR 4.118

Skin conditions are rated in 38 CFR 4.118. Most of them use one shared yardstick, the General Rating Formula for the Skin. It looks at two things: how much of your body (or of your exposed skin) the condition covers, and what kind of treatment you needed over the past 12 months.

The rule defines the two treatment types. Systemic therapy is treatment given by any route other than through the skin (by mouth, injection, suppository or nasally). Topical therapy is treatment applied through the skin.

Two or more skin conditions can be combined only if they involve separate areas of skin. If they involve the same area, only the highest evaluation is used.

The General Rating Formula for the Skin

38 CFR 4.118

VA uses the formula for dermatitis or eczema (7806), discoid lupus (7809), ringworm and other fungal infections (7813), bullous disorders (7815), psoriasis (7816), skin infections not listed elsewhere (7820), collagen-vascular skin disease (7821), papulosquamous disorders (7822) and keratinization diseases (7824). At each level, one of the listed items is enough:

• 60%: characteristic lesions over more than 40% of the whole body or of exposed areas, or constant or near-constant systemic therapy over the past 12 months.
• 30%: lesions over 20 to 40% of the body or exposed areas, or systemic therapy for a total of 6 weeks or more, but not constantly, over the past 12 months.
• 10%: lesions over at least 5% but less than 20% of the body or of exposed areas, or intermittent systemic therapy for a total of less than 6 weeks over the past 12 months.
• 0%: no more than topical therapy over the past 12 months, and lesions over less than 5% of the body or of exposed areas.

The formula also says that, depending on the predominant disability, the condition may instead be rated as disfigurement of the head, face or neck (DC 7800) or as scars (DCs 7801, 7802, 7804 or 7805). That instruction does not apply to DC 7824.

What counts as systemic therapy

38 CFR 4.118 General Rating Formula

The formula names these examples of systemic therapy, and says the list is “including, but not limited to”:

• Corticosteroids
• Phototherapy
• Retinoids
• Biologics
• Photochemotherapy, including PUVA (psoralen with long-wave ultraviolet-A light)
• Other immunosuppressive drugs

Under the rule’s own definition, systemic therapy means treatment given by a route other than through the skin. A steroid cream is topical. A steroid pill or injection is systemic.

Eczema, dermatitis and psoriasis

38 CFR 4.118, DC 7806, 7816, 7815

• Dermatitis or eczema (7806): rated under the General Rating Formula.
• Psoriasis (7816): rated under the General Rating Formula. The note says to rate complications such as psoriatic arthritis and other manifestations (for example the oral mucosa or nails) separately under the appropriate code.
• Bullous disorders (7815) (including pemphigus vulgaris, bullous pemphigoid and porphyria cutanea tarda): the General Rating Formula, with mucosal complications (eye, mouth, stomach and intestine, breathing or urinary and genital) rated separately.
• Ringworm and other fungal infections, such as athlete’s foot and jock itch (7813): the General Rating Formula.

Skin conditions with their own levels

38 CFR 4.118, DC 7817 to 7832

• Erythroderma (7817): up to 100% with generalized skin involvement, systemic manifestations (such as fever or weight loss) and constant systemic therapy or documented treatment failure; 60, 30, 10 and 0 for lesser levels.
• Chronic urticaria, hives (7825): 10% if antihistamines control it, 30% if second-line treatment is needed, 60% if it is refractory and needs third-line treatment. Chronic means continuous urticaria at least twice a week, off treatment, for six weeks or more.
• Vasculitis, primary cutaneous (7826): 10, 30 or 60, by how often episodes recur and what immunosuppressive therapy is needed.
• Erythema multiforme and toxic epidermal necrolysis (7827): 10, 30 or 60, by episodes and impairment of chewing, using the hands or walking.
• Acne (7828): deep acne on 40% or more of the face and neck 30%; less than 40%, or deep acne elsewhere, 10%; superficial acne 0%.
• Chloracne (7829): deep acne on 40% or more of the face and neck 30%; in skin folds such as the armpit, groin or between digits 20%; less than 40% of the face and neck or other body areas 10%; superficial 0%.
• Scarring alopecia (7830): over 40% of the scalp 20%; 20 to 40% 10%; under 20% 0%.
• Alopecia areata (7831): loss of all body hair 10%; limited to scalp and face 0%.
• Hyperhidrosis (7832): 30% if you cannot handle paper or tools because of moisture and it does not respond to therapy; 0% if you can after therapy.
• Vitiligo (7823): 10% with exposed areas affected; 0% with none.

Skin cancer and melanoma

38 CFR 4.118, DC 7818, 7819, 7833

Malignant skin neoplasms (7818), benign ones (7819) and malignant melanoma (7833) are rated as disfigurement of the head, face or neck, scars, or impairment of function.

The note gives a 100% evaluation from the date treatment starts if the cancer needs therapy comparable to that for systemic cancers: systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. It continues, with a mandatory VA exam six months after treatment ends, and then rates on residuals if there is no local recurrence or spread. If treatment is confined to the skin, the 100% provision does not apply.

When scars or disfigurement are the main problem

38 CFR 4.118, DC 7800 to 7805

Skin conditions that leave scars, or that mainly affect the head, face or neck, may be rated under the scar and disfigurement codes instead, depending on the predominant disability. DC 7800 (head, face and neck) counts “characteristics of disfigurement” such as a scar 5 inches or longer, or one at least a quarter inch wide.

For scars that are painful or unstable, see scar ratings under DC 7804.

Chloracne and the presumptive list

38 CFR 3.309(e)

Chloracne is on VA’s Agent Orange presumptive list, with a time limit. See presumptive conditions by era for the rule and who it covers. Once it is service connected, it is rated under DC 7829 above.

What VA’s skin diseases exam form covers

VA Skin Diseases DBQ (updated 2024-07-15)

• Diagnosis: a checklist of skin conditions, including eczema, psoriasis, acne, chloracne, urticaria and others.
• Treatment in the past 12 months: which medicines (corticosteroids or other immunosuppressives, antihistamines, retinoids, sympathomimetics, biologics), by what route (oral, injection, topical and others), and for how long: less than 6 weeks, 6 weeks or more but not constant, or constant or near-constant. Also phototherapy, PUVA and other procedures.
• Physical exam: the share of total body area and of exposed area (face, neck and hands) covered, in bands: none, under 5%, 5% to under 20%, 20% to 40%, and over 40%.
• Condition-specific questions for acne, chloracne, vitiligo, alopecia, hyperhidrosis, urticaria, vasculitis, erythroderma and erythema multiforme.
• Tumors, scarring and disfigurement, and functional impact on work.

The bands and the treatment categories on the form line up with the formula above. See Preparing for Your C&P Exam.

How skin ratings add up

38 CFR 4.118(b), 4.25

Separate skin ratings combine only when separate areas of skin are involved. If two skin conditions involve the same area, only the highest evaluation counts. Ratings that do combine are combined, not added. See Why 50% + 50% Is Not 100%. If a skin condition has worsened, see When To Ask VA For A Rating Increase.

What I could not verify

• The rating levels come from the eCFR text of 38 CFR 4.118 (current as of October 16, 2026). eCFR is unofficial, and the official text wins over me.
• I checked the skin exam form through a text reader of VA’s PDF, not line by line. The form itself is the authority.
• I did not research which skin conditions are linked to other conditions, service events or exposures, except what your presumptive-conditions page already says about chloracne.
• The page does not cover how VA measures percent of body area in practice, and I found no VA source that says how.