A pilonidal cyst is a cystic structure that develops in the cleft at the top of the buttocks (the natal cleft / sacrococcygeal area). The cyst contains hair, debris, and skin cells and typically has one or more openings (sinuses) to the skin surface. When infected — which is common — the cyst becomes an abscess that causes:
Pilonidal cysts are not merely a nuisance — they are a significantly disabling condition when active. The pain from an infected pilonidal abscess is described by patients as among the most severe they experience, frequently requiring hospitalization for incision and drainage (I&D) under general anesthesia, followed by weeks of wound care and restricted activity.
The condition is chronic and prone to recurrence. Even after surgical excision — the definitive treatment — recurrence rates range from 10-40% depending on surgical technique, wound care compliance, and underlying risk factors. Many veterans experience multiple recurrences over years or decades following their military service.
VA's rating schedule (38 CFR Part 4) does not have a specific Diagnostic Code dedicated exclusively to pilonidal cysts. Instead, VA rates these conditions by analogy under 38 CFR § 4.20, which allows rating under the DC applicable to the "most nearly analogous" condition when the specific condition is not listed in the schedule.
The most commonly applied analogous codes for pilonidal cysts are:
In practice, VA most often rates active pilonidal disease (with cyst, sinus, and infection) under DC 7806 by analogy. Post-surgical residuals (scars, recurrent sinus tracts) may be rated under the scar DCs if more appropriate.
| Rating | Criteria (Applied by Analogy to Pilonidal Disease) |
|---|---|
| 0% | Asymptomatic; no active infection, no drainage, fully healed post-surgical state with no residuals. Pilonidal cyst present on imaging only. |
| 10% | Mild or intermittent symptoms; occasional recurrent minor infections or drainage managed without hospitalization; limited area involved |
| 30% | Moderate disease; frequent exacerbations requiring medical treatment (antibiotics, I&D); significant area with chronic sinus tract; recurring drainage; affects ability to sit for prolonged periods |
| 60% | Severe, widespread involvement; constant or near-constant symptoms; multiple sinus tracts; requires repeated surgical procedures; significant limitation of daily function |
Under the VA's general rating principles, your disability should be rated based on the average impact, including the frequency and severity of flare-ups. A veteran who is symptom-free most of the year but has 2-3 severe infected episodes requiring hospitalization and surgical drainage per year should be rated for the full picture — not just the quiet periods. Document every flare-up with dates, treatment, and functional impact.
The link between military service and pilonidal cysts was first formally documented during World War II. In 1944, Army physicians noted an extraordinary surge in pilonidal cyst cases among soldiers in vehicle-intensive roles — particularly Jeep drivers and passengers. The condition became so synonymous with military vehicle crews that it was widely called "Jeep Disease" in military medical literature of the era.
The mechanism is well understood:
Extended sitting creates constant direct pressure on the natal cleft, forcing hairs into the skin. The sacrococcygeal area, which has limited subcutaneous fat padding in the natal cleft, is particularly vulnerable to pressure-induced hair penetration. Long vehicle patrols, 12+ hour guard duty seated positions, and extended combat operations kept troops seated in these conditions for hours on end, day after day.
Tactical vehicles — HMMWVs (Humvees), Bradley Fighting Vehicles, M1 Abrams tanks, MRAPs, 5-ton trucks — transmit significant whole-body vibration to seated occupants. The vibratory forces repeatedly traumatize the natal cleft skin, creating micro-lacerations that serve as entry points for hair follicles and debris.
Military uniforms, particularly in warm climates, create significant friction in the gluteal cleft area. Combined with perspiration from heavy physical loads and heat, this friction environment promotes the follicular disruption that initiates pilonidal cyst formation.
The pilonidal cyst theory of acquired origin (now the dominant theory) holds that loose hairs — not necessarily the veteran's own — are drilled into the skin by repetitive mechanical forces. Vehicle interiors, heavy fabric seats, and shared equipment create an environment rich in hair and debris that can be forced into the natal cleft under seated pressure.
| Occupation/Branch | Specific Risk Exposure |
|---|---|
| Motor Transport Operators (Army 88M, Marine 3531) | Extended hours driving HMMWVs, 5-ton trucks, fuel tankers on rough terrain |
| Cavalry Scouts / Armor (19D, 19K) | Seated in Bradley IFVs, M1 tanks, Strykers on extended patrols |
| Aviation Crews (helicopter/fixed wing) | Seated flight operations in vibrating aircraft, 4-10+ hour missions |
| MRAP / Combat Vehicle Crews (Multiple MOS) | Extended QRF and patrol operations in MRAP, MATV, Cougar vehicles |
| Navy/Coast Guard Small Boat | Seated in small high-vibration patrol craft |
| Artillery Crews | Self-propelled artillery vehicles, extended field operations |
While these vehicle-heavy specialties are at highest risk, any service member who spent significant time seated in military vehicles, aircraft, or equipment is potentially at risk. Even infantry soldiers who spent time in trucks on extended convoys have a documentable exposure history.
Service connection follows the three-element standard under 38 CFR § 3.303. For pilonidal cysts, the pathways are:
The ideal service connection scenario: service treatment records document the pilonidal cyst, abscess, or surgical treatment during active duty. Many vehicle operators had pilonidal cysts diagnosed and treated while in service — the condition is well-known to military medical personnel, and treatment was common in garrison settings. If your STRs include any record of tailbone/sacral area cyst, abscess, I&D procedure, or pilonidal mention, you have direct service connection evidence.
Many veterans had pilonidal problems develop or worsen in the months following discharge, after the sustained occupational exposure ended. In these cases, a medical nexus letter must:
Veterans with any pre-service pilonidal history who experienced worsened frequency or severity during service can claim aggravation under 38 CFR § 3.306. The in-service vehicle exposure is a documented aggravating factor.
Pilonidal cysts have several surgical treatment options, each with different residual implications:
I&D is an emergency treatment, not a definitive cure. After I&D, the cyst cavity must heal by secondary intention (from inside out), requiring weeks of wound packing. Recurrence after I&D is nearly universal without definitive surgical excision. Veterans who had I&D without follow-up excision typically experience recurrent infections.
The cyst and primary sinus are surgically removed. Recurrence rates of 10-15% with primary closure; somewhat lower with open healing techniques (Bascom or Karydakis procedures).
For recurrent disease or large lesions, reconstructive procedures (Bascom cleft lift, rhomboid flap) are used. These procedures have lower recurrence but create significant post-surgical scars in the natal cleft area.
After any surgical approach, veterans may have:
The C&P exam for pilonidal disease may be conducted by a dermatologist, general surgeon, or primary care physician. Ensure a complete evaluation:
Need a Nexus Letter for Your Pilonidal Cyst Claim?
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Editorial Standards: Written by Marcus J. Webb, veterans benefits researcher. Verified against current 38 CFR regulations. Last reviewed: July 2026. Not legal advice — for representation, talk to a VA-accredited attorney.
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