Skin conditions are among the most prevalent — and most under-claimed — VA disabilities. Veterans are routinely exposed to industrial chemicals, herbicides, tropical pathogens, harsh environmental extremes, and chronic stress, all of which cause or aggravate skin conditions. Despite this, many veterans either never file skin condition claims or accept low ratings without understanding how the VA rating system actually works for dermatological conditions. This guide explains exactly how the VA rates psoriasis, eczema, dermatitis, and related skin conditions — and how to build a claim that accurately reflects your disability level.
Ratings governed by 38 CFR § 4.118 — Schedule of Ratings — Skin. See also: DC 7806 — Dermatitis or Eczema, DC 7816 — Psoriasis.
Why Skin Conditions Are Under-Claimed
Several factors combine to make skin conditions systematically under-claimed:
- Visibility bias: Veterans often think the VA only cares about "serious" conditions like PTSD or back injuries. Skin conditions feel less legitimate, even when they're debilitating.
- No nexus letter culture: Unlike orthopedic or mental health claims, skin claims don't usually require a nexus letter — but veterans don't know they can still claim them.
- Flare-pattern symptoms: Conditions like psoriasis are intermittent. Veterans are rated during a quiet period and receive 0%, not realizing they should be rated at their worst.
- Wrong diagnostic code: VA raters sometimes assign skin conditions to incorrect DCs, resulting in improper ratings. Knowing the correct code and pushing back matters.
- Chemical exposure stigma: Veterans exposed to fuels, solvents, defoliants, or burn pit smoke may not connect their skin condition to that exposure without explicit guidance.
Skin conditions can warrant ratings of 10%, 30%, or 60% — and 60% is not uncommon for veterans with severe psoriasis or eczema requiring ongoing biologics. These ratings add meaningfully to your combined disability rating.
DC 7806: The General Skin Rating Formula
The primary diagnostic code for dermatitis and eczema is Diagnostic Code 7806, found in 38 CFR Part 4, Schedule for Rating Disabilities, under the skin conditions diagnostic codes. DC 7806 covers "Dermatitis or eczema" and is the default code used when a specific skin condition doesn't have its own dedicated code.
The rating criteria under DC 7806 are based on two independent measures:
- Body surface area (BSA) affected — what percentage of your skin surface shows active disease
- Treatment intensity — whether you require systemic therapy and how frequently
Either threshold is sufficient to reach a given rating level. You don't need both — if your BSA involvement is high, you're entitled to the corresponding rating even if you're not currently on systemic therapy. Conversely, if you're using systemic therapy even for a moderate area of involvement, that treatment fact alone can trigger a higher rating.
Rating Criteria: 10%, 30%, and 60%
| Rating | Body Surface Area | OR Treatment Criteria |
|---|---|---|
| 10% | At least 5% but less than 20% of the entire body OR at least 5% but less than 20% of exposed areas affected | Intermittent systemic therapy (e.g., short courses of topical steroids, occasional oral steroids) |
| 30% | 20%–40% of body surface area affected | Systemic therapy required for 6 weeks or more during the past 12 months |
| 60% | More than 40% of body surface area affected | Constant systemic therapy required (year-round medication to control symptoms) |
The zero-percent rating applies when your skin condition exists but affects less than 5% of BSA and requires no systemic therapy. This is not the same as a denial — you're still service-connected, and the condition can be re-evaluated if it worsens.
Body surface area is estimated using the "Rule of Nines" in clinical practice. The hand palm (including fingers) equals approximately 1% BSA. The entire face is roughly 4.5%. One full arm is 9%. One full leg is 18%. This means widespread eczema affecting both arms plus the face could easily reach 20%+ BSA and qualify for the 30% rating threshold.
Psoriasis: DC 7816 vs. DC 7806
Psoriasis has its own dedicated diagnostic code: DC 7816. The rating criteria are substantively the same as DC 7806 — the same BSA thresholds (5–20%, 20–40%, 40%+) and the same systemic therapy triggers apply. The key reason this distinction matters:
The VA should use the specific diagnostic code (DC 7816 for psoriasis) rather than the general code (DC 7806 for dermatitis/eczema). If your psoriasis is rated under DC 7806 when it should be under DC 7816, the rating percentage may still be the same — but the diagnostic accuracy matters for future claims, appeals, and secondary condition relationships. Always verify your rating decision uses the correct DC for your specific diagnosis.
Other specific skin conditions with their own DCs include:
- DC 7800 — Burn scars
- DC 7801–7805 — Various scar conditions
- DC 7807 — Contact dermatitis
- DC 7809 — Discoid lupus erythematosus
- DC 7813 — Tinea (fungal infections)
- DC 7815 — Pemphigus
- DC 7816 — Psoriasis
- DC 7817 — Erythroderma
- DC 7820 — Chloracne (discussed below)
- DC 7822 — Papulosquamous disorders (seborrheic dermatitis, etc.)
If your condition is seborrheic dermatitis (dandruff/scalp) or atopic dermatitis (allergic eczema), it may have a more specific code. Ensure the VA rates your condition under the most accurate DC — it affects how the rating is analyzed on review and appeal.
Chloracne and Agent Orange: DC 7820
Veterans who served in Vietnam, or in other locations with Agent Orange/dioxin exposure, may develop chloracne — a severe acne-like skin condition caused by dioxin toxicity. Chloracne is rated under DC 7820 and is a presumptive condition for Agent Orange exposure.
This means if you were exposed to Agent Orange and develop chloracne, the VA presumes service connection without requiring you to prove causation. You only need to establish:
- You served in a qualifying location during qualifying dates, OR were otherwise exposed to dioxins/herbicides
- You have a current diagnosis of chloracne
Chloracne manifests as blackheads, cysts, and acneiform lesions, particularly on the face, ears, and neck. It can be persistent and disfiguring. If you served in Vietnam or in another Agent Orange exposure zone and have chronic skin problems that fit this description, discuss this with a dermatologist and file under the Agent Orange presumptive pathway.
Service Connection Pathways
Direct Service Connection
Direct service connection for skin conditions is often straightforward because military service involves documented exposures:
- Chemical exposure: Herbicides (Agent Orange, other defoliants), fuels (JP-8 jet fuel, diesel), industrial solvents, cleaning agents, paints, and insecticides are all known skin irritants and sensitizers
- Tropical environments: Prolonged hot, humid conditions with insect exposure, tropical organisms, and limited hygiene infrastructure cause fungal infections, tropical dermatoses, and chronic skin conditions
- Harsh environmental conditions: Extreme cold, wind, and sun exposure cause or aggravate skin conditions
- Biological and chemical warfare protective equipment: MOPP suits, chemical protective gear, and decontamination agents can cause contact dermatitis
PACT Act Claims
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act expanded VA presumptive conditions for toxic exposure, including skin conditions. Veterans who served in areas with documented burn pit exposure, open-air burn pit smoke, contaminated water, or other toxic exposures may be able to claim skin conditions as PACT Act presumptives. Use the PACT Act guide at claim.vet to determine if your service qualifies.
Secondary Service Connection
Skin conditions can also be established secondarily:
- Secondary to PTSD or anxiety: Stress is a well-documented trigger for psoriasis and eczema flares. If you have service-connected PTSD, a treating dermatologist or psychiatrist can provide a nexus opinion connecting your skin flares to your PTSD stress response.
- Secondary to medications: Some psychotropic or other medications prescribed for service-connected conditions cause drug-induced skin reactions. Document the medication, the prescribing indication, and the dermatological reaction.
- Secondary to immune dysregulation: Conditions affecting immune function, including some service-connected systemic diseases, can trigger or worsen autoimmune skin conditions like psoriasis.
The Systemic Therapy Key
One of the most powerful — and most misunderstood — aspects of DC 7806/7816 ratings is the systemic therapy criterion. Many veterans are rated at 10% when they should be rated at 30% or 60%, simply because they or their physician didn't document their treatment intensity accurately in terms of VA rating criteria.
Here's what counts as systemic therapy under the VA rating schedule:
- Oral corticosteroids (prednisone, methylprednisolone) — even short courses, if they're recurring
- Biologics (adalimumab/Humira, secukinumab/Cosentyx, ustekinumab/Stelara, guselkumab/Tremfya, ixekizumab/Taltz, and others) — these are injectable or infused medications that systemically modulate the immune response
- Oral immunosuppressants (methotrexate, cyclosporine, mycophenolate) — systemic disease-modifying agents
- PUVA/phototherapy in some contexts — though primarily topical, it may be considered systemic in certain protocols
- Oral retinoids (acitretin) — used for severe psoriasis
- JAK inhibitors (tofacitinib/Xeljanz, abrocitinib/Cibinqo for atopic dermatitis) — oral systemic agents
If you take a biologic like Humira or Cosentyx — even once every few weeks — for your psoriasis or eczema, you meet the systemic therapy criterion. This alone qualifies you for at least a 30% rating if the therapy is required for 6 weeks or more in any 12-month period, and 60% if it's constant. Make sure your dermatologist's records explicitly document the reason the biologic was prescribed (skin disease severity) and the dosing schedule.
Topical treatments alone (steroid creams, emollients, topical calcineurin inhibitors like Elidel/Protopic) do not meet the systemic therapy criterion. However, they document active disease and treatment, which is still relevant to your claim.
Evidence and Documentation
Building a strong skin condition claim requires the right combination of medical records, photographic evidence, and treatment documentation:
Dermatologist Records with BSA Assessment
The most important document in a skin condition claim is a dermatologist's note that includes a body surface area (BSA) assessment. Dermatologists routinely document BSA affected as part of standard assessments (using tools like the PASI score for psoriasis). Make sure your dermatologist notes the percentage of BSA affected at each visit. If they don't currently document this, ask them to start.
A dermatologist's record showing 22% BSA involvement directly places you in the 30% rating tier. Without that number, a VA rater may estimate lower.
Medication History
Your prescription history is powerful evidence. Obtain pharmacy records or a medication list that shows:
- The name and dosage of every prescription for your skin condition
- Fill dates and refill frequency (showing ongoing, not one-time, use)
- Any biologic infusion or injection records
A pattern of recurring oral steroid prescriptions, or a standing biologic prescription, directly demonstrates the systemic therapy threshold has been met.
Photographic Evidence
The VA now explicitly accepts photographic evidence for skin conditions. Photos can document:
- Active disease extent (supporting BSA estimates)
- Severity of lesions, plaques, or weeping areas
- Flare episodes not captured in clinic visits
Date-stamp your photos (most smartphone cameras embed metadata). Include a ruler or hand for scale when possible. Submit these directly with your claim or at your C&P exam.
Personal Statement
Write a detailed personal statement describing how your skin condition affects your daily life: sleep disruption from itching, self-consciousness limiting social activities, restrictions on physical activity, work limitations (e.g., gloves required, inability to work with certain materials), and the burden of ongoing treatment (time, cost, side effects).
The Flare Rule: 38 CFR 4.59
This is one of the most important — and most ignored — provisions in VA disability law for skin conditions: under 38 CFR 4.59, painful motion or, by extension, rating decisions should reflect the predominant disability level, not an average. For skin conditions, this principle has been interpreted to mean your rating should reflect the worst typical condition, not just what the examiner observed on one day during a quiet period.
Psoriasis and eczema are notoriously cyclical. You may have 5% BSA involvement on the day of your C&P exam but 35% BSA involvement during a bad flare two months earlier. If your medical records document those flares — with dermatologist notes, photographs, or increased medication prescriptions — the VA is supposed to rate you at the level reflecting your typical worst condition, not an artificially quiet snapshot.
Keep a flare diary. When you have a bad outbreak, photograph it, note the date and body areas affected, and visit your dermatologist (or at least call for a prescription refill — that creates a medical record). This documentation prevents the VA from rating you at your absolute best when your worst is much more representative of your disability.
Building Your Skin Condition Claim
Here's a step-by-step approach to a well-supported skin condition claim:
- Get a current dermatologist evaluation with explicit BSA documentation and a summary of your treatment history, including all systemic therapies used in the past 12 months
- Pull your pharmacy records for the past 2–3 years showing all prescriptions related to your skin condition, especially any oral steroids or biologics
- Compile photographic evidence of flares, with dates, showing BSA involvement beyond what might be visible during a calm period
- Write a personal statement explaining how the condition began or worsened during military service, what specific exposures or duties you connect it to, and how it impacts your life now
- Identify the correct diagnostic code — DC 7806 for general eczema/dermatitis, DC 7816 for psoriasis, DC 7820 for chloracne — and ensure your claim references the right one
- Consider secondary connection if you have service-connected PTSD or anxiety — a dermatologist or psychiatrist who understands the stress-skin flare relationship can provide a supporting opinion
- Use the rating estimator at claim.vet/tools/rating-estimator/ to understand how a 10%, 30%, or 60% skin rating interacts with your other conditions in the combined rating formula
Skin conditions are real disabilities. Chronic psoriasis disrupts sleep, causes social isolation, requires expensive treatment, and can be debilitating during flares. The VA's rating system acknowledges this — but only if you document your condition accurately and advocate for the rating tier your evidence actually supports.
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