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VA Rating Assistant

DC 7813 · 38 CFR 4.118

Skin Diseases (Dermatitis / Psoriasis / Acne) C&P Exam Prep

To document the nature, severity, and extent of your skin condition for VA disability rating purposes under 38 CFR - 4.118. The examiner will assess the specific diagnosis, body surface area affected, treatment history, and functional impact to assign a rating under the General Rating Formula for the Skin.

Format:
Interview + Physical
Typical duration:
15-30 minutes
DBQ form:
Skin_Diseases (Skin_Diseases)
Examiner:
Dermatologist or appropriate clinician

What the examiner evaluates

  • Specific diagnosis and ICD code (e.g., dermatitis, psoriasis, acne, eczema)
  • Total body surface area (TBSA) affected expressed as a percentage
  • Exposed body surface area (EBSA) affected expressed as a percentage
  • Whether the condition is active or in remission
  • Type and complexity of medications required (topical, systemic, biologics, retinoids, corticosteroids, antihistamines, immunosuppressives)
  • Treatment history including phototherapy, photochemotherapy, electron beam therapy, and intensive light therapy
  • Involvement of special areas: palmar, plantar, mucosal, intertriginous, face and neck
  • Presence of erythroderma or exfoliative dermatitis
  • Complications such as psoriatic arthritis, nail involvement, oral mucosa involvement
  • Acne severity classification (superficial vs. deep inflamed nodules and cysts)
  • Vitiligo extent and distribution
  • Hyperhidrosis severity
  • Alopecia type and extent
  • History of resolved conditions and prior treatments
  • Impact on daily activities and occupational functioning

The examination will include both an interview about your medical history and symptoms AND a direct visual inspection of all affected skin areas. Wear clothing that allows easy access to all affected body regions. Bring a list of all current medications. The examiner must document TBSA and EBSA percentages for the rating to be sufficient, per M21-1 guidance. Photographs may be taken as part of the documentation.

Measurements and tests

Total Body Surface Area (TBSA) Assessment

What it measures: The percentage of your entire skin surface that is currently affected by the skin condition. This is a critical rating factor under the General Rating Formula for the Skin.

What to expect: The examiner will visually inspect all areas of your body, estimating the percentage of skin covered by lesions, plaques, rashes, or other manifestations. Common methods include the Rule of Nines or the palm method (each palm equals approximately 1% TBSA).

Critical thresholds

  • Less than 5% TBSA, or systemic therapy not required 0% - Condition present but minimal impact; may still be service-connected at 0%
  • At least 5% but less than 20% TBSA, OR; at least 20% TBSA but not requiring systemic therapy 10% - Moderate involvement with limited treatment requirements
  • 20% or more TBSA, OR; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period 30% - Significant involvement or systemic treatment burden
  • More than 40% TBSA involved, OR; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period 60% - Severe, widespread involvement or constant systemic treatment requirement

Tips

  • Do NOT apply topical treatments, creams, or moisturizers on the day of the exam so lesions are fully visible.
  • If your condition fluctuates, come to the exam during or just after a flare-up if possible, or bring photographic documentation of your worst presentation.
  • Point out ALL affected areas to the examiner, including scalp, behind ears, groin, underarms, between toes, and other areas that might be overlooked.
  • Ask the examiner to confirm they have documented the TBSA and EBSA percentages - this is required for a sufficient rating exam.
  • The examiner should assess your typical or worst-day presentation, not only what is visible that specific day.

Pain considerations: Although skin conditions are not musculoskeletal, note any pain, burning, stinging, or pruritus (itching) associated with your skin lesions, as this affects functional impairment documentation.

Exposed Body Surface Area (EBSA) Assessment

What it measures: The percentage of skin that is normally exposed to view (face, neck, hands, forearms, lower legs, feet) that is affected. EBSA is specifically referenced in M21-1 adjudication guidance as a required documentation element for skin condition DBQs.

What to expect: The examiner will separately note what percentage of typically exposed body areas (face, neck, hands, arms below elbow, legs below knee) are affected. This is relevant because visible skin conditions can independently affect occupational and social functioning.

Critical thresholds

  • Any EBSA involvement documented Supports higher rating when combined with TBSA thresholds; critical for demonstrating visibility-related occupational and social impact

Tips

  • Explicitly tell the examiner which exposed areas are affected, particularly face, neck, and hands.
  • Describe how visible lesions have affected your employment, social interactions, or daily activities.
  • If you have chloracne affecting the face and neck, note whether it covers less than 40% or 40% or more of the face and neck - this determines the specific acne rating level.

Pain considerations: Note any cosmetically disfiguring effects and psychological impact of visible skin lesions, including anxiety, depression, or social withdrawal.

Systemic Treatment Duration Assessment

What it measures: Whether your condition has required systemic therapy (oral or injectable corticosteroids, immunosuppressives, biologics, retinoids, antihistamines) and for how long during the past 12 months. Treatment duration is a primary rating driver under the General Rating Formula for the Skin.

What to expect: The examiner will review your medication list and medical history to determine cumulative weeks of systemic therapy in the past 12-month period. They will document each medication class: corticosteroids, biologics, immunosuppressives, retinoids, antihistamines, sympathomimetics, and others.

Critical thresholds

  • No systemic therapy, or systemic therapy less than 6 weeks total in past 12 months 10% range - treatment burden does not independently elevate rating above 10%
  • Systemic therapy 6 weeks or more but not constant in past 12 months 30% - significant treatment burden even without TBSA threshold being met
  • Constant or near-constant systemic therapy required during past 12 months 60% - maximum rating level supported by treatment burden alone

Tips

  • Bring a complete medication list including all prescription and over-the-counter treatments, with start dates and dosages.
  • Track and document how many weeks per year you require systemic medications - keep a medication diary or calendar.
  • If you take corticosteroid tapers (burst and taper cycles), each cycle counts toward cumulative systemic therapy weeks.
  • Biologic injections (e.g., adalimumab, secukinumab, dupilumab) count as systemic therapy - document frequency and duration.
  • If you have historically required systemic therapy but not currently due to medication access issues or side effects, ask the examiner to document the prior treatment history.

Pain considerations: Note any side effects from systemic medications (e.g., steroid-induced weight gain, bone density loss, immunosuppression leading to infections) as these represent additional disability burden.

Rating criteria by percentage

0%

Skin condition is diagnosed and service-connected but involves less than 5% total body surface area AND does not require systemic therapy. Minimal functional impact.

Key symptoms

  • Small, localized lesions covering less than 5% TBSA
  • Managed with topical treatments only (no systemic medications)
  • Minimal or no impact on daily activities
  • Condition may be stable or in remission

From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 0 percent - the condition is present and diagnosed but does not meet the 5% TBSA threshold and requires no systemic therapy. A 0% rating still establishes service connection, which is important for future increases.

10%

At least 5% but less than 20% total body surface area affected; OR; at least 20% TBSA but systemic therapy not required. Condition is manageable with topical or minimal treatment.

Key symptoms

  • 5% to less than 20% TBSA involvement
  • OR 20% or more TBSA but controlled with topical treatments only
  • Periodic flare-ups requiring increased topical treatment
  • Pruritus, scaling, or erythema present but limited
  • Intermittent impact on sleep or daily activities

From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 10 percent - at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period.

30%

20% or more total body surface area affected; OR systemic therapy (corticosteroids, immunosuppressives, biologics) required for 6 weeks or more but not constantly during the past 12-month period.

Key symptoms

  • 20% or more TBSA with active lesions
  • Requires systemic treatment 6 or more weeks per year
  • Significant pruritus, scaling, cracking, or weeping lesions
  • Sleep disruption due to itching or pain
  • Involvement of functionally or cosmetically significant areas (hands, face, genitalia)
  • Palmar or plantar involvement limiting fine motor function or ambulation
  • Flare-ups requiring steroid burst/taper cycles multiple times per year

From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 30 percent - 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

60%

More than 40% total body surface area affected; OR constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. This is the maximum rating under the General Rating Formula for the Skin.

Key symptoms

  • More than 40% TBSA with active disease
  • Constant systemic medication requirement (daily or near-daily use)
  • Severe, widespread plaques, weeping, or exfoliation
  • Erythroderma (generalized redness involving most of body surface)
  • Severely impaired ability to work, sleep, or perform self-care
  • Frequent hospitalizations or urgent care visits for skin condition
  • Biologic injections required continuously
  • Severe palmar and plantar involvement preventing occupational use of hands or normal ambulation
  • Mucosal involvement (oral, genital)
  • Significant scarring or permanent skin changes

From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 60 percent - more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period.

Describing your symptoms accurately

Extent of Skin Involvement

How to describe it: Describe affected body areas with specific location names and approximate surface coverage. Quantify using landmarks (e.g., 'plaques cover both forearms from wrist to elbow, both shins, and my entire lower back'). Mention whether involvement is constant or fluctuating.

Example: On my worst days, the plaques on my arms, legs, and back become inflamed, weeping, and cover what feels like half my body. I have measured by comparing to diagrams and estimate about 35-40% of my skin is affected during major flares, which happen 4-6 times per year and last 2-4 weeks each.

Examiner listens for: Specific body regions, estimated percentages, whether the condition is currently active or in remission, duration and frequency of flare-ups, and whether today's exam presentation is representative of typical severity.

Avoid: Do not say 'it comes and goes' without specifying how often and how severely. Do not minimize by saying 'it's not that bad right now' - explain that today may not represent your worst or average presentation.

Systemic Treatment Requirements

How to describe it: Provide a complete, chronological medication history. State each medication by name, dose, route (oral/injection), and how many weeks per year you use it. Distinguish between topical-only periods and periods requiring systemic treatment.

Example: I take oral prednisone approximately 3-4 times per year in 2-week tapers - that is about 6-8 weeks of systemic corticosteroids annually. I also receive biologic injections every two weeks year-round. Despite this, I continue to have significant flare-ups during high-stress periods.

Examiner listens for: Whether systemic therapy has been used for less than 6 weeks, 6 or more weeks, or constantly in the past 12 months. The examiner will ask about each drug class separately. Be prepared to name all medications including biologics, retinoids, immunosuppressives, and antihistamines.

Avoid: Do not forget to count all systemic treatments including injections, oral medications, and infusions. Do not omit short steroid tapers or 'burst' courses - each one counts toward your annual total.

Functional and Daily Life Impact

How to describe it: Describe specific activities you cannot perform or perform with difficulty due to your skin condition. Include work limitations, sleep disruption, social withdrawal, hygiene challenges, and limitations in use of hands or feet if palmar/plantar involvement is present.

Example: During flares my hands crack and bleed, making it impossible to grip tools or type at a computer for more than 20 minutes. The itching wakes me 3-4 times per night. I have missed work approximately 10-15 days per year due to severe flare-ups and have declined social invitations because of embarrassment about my visible skin lesions.

Examiner listens for: Concrete examples of functional impairment, occupational limitations, sleep disturbance, social/psychological effects, and whether visible lesions on exposed areas affect employment or social functioning. The examiner will complete the functional impact field on the DBQ.

Avoid: Do not say you 'manage fine' if you have made accommodations or sacrifices. Do not minimize psychological impacts such as depression, anxiety, or social isolation caused by your skin condition.

Flare-Up Pattern and Triggers

How to describe it: Describe how often flares occur, how long they last, what triggers them (stress, weather, chemicals, certain foods, infections), and how severe they become. Distinguish your 'baseline' presentation from your 'worst-day' presentation.

Example: I have major flares 4-6 times per year, each lasting 3-4 weeks. During these flares I cannot wear certain clothing because it sticks to weeping lesions. Minor flares occur more frequently, roughly monthly, lasting 1-2 weeks. My condition is never completely clear.

Examiner listens for: Frequency, duration, and severity of flare-ups; whether the condition ever achieves complete remission; and what the condition looks like between flares. The examiner needs to understand that a 'good day' during the exam may not be representative.

Avoid: Do not allow the examiner to assume that your condition looks the same year-round as it does on the day of the exam. Proactively state that today may be a relatively better day and describe your typical and worst presentations.

Special Area Involvement

How to describe it: Specifically call out involvement of palms, soles, face, neck, genitalia, intertriginous areas (armpits, groin, under breasts), oral mucosa, scalp, and nails. These areas carry special rating significance and functional implications.

Example: My psoriasis involves my palms and makes it painful to grip objects. The soles of my feet crack and bleed making it difficult to walk long distances. I have nail pitting on all ten fingers. I also have oral mucosal plaques that my dentist has noted.

Examiner listens for: Whether palmar involvement (hands) or plantar involvement (feet) is present, as these are specifically noted on the DBQ. Mucosal involvement, nail changes, and facial/neck involvement percentage (less than 40% vs. 40% or more of face and neck for acne rating) are separately documented.

Avoid: Do not omit areas that are covered by clothing during the exam. Proactively show or describe all affected areas including scalp, genitalia, and intertriginous zones.

Acne-Specific Severity (if applicable)

How to describe it: Distinguish between superficial acne (comedones, papules, pustules) and deep acne (inflamed nodules and pus-filled cysts). Specify what percentage of face and neck is affected and whether body areas beyond face and neck are involved.

Example: I have deep cystic acne with inflamed nodules covering more than 40% of my face and neck, extending to my chest and upper back. I have required multiple courses of oral antibiotics and isotretinoin (a retinoid) over the past three years.

Examiner listens for: Whether acne is superficial or deep/cystic (nodular), what percentage of face and neck is involved (under 40% vs. 40% or more), whether body areas beyond face and neck are affected, and chloracne diagnosis if applicable.

Avoid: Do not describe cystic nodular acne as just 'bad acne.' Use the clinical language: deep inflamed nodules and pus-filled cysts. Do not underreport face and neck surface area involvement.

Common mistakes to avoid

Applying skincare products, moisturizers, or topical treatments immediately before the exam

Why: Topical treatments can temporarily reduce redness, scaling, and the visible extent of lesions, causing the examiner to underestimate the true TBSA affected and potentially resulting in a lower rating.

Do this instead: Do not apply any topical treatments on the morning of the exam. Allow your skin to present in its natural state so the examiner can accurately assess the full extent of involvement.

Impact: 10% vs 30% or 30% vs 60%

Only mentioning current medications and not the full 12-month treatment history

Why: The rating criteria for 30% and 60% are based on how many weeks of systemic therapy were required during the PAST 12 MONTHS. If you are not currently on systemic therapy but were for many weeks earlier in the year, the examiner may miss critical rating evidence.

Do this instead: Bring a written medication history documenting every systemic medication used in the past 12 months, including dates and duration of each course. Include steroid tapers, antibiotic courses, biologic injection schedules, and immunosuppressive courses.

Impact: 10% vs 30% or 30% vs 60%

Attending the exam on a good day and not explaining that it is not representative

Why: Skin conditions fluctuate significantly. If the examiner only sees a mild presentation on exam day, they may document only what is visible and assign a lower rating that does not reflect the typical or worst-day severity.

Do this instead: Proactively tell the examiner: 'Today is a relatively better day. My typical presentation and worst-day presentation are more severe.' Bring dated photographs showing your condition during flares. Provide a brief written symptom log.

Impact: 10% vs 30% or 30% vs 60%

Failing to show all affected body areas during the physical examination

Why: The examiner can only document what they observe. If you do not show your scalp, groin, underarms, soles of feet, or genitalia, these affected areas will not be counted toward TBSA, and your rating will be based on an incomplete picture.

Do this instead: Remove clothing as needed and actively direct the examiner to every affected area. Say: 'I also need to show you my scalp, my armpits, and the soles of my feet - these areas are also affected.'

Impact: 10% vs 30%

Not mentioning palmar and plantar involvement specifically

Why: Palmar (hands) and plantar (feet) involvement are specifically documented on the DBQ and carry functional significance. If the examiner does not specifically check these fields, this important involvement may be omitted from the rating evidence.

Do this instead: Explicitly state whether your palms or soles are affected, how severe the involvement is, and how it limits your ability to use your hands or walk. Show any cracking, scaling, or lesions on these areas.

Impact: 30% vs 60%

Describing condition in vague terms without specific functional impacts

Why: The DBQ includes a field asking the examiner to describe the impact on the veteran's daily activities and occupation. If you only describe symptoms without explaining functional consequences, the examiner may not fully document impairment.

Do this instead: Prepare specific examples: 'My skin condition causes me to miss X days of work per year, prevents me from wearing certain uniforms or protective equipment, wakes me X times per night, and prevents me from performing tasks requiring hand grip.' Use concrete numbers and examples.

Impact: All rating levels

Failing to mention psoriatic arthritis or other complications separately

Why: Under 38 CFR - 4.118 DC 7816, psoriatic arthritis and other clinical manifestations such as nail and oral mucosa involvement are rated SEPARATELY from the skin condition. If you do not mention these, they may not be documented or claimed.

Do this instead: Separately describe any joint pain, stiffness, or arthritis-like symptoms and ask whether a separate musculoskeletal DBQ should be completed. Mention nail pitting, nail dystrophy, or oral mucosal plaques explicitly.

Impact: Separate secondary condition claims

Underreporting biologic medication as 'just a shot' without clarifying it is systemic immunosuppressive therapy

Why: Biologic medications (e.g., adalimumab, secukinumab, dupilumab, ustekinumab) are systemic treatments that count toward the systemic therapy duration thresholds. If described vaguely, the examiner may not properly categorize them.

Do this instead: Name each biologic by its full name and brand name, state the dosing frequency (e.g., every two weeks, monthly), and confirm with the examiner that it is being documented as systemic/biologic therapy on the DBQ.

Impact: 30% vs 60%

Prep checklist

  • critical

    Gather complete 12-month medication history

    Create a written list of all systemic medications used in the past 12 months for your skin condition: corticosteroids (oral/injectable), immunosuppressives (methotrexate, cyclosporine, mycophenolate), biologics (adalimumab, secukinumab, dupilumab, ustekinumab, ixekizumab), retinoids (isotretinoin, acitretin), antihistamines (cetirizine, hydroxyzine), and any others. Include start date, end date or duration, and dosage for each. Calculate total weeks of systemic therapy in the past 12 months.

    before exam

  • critical

    Take dated photographs of worst-day skin presentation

    Use a smartphone to photograph all affected areas during active flares. Ensure photos are dated (use phone timestamp or write date on a piece of paper in the photo). Cover all body areas: face, scalp, ears, neck, chest, back, arms, hands, palms, legs, feet, and soles. Bring printed or digital copies to the exam. Include a ruler or coin for scale reference if possible.

    before exam

  • critical

    Write a symptom impact statement

    Prepare a 1-2 page written description of how your skin condition affects you: average days of work missed per year, sleep disruption frequency and cause, activities you cannot perform, accommodations you have made (special clothing, avoiding sun, air conditioning requirements), social withdrawal, and psychological impact. Include specific numbers where possible (e.g., '10-15 missed work days per year,' 'woken 3-4 times per night').

    before exam

  • critical

    Obtain and review all relevant medical records

    Gather treatment records from your dermatologist, primary care provider, and any specialists. Include biopsy reports confirming diagnosis, lab work related to skin condition monitoring (e.g., CBC for methotrexate monitoring), records of prior hospitalizations for skin condition, and documentation of phototherapy or photochemotherapy treatments received.

    before exam

  • critical

    Identify all affected body areas and estimate TBSA

    Before the exam, use a body diagram to mark all affected areas. Use the 'rule of nines' (head=9%, each arm=9%, each leg=18%, front torso=18%, back torso=18%, genitalia=1%) or palm method (1 palm = ~1% TBSA) to estimate your typical and worst-day TBSA percentage. Write this estimate down to share with the examiner if asked.

    before exam

  • recommended

    Check your state's rules on recording C&P examinations

    Many states permit veterans to record their C&P examination. Contact your VSO or check your state's recording consent laws. If permitted, prepare to use your smartphone to record audio or video of the exam. Recording protects you if exam findings are later disputed.

    before exam

  • recommended

    Request a VSO review of your claim prior to exam

    Ask a Veterans Service Organization (VSO) representative to review your claim file (C-file) before the exam to confirm what conditions are being evaluated, ensure no relevant records are missing, and identify any prior exam reports that may need to be addressed.

    before exam

  • recommended

    Note all psoriasis complications separately

    If you have psoriasis, document any joint pain (psoriatic arthritis), nail changes (pitting, onycholysis, discoloration), or oral mucosal involvement separately. These must be claimed and rated independently under appropriate diagnostic codes per the DC 7816 note in 38 CFR - 4.118.

    before exam

  • critical

    Do NOT apply topical treatments before the exam

    Avoid applying any creams, ointments, moisturizers, calcineurin inhibitors, vitamin D analogues, or coal tar preparations on the day of the exam. Allow lesions to present in their natural, untreated state so the examiner can accurately assess full extent and severity.

    day of

  • critical

    Wear clothing that allows easy access to all affected areas

    Wear loose, easy-to-remove clothing so you can quickly show all affected body areas during the physical examination. Consider wearing a button-down shirt, shorts or loose pants, and easily removable socks and shoes. If your scalp is affected, do not style hair in ways that hide scalp plaques.

    day of

  • critical

    Bring all documentation to the appointment

    Bring: written medication history, dated photographs of worst-day presentation, written symptom impact statement, list of all current and recent medications in original bottles if possible, and any medical records not already in your VA file. Have a copy for the examiner and keep your own copy.

    day of

  • recommended

    Arrive early and request documentation review confirmation

    Arrive at least 15 minutes early. When you meet the examiner, confirm they have reviewed your medical records and claims file before the physical exam begins. If they have not reviewed records, politely request they do so.

    day of

  • critical

    Proactively state that exam day may not be your worst or typical presentation

    At the start of the interview, clearly state: 'I want you to know that today may be a relatively better day for my skin condition. My typical presentation and worst-day presentation are more extensive. I have photographs documenting my condition during flares, which I would like you to review and include in your assessment.'

    during exam

  • critical

    Show every affected body area - do not wait to be asked

    Actively direct the examiner to each affected area: 'I also need to show you my scalp, my underarms, behind my knees, my palms, and the soles of my feet.' Do not assume the examiner will think to look at all areas. Point out any areas covered by clothing.

    during exam

  • critical

    Confirm TBSA and EBSA documentation

    Before concluding the exam, ask the examiner: 'Have you documented both the total body surface area (TBSA) percentage and the exposed body surface area (EBSA) percentage affected? Per VA guidance, both are required for a sufficient skin exam report.' This is a critical requirement per M21-1.

    during exam

  • critical

    Describe all systemic medications and confirm they are documented

    Go through your medication list with the examiner and confirm each systemic medication is being recorded. Ask: 'Are you documenting my biologic injection as systemic therapy? Are you recording the total weeks of corticosteroid use in the past 12 months?' Verify the examiner records the medication class and duration fields.

    during exam

  • critical

    Describe functional impacts with specific examples

    When asked about impact on daily activities, provide concrete examples: 'My skin condition causes me to miss approximately X days of work per year. I cannot wear certain fabrics. I am unable to grip tools during flares. I wake up X times per night due to itching. I avoid social situations because of visible lesions on my face and hands.'

    during exam

  • recommended

    Submit photographs to the examiner and request they be included

    Physically hand your dated flare photographs to the examiner and ask them to be attached to or referenced in the exam report. State: 'These photographs are dated and show my condition during active flares, which is more representative of my typical severity than today's presentation.'

    during exam

  • recommended

    Mention all special area involvement explicitly

    Explicitly mention whether you have palmar involvement (hands), plantar involvement (feet), mucosal involvement (oral or genital), nail changes, intertriginous area involvement (armpits, groin), or facial and neck involvement. These are specifically documented fields on the DBQ and directly affect your rating.

    during exam

  • critical

    Request a copy of the completed DBQ or exam report

    After the exam, request a copy of the completed DBQ through your MyHealtheVet portal or by requesting your C-file. Review it for accuracy - particularly verify that TBSA and EBSA percentages are documented, all medications are listed, and functional impacts are described.

    after exam

  • critical

    Check for exam sufficiency issues

    Review the exam report to confirm: (1) TBSA percentage is documented, (2) EBSA percentage is documented, (3) systemic therapy duration in past 12 months is specified, (4) all affected body areas are listed including special areas, (5) functional impact is described. If any of these are missing, the exam may be insufficient for rating and you can request a new exam or submit a letter identifying the deficiency.

    after exam

  • recommended

    File a buddy statement or personal statement if exam was inadequate

    If the examiner only briefly examined you, did not document all areas, or produced a report inconsistent with your actual condition, submit a personal statement (VA Form 21-4138) describing the discrepancy. Consider obtaining a private medical opinion from a dermatologist if the VA exam significantly underestimates your condition.

    after exam

  • optional

    Consult VSO about rating decision appeal options if applicable

    If you receive a rating that does not align with the rating criteria based on your documented TBSA and systemic therapy history, consult a VSO about filing a Supplemental Claim, Reconsideration, or Board of Veterans Appeals (BVA) appeal. Include additional evidence such as private dermatologist opinions and treatment records.

    after exam

Your rights during a C&P exam

  • You have the right to record your C&P examination in most states - check your state's consent laws and your specific exam facility's policy before recording.
  • You have the right to request that the examiner review your complete medical records and claims file before conducting the examination.
  • You have the right to submit photographs, personal statements, buddy statements, and private medical opinions as supporting evidence for your claim.
  • You have the right to request a new C&P examination if the original exam report is insufficient - for skin conditions, the DBQ must document TBSA and EBSA percentages or it may be considered insufficient for rating purposes per M21-1 guidance.
  • You have the right to submit a Notice of Disagreement (NOD) or request a Higher-Level Review if you believe the rating decision does not accurately reflect the rating criteria.
  • You have the right to obtain a copy of your C-file (claims file) and all exam reports - request this through your VSO or by submitting VA Form 20-10206 (Freedom of Information Act Request).
  • You have the right to have a VSO representative present during your C&P examination in some circumstances - contact your VSO in advance to explore this option.
  • You have the right to receive a private independent medical examination and submit it as evidence, even if VA has already completed their C&P exam.
  • Under 38 CFR - 4.7, when there is reasonable doubt regarding the degree of disability, such doubt shall be resolved in the veteran's favor - this applies to determining TBSA percentages and treatment duration when records are ambiguous.
  • Under the benefit-of-the-doubt standard (38 CFR - 3.102), when there is an approximate balance of positive and negative evidence, the claim shall be resolved in favor of the veteran.
  • Complications of psoriasis (e.g., psoriatic arthritis per DC 7816 note) must be rated separately under appropriate diagnostic codes - you have the right to claim and be rated for all manifestations of a service-connected condition.
  • You have the right to claim secondary conditions caused or aggravated by your service-connected skin condition, such as depression, anxiety, or secondary infections, under 38 CFR - 3.310.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.