DC 7824 · 38 CFR 4.118
Skin Diseases (Dermatitis / Psoriasis / Acne) C&P Exam Prep
To document the nature, severity, and extent of your skin condition(s) for VA disability rating purposes under 38 CFR - 4.118. The examiner will assess body surface area affected, treatment history, and functional impairment 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
- Total body surface area (TBSA) affected by the condition (expressed as a percentage)
- Exposed body surface area affected (expressed as a percentage)
- Whether affected areas are on exposed vs. non-exposed body surfaces
- Specific diagnosis and ICD code (dermatitis/eczema, psoriasis, acne, infections, etc.)
- Whether condition involves intertriginous areas (armpits, groin, between skin folds)
- Whether palmar (palm) or plantar (sole) involvement is present
- Whether mucosal surfaces are involved
- Whether erythroderma (widespread skin redness) is present
- Active vs. remission status and frequency of flare-ups
- Current medications and treatment line (first, second, third-line)
- Whether systemic medications such as corticosteroids, biologics, retinoids, or immunosuppressives are required
- History and course of the condition including onset
- Functional impairment in occupational and daily activities
- Presence of complications such as scarring alopecia, vitiligo, hyperhidrosis, or vasculitis
- Whether condition was previously resolved or is currently active
- Phototherapy or photochemotherapy treatment history
The examiner will visually inspect affected skin areas and document measurements. You may be asked to expose affected areas of skin. The exam may be conducted in-person or via telehealth. Bring a list of all current medications, prior treatment records, and photographs taken on your worst days if available. You have the right to request exam recording in most states - check your state's laws before the exam.
Measurements and tests
Total Body Surface Area (TBSA) Affected
What it measures: The percentage of the entire body's skin surface covered by the active skin condition. This is the single most critical measurement for determining your disability rating under the General Rating Formula for the Skin.
What to expect: The examiner will visually assess and estimate what percentage of your total body surface is affected. Common clinical estimation uses the 'Rule of Nines' (head=9%, each arm=9%, each leg=18%, trunk front=18%, trunk back=18%). The examiner documents this as a percentage and records it on the DBQ.
Critical thresholds
- Less than 5% TBSA 0% - No compensable rating if no systemic therapy required
- 5% to less than 20% TBSA, or; at least 5% TBSA if in an exposed area, or; intermittent systemic therapy required for a total duration of less than six weeks during the past 12-month period 10% rating
- 20% to less than 40% TBSA, or; at least 20% TBSA if in an exposed area, or; systemic therapy required for a total duration of six weeks or more, but not constantly, during the past 12-month period 30% rating
- 40% or more TBSA affected, or; at least 40% TBSA if in an exposed area, or; constant or near-constant systemic therapy required during the past 12-month period 60% rating
Tips
- On your worst days, your affected area may be significantly larger than on the exam day - tell the examiner explicitly what your TBSA looks like during flare-ups, not just on the day of exam.
- Ask the examiner to document both your 'exam-day' TBSA and your 'worst-day' TBSA during flare-ups.
- Consider bringing dated photographs showing your worst flare episodes to give the examiner an accurate picture.
- Know the approximate percentage of your body that is regularly affected - prepare this estimate before the exam.
Pain considerations: Skin conditions can cause significant pain, burning, itching, and discomfort. Clearly communicate the pain level associated with your skin condition, especially during flare-ups, and how it affects your ability to sleep, work, and perform daily activities.
Exposed Body Surface Area (Exposed TBSA) Affected
What it measures: The percentage of exposed body surface area (areas visible without clothing, such as face, neck, hands, forearms) affected by the skin condition. Involvement of exposed areas can result in a higher rating at lower TBSA thresholds due to social, occupational, and psychological impact.
What to expect: The examiner specifically notes whether affected areas are on exposed skin (face, neck, hands, arms below sleeve line). The DBQ requires this to be documented separately from total TBSA. Per M21-1, both TBSA and exposed TBSA must be documented or the exam may be considered insufficient for rating.
Critical thresholds
- At least 5% of exposed body surface area affected 10% rating (even if total TBSA is less than 5%)
- At least 20% of exposed body surface area affected 30% rating (even if total TBSA is less than 20%)
- At least 40% of exposed body surface area affected 60% rating (even if total TBSA is less than 40%)
Tips
- If your condition affects your face, neck, or hands, emphasize this clearly - these are high-value areas for rating purposes.
- Describe any social embarrassment, avoidance of public situations, or work-related impacts caused by visible skin lesions.
- If your acne or dermatitis affects 40% or more of your face and neck, this is specifically captured on the DBQ (field for 'Affects 40% or more of face and neck').
Pain considerations: Involvement of exposed areas such as hands can interfere with gripping, fine motor tasks, and handwashing, and can cause chronic discomfort. Describe these functional impacts explicitly.
Systemic Therapy Assessment
What it measures: Whether and for how long systemic medications (oral or injectable treatments affecting the whole body, not just topical) were required over the past 12 months. This is an independent pathway to a higher rating regardless of TBSA percentage.
What to expect: The examiner will review your medication history and ask about systemic treatments including oral corticosteroids, immunosuppressives (methotrexate, cyclosporine), biologics (Humira, Dupixent, Stelara, Cosentyx, etc.), retinoids (isotretinoin, acitretin), antihistamines, and sympathomimetics. The examiner documents whether therapy was intermittent (less than 6 weeks), required for 6+ weeks, or required constantly/near-constantly.
Critical thresholds
- No systemic therapy required Supports 0% if TBSA also below threshold
- Intermittent systemic therapy less than 6 total weeks in past 12 months Supports 10% rating
- Systemic therapy required 6+ weeks but not constantly in past 12 months Supports 30% rating
- Constant or near-constant systemic therapy required in past 12 months Supports 60% rating
Tips
- Bring a complete, accurate medication list including start dates, stop dates, and dosages for all systemic skin medications.
- Include biologics (self-injected or infused), oral immunosuppressants, systemic steroids, oral retinoids, and prescription oral antihistamines.
- If you take a biologic continuously (e.g., every 2 weeks or monthly), this is 'constant' systemic therapy - state this clearly.
- If you have had multiple short courses of oral prednisone for flares, add up the total weeks per year and communicate this to the examiner.
- Do not understate your medication regimen - accurately reporting your systemic therapy use is critical for an accurate rating.
Pain considerations: Side effects of systemic therapy (e.g., immunosuppression risk, liver monitoring for methotrexate, mood effects from steroids) represent additional burden. Mention these side effects and monitoring requirements to demonstrate the severity of your condition.
Intertriginous, Palmar, and Plantar Area Assessment
What it measures: Whether skin disease involves skin folds (axilla/armpits, groin, under breasts, between toes), palms of hands, or soles of feet. These locations carry special rating significance for certain conditions such as psoriasis and eczema.
What to expect: The examiner will check for involvement in these specific high-impact locations. The DBQ has dedicated fields for palmar involvement (with episode frequency) and plantar involvement (with episode frequency). Intertriginous area involvement is separately documented.
Critical thresholds
- Involvement of intertriginous areas (armpits, groin, skin folds) Affects location-based rating criteria and severity documentation
- Palmar or plantar involvement with episodic flares Can affect functional impairment rating and frequency-based documentation
Tips
- If your condition affects your palms, describe how this impacts your ability to grip, use tools, type, or perform manual tasks.
- If plantar involvement causes pain with walking or standing, describe how this limits your mobility and daily function.
- Describe whether palmar or plantar episodes are constant, intermittent, or triggered by specific activities.
Pain considerations: Palmar and plantar psoriasis or eczema can be extremely painful and functionally disabling. Describe pain with pressure, walking, or use of hands in concrete terms (e.g., 'I cannot stand for more than 20 minutes without severe burning on the soles of my feet').
Rating criteria by percentage
0%
No disability, or less than 5% of the total body surface area OR less than 5% of the exposed body surface area affected; no systemic therapy required. Condition may be present but compensable threshold is not met.
Key symptoms
- Minimal skin involvement affecting less than 5% TBSA
- No systemic medications required
- Condition controlled with topical treatments alone
- No involvement of exposed areas meeting threshold
From 38 CFR: Under the General Rating Formula for the Skin (38 CFR - 4.118), a 0% noncompensable rating applies when the condition does not meet the 5% TBSA or exposed area threshold and requires no systemic therapy.
10%
At least 5% but less than 20% of the total body surface area affected; OR at least 5% of exposed body surface area affected; OR intermittent systemic therapy required for a total duration of less than six weeks during the past 12-month period.
Key symptoms
- 5-19% TBSA covered by active skin disease
- Visible lesions on face, neck, hands, or forearms (exposed areas meeting 5% threshold)
- Intermittent oral steroids (e.g., one or two short courses per year totaling under 6 weeks)
- Occasional prescription antihistamines or short-course systemic therapy
- Periodic flare-ups requiring medical attention
- Itching, scaling, redness, or plaques in multiple areas
From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 10% - at least 5% but less than 20% of the total body surface area affected; or at least 5% of the exposed body surface area affected; or intermittent systemic therapy used for a total duration of less than six weeks during the past 12-month period.
30%
At least 20% but less than 40% of the total body surface area affected; OR at least 20% of exposed body surface area affected; OR systemic therapy required for a total duration of six weeks or more, but not constantly, during the past 12-month period.
Key symptoms
- 20-39% TBSA covered by active skin disease
- Significant visible involvement of face, neck, or hands (20%+ exposed area)
- Multiple courses of systemic therapy totaling 6+ weeks per year (but not year-round)
- Repeated flare-ups requiring systemic steroids, methotrexate, cyclosporine, or similar
- Significant impact on sleep, work, and social functioning
- Oozing, crusting, extensive scaling, or painful plaques
- Involvement of intertriginous areas causing functional limitation
From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 30% - at least 20% but less than 40% of the total body surface area affected; or at least 20% of the exposed body surface area affected; or systemic therapy required for a total duration of six weeks or more, but not constantly, during the past 12-month period.
60%
At least 40% or more of the total body surface area affected; OR at least 40% of the exposed body surface area affected; OR constant or near-constant systemic therapy required during the past 12-month period.
Key symptoms
- 40% or more TBSA covered by active skin disease
- 40% or more of exposed body surface area affected
- Year-round continuous systemic therapy (daily biologic injections, daily immunosuppressants, constant oral steroids)
- Near-constant flaring requiring ongoing systemic management
- Severe functional impairment in work and daily activities
- Erythroderma (widespread redness and peeling across body)
- Significant psychological and social impact
- Multiple hospitalizations or urgent care visits for skin condition
- Palmar or plantar involvement severely limiting use of hands or ambulation
From 38 CFR: Under 38 CFR - 4.118 General Rating Formula for the Skin: 60% - at least 40% of the total body surface area affected; or at least 40% of the exposed body surface area affected; or constant or near-constant systemic therapy required during the past 12-month period.
Describing your symptoms accurately
Body Surface Area and Flare Severity
How to describe it: Describe both your current presentation AND your typical worst-day presentation. State the approximate percentage of your body covered during a flare. Use anatomical landmarks: 'During flares, plaques cover my entire back (18%), both arms (18%), and my scalp and face (9%), totaling approximately 45% of my body surface area.'
Example: On my worst days, I have thick, cracked, bleeding plaques covering my entire trunk, both arms, and my face. My skin is so inflamed and painful that I cannot wear normal clothing or sleep in a comfortable position. This happens at least 4-6 times per year and lasts 2-3 weeks at a time.
Examiner listens for: Specific percentage estimates, descriptions of which body regions are involved, frequency and duration of severe flares, and whether the exam-day presentation is typical or represents a better-than-average day.
Avoid: Do not say 'it's not that bad today' without clarifying that today may not reflect your typical or worst state. Do not say 'just a little rash' - use accurate, specific language about coverage and severity.
Systemic Treatment Burden
How to describe it: List every systemic medication you have taken in the past 12 months, including how long you took it. Distinguish topical treatments from systemic ones. State whether you are currently on continuous systemic therapy (e.g., 'I inject Dupixent every two weeks without interruption - I have done this continuously for 18 months').
Example: I take methotrexate weekly and have done so for the past 8 months continuously. I have also had four courses of prednisone this year totaling approximately 10 weeks. Without these medications, my skin becomes completely unmanageable within days.
Examiner listens for: Total weeks of systemic therapy in the past 12 months, whether therapy is continuous vs. intermittent, names and classes of medications, and whether therapy is required to prevent severe flares or maintain any level of function.
Avoid: Do not omit short-term oral steroid courses - each one counts toward the total duration. Do not say 'I just take a pill sometimes' - name the medication and state how frequently and how long you have taken it.
Functional Impact and Daily Activities
How to describe it: Describe specifically how your skin condition affects your ability to work, sleep, perform hygiene, socialize, and engage in physical activity. Use concrete examples: 'I cannot wear a uniform because the fabric causes severe irritation and bleeding of plaques on my torso. I miss approximately 3-4 days of work per month during flares.'
Example: During flares I cannot sleep more than 2-3 hours due to itching and pain. I cannot wear shoes because of plantar lesions. I avoid public places because of embarrassment from visible lesions on my face and neck. My hands crack and bleed, preventing me from gripping tools or typing without pain.
Examiner listens for: Specific functional limitations, occupational impact, social isolation, sleep disruption, and any activities that have been abandoned or modified due to the skin condition.
Avoid: Do not minimize your functional limitations by focusing only on the physical skin appearance. The examiner needs to understand how the condition affects your life, not just what it looks like.
Frequency and Pattern of Flare-Ups
How to describe it: Describe how often you experience flare-ups, what triggers them, how long they last, and what severity they reach. Distinguish between your baseline state and your flare state. Example: 'I have a baseline of about 10-15% TBSA affected at all times, but I flare 5-6 times per year where coverage expands to 40-50% TBSA and lasts 2-4 weeks.'
Example: My worst flares occur in winter and after stress. Last winter I had a 6-week flare where my entire scalp, face, chest, and back were covered. I required two courses of steroids plus my biologic dose was increased. I could not work for three weeks.
Examiner listens for: Number of flares per year, average duration, peak severity, triggers, and whether there are true remission periods or the condition is essentially constant.
Avoid: Do not describe only your remission state. If you flare regularly, the examiner must understand the active disease pattern, not just the current controlled state.
Exposed Area and Social/Psychological Impact
How to describe it: Clearly identify which visible areas are affected (face, neck, hands, forearms). Describe the social and psychological consequences: workplace discrimination concerns, social withdrawal, depression, or anxiety related to appearance. Example: 'My face and neck have active plaques approximately 70% of the time, covering more than 40% of those areas. I have stopped attending social events and declined a promotion because I feared customer-facing work.'
Example: During flares my entire face is red, scaly, and oozing. I cannot leave the house without people staring. I have developed significant depression and anxiety directly related to my skin condition, for which I am now receiving mental health treatment.
Examiner listens for: Percentage of face/neck/hands affected, social avoidance behaviors, occupational limitations related to appearance, and secondary psychological conditions.
Avoid: Do not omit psychological impact. The DBQ asks about functional impact on occupational and daily activities - mental health consequences of a visible skin condition are directly relevant.
Acne-Specific Severity (if applicable)
How to describe it: For acne, the rating formula requires identification of acne type and affected location. Distinguish between superficial acne (comedones, papules, pustules) and deep acne (inflamed nodules and pus-filled cysts). Specify whether it affects the face/neck vs. body areas vs. intertriginous areas, and what percentage of the face and neck is affected.
Example: I have deep cystic acne with painful inflamed nodules across my entire face (covering more than 40% of my face and neck) and upper chest. The cysts are painful to touch and frequently rupture. I have been on isotretinoin (Accutane) continuously for 6 months.
Examiner listens for: Acne type (superficial vs. deep/cystic), body location, percentage of face and neck affected, and whether systemic retinoids or other systemic treatments are required.
Avoid: Do not describe cystic nodular acne as 'just pimples.' The distinction between superficial and deep acne is critical to the rating level - use accurate clinical language or describe your lesions in detail.
Common mistakes to avoid
Describing only your exam-day skin condition without mentioning typical flares
Why: C&P exams are a snapshot in time. If your condition is controlled that day due to recent treatment, you may appear far less severe than your actual impairment level.
Do this instead: Explicitly tell the examiner: 'My condition today is better than usual because I recently completed a steroid course / my biologic was just administered. On a typical bad day, my condition looks like [describe worst-day presentation].' Bring photographs of flares.
Impact: Could prevent 30% or 60% rating by appearing to only merit 0% or 10%
Failing to disclose all systemic medications or characterizing them as minor
Why: Systemic therapy duration over the past 12 months is an independent basis for a 10%, 30%, or 60% rating. Omitting medications or saying 'I just take a pill when it gets bad' without specifics loses this rating pathway entirely.
Do this instead: Bring a complete medication list with names, start/stop dates, and frequency. Calculate total weeks of systemic therapy per year before the exam and share this with the examiner.
Impact: Could prevent 30% or 60% rating based on systemic therapy criteria
Not mentioning exposed area involvement or its functional consequences
Why: The exposed body surface area threshold is lower than total TBSA for each rating level. Veterans with significant facial, hand, or forearm involvement may qualify for a higher rating solely on exposed area criteria.
Do this instead: Proactively identify and describe all involvement of face, neck, hands, and forearms. State the approximate percentage of your face and neck that is affected. Describe social and occupational impacts of visible disease.
Impact: Could prevent 10% or 30% rating for veterans with predominantly visible-area disease
Forgetting to mention intertriginous, palmar, or plantar involvement
Why: These locations are specifically documented on the DBQ and carry functional significance. Involvement in skin folds, palms, or soles can demonstrate additional severity that supports a higher rating.
Do this instead: Tell the examiner if your condition affects armpits, groin, between toes, palms, or soles. Describe functional limitations caused by these locations (e.g., inability to walk without pain, inability to grip due to palm involvement).
Impact: Affects accurate documentation at 10-60% levels
Not disclosing secondary conditions or complications related to the skin disease
Why: Psoriasis can cause psoriatic arthritis, nail psoriasis, and oral mucosal involvement - all ratable separately under appropriate diagnostic codes. Missing these can leave significant additional ratings on the table.
Do this instead: Tell the examiner about ALL complications of your skin disease: joint pain (psoriatic arthritis), nail changes, oral sores, hair loss (scarring alopecia), and any other systemic manifestations. Request that complications be documented for separate rating consideration.
Impact: Affects overall combined rating through unclaimed secondary conditions
Minimizing impact by using vague language like 'a little itchy' or 'some redness'
Why: The examiner documents what you report. Understating symptoms results in a lower-severity record that will be used against you in the rating decision.
Do this instead: Use specific, concrete language: 'Severe, constant itching that wakes me from sleep 3-4 times per night,' 'Cracking and bleeding of skin on hands that prevents me from gripping objects,' 'Burning pain rated 7/10 during flares.' Describe the worst, not the average.
Impact: Can affect rating at any level from 0% to 60%
Not mentioning the impact on work and daily activities
Why: The DBQ has a dedicated section asking about functional impact on occupational and daily activities. This section directly influences the examiner's documentation and the rater's decision. Failing to report occupational impact is a missed opportunity.
Do this instead: Prepare specific examples of how your skin condition has affected your job performance, resulted in missed work days, limited your ability to perform duties, or caused you to change careers or decline opportunities.
Impact: Affects overall rating documentation and potential TDIU eligibility
Prep checklist
- critical
Compile a complete medication list with systemic therapy dates
Write down every systemic medication (oral, injectable, infused) you have taken for your skin condition in the past 12-24 months. Include the medication name, dose, start date, stop date, and total weeks taken. Calculate the total number of weeks of systemic therapy in the past 12-month period (key threshold: under 6 weeks = 10%, 6+ weeks but not constant = 30%, constant = 60%).
before exam
- critical
Take dated photographs of your worst flare presentations
Gather or take photographs documenting your skin at its worst. Include photos of all affected body areas, especially exposed areas (face, neck, hands). Date the photos. Print copies to bring to the exam. Per M21-1, photographs may be considered when evaluating skin conditions, and examiners may be asked to include them in the record.
before exam
- critical
Estimate your TBSA and exposed TBSA percentages
Using the Rule of Nines (head/neck = 9%, each arm = 9%, front trunk = 18%, back trunk = 18%, each leg = 18%), estimate what percentage of your body is typically affected during a flare and what percentage of your face/neck/hands is affected. Write this down to communicate clearly to the examiner.
before exam
- critical
Document your flare frequency, duration, and triggers
Write a brief chronology: how many flares per year, average duration of each flare, what triggers flares (stress, weather, certain foods, irritants), and how long your worst flares have lasted. This helps the examiner document active disease pattern vs. isolated episodes.
before exam
- critical
Gather all relevant medical records and treatment history
Collect dermatology clinic notes, primary care records documenting your skin condition, prescription records, lab results (e.g., liver function tests for methotrexate monitoring), and any prior skin biopsy results. Bring copies to the exam or ensure they are in your VA file.
before exam
- recommended
Identify and document all complications of your primary skin condition
List any joint pain, nail changes, oral lesions, hair loss, or other systemic complications that may be related to your skin disease (e.g., psoriatic arthritis from psoriasis). These should be mentioned to the examiner as they may warrant separate rating claims.
before exam
- recommended
Write out your functional impact statement
Prepare a written statement describing specifically how your skin condition affects your ability to work, sleep, perform hygiene, wear clothing, socialize, and participate in daily activities. Include worst-day descriptions. You can read from this or refer to it during the exam.
before exam
- optional
Research your state's exam recording laws
Many states allow veterans to audio or video record their C&P exam. Check your state's recording consent law before the exam. If permitted, bring a recording device or use your smartphone. Notify the examiner you are recording at the start of the exam.
before exam
- critical
Do NOT use heavy makeup, bandages, or coverings that hide affected areas
Arrive at the exam with your skin condition visible and unobscured. Do not apply heavy topical steroids immediately before the exam that would temporarily reduce redness or scaling. The examiner needs to see your actual current presentation.
day of
- critical
Bring your medication list, photographs, and functional impact statement
Organize all documents in a folder. Bring at least two copies of each - one for the examiner and one for your records. Ensure your medication list includes systemic medications with dates.
day of
- recommended
Wear clothing that allows easy access to affected areas
Wear clothing that can be easily adjusted or removed to allow the examiner to see all affected body areas. If you have back or torso involvement, wear a shirt that can be easily lifted. If you have leg involvement, wear shorts or pants that can be raised.
day of
- critical
Note whether today is a typical, better-than-average, or worse-than-average day
Before the exam, assess whether your skin is at a typical level, in remission, or in an active flare. Tell the examiner explicitly at the start: 'Today my skin is [better than usual / typical / in an active flare] because [recent steroid course / biologic dose was yesterday / winter weather trigger].'
day of
- critical
Explicitly communicate your worst-day TBSA and exposed area percentages
Do not wait for the examiner to ask about worst days - proactively state: 'During my worst flares, approximately X% of my body is affected, including X% of my face and neck.' Ask the examiner to document both exam-day and typical worst-day presentations.
during exam
- critical
Clearly describe total duration of systemic therapy in the past 12 months
State explicitly: 'Over the past 12 months, I have been on systemic therapy for approximately X total weeks,' or 'I have been on continuous biologic therapy for the past X months without interruption.' Ensure this is accurately captured.
during exam
- critical
Describe functional impact on work and daily activities
Answer the examiner's questions about daily activities thoroughly. Mention missed work days, tasks you cannot perform, activities you have stopped, and how the condition affects your sleep, concentration, and mental health. The DBQ has a dedicated section for this impact.
during exam
- critical
Mention all affected body regions including exposed, intertriginous, palmar, and plantar areas
Systematically describe all areas of your body affected: scalp, face, neck, ears, hands, forearms, trunk, back, intertriginous areas (armpits, groin), palms, soles, and any mucosal involvement. Do not wait to be asked - volunteer this information.
during exam
- recommended
Mention all related complications and secondary conditions
Tell the examiner about psoriatic arthritis, nail involvement, oral mucosal lesions, scarring alopecia, vitiligo, or any other conditions directly related to your skin disease. Ask whether separate DBQs should be completed for these complications.
during exam
- critical
Document everything that happened and was said during the exam
Immediately after the exam, write down everything you remember: what the examiner asked, what you said, what the examiner observed, how long the exam lasted, and whether all affected areas were examined. This is important if you need to challenge an insufficient exam.
after exam
- recommended
Request a copy of the completed DBQ
You have the right to request a copy of your DBQ once it is completed. Submit a written request through the VA or your VSO. Review it carefully to ensure your reported symptoms, TBSA percentages, medication history, and functional impact are accurately documented.
after exam
- recommended
Submit a buddy statement or personal statement if exam was inadequate
If the examiner did not document your worst-day presentation, failed to document TBSA and exposed TBSA percentages (which would make the exam insufficient per M21-1), or failed to record your systemic therapy history accurately, submit a personal statement (VA Form 21-4138) correcting the record.
after exam
- optional
File for secondary conditions not addressed at the exam
If the examiner did not address psoriatic arthritis, nail changes, scarring alopecia, or other complications of your skin disease, consider filing secondary claims for these conditions. Consult a VSO or VA-accredited attorney about your options.
after exam
Your rights during a C&P exam
- You have the right to an adequate C&P exam. Under M21-1, a skin disease exam is insufficient for rating purposes if it does not identify both the total body surface area and the exposed body surface area affected (expressed as percentages). If these are missing from your DBQ, the exam may be returned as insufficient or you may request a new exam.
- You have the right to request a copy of your completed DBQ. Review it carefully for accuracy and submit a personal statement to correct any errors or omissions.
- You have the right to submit photographs of your skin condition as evidence. Dated photographs showing your worst flare presentations are acceptable supporting evidence and should be considered when evaluating your condition per M21-1 guidance.
- You have the right to audio or video record your C&P examination in many states. Check your state's recording consent law before the exam. You should notify the examiner at the start of the exam if you are recording.
- You have the right to bring supporting documentation to the exam, including medical records, medication lists, and written statements. You cannot be prevented from bringing this material.
- You have the right to a second opinion or an Independent Medical Opinion (IMO) from a private physician if you disagree with the examiner's findings. A well-supported IMO from a board-certified dermatologist can carry significant probative value in your claim.
- You have the right to challenge an inadequate or negative exam through a Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals. If the examiner failed to document critical elements (e.g., TBSA percentages, systemic therapy duration), this constitutes an inadequate exam and may be grounds for a new exam.
- You have the right to report that today's presentation is not representative of your typical or worst condition. Per M21-1 guidance, your rating should reflect your condition as it typically manifests, including during flare-ups, not only at the snapshot taken during the exam.
- You have the right to claim psoriatic arthritis, nail disease, oral mucosal involvement, and other complications of psoriasis as separately ratable conditions. These complications should not be subsumed into the skin rating alone - 38 CFR - 4.118 DC 7816 specifically notes that complications such as psoriatic arthritis should be rated separately under the appropriate diagnostic code.
- You have the right to a rating that reflects the total burden of your treatment, including systemic therapy. If you require constant or near-constant systemic therapy, you are entitled to the 60% rating regardless of your TBSA percentage on any given exam day.
Related conditions
- Psoriatic Arthritis Direct complication of psoriasis (DC 7816). 38 CFR - 4.118 explicitly instructs that psoriatic arthritis should be rated separately under the appropriate diagnostic code (DC 5002 or 5009-5002 under 38 CFR - 4.71a). Veterans with psoriasis and joint involvement should file a separate claim for psoriatic arthritis.
- Scarring / Disfigurement Chronic skin conditions can result in permanent scarring or disfigurement, which is separately ratable under 38 CFR - 4.118 DCs 7800-7805. If your skin disease has caused scars, a separate scar DBQ should be completed documenting scar location, type (linear, superficial non-linear, painful/unstable), and dimensions.
- Alopecia (Hair Loss) Inflammatory skin conditions (lichen planopilaris, discoid lupus, severe psoriasis) can cause scarring alopecia, which is separately ratable. The DBQ includes fields for scarring alopecia, alopecia areata, and total body hair loss. Alopecia areata limited to scalp and face vs. total body hair loss have distinct rating implications.
- Depression / Anxiety Secondary to Skin Condition Chronic, visible skin conditions frequently cause or aggravate depression, anxiety, and social phobia. These mental health conditions may be separately ratable as secondary to the primary skin condition under 38 CFR - 3.310. Veterans experiencing psychological distress related to their skin disease should file a secondary mental health claim.
- Hyperhidrosis (Excessive Sweating) Hyperhidrosis may co-occur with or be caused by certain skin conditions. It is separately listed on the Skin DBQ (DC 7825) and may qualify for a separate rating. The DBQ has dedicated fields for documenting hyperhidrosis.
- Vitiligo Vitiligo is separately ratable under DC 7823. It may co-occur with other immune-mediated skin conditions. The Skin DBQ has a dedicated section for vitiligo documentation. Veterans with both vitiligo and another primary skin condition may receive separate ratings for each.
- Discoid Lupus Erythematosus Discoid lupus is rated under DC 7809 and follows the General Rating Formula for the Skin. It is a distinct condition from systemic lupus erythematosus and is separately rated. The Skin DBQ includes dedicated fields for discoid lupus / subacute cutaneous lupus erythematosus.
- Chronic Urticaria (Hives) Chronic urticaria is separately ratable under DC 7825 and is listed on the Skin DBQ. It may require separate documentation of episode frequency, severity, and treatment requirements distinct from other skin 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.
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.