Skip to main content
VA Rating Assistant

DC 7825 · 38 CFR 4.118

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

To document the current severity, extent, treatment history, and functional impact of your skin condition so VA can assign a disability rating under 38 CFR - 4.118 using 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

  • Diagnosis and ICD code for each skin condition
  • 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, location, and characteristics of lesions (e.g., plaques, papules, pustules, nodules, cysts)
  • Presence of erythroderma or exfoliative dermatitis
  • Involvement of special areas: palmar, plantar, mucosal, intertriginous
  • Current medications including corticosteroids, biologics, retinoids, antihistamines, immunosuppressives
  • Duration and frequency of systemic and topical treatments
  • Frequency and severity of flare-ups
  • Whether regular clinic visits are required
  • Functional and occupational impact of the skin condition
  • Presence of secondary complications such as infections, scarring alopecia, hyperhidrosis, or vitiligo
  • History of phototherapy, photochemotherapy, or electron beam therapy
  • Resolved prior skin conditions and their history

The examiner will perform a physical inspection of affected skin areas. Wear clothing that allows easy access to all affected body areas. Bring a written summary of your flare-up history, current medications with dosages, and a list of all affected body locations. The examiner will also review your service treatment records and VA medical records.

Measurements and tests

Total Body Surface Area (TBSA) Affected

What it measures: The percentage of the entire body surface covered by the skin condition, including non-exposed areas.

What to expect: The examiner will visually assess and estimate what percentage of your full body surface is affected by lesions, plaques, or other manifestations. The 'rule of nines' or palm method may be used. This is a critical rating driver under the General Rating Formula for the Skin.

Critical thresholds

  • Less than 5% of TBSA May support 0% rating if controlled with topical therapy only
  • 5-20% of TBSA Supports 10% rating range; key threshold for initial compensation
  • 20-40% of TBSA or systemic therapy required Supports 30% rating range
  • 40%+ of TBSA or constant systemic therapy required Supports 60% rating range

Tips

  • Do not cover or treat your skin heavily the day before the exam so the examiner can see the full extent of involvement
  • If your condition fluctuates, inform the examiner of your worst-day extent, not just what they see today
  • Bring photographs from flare-up periods that show the true extent of involvement
  • Tell the examiner about ALL affected areas including scalp, genital area, intergluteal cleft, and intertriginous zones - these are easy to overlook during a rushed exam

Pain considerations: Skin conditions can cause significant pain, burning, and pruritus that worsens with heat, sweating, or activity. Communicate any pain associated with skin involvement to the examiner.

Exposed Body Surface Area (EBSA) Affected

What it measures: The percentage of exposed body surface area (face, neck, hands, forearms, lower legs, and other areas typically visible) affected by the condition.

What to expect: The examiner will separately document what percentage of exposed skin is affected. Under M21-1 adjudication guidance, both TBSA and EBSA must be documented or the DBQ is considered insufficient for rating purposes.

Critical thresholds

  • Any exposed area involvement Supports higher rating and documents vocational/social impact
  • Face and neck involvement less than 40% Noted separately on DBQ; affects disfigurement analysis
  • Face and neck involvement 40% or more Documented separately and may support higher rating or separate disfigurement claim

Tips

  • Specifically mention if your face, neck, or hands are affected - these areas carry significant functional and social impact
  • Describe how visible skin involvement affects your social interactions, employment, and daily activities
  • If your hands are affected, describe impact on manual tasks, hygiene, and grip

Pain considerations: Involvement of hands and feet can impair work performance and daily function. Describe any limitations in gripping, writing, or operating machinery due to skin involvement.

Lesion Characterization

What it measures: Type, depth, and distribution of lesions including comedones, papules, pustules, nodules, cysts, plaques, and scales.

What to expect: For acne specifically, the examiner will note whether lesions are superficial (comedones, papules, pustules) or deep (inflamed nodules and pus-filled cysts), and where they are located (face/neck vs. body areas vs. intertriginous areas). This directly drives the DC 7825 rating.

Critical thresholds

  • Superficial acne only 0% rating under DC 7825
  • Deep acne affecting less than 40% of face and neck or body areas other than face and neck 10% rating under DC 7825
  • Deep acne affecting 40%+ of face and neck 30% rating under DC 7825
  • Deep acne affecting intertriginous areas (axilla, anogenital, etc.) 30% rating under DC 7825
  • Chloracne with systemic involvement Evaluated under applicable General Formula thresholds

Tips

  • Point out every individual affected area and type of lesion during the physical exam - do not assume the examiner will find them all
  • Describe lesions at their worst, not only what is present on exam day
  • If you have scarring from prior deep lesions, ensure this is documented even if active lesions are fewer today

Pain considerations: Deep acne nodules and cysts are often painful and tender to touch. Describe pain level, tenderness, and any impact on wearing clothing, equipment, or protective gear.

Treatment Intensity Assessment

What it measures: The level of treatment required to control the condition, including topical-only, systemic medications, biologics, phototherapy, and hospitalization-level care.

What to expect: The examiner will document all current and past treatments, their duration, and whether the condition requires systemic (oral or injected) therapy as opposed to topical-only treatment. Systemic therapy requirement is an independent rating trigger under the General Rating Formula.

Critical thresholds

  • Topical therapy only required Supports lower rating range (0-10%)
  • Systemic therapy (oral steroids, methotrexate, cyclosporine, etc.) required Independently supports 30% or higher rating
  • Biologics required (e.g., adalimumab, ustekinumab, secukinumab) Supports 60% or higher rating; indicates severe refractory disease
  • Phototherapy or photochemotherapy (PUVA) required Documents severity beyond topical-only management

Tips

  • Bring a complete medication list including drug name, dose, frequency, and how long you have been on each medication
  • If you tried and failed multiple therapies, list them in order - escalating treatment history documents severity
  • Mention any side effects from medications that also affect your daily function
  • If you were ever hospitalized or received intravenous treatment for your skin condition, state this clearly

Pain considerations: Systemic medications such as retinoids and immunosuppressives have significant side effects that affect quality of life. Describe how treatment-related side effects impact your daily activities.

Rating criteria by percentage

0%

No active skin disease, or condition is controlled with topical therapy alone with no significant area involvement. Under DC 7825 (Acne): superficial acne with comedones, papules, and pustules of any extent.

Key symptoms

  • Superficial lesions only (comedones, papules, pustules)
  • Condition managed with over-the-counter or prescription topical products only
  • No requirement for systemic medications
  • No significant body surface area involvement triggering higher criteria

From 38 CFR: DC 7806 (Dermatitis/Eczema), DC 7816 (Psoriasis), DC 7825 (Acne): evaluated under General Rating Formula for the Skin; 0% if topical therapy only controls condition with minimal area involvement.

10%

At least 5% but less than 20% of the entire body (or exposed areas) affected, OR; at least 5% but less than 20% of exposed areas affected. Under DC 7825 (Acne): deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40% of the face and neck, or affecting body areas other than the face and neck.

Key symptoms

  • Deep inflamed nodules or pus-filled cysts present
  • Affects less than 40% of face and neck
  • Affects body areas other than face and neck (trunk, back, shoulders)
  • 5-20% total or exposed body surface area affected
  • Intermittent flare-ups requiring topical or mild systemic treatment

From 38 CFR: DC 7825: deep acne affecting <40% face/neck or body areas other than face/neck. General Formula 10%: 5-19% of entire body or 5-19% of exposed areas affected, or intermittent systemic therapy such as corticosteroids required for a total duration of less than 6 weeks during the past 12 months.

30%

20-39% of the entire body or 20-39% of exposed areas affected, OR; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of 6 weeks or more but not constantly during the past 12 months. Under DC 7825 (Acne): deep acne affecting 40%+ of face and neck, OR affecting intertriginous areas (axilla, anogenital area, under the breasts, etc.)

Key symptoms

  • Deep acne affecting 40% or more of face and neck
  • Deep acne affecting intertriginous areas (armpits, groin, under breasts, between buttocks)
  • 20-39% total body surface area with active disease
  • Systemic corticosteroids or immunosuppressives required 6+ weeks in past year
  • Regular dermatology clinic visits required
  • Phototherapy required to manage condition

From 38 CFR: DC 7825: deep acne affecting -40% of face/neck or intertriginous areas. DC 7806/7816 General Formula 30%: 20-39% TBSA or exposed area affected, or systemic therapy required 6+ weeks but not constantly in past 12 months.

60%

40% or more of the entire body or 40% or more of exposed areas affected, OR; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12 months.

Key symptoms

  • 40%+ of total body surface area affected with active disease
  • 40%+ of exposed skin areas affected
  • Constant systemic therapy required (biologics, cyclosporine, methotrexate, oral steroids virtually continuously)
  • Erythroderma or exfoliative dermatitis
  • Condition refractory to multiple treatment lines
  • Severe functional and occupational impairment
  • Photochemotherapy (PUVA) or electron beam therapy required

From 38 CFR: General Rating Formula for the Skin 60%: 40%+ of entire body or exposed areas affected, or constant/near-constant systemic therapy including corticosteroids or immunosuppressives required during past 12 months. Biologics such as TNF inhibitors or IL-17/23 inhibitors indicate severity at this level.

Describing your symptoms accurately

Extent and Distribution of Skin Involvement

How to describe it: Be specific about every body area affected. Name the exact locations: scalp, face, neck, chest, back, abdomen, arms, forearms, hands, legs, feet, groin, armpits, under breasts, buttocks, genitals. Estimate what percentage of each area is covered during a flare-up.

Example: On my worst days, I have thick, scaly plaques covering my entire scalp, both elbows, both knees, my lower back, and the crack between my buttocks. My hands are cracked, bleeding, and covered in plaques. I would estimate at least 35-40% of my body surface is affected during a bad flare.

Examiner listens for: Specific body locations and estimated percentage coverage, involvement of high-impact areas (hands, face, intertriginous zones), whether involvement is consistent or fluctuating.

Avoid: Do not say 'it comes and goes' without quantifying how bad it gets. Do not omit involvement of private or intertriginous areas assuming they are not relevant - they are specifically rated.

Flare-Up Frequency, Duration, and Triggers

How to describe it: Describe how often you have flare-ups, how long they last, what triggers them (stress, heat, sweat, certain fabrics, chemicals, weather), and how long it takes to recover. Contrast your baseline with your worst flare.

Example: I have a moderate flare approximately every 6-8 weeks that lasts 2-3 weeks at a time. During a flare, I cannot wear long sleeves because the fabric rubs against my oozing plaques. I cannot sleep through the night because of itching. My worst flare lasted 6 weeks last spring and I missed 4 days of work.

Examiner listens for: Frequency and duration of active phases versus remission, identifiable triggers, impact of flares on sleep, work, and activities of daily living.

Avoid: Do not say 'I manage okay' if you are suffering during flares. The exam likely occurs on a relatively controlled day - you must communicate what your bad days look like.

Treatment Burden and Side Effects

How to describe it: List every treatment you use or have used: topical steroids (strength and frequency), calcineurin inhibitors, vitamin D analogs, oral medications (methotrexate, cyclosporine, retinoids, dapsone), biologic injections, phototherapy sessions. Describe the time burden of treatment, side effects, and what happens when you miss doses.

Example: I apply prescription-strength topical clobetasol twice daily to multiple body areas, which takes 30 minutes each morning. I also receive monthly biologic injections at the VA clinic. When I miss an injection, my psoriasis returns severely within 2 weeks. The biologic causes fatigue the day after injection and I have had repeated upper respiratory infections requiring antibiotics.

Examiner listens for: Whether systemic or biologic therapy is required, duration of systemic therapy use in the past 12 months, whether condition is refractory to simpler treatments, treatment side effects that cause additional disability.

Avoid: Do not minimize your treatment regimen. If you are on a biologic, that is clinically significant - say so clearly. Do not omit over-the-counter products if you use them constantly in addition to prescriptions.

Functional and Occupational Impact

How to describe it: Describe concretely how your skin condition limits your ability to work, perform military duties, engage in social activities, and maintain hygiene. Mention any restrictions from your employer or VA providers.

Example: My psoriasis on my hands prevents me from shaking hands with customers without embarrassment and physical pain. I cannot wear my military uniform without significant skin irritation from the fabric. I avoid swimming, the gym, and social gatherings because of the appearance of my skin. I have been passed over for promotion because my supervisor considered my frequent medical appointments disruptive.

Examiner listens for: Specific work tasks limited by the condition, social withdrawal due to appearance or discomfort, need for special accommodations, frequency of medical appointments.

Avoid: Do not say your condition does not affect your work if it does. Examiners document functional impact in a dedicated DBQ section - this feeds directly into the overall rating and any TDIU consideration.

Pain, Itching, Burning, and Sleep Disruption

How to describe it: Quantify itching and pain on a 0-10 scale. Describe how symptoms affect your sleep, concentration, and mood. Mention any secondary scratch injuries, infections, or open wounds from the condition.

Example: On a bad night, I rate my itching at 9 out of 10. I wake up 3-4 times scratching until I bleed. I have had secondary skin infections from scratching open my plaques on two occasions in the past year, requiring antibiotics. The sleep deprivation affects my concentration at work the next day.

Examiner listens for: Severity of pruritus and pain, documented sleep disruption, secondary complications such as infection, impact on mental health.

Avoid: Do not say the itching is 'just uncomfortable' if it disrupts your sleep. Sleep disruption is a serious functional consequence - name it directly.

Common mistakes to avoid

Showing up with skin treated and covered up on exam day

Why: If you applied heavy moisturizer, covered lesions with clothing, or recently had a flare resolve, the examiner may underestimate the true extent of your condition.

Do this instead: Arrive with skin in its natural state for the exam. Avoid applying thick topical treatments to affected areas the morning of the exam. Wear clothing that allows easy visual access to all affected areas.

Impact: All levels - particularly the difference between 10% and 30% based on TBSA assessed

Describing only what the examiner can see on exam day

Why: VA rating is based on your condition over time, not just one snapshot. If your condition fluctuates, the examiner must understand your worst-day presentation.

Do this instead: Bring dated photographs from flare-up periods showing maximum extent of involvement. Verbally describe your worst-day appearance and confirm the examiner has noted it in the record.

Impact: Primarily 10% vs. 30% threshold (20-39% TBSA)

Failing to mention ALL affected body areas including private or intertriginous areas

Why: Intertriginous involvement (armpits, groin, under breasts, between buttocks) is a specific rating criterion under DC 7825 and is clinically significant for dermatitis and psoriasis as well.

Do this instead: Proactively disclose every affected area including scalp, genitals, perianal area, intertriginous folds, and nail beds. Do not omit areas out of embarrassment.

Impact: DC 7825: difference between 10% and 30% rating

Understating treatment intensity or omitting biologic use

Why: Whether you require constant systemic therapy is an independent path to a 60% rating. Failing to document biologic or continuous systemic therapy use means the examiner cannot select the correct rating criteria.

Do this instead: Bring a complete written medication list with drug names, doses, frequency, and start dates. Specifically tell the examiner you are on a biologic, systemic immunosuppressive, or have been on oral corticosteroids for 6+ weeks in the past year.

Impact: Critical difference between 30% and 60% rating

Not mentioning psoriatic arthritis or nail involvement separately

Why: Under DC 7816, complications such as psoriatic arthritis and other clinical manifestations (oral mucosa, nails) must be rated separately. Failing to mention these means they will not be evaluated or rated.

Do this instead: If you have joint pain, nail changes (pitting, separation, discoloration), or oral mucosal lesions related to psoriasis, explicitly report these to the examiner and ask that they be documented for separate rating consideration.

Impact: Separate additional ratings - could add 10-40% additional compensation

Not discussing the functional and occupational impact of the condition

Why: The DBQ has a dedicated field for impact on work and daily life. If left blank or minimized, it cannot support a higher rating or a TDIU claim.

Do this instead: Prepare a written statement describing specific work tasks you cannot perform, social activities you avoid, and daily living limitations caused directly by your skin condition. Hand it to the examiner if needed.

Impact: All levels; critical for TDIU consideration

Failing to bring documentation of treatment history

Why: If the examiner cannot verify that you have required systemic therapy, phototherapy, or biologic treatment, they may underestimate severity on the DBQ.

Do this instead: Bring pharmacy printouts, VA medical records, or private dermatology records documenting your treatment escalation history, the duration of each therapy, and any treatments that failed.

Impact: 30% vs. 60% rating based on systemic therapy duration and type

Prep checklist

  • critical

    Gather dated photographs of your skin during flare-ups

    Collect clear, dated photographs showing the maximum extent of your skin involvement during flare-ups. Include all affected body areas. Store in a phone album or printed copies organized by date.

    before exam

  • critical

    Prepare a complete medication list

    Write down every medication - topical and systemic - with the drug name, dose, frequency, start date, and what condition it is treating. Include biologics, immunosuppressives, oral steroids, retinoids, antihistamines, and all topical agents.

    before exam

  • critical

    Calculate approximate body surface area affected

    Using the rule of nines or palm method (one palm = approximately 1% BSA), estimate what percentage of your body is affected during a typical flare and during your worst flare. Write this down. Also estimate the percentage of exposed areas affected.

    before exam

  • critical

    List all body locations affected including private areas

    Write down every location: scalp, face, neck, chest, back, abdomen, bilateral arms, forearms, hands, legs, feet, axillae, groin, perianal area, under breasts, genitals, nail beds, oral mucosa. Include locations even if intermittently affected.

    before exam

  • critical

    Document flare-up frequency and duration over the past 12 months

    Reconstruct a timeline of your flare-ups over the past year: approximate dates, duration, severity (percentage of body affected), triggers, and how they were treated. This supports systemic therapy duration documentation.

    before exam

  • critical

    Write a functional impact statement

    Prepare a written description of how your skin condition affects your work, social activities, sleep, hygiene, and daily tasks. Include specific examples such as inability to wear certain clothing, missed workdays, limitations on physical activities, and social avoidance.

    before exam

  • recommended

    Gather private dermatology records if treatment occurred outside VA

    Obtain records from any private dermatologists documenting diagnosis dates, treatment history, biopsy results, and treatment escalation. Submit copies to VA prior to the exam or bring them to the appointment.

    before exam

  • recommended

    Research whether psoriatic arthritis or nail involvement warrants a separate claim

    If you have psoriasis with joint involvement or nail changes, consult with a VSO about filing a separate claim for psoriatic arthritis under DC 5009 or an appropriate musculoskeletal code, as these are rated separately under DC 7816.

    before exam

  • recommended

    Review your nexus letter or service connection documentation

    Understand the basis of your service connection claim - in-service exposure, direct injury, or secondary to another condition. Be prepared to explain the onset and timeline of your condition relative to your military service.

    before exam

  • critical

    Do not apply heavy topical treatments to affected areas the morning of the exam

    Avoid covering or masking lesions with thick moisturizers, dressings, or makeup before the exam. The examiner must see the true extent of your skin involvement. Normal hygiene is acceptable.

    day of

  • critical

    Wear clothing that provides easy access to all affected areas

    Wear loose, easily removable clothing that allows the examiner to visually inspect your scalp, torso, extremities, and any other affected areas without significant difficulty.

    day of

  • critical

    Bring all prepared documentation

    Bring your medication list, flare-up timeline, functional impact statement, dated photographs, and any private medical records. Offer them to the examiner and ask that they be included in the examination record.

    day of

  • recommended

    Know your right to record the exam

    In most states, you have the right to record your C&P examination. Check your state's recording consent laws. If permitted, inform the examiner you will be recording. This protects accuracy and provides a record if the examination report is later disputed.

    day of

  • critical

    Verbally confirm that TBSA and EBSA percentages are being documented

    Ask the examiner directly: 'Are you documenting the total body surface area and exposed body surface area affected?' Both are required by M21-1 for the DBQ to be sufficient for rating. If the examiner appears to be skipping this, point it out respectfully.

    during exam

  • critical

    Describe your worst-day presentation, not just today's presentation

    If your skin looks better today than usual, say so explicitly: 'This is actually a relatively good day for me. On my worst days, which occur approximately X times per year, my condition looks like [describe].' Show photographs from bad days.

    during exam

  • critical

    Disclose all affected areas proactively, including intertriginous and private areas

    Do not wait for the examiner to ask about every area. Proactively state all locations including axillae, groin, perianal area, and genitals if applicable. These areas have specific rating implications.

    during exam

  • critical

    Clearly state your systemic medication history and duration

    When asked about medications, be specific: 'I have been on [biologic name] for [X months], and prior to that I was on methotrexate for [X months]. I was on oral prednisone courses for a total of approximately [X weeks] in the past year.'

    during exam

  • recommended

    Report functional and occupational limitations in concrete terms

    Do not give vague answers. Say 'My skin condition prevents me from [specific task] because [specific reason].' Mention missed workdays, sleep disruption, social avoidance, and any work accommodations.

    during exam

  • recommended

    Mention any secondary complications

    Report any secondary skin infections, scarring, alopecia related to your skin condition, nail changes, joint involvement, or mucosal involvement. These may support separate claims or influence the rating.

    during exam

  • critical

    Request a copy of the completed DBQ

    You are entitled to a copy of your C&P examination report. Request it through MyHealtheVet, the VBMS portal, or by submitting a Privacy Act request. Review it for accuracy as soon as it is available.

    after exam

  • critical

    Review the DBQ for completeness and accuracy

    Check that the examiner documented: TBSA and EBSA percentages, all affected body locations, current medications with duration, your worst-day description, functional impact, and systemic therapy duration. If any critical information is missing or inaccurate, contact your VSO immediately.

    after exam

  • recommended

    Submit a lay statement if the exam was inadequate

    If you believe the examiner did not capture the full extent of your condition, submit a personal statement (21-4138) or buddy statements describing your symptoms, treatment burden, and functional limitations in detail. This becomes part of your claims file.

    after exam

  • optional

    Consult your VSO about whether a nexus opinion is needed

    If the examiner's report does not support service connection or assigns an inadequate severity rating, consult with your VSO or an accredited VA claims agent about obtaining an independent medical opinion (IMO) from a private dermatologist.

    after exam

Your rights during a C&P exam

  • You have the right to have a representative (VSO, attorney, or claims agent) present or available during your C&P examination.
  • You have the right to record your C&P examination in most states - check your state's one-party vs. two-party consent recording laws before the exam.
  • You have the right to request a copy of your completed DBQ examination report through MyHealtheVet, VBMS, or a Privacy Act request.
  • You have the right to submit additional evidence (lay statements, private medical opinions, photographs) after the exam and before a rating decision is issued.
  • You have the right to request a new or additional C&P examination if you believe the original exam was inadequate, incomplete, or based on an inaccurate history.
  • You have the right to appeal a rating decision through the Supplemental Claim lane, Higher-Level Review, or Board of Veterans Appeals (BVA) if you disagree with the outcome.
  • You have the right to submit a private independent medical opinion (IMO) or independent medical evaluation (IME) from a treating dermatologist that contradicts or supplements the C&P examiner's findings - VA must weigh this evidence.
  • Under the PACT Act, certain veterans with service in specific locations or with specific exposures may have presumptive service connection for skin conditions - ask your VSO whether presumptive provisions apply to your claim.
  • You have the right to be examined in person rather than by records review only, unless your condition is clearly established in the record - if asked to consent to a records-only review, you may decline and request an in-person examination.
  • The DBQ must document both TBSA and EBSA percentages to be sufficient for rating per M21-1 guidance - if the examiner declines to perform a full physical examination, document this in a contemporaneous written statement.

Related conditions

Get a personalized prep packet

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.

Get personalized prep

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.