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VA Rating Assistant

DC 7828 · 38 CFR 4.118

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

To document the current severity, extent, and treatment history of your skin condition for VA disability rating purposes under 38 CFR - 4.118. The examiner will assess total and exposed body surface area affected, active versus remission status, and the type and intensity of treatment required.

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 (dermatitis, eczema, psoriasis, acne, chloracne, or other coded conditions)
  • Total body surface area (TBSA) affected, expressed as a percentage
  • Exposed body surface area (EBSA) affected, expressed as a percentage
  • Whether condition affects intertriginous areas (axilla, anogenital region, etc.)
  • Whether condition affects face and neck, and what percentage
  • Active versus remission status of condition
  • Type, frequency, and duration of medications required (topical corticosteroids, biologics, retinoids, antihistamines, immunosuppressives, sympathomimetics)
  • Whether phototherapy or photochemotherapy (PUVA) has been used
  • Presence of special features: erythroderma, mucosal involvement, palmar/plantar involvement, scarring alopecia, vitiligo extent, hyperhidrosis, vasculitis
  • Episodes of erythema multiforme or toxic epidermal necrolysis
  • Impact on daily activities, work, and quality of life
  • Associated conditions warranting separate rating (psoriatic arthritis, nail involvement, oral mucosal involvement)

You will be asked to disrobe or expose affected areas for visual inspection. The examiner will conduct a skin surface examination and interview. Bring all current medications in original containers. If your condition fluctuates, be prepared to describe your worst typical presentation, not just your condition on exam day.

Measurements and tests

Total Body Surface Area (TBSA) Affected

What it measures: The percentage of the entire body surface covered by your skin condition. This is a critical rating driver under the General Rating Formula for the Skin.

What to expect: The examiner visually estimates what percentage of your total skin surface shows active disease. The 'Rule of Nines' or similar estimation tools may be used. Be aware your condition may look better or worse on exam day than on a typical day.

Critical thresholds

  • Less than 5% TBSA Supports 0% rating if only topical treatment required
  • At least 5% TBSA or involves exposed areas Supports 10% rating with topical therapy
  • 20-40% TBSA or systemic therapy required Supports 30% rating
  • More than 40% TBSA or systemic/immunosuppressive therapy Supports 60% rating

Tips

  • Bring dated photographs of your skin on bad days - examiners CAN and SHOULD consider your worst typical presentation
  • Describe your condition at its typical worst, not just on exam day if today is a good day
  • Ask the examiner to document the typical extent when your condition flares, not just today's observation
  • If your rash is currently in remission due to treatment, make sure the examiner documents this fact and the treatment required to maintain remission

Pain considerations: Describe any burning, stinging, pruritus, or skin pain associated with affected areas, especially if it disrupts sleep or daily activities.

Exposed Body Surface Area (EBSA) Affected

What it measures: The percentage of exposed (visible) body surface area affected. Involvement of exposed areas such as face, hands, forearms, and lower legs can affect rating because they are more socially and functionally significant.

What to expect: Examiner documents whether affected areas are on exposed skin (face, neck, hands, arms, lower legs) versus covered areas. The DBQ specifically requires this percentage to be documented for the exam to be sufficient for rating.

Critical thresholds

  • Exposed areas involved at any percentage Can support higher rating tier; face/neck involvement specifically coded in acne ratings
  • 40% or more of face and neck affected (acne/chloracne) Supports higher rating for acne-type conditions
  • Less than 40% of face and neck affected (acne/chloracne) Supports lower rating tier for acne-type conditions

Tips

  • Clearly describe which exposed areas are affected - face, neck, hands, forearms
  • If social interactions are impacted due to visible lesions, state this explicitly
  • Document whether lesions on face/neck leave scars, discoloration, or permanent changes

Pain considerations: Note any functional limitations caused by lesions on hands or feet, such as difficulty gripping, writing, or walking.

Treatment Intensity Assessment

What it measures: The type and duration of treatment required to manage your condition. Under the General Rating Formula for the Skin, treatment requirement is a primary rating driver - systemic therapy signals greater severity.

What to expect: Examiner will document all medications: topical steroids, topical calcineurin inhibitors, antihistamines, systemic corticosteroids, retinoids (isotretinoin), biologics (adalimumab, secukinumab, dupilumab, etc.), immunosuppressives (methotrexate, cyclosporine), sympathomimetics, and procedures like phototherapy (UVB), photochemotherapy (PUVA), and electron beam therapy.

Critical thresholds

  • Topical therapy only Associated with 0-10% ratings depending on TBSA
  • Systemic therapy (oral corticosteroids, retinoids, immunosuppressives) Associated with 30-60% ratings
  • Biologics required Strong indicator of severe, refractory disease - supports higher ratings
  • Phototherapy or photochemotherapy required Indicates moderate-to-severe disease; supports higher rating tiers

Tips

  • Bring ALL medications - prescription and over-the-counter - to the exam in original bottles
  • Know the names, doses, and how long you have been on each medication
  • If you are not currently on treatment but previously required systemic therapy, explain why treatment was stopped
  • If your condition is currently controlled only because of ongoing treatment, make clear that without treatment your condition would be active and extensive

Pain considerations: Describe any side effects from medications, especially systemic agents, as these represent additional burden of disease.

Intertriginous and Special Area Involvement

What it measures: Whether the skin condition affects intertriginous areas (axilla, groin, anogenital region, under breasts, between toes) or special sites like palms, soles, mucous membranes, or the scalp. These areas carry special significance in rating certain conditions.

What to expect: Examiner will specifically ask about and visually assess intertriginous areas, palmar and plantar involvement, mucosal involvement, and scalp involvement. The DBQ has dedicated fields for palmar involvement, plantar involvement, mucosal involvement, and erythroderma.

Critical thresholds

  • Intertriginous area involvement Specifically noted in rating criteria; supports higher ratings for many conditions
  • Palmar or plantar involvement with episodic flares May support separate or higher rating for conditions like pustular psoriasis
  • Mucosal involvement Indicates more severe/systemic disease; documented separately on DBQ
  • Erythroderma (generalized skin involvement) Supports maximum rating tiers; indicates life-threatening severity

Tips

  • Do not be embarrassed to report involvement in private areas - this information is critical to an accurate rating
  • Describe any nail involvement (pitting, onycholysis) if present, especially with psoriasis
  • Report any oral ulcers, eye involvement, or joint symptoms as these may warrant separate ratings

Pain considerations: Intertriginous involvement often causes significant pain, friction discomfort, and infection risk - describe these functional impacts clearly.

Rating criteria by percentage

0%

No more than topical therapy required over the past 12-month period AND less than 5 percent of the entire body, or less than 5 percent of exposed areas affected. Condition may be well-controlled with minimal treatment.

Key symptoms

  • Minimal affected area (less than 5% TBSA)
  • Topical moisturizers or mild topical steroids only
  • Condition largely in remission
  • No systemic symptoms or significant functional impairment

From 38 CFR: General Rating Formula for the Skin: At least one treatment per year requires topical therapy only, with minimal body surface area involved.

10%

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 if the condition requires intermittent systemic therapy for periods totaling no more than 6 weeks during the past 12-month period.

Key symptoms

  • 5-19% TBSA affected
  • 5-19% exposed area affected
  • Topical therapy as primary treatment
  • Intermittent systemic therapy (6 weeks or less per year)
  • Periodic flares requiring more intensive treatment

From 38 CFR: DC 7806 (Dermatitis/Eczema), DC 7816 (Psoriasis): 5 to less than 20 percent of total body or exposed areas affected, OR intermittent systemic therapy 6 weeks or less per year.

30%

20 to 40 percent of the entire body OR 20 to 40 percent of exposed areas affected. OR if the condition requires systemic therapy such as corticosteroids, retinoids, biologics, or immunosuppressive drugs for a cumulative period of more than 6 weeks but not constantly during the past 12-month period.

Key symptoms

  • 20-40% TBSA affected
  • 20-40% exposed area affected
  • Systemic therapy required for more than 6 weeks per year but not constant
  • Oral corticosteroids, retinoids (isotretinoin), or immunosuppressives used
  • Phototherapy (UVB) or photochemotherapy (PUVA) required
  • Significant impact on daily activities and quality of life
  • Intertriginous or special area involvement

From 38 CFR: DC 7816 (Psoriasis), DC 7806 (Dermatitis): 20 to 40 percent of total body or exposed areas, OR systemic therapy more than 6 weeks but not constantly during past 12 months.

60%

More than 40 percent of the entire body OR more than 40 percent of exposed areas affected. OR if the condition requires constant or near-constant systemic therapy including corticosteroids, retinoids, biologics, or immunosuppressive drugs during the past 12-month period.

Key symptoms

  • Greater than 40% TBSA affected
  • Greater than 40% exposed area affected
  • Constant systemic therapy required (biologics, immunosuppressives, corticosteroids)
  • Condition refractory to multiple treatment lines
  • Significant disfigurement or functional impairment
  • Erythroderma or near-total skin involvement
  • Mucosal involvement
  • Severe impact on all activities of daily living
  • Multiple hospitalizations or urgent care visits for skin condition
  • Psoriatic arthritis or other systemic complications

From 38 CFR: DC 7806, DC 7816: More than 40 percent of total body or exposed areas, OR constant or near-constant systemic therapy during the past 12 months. Note for DC 7816: Psoriatic arthritis and other manifestations (oral mucosa, nails) rated separately.

Describing your symptoms accurately

Body Surface Area and Distribution

How to describe it: Describe every part of your body currently affected and how large the affected areas are. Use body parts as reference: 'My entire back is covered,' 'Both arms from elbow to wrist,' 'My face, neck, and scalp.' Estimate percentage if you can: 'I estimate about 30% of my body is affected when it flares.'

Example: On my worst days, the rash covers my entire back, both arms, my chest, and the back of my neck - probably 40 to 50 percent of my body. I have plaques on my palms that crack and bleed, making it hard to grip anything.

Examiner listens for: Specific body areas affected, percentage estimates, involvement of exposed areas, involvement of intertriginous areas, palmar/plantar involvement, scalp involvement, and whether distribution is constant or fluctuating.

Avoid: Do not say 'it's just a little rash' or minimize the extent. Do not only describe today's appearance if you are having a good day. Say: 'Today is actually a better day for me - on a typical bad day it is much more extensive.'

Treatment Burden and Medication Requirements

How to describe it: Describe every medication you use - topical and systemic - how often you use them, how long you have been on them, and what happens when you stop. Explain if you are only controlled because of ongoing treatment: 'Without my biologic injection, within two weeks my psoriasis comes back across 60% of my body.'

Example: I am currently on a biologic injection every two weeks and apply topical steroids twice daily. I tried stopping the biologic once and within a month I was hospitalized for a severe flare. I have been on some form of systemic medication continuously for the past three years.

Examiner listens for: Names and doses of all medications, duration of systemic therapy in the past 12 months, whether therapy is continuous versus intermittent, any hospitalizations or urgent care visits, failed treatment trials, and side effects of medications.

Avoid: Do not forget to mention over-the-counter antihistamines, medicated shampoos, or moisturizers used specifically for your skin condition. Do not say 'I just use some cream' when you use multiple treatments - list them all.

Flares and Active Versus Remission Status

How to describe it: Clearly describe how often your condition flares, how long flares last, and what triggers them. Explain what 'remission' looks like for you - for many veterans, 'remission' still means daily symptoms managed by ongoing treatment.

Example: I flare about four to five times per year, and each flare lasts three to four weeks. During a flare, the rash spreads to cover my back, abdomen, and both legs. Even between flares, I have persistent patches on my elbows, knees, and scalp that never fully clear.

Examiner listens for: Frequency and duration of active flares, percentage of the year spent in active versus remission phases, whether remission is complete or partial, and whether remission requires maintenance therapy.

Avoid: Do not say 'it comes and goes' without quantifying. Say how often, how long, and how severe each episode is. Do not describe partial remission as full remission.

Functional and Daily Life Impact

How to describe it: The DBQ specifically asks about functional impact. Describe how your skin condition limits work, social activities, sleep, hygiene, and relationships. Be specific: 'I cannot wear short sleeves in public,' 'I miss two to three days of work per month during flares,' 'I cannot use my hands for grip-heavy tasks when my palms crack.'

Example: During severe flares, I cannot sleep more than two to three hours because the itching is unbearable. I have called in sick to work multiple times because my hands were cracked and bleeding. I avoid social situations because I am self-conscious about the visible lesions on my face and arms.

Examiner listens for: Specific work-related limitations, sleep disruption due to pruritus or pain, social withdrawal, hygiene challenges, limitations in hand function from palmar/plantar involvement, and psychological impact.

Avoid: Do not say 'it doesn't really affect me that much' to appear stoic. The examiner's job is to document your actual functional impairment. Underreporting leads to lower ratings that do not reflect your true disability.

Special Features: Itching, Pain, and Associated Symptoms

How to describe it: Describe the character and severity of pruritus (itching), pain, burning, and any associated symptoms like joint pain, nail changes, or eye involvement. Rate your itch/pain on a 0-10 scale and describe its pattern.

Example: At its worst, the itching is a 9 out of 10 and I scratch until I bleed during the night. My skin burns constantly in the affected areas, like a sunburn that never goes away. My psoriasis has also affected my fingernails - they are pitted and separated from the nail bed.

Examiner listens for: Pruritus severity and frequency, sleep disruption from itching, pain associated with cracked or inflamed skin, nail changes, joint symptoms suggesting psoriatic arthritis, and eye or mucosal symptoms.

Avoid: Do not minimize itching as 'just annoying.' Severe pruritus is a significant disability that disrupts sleep and daily functioning. Describe its full impact honestly.

Common mistakes to avoid

Only describing how your skin looks on exam day when you are in remission or having a good day

Why: VA ratings are based on the overall severity of your condition over the past 12 months, not just how it appears on exam day. If you are in remission today, the examiner may document minimal findings and assign a low rating.

Do this instead: Bring dated photographs of your skin during active flares. Explicitly tell the examiner: 'Today is not typical for me. On a bad day, my condition looks like this...' and describe or show photos of your worst presentations.

Impact: Can reduce rating from 30-60% to 0-10%

Failing to mention all systemic medications, or not knowing the names of your medications

Why: The type and duration of systemic therapy is one of the primary rating criteria. Underreporting medications can result in a rating based on topical therapy only, when systemic therapy would support a higher rating.

Do this instead: Bring all medications in original containers. Know each medication's name, dose, and how long you have been on it. Specifically mention biologics, immunosuppressives, and systemic corticosteroids.

Impact: Can reduce rating from 60% to 10-30%

Failing to report intertriginous area, palmar, plantar, or mucosal involvement

Why: These specific features are tracked on the DBQ and influence the rating. Veterans often feel embarrassed to mention involvement in the groin, axilla, or anogenital areas.

Do this instead: Proactively report all areas of involvement, including private areas. Say: 'I also have involvement in my groin/under my arms/on my palms and soles.' These areas have specific DBQ fields and rating significance.

Impact: Can suppress rating from higher tier to lower tier

Not reporting the impact of skin condition on work and daily activities

Why: The DBQ includes a dedicated functional impact field. If you do not describe functional limitations, the examiner may not document them, and the rating will not reflect your true disability.

Do this instead: Prepare a specific list of activities you cannot do or do with difficulty because of your skin condition: work tasks, sleep, social activities, wearing certain clothing, using your hands, etc.

Impact: Affects all rating levels and can support higher ratings

Assuming the examiner will review all your records without prompting

Why: C&P exams are typically 15-30 minutes. Examiners may not have time to thoroughly review your full claims file.

Do this instead: Bring a one-page summary of your skin condition history, listing: date of first diagnosis, all treatments tried, hospitalizations, and current medications. Reference specific medical records if possible.

Impact: Affects all rating levels

For psoriasis, failing to separately report psoriatic arthritis or nail/oral mucosal involvement

Why: 38 CFR DC 7816 specifically notes that complications such as psoriatic arthritis and other clinical manifestations (oral mucosa, nails) should be rated separately. Failing to report these can result in lost separate rating opportunities.

Do this instead: Separately and explicitly report any joint pain/swelling, nail changes (pitting, separation, discoloration), and oral ulcers. Ask your VSO or attorney about filing separate claims for psoriatic arthritis.

Impact: Can represent significant additional combined rating

Prep checklist

  • critical

    Gather and organize all skin-related medical records

    Collect all records documenting your skin condition: original diagnosis date, treatment history, hospitalizations, dermatology visit notes, and lab results. Organize chronologically. Include records from military service if available.

    before exam

  • critical

    Photograph your skin on bad days before the exam

    Take dated, well-lit photos of affected areas when your condition is at its worst. Include photos of intertriginous areas, palms, soles, face, scalp, and nails if affected. Store photos on your phone or print copies to bring to the exam.

    before exam

  • critical

    Make a complete medication list with names, doses, and duration

    List every medication you use for your skin condition: topical steroids, biologics (adalimumab, dupilumab, secukinumab, etc.), oral retinoids, immunosuppressives (methotrexate, cyclosporine), antihistamines, and phototherapy. Include start dates and any medications you have tried in the past.

    before exam

  • critical

    Calculate your approximate body surface area affected

    Using the Rule of Nines (each arm = 9%, each leg = 18%, front torso = 18%, back torso = 18%, head = 9%), estimate your TBSA affected during a typical flare and on your worst days. Write this down to communicate clearly to the examiner.

    before exam

  • critical

    Document your flare frequency and duration over the past 12 months

    Write down how many flares you had, how long each lasted, what triggered them, and what percentage of the year your skin was actively affected. Include any work days missed, medical visits, or emergency care needed.

    before exam

  • critical

    Prepare a written functional impact statement

    Write down specific ways your skin condition limits your daily activities, work performance, social life, sleep, and personal hygiene. Include specific examples: 'I cannot wear dress shirts because the fabric aggravates my eczema,' 'I missed 8 days of work last year due to flares.'

    before exam

  • recommended

    Research your specific diagnosis against 38 CFR - 4.118 rating criteria

    Understand the rating criteria for your specific condition (DC 7806 for dermatitis, DC 7816 for psoriasis). Know what percentage of body surface area corresponds to each rating level (10%, 30%, 60%) and what treatment intensity thresholds apply.

    before exam

  • recommended

    Identify and note all special features of your condition

    Note whether you have: intertriginous involvement, palmar/plantar involvement, mucosal involvement, nail changes, erythroderma, scarring, alopecia, hyperhidrosis, or vasculitis. These have dedicated DBQ fields and can affect your rating.

    before exam

  • critical

    Do not over-treat or cover up your skin condition before the exam

    If possible, do not apply heavy moisturizers, cover-up, or bandages that would obscure the extent of your condition for the examiner. The examiner needs to see your skin as it typically appears. If you must treat for comfort, mention this to the examiner.

    day of

  • critical

    Bring all medications in original containers

    Bring every prescription and OTC medication you use for your skin condition. Original bottles allow the examiner to document names, doses, and prescribing physicians accurately.

    day of

  • critical

    Bring dated photographs of your condition at its worst

    Have your worst-day photos readily accessible on your phone or as prints. Offer these to the examiner proactively and ask that they be considered and noted in the examination report.

    day of

  • recommended

    Bring your written summary and functional impact statement

    Have your one-page written summary ready to hand to the examiner. This ensures critical information is documented even if the exam is brief.

    day of

  • optional

    Arrive early and request exam recording if desired

    In most states you have the right to record your C&P examination. Check your state's laws and VA policy beforehand. Notify the examiner at the start that you intend to record.

    day of

  • critical

    State explicitly if today is a better-than-typical day

    If your skin condition is in remission or less active than usual on exam day, say so clearly: 'Today is actually one of my better days. My condition is typically much more extensive. On a bad day, it looks like the photos I brought.'

    during exam

  • critical

    Describe your worst typical presentation when asked about your condition

    Per M21-1 guidance, VA ratings should reflect the veteran's worst typical day, not just the presentation on the exam date. Proactively describe your worst-day symptoms, extent of involvement, and functional impairment.

    during exam

  • critical

    Report ALL body areas affected, including private areas

    Do not omit involvement of groin, axilla, under breasts, anogenital area, or other areas you feel embarrassed about. These are medically significant and have dedicated DBQ fields. Use clinical language: 'I have involvement in my axillary and inguinal areas.'

    during exam

  • critical

    Clearly describe your treatment history including failed treatments

    If you tried and failed topical steroids before requiring systemic therapy, say so. Describe the progression: 'I started with topical steroids, they stopped working, then I was on oral prednisone, now I require a biologic.' This history supports the severity of your condition.

    during exam

  • recommended

    Report all associated conditions that may warrant separate ratings

    For psoriasis: report psoriatic arthritis symptoms (joint pain, swelling, morning stiffness), nail changes, and oral mucosal involvement. For any skin condition: report associated anxiety, depression, or social isolation as these may support additional claims.

    during exam

  • recommended

    Ask the examiner to confirm they are documenting TBSA and EBSA percentages

    Per M21-1 adjudication guidance, the skin DBQ MUST document both total body surface area and exposed body surface area (both as percentages) for the exam to be sufficient for rating. You may politely confirm this is being documented.

    during exam

  • critical

    Request a copy of the DBQ once it is completed

    You have the right to obtain a copy of your C&P examination report. Request it through your VSO, eBenefits, or VA.gov once it is uploaded to your claims file. Review it for accuracy and completeness.

    after exam

  • critical

    Review the DBQ for insufficient findings and act promptly

    If the DBQ does not document TBSA and EBSA percentages, your claim may be returned as insufficient. If the exam does not reflect your actual severity, work with your VSO to request a supplemental exam or submit a nexus letter or buddy statement.

    after exam

  • recommended

    Submit buddy statements and additional evidence

    Have family members, coworkers, or caregivers submit lay statements describing your skin condition's impact on daily life. Submit any additional medical records, photographs, or letters from your treating dermatologist that were not already in your file.

    after exam

Your rights during a C&P exam

  • You have the right to have your C&P examination recorded (audio or video) in most states - notify the examiner at the beginning of the exam.
  • You have the right to request a copy of your completed DBQ examination report through VA.gov, eBenefits, or your accredited VSO.
  • You have the right to submit additional evidence (photographs, buddy statements, treating physician letters) before a rating decision is issued.
  • You have the right to request a new or supplemental C&P examination if you believe the original exam was inadequate, incomplete, or did not reflect your actual condition.
  • You have the right to bring a VSO representative, accredited claims agent, or attorney to your C&P examination as an observer.
  • Under M21-1 adjudication guidance, the Skin Diseases DBQ MUST document both total body surface area AND exposed body surface area as percentages - an exam missing these measurements can be challenged as insufficient for rating.
  • You have the right to provide photographs of your condition taken on your worst days as evidence - examiners must consider this evidence, and you should proactively offer it.
  • If your condition varies in severity, you have the right to have your rating reflect your typical worst-day severity, not just your presentation on exam day.
  • You have the right to appeal a rating decision you disagree with through the Supplemental Claim, Board of Veterans' Appeals Direct Review, or Higher-Level Review lanes.
  • For psoriasis (DC 7816), you have the right to have complications such as psoriatic arthritis and nail or mucosal involvement rated separately under appropriate diagnostic codes.
  • You have the right to receive an examination by a qualified specialist (dermatologist) for complex skin conditions - if a non-specialist examines you, you may request review by a dermatologist.

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.