VA rating for scars: painful, unstable and surgical scars
Scars are easy to overlook. They sit on the same body as the condition that caused them, a scar left off the claim may not get decided at all, and a painful or unstable scar can be rated on its own. If you have had surgery for a service-connected condition, read this.
VA rates service-connected scars under five diagnostic codes in the skin schedule. Scars of the head, face or neck are rated on disfigurement. Other scars are rated on their area and whether there is underlying soft tissue damage. Any scar can also be rated on how many scars are painful or unstable, and on other effects such as limited motion. A surgical scar is not rated just for existing (38 CFR § 4.118).
Scars are rated in 38 CFR § 4.118, the skin section, under five codes that each measure something different. A single scar can qualify under more than one, and the schedule expressly allows separate ratings where the codes measure different things.
DC 7804: painful or unstable scars
This code does not care where the scar is or how big it is. It counts.
| Rating | What the schedule requires |
|---|---|
| 10% | One or two scars that are unstable or painful. |
| 20% | Three or four scars that are unstable or painful. |
| 30% | Five or more scars that are unstable or painful. |
Three notes matter. Note (1) defines unstable as a scar with frequent loss of skin covering over it. Note (2) says that if any scar is both unstable and painful, add 10% to the rating. Note (3) says scars rated under 7800, 7801, 7802, or 7805 can also be rated under 7804 when applicable, which is the schedule's express permission for a second rating that measures something different.
Suppose a veteran has four scars from surgery on a service-connected left knee: three arthroscopy portals of about 1 cm by 0.5 cm each, and a 15 cm by 1 cm incision from a later open repair. At the exam, two of the portals are tender to palpation. The incision is tender too, and the skin over it repeatedly breaks open, which Note (1) calls unstable. The third portal causes no symptoms. The knee moves normally.
- Count the scars that are painful or unstable: two portals plus the incision makes three. The symptom-free portal does not count. Three or four scars is 20% under DC 7804.
- Apply Note (2): at least one scar, the incision, is both unstable and painful, so 10% is added, for 30%.
- Check the area codes covered below: all four scars sit in one zone, the left lower extremity, and cover 16.5 square centimeters (15 plus three times 0.5). DC 7801 starts at 39 square centimeters (6 square inches) and DC 7802 at 929, so even counting every scar toward either code, neither adds a rating.
- Check DC 7805: if the incision limited knee motion, that could be rated under the knee codes, but only for loss of motion the knee rating does not already cover (§ 4.14). Since the knee moves normally, DC 7804 at 30% is the whole scar rating.
Had the incision been painful but never broken open, the Note (2) add-on would not apply and DC 7804 would stay at 20%.
A scar from surgery to treat a service-connected condition can be service connected as part of that condition under § 3.310(a), whether it came from a knee arthroscopy, a spinal fusion, a shoulder repair, a hernia mesh repair, or a cholecystectomy. Service connection does not by itself mean a percentage: the scar still has to meet one of the scar codes. If the scar hurts and there is objective support for the pain, such as the examiner checking it as tender to palpation, it counts as a painful scar, and one or two painful scars is 10%. That rating is separate from the rating for the underlying condition and combines into the total, as long as it does not compensate a symptom the other rating already covers (§ 4.14). A painful scar that shows up at the exam or in the records but was never claimed is decided as part of the claim only if VA treats it as within the scope of that claim, so claim it by name.
DC 7801 and 7802: scars by area
Scars not on the head, face, or neck are also rated by size, and the rating depends on whether there is underlying soft tissue damage.
- DC 7801, scars associated with underlying soft tissue damage: 10% for at least 6 square inches, 20% for at least 12, 30% for at least 72, 40% for 144 square inches or more.
- DC 7802, scars not associated with underlying soft tissue damage: 10% for 144 square inches or more. That is a single tier, and it takes scarring that adds up to a full square foot (12 by 12 inches).
The notes divide the body into six zones, each extremity, the front of the trunk, and the back of the trunk, split at the midaxillary line. Each affected zone can get its own rating, combined under § 4.25, or the areas from several zones can be added into a single rating if that comes out higher. Scarring that adds up to less than 6 square inches (39 square centimeters) earns nothing under either code, so a small surgical scar outside the head, face, and neck can only be rated under 7804 if it is painful or unstable, or under 7805 for what it does, not for its size.
DC 7800: head, face, and neck
Scars and disfigurement of the head, face, or neck are rated on the eight characteristics of disfigurement listed in the note: a scar 5 inches or longer, a scar at least a quarter inch wide, surface contour elevated or depressed, scar adherent to underlying tissue, abnormal pigmentation over more than six square inches, abnormal texture over more than six square inches, missing underlying soft tissue over more than six square inches, and indurated and inflexible skin over more than six square inches.
| Rating | What the schedule requires |
|---|---|
| 10% | One characteristic of disfigurement. |
| 30% | Visible or palpable tissue loss with gross distortion or asymmetry of one feature or paired set (nose, chin, forehead, eyes, ears, cheeks, lips); or two or three characteristics. |
| 50% | Tissue loss with gross distortion or asymmetry of two features or paired sets; or four or five characteristics. |
| 80% | Tissue loss with gross distortion or asymmetry of three or more features or paired sets; or six or more characteristics. |
Facial scars should be photographed. Note (3) to the code tells the rater to consider unretouched color photographs, and the scars exam form says the examiner is not required to take any, so the veteran's own photos may be the only ones in the file. A scar that is hard to see in a clinic under fluorescent light may be obvious in daylight; bring the photos, unedited.
DC 7805: everything else a scar does
DC 7805 directs the rater to evaluate any disabling effect of a scar not already covered, under the appropriate code. A scar across a joint that limits motion is rated for the limitation of motion. A scar that entraps a nerve is rated under the nerve code. This is where a scar stops being a skin condition and becomes whatever it is actually doing.
Service connection
A scar from an in-service injury or surgery is directly service connected, and the service treatment records may contain the operative note or the wound care. A scar from post-service surgery on a service-connected condition can be secondary under § 3.310(a), which service connects a disability that is proximately due to or the result of a service-connected condition and treats it as part of the original one. The operative report shows what the surgery was for, which is the link VA looks for. List the scar as its own claimed condition: "surgical scar, left knee, secondary to service-connected left knee condition."
The exam
The Scars/Disfigurement DBQ asks the examiner to measure each scar in centimeters, note its location, record how many scars are painful and which are tender to palpation, check for instability, and describe any limitation of function. It states that color photographs are not required, though any that are taken must be attached. Three things to do:
- Point out every scar from a service-connected injury or surgery, including the small ones. Arthroscopy portals count.
- If a scar hurts, say so when the examiner asks about its history and again when the examiner presses on it. The form records both, and DC 7804 turns on whether a scar is painful, not on whether it looks bad.
- Mention any scar where the skin over it keeps breaking down or opening up. Frequent loss of skin covering is what Note (1) calls instability, and a scar that is both painful and unstable adds 10%.
Read Preparing for a C&P exam for the general approach.
The checklist
- Operative reports or injury records for each scar.
- Each scar listed separately on the 21-526EZ with its location and the service-connected condition it came from.
- Photographs, especially for facial scars and any that are unstable.
- A statement noting which scars are tender, which break down, and anything a scar limits.
Scar rating questions
How does VA rate scars?
VA uses five codes in § 4.118. DC 7800 rates scars and other disfigurement of the head, face or neck on eight characteristics of disfigurement and on tissue loss, from 10% to 80%. DC 7801 rates other scars with underlying soft tissue damage by area, from 10% at 6 square inches up to 40% at 144 square inches or more. DC 7802 rates other scars without soft tissue damage at 10% for 144 square inches or more. DC 7804 rates painful or unstable scars by count: 10% for one or two, 20% for three or four, 30% for five or more. DC 7805 rates any other disabling effect, such as limited motion, under the code for that effect (38 CFR § 4.118).
What is an unstable scar?
Under Note (1) to DC 7804, an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar: the skin over it keeps breaking down or opening up. Instability and pain are separate findings, and either one makes a scar count toward the DC 7804 total. If one or more scars are both unstable and painful, Note (2) adds 10% once to the evaluation based on the number of scars. The scars exam form asks the examiner whether any scar is unstable and to describe the loss of skin covering (38 CFR § 4.118; VA Scars DBQ).
Does a surgical scar get a separate VA rating?
It can, but not automatically. A scar from surgery on a service-connected condition can be service connected as secondary to that condition under § 3.310(a). A percentage then depends on the scar meeting a scar code: painful or unstable under DC 7804, large enough under DC 7801 or 7802, disfiguring on the head, face or neck under DC 7800, or causing another effect, such as limited motion, under DC 7805. A small scar off the head, face and neck that is neither painful nor unstable and limits nothing meets no compensable criterion, so it is rated 0%. On the head, face or neck, even a small scar can meet DC 7800 if it has a characteristic of disfigurement, such as an elevated or depressed surface. A scar rating also cannot pay again for a symptom the underlying condition's rating already covers. The shoulder guide and knee guide cover how the joint itself is rated after surgery (38 CFR §§ 3.310, 4.14, 4.31, 4.118).
How does VA rate a keloid scar?
There is no separate code or fixed percentage for keloids. A keloid is rated like any other scar, by where it is and what it does. On the head, face or neck, a raised surface contour is one of the eight characteristics of disfigurement under DC 7800, and a scar 5 inches or longer, or at least a quarter inch wide, counts as another. Elsewhere, its area counts under DC 7801 or 7802. A keloid that is painful or unstable counts under DC 7804, and one that limits motion is rated under DC 7805. Skin diseases that are not scars use different criteria, covered in the skin conditions guide (38 CFR § 4.118).
How does VA rate scars on the head?
Scars anywhere on the head, face or neck are rated under DC 7800. One characteristic of disfigurement is 10%, two or three is 30%, four or five is 50%, and six or more is 80%. Visible or palpable tissue loss with gross distortion or asymmetry of one, two, or three or more features, such as the nose, eyes, ears, cheeks or lips, is another way to reach 30%, 50% or 80%. The characteristics can come from one scar or several. Pain, instability and muscle or nerve damage from the same scars are rated separately and combined, and VA considers unretouched color photographs (38 CFR § 4.118, DC 7800, Notes (1) and (3) to (5)).
Sources
- 38 CFR § 4.118, Schedule of ratings: skin: the rating criteria and notes for scars and disfigurement, including the eight characteristics, the six body zones, the painful-or-unstable count, and the 10% add-on.
- 38 CFR § 4.25, Combined ratings table: how a scar rating combines with other ratings and how the combined value is rounded.
- 38 CFR § 4.14, Avoidance of pyramiding: the rule against rating the same manifestation under two diagnostic codes, which limits what DC 7805 can add.
- 38 CFR § 4.31, Zero percent evaluations: a 0% evaluation when a code's requirements for a compensable rating are not met.
- 38 CFR § 3.310(a), Disabilities that are proximately due to, or aggravated by, service-connected disease or injury: service connection for a disability that is proximately due to or the result of a service-connected condition.
- Scars/Disfigurement Disability Benefits Questionnaire (updated Dec. 3, 2025): what the examiner measures and records, including painful, tender, and unstable scars and the note that photographs are not required.
- M21-1, Part V, Subpart iii, Chapter 10, Topic 3 (Rating Painful or Unstable Scars): VA's procedures manual on when a painful scar gets a separate rating, the tender-to-palpation box as objective evidence of pain, and when a scar that was not expressly claimed is decided as part of the claim.
- VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits: the form used to claim each scar as a condition.
A 10% scar on top of a 40% back and a 20% knee looks small, but it moves the combined value from 52, which rounds to 50%, to 57, which rounds up to 60%. The combined rating math is such that several small ratings can push the total across a rounding line. READY214's calculator shows where that line is.