How the VA rates scars
Scars are the quiet rating. Nobody files a claim for them, they show up on the same body as the condition that caused them, and the schedule hands out a separate 10% for a scar that hurts when you press it. If you have had surgery for a service-connected condition, read this.
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 is the code that matters for most veterans. It 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. |
Two notes change the arithmetic. 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 7804 can also be rated under 7800, 7801, 7802, or 7805 when applicable, which is the express permission for stacking.
Every incision from surgery on a service-connected condition is a scar from a service-connected condition. A knee arthroscopy leaves two or three small portals; a spinal fusion leaves one long one; a shoulder repair, a hernia mesh, a cholecystectomy, all the same. If the scar is tender to pressure, it is a painful scar, and one or two painful scars is 10%. It is a separate rating from the underlying condition, it combines into the total, and it is routinely left unclaimed because the examiner did not ask and the veteran did not think to say.
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, deep 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, superficial scars (no underlying soft tissue damage): 10% for 144 square inches or more. That is a single tier, and it requires a scar the size of a sheet of paper.
The notes divide the body into six zones, each extremity, the front of the trunk, and the back of the trunk, and scars in separate zones get separate ratings. Burn survivors and veterans with large traumatic wounds are the main beneficiaries; for most surgical scars, area ratings do not reach a compensable level, and 7804 is the working code.
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 or 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 distortion of two features; or four or five characteristics. |
| 80% | Tissue loss with distortion of three or more features; or six or more characteristics. |
Facial scars should be photographed, and the note to the code says the VA will take the photographs into account. A scar that is hard to see in a clinic under fluorescent light may be obvious in daylight; bring the photos.
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 will usually contain the operative note or the wound care. A scar from post-service surgery on a service-connected condition is secondary under § 3.310, and this is the common case: the surgery was for the service-connected knee, so the scar from it is service connected too. No separate nexus opinion is needed; the surgical record tying the operation to the condition is the link. List the scar as its own claimed condition: "surgical scar, left knee, secondary to service-connected left knee condition."
The exam
The scars DBQ asks the examiner to measure each scar, note its location, press on it to test for pain, check for instability, and photograph it if on the face. 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 is tender, say so when the examiner presses it. "Painful on examination" is the finding the 10% turns on; stoicism costs money here.
- Mention any scar that breaks down, cracks, or bleeds. That is 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.
A 10% scar on top of a 20% knee and a 10% tinnitus does not change the combined number much on its own, but the combined rating math is such that several small ratings frequently push the total across a rounding line. READY214's calculator shows where that line is.