How the VA rates eczema and other skin conditions
Skin conditions are rated two ways: how much of you is covered, or how much treatment it takes to control. You get whichever is higher, and the second route is the one veterans forget to document.
Eczema and dermatitis are rated under diagnostic code 7806 in 38 CFR § 4.118. Since the 2018 revision of the skin schedule, DC 7806 and a group of related codes are all rated on one shared table, the General Rating Formula for the Skin, which also covers psoriasis (7816), dermatophytosis such as athlete's foot and jock itch (7813), and several others.
The formula: two independent routes
Each tier can be met by either the amount of skin involved or the systemic therapy required. You do not need both. The word in the regulation is "at least one of the following."
| Rating | Body surface area route | Systemic therapy route |
|---|---|---|
| 60% | Characteristic lesions on more than 40% of the entire body, or more than 40% of exposed areas | Constant or near-constant systemic therapy over the past 12 months |
| 30% | Lesions on 20 to 40% of the entire body, or 20 to 40% of exposed areas | Systemic therapy for a total of 6 weeks or more, but not constantly, over the past 12 months |
| 10% | Lesions on at least 5% but less than 20% of the entire body, or of exposed areas | Intermittent systemic therapy for a total of less than 6 weeks over the past 12 months |
| 0% | Lesions on less than 5% of the body and less than 5% of exposed areas | No more than topical therapy over the past 12 months |
"Exposed areas" means the parts normally visible: head, face, neck, and hands. That distinction matters, because a condition confined to the hands can cover a very small share of your total body while covering a large share of your exposed area, and the schedule takes whichever is more favourable.
What counts as systemic therapy
The regulation lists corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, and other immunosuppressive drugs, and it says "including, but not limited to," so the list is not closed.
Systemic means it acts on your whole body. Oral prednisone is systemic. An injected biologic is systemic. Light therapy in a clinic is systemic for these purposes because the regulation names it. A cream you rub on the affected patch is topical, and topical treatment alone puts you in the 0% tier under the therapy route.
The therapy route turns entirely on duration over a 12-month period, and that is a documentary question. Two separate two-week courses of oral steroids in a year is four weeks, which is the 10% tier. Add a third and you are at six weeks, which is 30%. Pharmacy records and prescription dates are what prove this, and almost nobody brings them to the exam.
Why the exam timing matters so much
Skin conditions flare and settle. An examiner measuring body surface area on a good week records a small number, and that number becomes the rating for years.
The regulations require the disability picture to reflect the condition over time rather than a single snapshot, but a rater can only work with what is in the file. So put it there:
- Photograph every flare, with the date visible or preserved in the file metadata. This is the single most useful thing you can do for a skin claim, and it costs nothing.
- Keep a dated log of when flares start and stop, what triggered them, and what treatment was used.
- Get seen during a flare, even briefly, so there is a contemporaneous clinical record rather than only your account afterwards.
- Bring pharmacy records showing every course of systemic treatment with its dates.
- If you are offered an exam during a quiet period, say clearly on the day that the condition is currently in remission and describe what it looks like at its worst.
Scars and disfigurement are separate
The skin formula includes an instruction to rate instead as disfigurement of the head, face, or neck (DC 7800) or as scars (DC 7801, 7802, 7804, 7805) where that is the predominant disability. Where a skin condition has left genuine disfigurement or painful scarring, check whether the scar codes pay more. See the scars guide for how those are measured.
What you cannot do is collect under both the skin formula and a scar code for the same skin, since that compensates one impairment twice, which § 4.14 prohibits.
Service connection routes
- Direct. A rash documented in your service treatment records that never fully resolved. Skin complaints at sick call are common and are frequently in the file even when the veteran has forgotten them.
- Environmental exposure. Conditions that began during deployment, particularly where heat, sand, chemicals, or burn pit smoke were involved. Chloracne (DC 7829) is a presumptive condition for herbicide exposure, rated on its own criteria rather than the general formula.
- Gulf War undiagnosed illness. Persistent skin signs and symptoms without a clear diagnosis can qualify as an undiagnosed illness for Southwest Asia veterans, with no nexus required. See the Gulf War guide.
- Secondary. Skin reactions caused by medication prescribed for a service-connected condition are claimable as secondary, and so is a skin condition aggravated by one. See secondary conditions.
A note on fungal conditions
Dermatophytosis under DC 7813, which covers athlete's foot, jock itch, and ringworm, uses the same general formula. Veterans dismiss these as trivial, but a persistent fungal condition on both feet, treated repeatedly for years since a deployment, is a legitimate service-connected disability and is documented in more service records than almost any other skin complaint.
The checklist
- Dated photographs of flares, taken over time, not one set.
- Pharmacy records showing every systemic course and its dates, totalled across 12 months.
- A treatment log with the start and end of each flare.
- Clinical notes recorded during a flare, not only between them.
- Body surface area measured for both total body and exposed areas.
- A separate look at whether scar or disfigurement codes pay more.