Eczema VA rating and dermatitis criteria
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 turns on how long systemic treatment lasted, which dated records show.
VA rates service-connected eczema and dermatitis under DC 7806, using the General Rating Formula for the Skin. The rating is 0%, 10%, 30% or 60%, set by how much of your whole body or exposed skin has lesions, or by how long you needed systemic treatment, such as oral steroids, over the past 12 months. Some other skin diseases use different criteria (38 CFR § 4.118).
Eczema and dermatitis are rated under diagnostic code 7806 in 38 CFR § 4.118. Since the 2018 revision of the skin schedule, effective August 13, 2018, 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 entire body, or on less than 5% of exposed areas | And no more than topical therapy over the past 12 months |
The 0% row is worded differently from the others: it needs no more than topical therapy and a small affected area. Because each higher tier needs only one of its criteria, a veteran who meets any criterion of a higher tier is rated at that tier instead.
The regulation does not define "exposed areas". When VA revised the schedule in 2018, it explained that dermatology practice treats only the head (including the face), neck, and hands as consistently exposed, and it declined requests to add forearms and lower legs. 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.
Suppose a veteran has service-connected hand eczema under DC 7806, on the palms and backs of both hands. At the exam, the examiner records lesions on 4% of the entire body and 30% of exposed areas. Over the past 12 months the veteran used a steroid cream daily and took two courses of oral prednisone, 10 days in March and 14 days in October.
- Entire body: 4% is under 5%, so this measure on its own supports only 0%.
- Exposed areas: 30% falls within "20 to 40 percent of exposed areas," which meets the 30% criterion.
- Therapy: the cream is applied through the skin, so § 4.118(a) makes it topical and it adds nothing. The prednisone is taken by mouth, so it is systemic: 10 + 14 = 24 days, or 3 weeks and 3 days. That is under 6 weeks, which is the 10% criterion.
- Result: each tier needs only "at least one" of its criteria, so on these facts the formula points to 30%, carried by the exposed-area figure.
Had the exam report recorded only the entire-body figure, the same facts would point to 10%, carried by the prednisone. A third course of 18 days would bring the total to 42 days, exactly 6 weeks, and meet 30% on the therapy route as well, but no higher: 60% needs more than 40% involvement or constant or near-constant systemic therapy.
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 is defined by route. Section 4.118(a) calls a treatment systemic when it is given by any route other than the skin: by mouth, by injection, by suppository, or through the nose. Treatment applied through the skin is topical. Oral prednisone is systemic. An injected biologic is systemic. Light therapy is less tidy: the formula's list names phototherapy and PUVA, while the Skin DBQ records phototherapy separately from systemic and topical medicines, so how a given light treatment counts is decided on the record. A cream you rub on the affected patch is topical, and topical treatment alone puts you in the 0% tier under the therapy route. Where a cream has to cover a large area, the body surface route is what captures that.
A steroid cream is still topical. In Johnson v. Shulkin (2017), the Federal Circuit rejected a reading of the old text that made every corticosteroid, even a cream, systemic. The 2018 definition then fixed the line at the route of administration.
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 show those durations, so bring 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 the rating can end up resting on that number.
The regulations require the disability picture to reflect the condition over time rather than a single snapshot: § 4.2 tells raters to read exam reports "in the light of the whole recorded history." But a rater can only work with what is in the file. So put it there:
- Photograph flares, with the date visible or preserved in the file metadata, so the record shows the skin at its worst and not only on exam day.
- 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.
When scar or disfigurement criteria apply
The skin formula ends with an alternative: rate instead as disfigurement of the head, face, or neck (DC 7800) or as scars (DC 7801, 7802, 7804, 7805), depending on the predominant disability. Where a skin condition has left disfigurement or painful scarring, the rater looks at which set of criteria fits what the condition mainly does. The scars guide explains how those codes 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. Section 4.118(b) says the same for the skin schedule: two skin conditions are combined under § 4.25 only if they involve separate areas of skin, and where they share an area, only the highest evaluation is used.
Service connection routes
- Direct. A rash documented in your service treatment records that never fully resolved. Read those records for any sick-call visit about a rash, including visits you no longer remember.
- 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 under § 3.309(e), but only if it reached a 10% level within one year of the last exposure (§ 3.307(a)(6)(ii)). It is rated on its own criteria rather than the general formula.
- Gulf War undiagnosed illness. Skin signs and symptoms that last six months or more, or come and go over six months, without a clear diagnosis can qualify as an undiagnosed illness, with no nexus required. This applies to Persian Gulf veterans: those who served during the Persian Gulf War in the Southwest Asia theater or, since the PACT Act, in Afghanistan, Israel, Egypt, Turkey, Syria or Jordan. The printed text of § 3.317 still requires the signs to have appeared during service in the Southwest Asia theater or reached 10% by December 31, 2026. The statute behind it, 38 U.S.C. § 1117 as amended by section 405 of the PACT Act, has no deadline: a qualifying chronic disability counts if it became manifest to any degree at any time. 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. These are easy to dismiss as trivial, but a persistent fungal condition on both feet, first treated during a deployment and repeatedly since, can be service connected like any other skin condition.
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 criteria fit the condition better.
Eczema and skin rating questions
What is the VA disability rating for eczema?
Eczema is rated under DC 7806 at 0%, 10%, 30% or 60%. 60% needs lesions on more than 40% of the entire body or of exposed areas, or constant or near-constant systemic therapy over the past 12 months. 30% needs lesions on 20 to 40% of the entire body or of exposed areas, or systemic therapy for a total of 6 weeks or more, but not constantly. 10% needs lesions on at least 5% but less than 20% of the entire body or of exposed areas, or intermittent systemic therapy for a total of less than 6 weeks. Meeting any one criterion of a tier is enough. No more than topical treatment, with lesions on less than 5%, is 0% (38 CFR § 4.118).
Is dermatitis rated differently from eczema?
No. DC 7806 is titled "Dermatitis or eczema," and both are evaluated under the same General Rating Formula for the Skin. The diagnosis picks the code; the percentage comes from the affected area and the systemic treatment needed over the past 12 months, as recorded at the exam and in your treatment records. The diagnosis on its own does not set a percentage (38 CFR § 4.118, DC 7806; VA Skin DBQ).
Do all skin conditions use the same VA rating formula?
No. The General Rating Formula for the Skin covers DCs 7806, 7809, 7813 to 7816, 7820 to 7822 and 7824, which include eczema and dermatitis, discoid lupus, fungal infections, bullous disorders, psoriasis and diseases of keratinization. Other skin conditions have their own criteria, among them acne and chloracne, vitiligo, chronic urticaria, erythroderma, alopecia, hyperhidrosis, and skin growths and cancers. Scars are rated under DCs 7800 to 7805, which the scars guide explains. Two skin conditions on the same area of skin get only the highest evaluation (38 CFR § 4.118).
What evidence helps an eczema or dermatitis claim?
The criteria look back 12 months, so records covering that period matter: prescriptions showing each treatment, how it was taken (by mouth, by injection or on the skin) and for how long, plus any phototherapy. The exam measures how much of the whole body and of exposed skin (the face, neck and hands) is affected that day, so dated photos and clinic notes from flares show what one exam may miss. Raters must read the exam against the whole recorded history, and the exam form also asks how the condition affects work. None of this guarantees a particular rating (38 CFR §§ 4.2, 4.118; VA Skin DBQ).
Sources
- 38 CFR § 4.118, Schedule of ratings: skin. The 0, 10, 30 and 60% tiers, the definitions of systemic and topical therapy in paragraph (a), the same-area rule in paragraph (b), the scar and disfigurement alternative, and the separate criteria for chloracne under DC 7829.
- 83 FR 32592 (July 13, 2018), Schedule for Rating Disabilities: Skin, final rule. The 2018 revision effective August 13, 2018: the two-route design, the head, neck and hands as exposed areas, and the response to Johnson v. Shulkin on topical corticosteroids.
- VA, Skin Diseases Disability Benefits Questionnaire. The exam's record of treatment route and duration, phototherapy, the whole-body and exposed-area percentages (face, neck and hands), and effect on work.
- 38 CFR § 4.14, Avoidance of pyramiding. The bar on rating the same disability or manifestation twice under different diagnoses.
- 38 CFR § 4.2, Interpretation of examination reports. Raters must read exam reports against the whole recorded history, not a single visit.
- 38 CFR § 3.309(e), Disease subject to presumptive service connection. Chloracne and other acneform disease consistent with chloracne on the herbicide presumptive list.
- 38 CFR § 3.307(a)(6)(ii), Presumptive service connection for chronic, tropical, or prisoner-of-war related disease, disease associated with exposure to certain herbicide agents, or disease associated with exposure to contaminants in the water supply at Camp Lejeune; wartime and service on or after January 1, 1947. The one-year window after the last herbicide exposure for chloracne to reach 10%.
- 38 CFR § 3.317, Compensation for certain disabilities occurring in Persian Gulf veterans. Skin signs and symptoms as undiagnosed illness, the six-month chronicity rule, and the December 31, 2026 date still printed in paragraph (a)(1)(i), which the amended statute has overtaken.
- 38 U.S.C. § 1117, Compensation for disabilities occurring in Persian Gulf War veterans, as amended by Pub. L. 117-168, § 405. The statute, which now allows a qualifying chronic disability that became manifest to any degree at any time, and whose definition of a Persian Gulf veteran now includes service in Afghanistan, Israel, Egypt, Turkey, Syria or Jordan.