How VA rates skin condition
The General Rating Formula for the Skin applies to specified codes, including dermatitis and eczema. It uses affected body or exposed area, or required systemic therapy and duration. Other skin diagnoses may use different codes. This general formula has 0%, 10%, 30%, and 60% levels, not a 50% level.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 0% | No more than topical therapy required in the past 12 months, with characteristic lesions on less than 5% of the entire body OR less than 5% of exposed areas. Compare all higher criteria before using this level. |
| 10% | Characteristic lesions on at least 5% but less than 20% of the entire body OR exposed areas; OR intermittent systemic therapy required for less than six weeks total in the past 12 months. |
| 30% | Characteristic lesions on 20% to 40% of the entire body OR exposed areas; OR systemic therapy required for at least six weeks total, but not constantly, in the past 12 months. |
| 60% | Characteristic lesions on more than 40% of the entire body OR exposed areas; OR constant or near-constant systemic therapy required in the past 12 months. |
DBQ and symptom topics to review
Review these topics against your own records and symptoms. Do not exaggerate or minimize; describe functional impact accurately.
- No more than topical therapy required in the past 12 months, with characteristic lesions on less than 5% of the entire body OR less than 5% of exposed areas. Compare all higher criteria before using this level.0%Compare the complete criterion with documented findings; not a personal rating.
- Characteristic lesions on at least 5% but less than 20% of the entire body OR exposed areas; OR intermittent systemic therapy required for less than six weeks total in the past 12 months.10%Compare the complete criterion with documented findings; not a personal rating.
- Characteristic lesions on 20% to 40% of the entire body OR exposed areas; OR systemic therapy required for at least six weeks total, but not constantly, in the past 12 months.30%Compare the complete criterion with documented findings; not a personal rating.
- Characteristic lesions on more than 40% of the entire body OR exposed areas; OR constant or near-constant systemic therapy required in the past 12 months.60%Compare the complete criterion with documented findings; not a personal rating.
What may happen in the exam room
- Identification of the skin diagnosis and affected areas.
- Review of treatment route, required duration, and changes during flares.
Measurements and findings to understand
- Percentage of the entire body and of exposed areas affected.
- Required therapy, route, and total duration during the past 12 months.
- Whether disfigurement, scars, or another code reflects the predominant disability.
Questions the examiner may cover
- Where and how often does the condition appear?
- What treatment was required and for how long?
- Do dated photographs or records show flares not present today?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- Describe documented flares, treatment, and practical impact.
- Do not estimate a percentage from redness alone or alter treatment to provoke a flare.
Common mistakes to avoid
- Assuming every treated skin condition has a minimum 10%.
- Using an invented 50% band for the general formula.
- Treating topical treatment as automatically systemic or counting overlapping manifestations twice.
Evidence to organize before the exam
- Dermatology diagnosis and treatment records.
- Medication route and duration records.
- Dated photographs of relevant flares when available.
Preparation notes
- Systemic therapy under section 4.118 is administered through a route other than the skin; topical therapy is administered through the skin.
- Use the code appropriate to the documented condition, not whichever description appears to give the highest number.
Official rating source
38 CFR 4.118, General Rating Formula for the Skin. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Distinct scars or disfigurement may be evaluated under DCs 7800–7805 when the same manifestations are not rated twice.
Review only with a distinct diagnosis and non-duplicative impairment.
Document sleep disruption as functional impact; it is not a separate disability by default.