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Thursday, October 6, 2016

Comments Submitted to the VA on the Changes to the Ratings for the Skin

The following are the comments we submitted on your behalf to the VA in regards to the proposed changes to the ratings of the Skin. After the VA publishes their proposed changes, they always allow a period for comments. Thank you for submitting your comments to us so that we could submit them in a unified front to the VA. Hopefully, we will be able to effect change and make the rating system more fair for all veterans.

Here are the comments we submitted for Skin Conditions:

We at would like to submit the following comments on behalf of our staff and veterans in response to the proposed changes to the ratings of the Skin.

Item #1

The proposed changes for code 7825 urticaria provide ratings for the number of “attacks” which are 6 weeks or more but doesn’t provide for on-going cases that do not have breaks between attacks. Although rare, there are documented cases of a single attack lasting years with no breaks. If the number of attacks is taken literally, then this on-going case would only count as a single attack and thus only qualify for a 10% rating although it is far more serious than the cases that qualify for the 60% rating.

We propose that an additional requirement is added that would allow long-lasting, continuous cases to be rated at the 60% or above level.

Item #2

For codes 7825 and 7827, in the discussion of the changes, it says, “The mucosal, palmar, and/or plantar findings would be restricted to the past 12-month period for all evaluation levels.”

In the ratings, however, it changes the phrasing from “at least four times during the past 12-month period” to “four or more times per 12-month period.” This contradicts what is specified in the discussion.

“Four or more times per 12-month period” does not indicate at all that it has to be in the past 12 months. If the past 12 months is required, then changing the phrasing is not justified.

Furthermore, “four or more times per 12-month period” is incredibly vague. Based on the literal statement, if a veteran has a single year with 4 episodes 20 years ago, then they would qualify, even though they haven’t had a single episode in years.

If adjusted to “every 12-month period”, then there is no defining factor as to sufficient history. To qualify, they would have to have 4 episodes every 12 months for the past 20 years? Is not the last year enough? Again, this would be vague and leave too much room for faulty interpretation.

Instead, we suggest leaving the phrasing as is since “at least four times during the past 12-month period” is very precise and does not leave things open to interpretation. It also satisfies the intent of the ratings as noted in the discussion.

Item #3

One of our female veterans brought up a good point regarding proper ratings for the complete, permanent loss of hair for females due to service-connected medical conditions.

While she is receiving the maximum rating possible (20%) under code 7830 for scarring alopecia, baldness in females is far more socially debilitating than in males, and the ratings do not properly compensate for the additional needs that females have in order to deal with this condition.  

As she states, “It seems the alopecia is mostly regarded as a cosmetic issue and is not regarded for the emotional scarring or financial impact that it has for the veteran that needs cranial prostheses (wigs) and supplies to maintain the units. Two units are available to veterans that have lost their hair from chemotherapy because it is highly suggestive that their hair loss is temporary, unlike veterans like me whose hair will not return. Therefore, we need access to a lifetime of cranial prostheses at regular intervals because the units are not built to last. It has been very costly and difficult to process orders for the cranial prosthesis because the vendors are few and far between and mostly sell inferior products for an extreme cost to the government. Therefore, when the government allots thousands of dollars for one cranial prosthesis (ie $1400-$2400) it is most difficult for the veteran to get the amount of units needed to sustain without enduring a financial hardship replacing units while awaiting another cycle of prostheses that may or may not be received for various reasons.”

It is clear from this veteran’s experience that she incurs a high financial responsibility that is not sufficiently covered by a 20% rating or the prosthetic system currently in place. Whether adjusting the ratings to better cover these costs or adjusting the prosthetic system, it is an issue that deserves to be recognized and addressed.

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