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Monday, July 23, 2018

Official Changes to the Ratings of the Skin


On July 13th, 2018, the VA published their final changes to the ratings of the Skin (including Scars). Of the nine sets of changes that have been proposed so far as part of the VA’s complete rewrite of the VASRD, this is the sixth to be made official and final.

The other finalized changes were the new Female Reproductive System and Eye ratings changed in May, the changes for Dental and Oral Conditions and the Endocrine System made last fall, the Mental Disorders made in 2014. 

Other proposed changes include the Hemic and Lymphatic System, the Genitourinary System, and the Musculoskeletal System.

The following Skin changes will go into effect August 13, 2018, and we’ll officially update all the information on our website at that time. These new ratings will automatically apply to any new claims for Skin conditions submitted on or after August 13th, however, any pending claims for Skin conditions submitted before this date will be considered under both the new and old criteria and given the highest rating allowed under either system. This could be a huge benefit to some veterans, so if you have yet to submit a claim for a skin condition, try to get it in before the 13th to give yourself a shot at the highest rating possible. 

On a positive note, two of the comments we submitted in response to the proposed changes were taken into consideration, and the VA made significant changes to the final codes based on our comments. It is great to know that our voices are being heard and changes being made for the better! Thank you for submitting your comments!

Now, the following are the VA’s final changes to the ratings for the Skin. The changes are fairly extensive, so I’ll walk through each, one at a time.

For each condition, the small, indented parts are the code as it is right now. Click on the code numbers to be taken to the discussion of that code on our site. After the current code, I’ll discuss the final changes. 
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First, a few changes to the overall system:

Systemic vs. Topical

The first change is to add a note that fully defines systemic vs. topical therapies for the treatment of skin conditions. As it is currently, it is a bit confusing what treatments are considered which due to the fact that some topical treatments can cause systemic reactions. Thus, to make it clear, the proposed change defines them as follows:

    - Systemic therapy is any treatment that is injected, or taken by mouth, through the nose, or anally. This includes, but is not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, and other immunosuppressive drugs.
- Topical therapy is any treatment applied directly to the skin, regardless of the type of drug. 

The VA reasons that these specifications allow for more fair ratings. If topical treatments of a very small skin area could qualify for a systemic rating, they would get an incredibly high rating for a fairly insignificant condition. On the other hand, in order for a topical treatment to cause systemic effects, it would have to be administered regularly over a very large area of the body. Because of this, a rating for the skin area alone would give a high enough rating to justify the severity of the condition.

Pyramiding Note

For these final changes, the VA decided that a note on how to apply the Pyramiding Principle to Skin conditions was necessary. 

Separate ratings can be given for multiple skin conditions as long as: 

1. each condition has a clear and distinct diagnosis
and
2. each condition affects a different area of skin

For a single condition that affects different skin areas, a single rating is given under that condition that takes into account all affected areas. For multiple conditions that affect the same area, the VA will rate only the one that gives the higher rating. 

Skin conditions and scars caused by those conditions cannot be rated separately unless specifically noted. 

Basic Rating System

The VA is also establishing a Basic Rating System that will be used to rate a number of skin conditions (though not all). The idea is that these conditions have similar enough symptoms, treatments, and overall disabilities that a single rating system would effectively rate each condition. 

The Basic Rating System

If the lesions (an area of rashes/bumps/scaly patches/etc.) cover more than 40% of total body or more than 40% of exposed divisions, orif it requires the constant or near-constant use of systemic therapy for the past 12 months, it is rated 60%. 

If the lesions cover 20 to 40% of total body or 20 to 40% of exposed divisions, orif it required the use of systemic therapy for a total of 6 weeks or more over the past 12 months, it is rated 30%. 

If the lesions cover 5 to 19% of total body or 5 to 19% of exposed divisions, orif it required the use of systemic therapy for a total of less than 6 weeks over the past 12 months, it is rated 10%. 

If the condition only required the use of topical medications over the past 12 months and the lesions cover less than 5% of total body or less than 5% of exposed divisions, it is rated 0%.

Now on to the codes.
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Code 7800 for scars or disfigurement of the head, face, and neck will not change.
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I’m going to discuss the changes for codes 7801, 7802, and 7805 together. These codes are fairly extensive, so I’m not going to reproduce the current ones here. Click on the linked codes just listed to go the discussion of them on our site. Here are the new changes:

Scars of the Body

Scars of the body are any scars that are not found on the head, face, and neck. 

Important! Each part of the body that is affected by a scar can be rated separately! Woo-hoo! For each kind of scar (deep, code 7801, superficial, code 7802, or other, code 7805), a single rating is given for each area of the body affected. These ratings are then combined using VA Math into a single overall scar rating assigned under the corresponding code. So if there are multiple scars or a single scar that affects more than one part of the body, then each is rated separately and then combined into a single overall rating for that kind of scar. For example, if a deep scar on the back is rated 30% and a deep scar on the stomach is rated 20%, the ratings would be combined using VA Math into a single 40% overall rating for deep scars. 

If, however, a higher rating can be achieved by adding the measurements for all of the scars in all the areas of the body together, then this rating can be given instead. For example, if there is a single deep scar that measures 6 inbut is divided between two areas (each 3 in2), then only a 0% would be given. But if the two areas are combined into 6 in2, then it would qualify for a 10% rating.

Below is a picture of the different areas of the body that can be rated separately. There are 6 areas in total, and they include the right arm, the left arm, the right leg, the left leg, the front of the torso, and the back of the torso. The front and back of the torso are separated by the midline on the side of the body. (The neck and head are rated under code 7800).




The ratings:

Code 7801: Deep scars are considered “deep” if there is damage to the soft tissues under the skin. If the area of scarring in a single body part is 144 in2or bigger, then it is rated 40%. If the area is between 72 in2and 144 in2, it is rated 30%. If the area is between 12 in2and 72 in2, then it is rated 20%. If it is between 6 in2and 12 in2, it is rated 10%.

Code 7802: Superficial scars are ones that only affect the skin, not the soft tissues underneath. If the area of scarring in a single body part is 144 in2or more, it is rated 10%. No other rating is given for superficial scars under this code.

Code 7805: All other scars are not ratable in and of themselves. If they cause another condition that makes it hard to properly do your job, however, then that other condition can be rated separately. For example, if a scar running up the arm makes it impossible to fully bend or straighten the arm at the elbow, then it is rated under limited motion of the elbow. The final code will look like this: 7805-3400. The first four-digit code defines the condition as a scar, and the second four-digit code tells how it is rated. 

The effects of scars rated under codes 7800-7804 but not covered by those ratings (like limited motion) can also be rated under this code.

The biggest change for these codes is getting rid of the differentiation between linear and non-linear scars. Under the current codes, linear scars are basically not ratable, even if they are considered deep. The final changes, however, allow for linear scars to be rated the same as non-linear scars. So a deep linear scar that measures at least 6 inwould qualify for a 10% rating instead of receiving nothing. 

The only other change is to allow all the areas of the body to be combined and then rated (instead of rated separately and then combined) if it would provide a higher rating. 
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Code 7804 for painful or unstable scars will not change.
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-Current- Code 7806Dermatitis and eczema are essentially the same thing, although some doctors might describe them slightly different. For rating purposes, however, they are treated the same. Basically, dermatitis is a condition where the skin swells and turns red—the standard rash. 

There are three different rating options for this condition. If the condition is so severe that it causes permanent scars, it can be rated as a scar condition under a scar code. The final code in that case would look like this: 7806-7801. The first four-digit code defines the condition as dermatitis, and the second four-digit code tells how it is rated. 

It can also be rated under this code either on calculations/estimations or on the required treatment of the condition itself. 

Calculations/estimations: If there is more than 40% of total body or more than 40% of exposed divisions affected, it is rated 60%. If there is 20 to 40% of total body or 20 to 40% of exposed divisions affected, it is rated 30%. If there is 5 to 20% of total body or 5 to 20% of exposed divisions affected, it is rated 10%. If there is less than 5% of total body or less than 5% of exposed divisions affected, it is rated 0%.

Treatments: If the condition required the almost constant use of oral or injected medications to regulate the immune system over the past 12 months (methotrexate, steroids, etc.), it is rated 60%. If the condition required oral or injected medications to regulate the immune system for a total of 6 weeks or more during the past 12 months, it is rated 30%. If the condition required oral or injected medications to regulate the immune system for a total of less than 6 weeks over the past 12 months, it is rated 10%. If the condition only required topical (put on the outside of the skin) medications over the past 12 months, it is rated 0%.

-Final- Code 7806: Dermatitis and eczema are essentially the same thing, although some doctors might describe them slightly different. For rating purposes, however, they are treated the same. Basically, dermatitis is a condition where the skin swells and turns red—the standard rash. 

This condition is either rated under the Basic Rating System, or as scars/disfigurement whichever best describes the disability. The final code in that case would look like this: 7806-7801. The first four-digit code defines the condition as dermatitis, and the second four-digit code tells how it is rated. 

In reality, the ratings for this code are not actually changing. 
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Code 7807 for New World (“American”) mucocutaneous leishmaniasis will not change.
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Code 7808 for Old World cutaneous leishmaniasis (“Oriental sore”) will not change.
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-Current- Code 7809Lupus is a condition where the immune system attacks the healthy cells of the skin, causing severe sores, tearing, and scarring of the skin. Most often, these occur on the head near the ears, eyes, nose, lips and cheeks, but in some cases lupus sores can affect other areas of the body. Lupus is either rated as dermatitis or as scars/disfigurement, whichever best describes the disability. The final code will look like this: 7809-7801. The first four-digit code defines the condition as lupus, and the second four-digit code tells how it is rated. 

If the lupus affects parts of the body besides the skin, then it is rated under code 6350 for systematic lupus erythematosus. A rating cannot be given under both codes. Only one or the other. 

-Final- Code 7809: Lupus is a condition where the immune system attacks the healthy cells of the skin, causing severe sores, tearing, and scarring of the skin. Most often, these occur on the head near the ears, eyes, nose, lips, and cheeks, but in some cases lupus sores can affect other areas of the body.

This condition is either rated under the Basic Rating System, or as scars/disfigurement whichever best describes the disability. The final code in that case would look like this: 7809-7801. The first four-digit code defines the condition as lupus, and the second four-digit code tells how it is rated. 

If the lupus affects parts of the body besides the skin, then it is rated under code 6350 for systematic lupus erythematosus. A rating cannot be given under both codes. Only one or the other. 

Subacute cutaneous lupus erythematosus is rated under code 7821

Again, the ratings for this code won’t change at all since the Basic Rating System is the dermatitis rating system and the scar option still applies. 

The main change is to move the rating of subacute cutaneous lupus erythematosus to code 7821. Right now, it is rated here, but based on more thorough and modern medical knowledge, the VA is moving the rating of subacute cutaneous lupus erythematosus to code 7821 because the condition is actually closer to collagen-vascular disease than this lupus. 
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Code 7811 for tuberculosis luposa will not change.
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-Current- Code 7813Dermatophytosis (“ringworm”) is a fungal infection that causes ring-shaped red and swollen patches on the skin. This condition is either rated under dermatitis, or scars/disfigurement whichever best describes the disability. The final code will look like this: 7813-7801. The first four-digit code defines the condition as dermatophytosis, and the second four-digit code tells how it is rated.

-Final- Code 7813: Dermatophytosis (“ringworm”) is a fungal infection that causes ring-shaped red and swollen patches on the skin. 

This condition is either rated under the Basic Rating System, or as scars/disfigurement whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7813-7801. The first four-digit code defines the condition as dermatophytosis, and the second four-digit code tells how it is rated.

Again, the ratings for this code aren’t changing at all since the Basic Rating System is the dermatitis rating system and the scar option still applies. 

The VA does specify a few additional conditions that are rated under this code, namely onychomycosis and tinea versicolor, but these are forms of dermatophytosis and so are rated here already anyway. All of the various kinds of dermatophytosis are rated here.
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-Final- Code 7815Bullous disorders cause blisters of clear liquid to form in between the layers of the skin, most often on the inner thighs and upper arms. 

This condition is either rated under the Basic Rating System, or as scars/disfigurement whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7815-7801. The first four-digit code defines the condition as a bullous disorder, and the second four-digit code tells how it is rated.

If the condition causes symptoms that affect other parts of the body besides the skin, it can be rated separately. So if it affects the lungs, it can receive a second rating under the lung code that best describes the symptoms, etc. 

This code has only a minor change, so I didn’t reproduce the original here. The only significant change to this code is the ability to rate additional symptoms under separate codes. Currently, no ratings are specified if the condition affects other areas of the body. 
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-Final- Code 7816Psoriasis is an autoimmune condition that tells the body to produce more skin cells even though they are not needed. This can cause numerous different things to happen to the skin, including redness, swelling, scaly texture, patches of red bumps, and more.

This condition is either rated under the Basic Rating System, or as scars/disfigurement whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7816-7801. The first four-digit code defines the condition as psoriasis, and the second four-digit code tells how it is rated.

If the condition causes symptoms that affect other parts of the body besides the skin, the symptoms can be rated separately. So if it causes psoriatic arthritis, it can receive a second rating under code 5002 for rheumatoid arthritis (psoriatic arthritis is rated as rheumatoid arthritis), etc. 

Like the last code, this code has only a minor change, so I didn’t reproduce the original here. The only significant change to this code is the ability to rate additional symptoms under separate codes. Currently, no ratings are specified if the condition affects other areas of the body. 
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-Current- Code 7817Exfoliative dermatitis (erythroderma) is a dermatitis that causes a scaly rash that covers the majority of the entire body. It is normally caused by another condition, like cancer or a reaction to a medication. If that condition is unfitting by itself, then the exfoliative dermatitis can only be rated as well if it contributes significantly to making the service member unfitting (super sensitive to motion, can’t wear his uniform, etc.). 

If the majority of the skin is affected andthings such as weight loss, fever, low protein in the blood, etc., are present, andcontinuous medications to regulate the immune system (methotrexate, steroids, etc.) were taken over the past 12 monthsorregular treatments of ultraviolet or other light wave/beam therapy were needed during the past 12 months, it is rated 100%. 

If the majority of the skin is affected, andcontinuous medications to regulate the immune system were taken over the past 12 months orregular treatments of ultraviolet or other light wave/beam therapy was needed during the past 12 months, it is rated 60%.

Regardless of how much skin is affected, if medications to regulate the immune system orultraviolet or other light wave/beam therapy were needed for a total of 6 weeks (does not need to be consecutive) or more during the past 12 months, it is rated 30%.

Regardless of how much skin is affected, if medications to regulate the immune system orultraviolet or other light wave/beam therapy were needed for a total of less than 6 weeks (does not need to be consecutive) or more during the past 12 months, it is rated 10%.

Regardless of how much skin is affected, if only topical treatments were used during the past 12 months, it is rated 0%.

-Final- Code 7817: Erythroderma is a dermatitis that causes a scaly rash that covers the majority of the entire body. It is normally caused by another condition, like cancer or a reaction to a medication. Because of this, it may already be covered under a rating for that condition. If not, it can be rated separately here.

If the majority of the skin is affected, there are systemic symptoms (weight loss, fever, low protein in the blood, etc.), andcontinuous systemic therapy (corticosteroids, immunosuppressive retinoids, biologics, etc.) or ultraviolet or other light wave/electron beam therapies were needed during the past 12 months, it is rated 100%. 

A 100% rating is also given if the same symptoms are present, but no treatment is currently being attempted since at least 2 treatment regimens failed in the past. The failed regimens must be clearly documented. In order to have “failed” the condition must have either gotten worse after the regimen or had less than 25% reduction in the severity after 4 weeks of treatment.

If the majority of the skin is affected andcontinuous systemic therapy or ultraviolet or other light wave/electron beam therapy was needed during the past 12 months, it is rated 60%. A 60% rating is also given if the majority of the skin is affected, but no treatment is currently being attempted since at least 1 treatment regimen failed in the past. The failed regimen must be clearly documented.

Regardless of how much skin is affected, if systemic or ultraviolet or other light wave/electron beam therapies were needed for a total of 6 weeks (does not need to be consecutive) or more during the past 12 months, it is rated 30%.

Regardless of how much skin is affected, if systemic or ultraviolet or other light wave/electron beam therapies were needed for a total of less than 6 weeks (does not need to be consecutive) during the past 12 months, it is rated 10%.

Regardless of how much skin is affected, if only topical treatments were used during the past 12 months, it is rated 0%.

The first change to this code is to get rid of “exfoliative dermatitis” from the title since it is a dated term that is no longer used for this condition. The VA also more clearly specified and included new systemic treatment options in the rating criteria. Finally, the VA added a rating option to compensate those veterans who are not undergoing treatment because previous treatments had failed. In the majority of these cases, the treatment failure is caused by the severity of the underlying condition and treatment failure of that condition. These cases currently cannot be rated although their condition is significant. 
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Code 7818 for malignant cancer of the skin will not change.
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Code 7819 for benign tumors will not change.
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-Current- Code 7820All other infections of the skin that are not listed elsewhere are rated under this code. These conditions are either rated as dermatitis or as scars/disfigurement, whichever best describes the disability. The final code will look like this: 7820-7801. The first four-digit code defines the condition as a skin infection, and the second four-digit code tells how it is rated.

-Final- Code 7820: All other infections of the skin that are not listed elsewhere are rated under this code.

These conditions are either rated under the Basic Rating System, or as scars/disfigurement, whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7820-7801. The first four-digit code defines the condition as a skin infection, and the second four-digit code tells how it is rated.
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-Current- Code 7821Cutaneous manifestations of collagen-vascular diseases are skin conditions that occur when the immune system attacks the collagen. Collagen is the proteins that are in the skin. Psoriasis is considered a collagen-vascular disease. This code is used to rate any collagen-vascular disease that is not listed elsewhere on this page.

-Final- Code 7821: Cutaneous manifestations of collagen-vascular diseases are skin conditions that occur when the immune system attacks the collagen. Collagen is the proteins that are in the skin. Psoriasis is considered a collagen-vascular disease. This code is used to rate any collagen-vascular disease that is not listed elsewhere on this page, including subacute cutaneous lupus erythematosus.

These conditions are either rated under the Basic Rating System, or as scars/disfigurement, whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7821-7801. The first four-digit code defines the condition as a cutaneous manifestation of a collagen-vascular disease, and the second four-digit code tells how it is rated.

The main change for this code is to include subacute cutaneous lupus erythematosus instead of it being rated under code 7809. The ratings themselves, although reformatted as the Basic Rating System, do not change. 
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-Final- Code 7822Any other skin conditions that cause hard, scaly bumps (“papulosquamous disorders”) to form on the skin that are not listed anywhere else on this page are rated under this code, including mycosis fungoides, lichen planus, plaque parapsoriasi, PLEVA, PRP, lymphomatoid papulosus, and more. 

This condition is either rated under the Basic Rating System, or scars/disfigurement whichever best describes the disability. If rated on scars/disfigurement, the final code will look like this: 7822-7801. The first four-digit code defines the condition as a papulosquamous disorder, and the second four-digit code tells how it is rated.

Besides adjusting things for the Basic Rating System, the primary change to this code is to further clarify some of the specific conditions rated under this code, specifically mycosis fungoides, which is often misrated under other codes. 
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Code 7823 for vitiligo will not change.
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-Current- Code 7824Diseases of keratinization affect the process where the lower layers of the skin turn into the harder outer layer of skin. Keratin is the protein that causes the skin to harden. Any condition that affects the process of keratinization is rated under this code. 

If the condition affects the whole body and required almost constant oral or injected medication over the past 12 months, it is rated 60%. If the condition affects the whole body and required the use of oral or injected medication for a total of at least 6 weeks during the past 12 months, it is rated 30%. If the condition only affects some areas of the body and required the use of oral or injected medication for a total of less than 6 weeks during the past 12 months, it is rated 10%. If only topical treatments were required during the past 12 months, it is rated 0%.

-Final- Code 7824: Diseases of keratinization affect the process where the lower layers of the skin turn into the harder outer layer of skin. Keratin is the protein that causes the skin to harden. Any condition that affects the process of keratinization is rated under this code. These conditions are rated under the Basic Rating System.

The only change to this code is to have it solely rated under the Basic Rating System. 
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-Current- Code 7825Chronic hives are pale red, itchy bumps on the skin that are caused either by allergic reactions or various other causes. To qualify as chronic, they must last for 6 weeks or more. If there were severe debilitating (it’s impossible to do your job) episodes that occurred at least 4 times over the past 12 months that cannot be controlled by treatment, it is rated 60%. If there were severe debilitating episodes that occurred at least 4 times over the past 12 months but it could be controlled by medications that regulate the immune system (methotrexate, steroids, etc.) it is rated 30%. If there were episodes (not debilitating) that occurred at least 4 times over the past 12 months, but the condition could be controlled by medications that control swelling, it is rated 10%.

-Final- Code 7825: Chronic hives (urticaria) are pale red, itchy bumps on the skin that are caused either by allergic reactions or various other causes. 

To qualify as “chronic,” the hives must occur at least twice per week for at least 6 weeks or more without treatment.

Chronic hives that requires third line treatment (plasmapheresis, immunotherapy, immunosuppressives, etc.) for control because lesser medications were ineffective (“refractory”) is rated 60%. 

Chronic hives that requires second line treatment (corticosteroids, sympathomimetics, leukotriene inhibitors, neutrophil inhibitors, thyroid hormone, etc.) for control is rated 30%.

Chronic hives that requires first line treatment (antihistamines) for control is rated 10%. 

The VA made significant changes to this code from what they originally proposed because of a comment we submitted. In order to ensure that someone with continuous, severe urticarial is properly rated, the use of episodes was not effective. Instead, this more appropriate definition of chronic allows for a wider range of conditions to be properly rated. 

These final changes also use not only the presence of chronic urticaria, but also the types of medication necessary to control the symptoms.  
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-Current- Code 7826Primary cutaneous vasculitis is a condition of the small blood vessels near the skin, which causes them to burst. The skin turns red or purple due to bleeding under the skin. If this condition is caused by other conditions, like infections, medications, cancer, autoimmune disorders, etc., it can only be rated as that condition. If it is not caused by another condition, then it can be rated here. Likewise, if the condition caused significant scarring, it can be rated under the scar codes. Choose the one rating system that would give the highest rating. 

If there were at least 4 debilitating (can’t perform your job) episodes over the past 12 months that did not respond to treatment, it is rated 60%. If there were at least 4 debilitating episodes over the past 12 months that were controlled by medications that regulate the immune system (methotrexate, steroids, etc.), then it is rated 30%. If there were 1 to 3 episodes (not debilitating) over the past 12 months that were controlled by medications that regulate the immune system, then it is rated 10%. 

-Final- Code 7826: Primary cutaneous vasculitis is a condition of the small blood vessels near the skin, which causes them to burst. The skin turns red or purple due to bleeding under the skin. If this condition is caused by other conditions, like infections, medications, cancer, autoimmune disorders, etc., it can only be rated as that condition. If it is not caused by another condition, then it can be rated here. Likewise, if the condition caused significant scarring/disfigurement, it can be rated under the scar codes instead. Choose the rating system that would give the highest rating.

An “episode” is a period of active symptoms. All episodes must be medically documented to count towards a rating.

If there are regular and consistent episodes where the symptoms do not properly respond to continuous medications that supress the immune system, it is rated 60%. 

If there were 4 or more episodes during the past 12 months that required systemic medications to suppress the immune system (steroids, cyclosporine, etc.) to control them, it is rated 30%. 

If there were 1 to 3 episodes during the past 12 months that required systemic medications to suppress the immune system (steroids, cyclosporine, etc.) to control them, it is rated 10%.

A 10% rating is also given if there are no documented episodes because it is sufficiently controlled by continuously taking systemic medications.

Similar to the changes for hives, the VA is getting rid of “debilitating episodes” and replacing it with “episodes.” The episodes will now not have to be specifically noted as debilitating. The VA also adds one additional rating criteria for the 10% rating in order to more completely cover the level of disability presented by conditions that are controlled successfully by constant medication. This broadens the number of cases that will be able to qualify for a rating under this code. 
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-Current- Code 7827Erythema multiforme and toxic epidermal necrolysis (“TENs”) are either caused by an infection or are reactions to medication. They cause red skin rashes and bumps to appear all over the body. They then attacks and kills the skin all over the body, causing the top layer of skin to detach from the lower layers all over the body, which can send the organs into failure. If the condition caused significant scarring, it can either be rated under the scar codes or this code. Choose the one that would give the highest rating.

If there were severe debilitating (it’s impossible to do your job) episodes that occurred at least 4 times over the past 12 months that could not be controlled by treatment, it is rated 60%. If there were episodes (not debilitating) that occurred at least 4 times over the past 12 months but it could be controlled by medications that regulate the immune system, it is rated 30%. If there were episodes (not debilitating) that occurred 2 or 3 times over the past 12 months that were controlled by medications that control swelling, it is rated 10%. A 10% rating is also given if there were 1 to 3 episodes that occurred over the past 12 months that were controlled by medications that regulate the immune system. 

-Final- Code 7827: Erythema multiforme and toxic epidermal necrolysis (“TENs”) are both rated under this code. Both are either caused by an infection or are reactions to medication. They cause red skin rashes and bumps to appear all over the body. They then attack and kill the skin all over the body, causing the top layer of skin to detach from the lower layers, which can send the organs into failure. Erythema multiforme is less severe than TENs, usually only affecting less than 10% of the body. If the condition causes significant disfigurement/scarring, it can either be rated under the appropriate scar code or this code, whichever gives the highest rating.

While both conditions can cause symptoms anywhere on the body, notable disabilities are caused when they affect the mouth (difficulty chewing), the hands (difficulty gripping), or the feet (difficulty walking). 

If the condition caused 4 or more episodes of mouth, hand, or foot impairment over the past 12 months despite taking constant medications that suppress the immune system, it is rated 60%. 

If it caused 4 or more episodes of mouth, hand, or foot involvement (but didn’t impair their functions) over the past 12 months that required occasional systemic treatments (immunosuppressives, antihistamines, or sympathomimetics), it is rated 30%. 

If it caused 1 to 3 episodes of mouth, hand, or foot involvement (but didn’t impair their functions) over the past 12 months that required occasional systemic treatments, it is rated 10%. 

A 10% rating is also given if there are no episodes, but it requires continuous systemic treatments to control the symptoms. 

The VA notes that for these conditions to be “debilitating” there must be mouth, hand, or foot involvement. So instead of using the vague phrase, they are instead changing the rating requirements to specify mouth, hand, or foot involvement and the severity of that involvement. 
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I’ll discuss both of the acne codes together. 

-Current- Code 7828: Acne is a skin condition that causes pus-filled raised bumps that can occur anywhere on the body. 

Code 7829: Chloracne is a condition where acne erupts over patches of skin that have come in contact with chemicals that contain dioxins. 

Some acne is very superficial, involving only one layer of the skin, while other acne can be very deep. Often acne causes scarring. If the scars are the main disability, then this condition can be rated under the scar codes

The ratings: If the acne is deep, causing inflammation and pus-filled cysts, and affects 40% or more of the face and neck, it is rated 30%. If the acne is deep, causing inflammation and pusy cysts, and affects less than 40% of the face and neck, orif deep acne is in areas other than the face and neck, it is rated 10%. If the acne is superficial, it is rated 0%. 

-Final- Code 7828: Acne is a skin condition that causes pus-filled raised bumps that can occur anywhere on the body. 

Some acne is very superficial, involving only one layer of the skin, while other acne can be very deep. Often, acne causes scarring. If the scars/disfigurement are the main disability, then this condition can be rated under one of the scar codes

If the acne is deep, causing inflammation and pus-filled cysts, and affects 40% or more of the face and neck, it is rated 30%. 

If the acne is deep, causing inflammation and pus-filled cysts, and affects less than 40% of the face and neck, orif deep acne is in areas other than the face and neck, it is rated 10%. 

If the acne is superficial, it is rated 0%.

Code 7829: Chloracne is a condition where acne erupts over patches of skin that have come in contact with chemicals that contain dioxins. 

Some chloracne is very superficial, involving only one layer of the skin, while other chloracne can be very deep. Often chloracne causes scarring. If the scars/disfigurement are the main disability, then this condition can be rated under one of the scar codes.

If the chloracne is deep, causing inflammation and pus-filled cysts, and affects 40% or more of the face and neck, it is rated 30%. 

A 20% rating is given if the chloracne is deep, causing inflammation and pus-filled cysts, and affects at least one of the following areas: the armpit, the genital region, the folds of the breast, and the areas between the fingers and toes.

If the chloracne is deep, causing inflammation and pus-filled cysts, and affects less than 40% of the face and neck, orif deep chloracne is in areas other than the face and neck or the areas noted above, it is rated 10%. 

If the chloracne is superficial, it is rated 0%. 

The only change to code 7828 for acne is to remove a term that is no longer used. In reality, nothing changes at all. 

For code 7829 for chloracne, however, the VA adds a new 20% rating for deep acne that is found in certain regions on the body. Deep, painful acne in these regions would cause a higher level of disability because of the difficulty of movement it would cause, so the VA feels that a 20% rating would more fully reflect the level of disability. 
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Code 7830 for scarring alopecia, code 7831 for alopecia areata, code 7832 for hyperhidrosis, and code 7833 for malignant melanoma will not change.


15 comments:

  1. Hello, I'm Anthony, how are you? I heard that due to a new law pass in April 2018 and that Veterans can now files claims on pain alone. I have a number of issues stemming from chronic back pain, which rate under degenerative arthritis. Can I file a claim for due to this condition? If so, how would I go about it?

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    1. It wasn't really a new law, just a court ruling on a case. Pain has always been a legitimate condition as long as there can be evidence of it (limited motion, etc.). You can definitely submit a claim. If degenerative arthritis of the spine is the diagnosed condition, then list that on the claim along with all medical evidence of the condition in service and after.

      http://www.militarydisabilitymadeeasy.com/vadisabilityclaim.html

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  2. Hi Dr Johnson,
    I had photorefractive keratectomy (PRK) at Naval Hospital Portsmouth in 2002 based upon a recommendation from a Navy Flight Surgeon. I didn't know at the time that dry eyes are a common occurrence after surgery. In 2017, while on active duty I was diagnosed as having chronic, bilateral, dry eyes at a military clinic. When I retired from the Navy my mild bilateral dry eyes, status post photorefractive keratectomy surgery was rated as Not Service Connected.
    I have to put rewetting drops in my eyes every day, especially at night and before bed, because of it being uncomfortable quite painful in the AM the following day should I not put the drops in at night. I do not understand why the dry eyes wouldn't be considered service connected. Any ideas?

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    Replies
    1. The only reason I can imagine is if there is not sufficient evidence that the surgery was the direct cause of the dry eye. Did the symptoms develop within the normal timeframe they normally would after the surgery? If they didn't start until significantly later, then that could be the reason. If they did develop relatively and you have clear evidence of their original diagnosis and connection to the surgery, then you could try to appeal.

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  3. Dr. Johnson, i was told today that i have thenar eminence in my left hand. Is this something that i can go to the va and file a claim for disability,

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    1. Thenar eminence is a group of muscles at the base of the thumb, not a condition. Do have problems with these muscles? If so, and you can prove that the issue is service-connected, then you can apply for compensation. It would be rated under code 5309:

      http://www.militarydisabilitymadeeasy.com/forearmandhandmuscles.html#ix

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  4. Dr. Johnson, I received a positive TB test when I was a young Airman. I was put on IPPD treatment for 9 months and told my chances of getting TB was lower to 10%. Can I submit a claim for this?

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    1. Do you have a current disability because of this? The VA only rates conditions that caused current and active symptoms that result in disabilities. If the TB has never caused any chronic symptoms that currently still affect your life, then it will not qualify.

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  5. Dr. Johnson, since my reply from you on the thenar eminence i have gotten a letter from my VA Doctor and it now says that i have severe basilar joint arthrois. Also mild arthrosis of the interphalangeal joints. All this from x-ray, so do i now have a claim i can go to the va for disability. The letter also states that i have narrowing and marginal osteophyte formation. i have pain and also less movement of the thumb.

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  6. Dr. Johnson, i have more info but don't know if it would help. I was discharged in 1974. The pain and lack of motion in my thumb started about 2-3 years ago and has gotten worse since then. The wife and i were working in the yard over labor day and the next morning is when i noticed the swelling and pain in my hand. That is when i went to see my va doctor as stated above in the other note to you. I am rated right now at 60% for other disability but looking through my ltr's from the VA they also said that i have dengeavitive shoulder. I also have a NEX letter from a other doctor i was seeing before going to the va doctor.

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    1. If you can prove that the arthritis in your hand is service-connected, then yes, you can submit a claim for this. It would be rated as a single minor joint group under code 5003 and rated on limited motion.

      http://www.militarydisabilitymadeeasy.com/diseasesofthemusculoskeletalsystem.html#arthritis

      The shoulder could also qualify, again if you can prove service-connection, and can be rated as a major joint under 5003.

      http://www.militarydisabilitymadeeasy.com/service-connected.html

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    2. Dr. Johnson, the only thing i have about my hand is that i have brachial neuritis which the va examiner noted left hand weakness and characterized as moderately affecting middle and lower radicular group. So would this be enough to start a claim for arthritis. The VA give give me a 20% for my degenerative left shoulder disease. The brachial neuritis, the VA has given me 30% and 10% for left ankle and left leg fracture of which there is arthritis in the ankle.

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    3. Neuritis is an issue separate from arthritis. If your service treatment records have neuritis diagnosed, then that is definitely a condition you could apply for. As for the arthritis, if that wasn't diagnosed until after service, the only way to get that rated is for you to prove that it was directly caused by the service-connected neuritis.

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  7. I have been diagnosed with Hailey Hailey Disease I was first diagnosed as Jock Itch in 1968 in basic training in the Army over the last 49 years it has been dehibilitating causing me pain,itching and draining blisters. The first 20 years I went to civilian doctors until Iwas diagnosed with MS and Non Hodgkins Lymphoma During that time I was diagnosed with Hidranis in 2017 Ihad a biopsy and was diagnosed Hailey Hailey Diseaseas you know there is no cure and it gets worse over the years it affects Groin, Armpits and back of knees. I did not know until last year there is no cure I am on social security but did not know there is no cure like my MS. I am currently appealing for MS and NonHodgkins lymphoma for herbicide exposure the Pentagon claims there was no herbicides in Okinawa. I did not know Hailey Hailey was claimable as 7815 skin disorder can I ammend my claim before I get a decision ?

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    1. Since Hailey Hailey is a new diagnosis you have never submitted before, you have to submit a brand new claim for that. The other conditions are in appeal, so at a different point in the process. New conditions must start at the beginning. Make sure to submit evidence that connects your Hailey Hailey to your original service-connected Jock Itch in order to get it granted.

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