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C&P Exam Prep: Malignant Melanoma
DBQ Overview
Interview + Physical- Form Name
- Skin_Diseases
- Form Code
- Skin_Diseases
- Page Count
- 12
- Examiner Type
- Dermatologist or appropriate clinician
- Estimated Duration
- 15-30 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To evaluate the current severity of malignant melanoma, document treatment history (including whether treatment rises to the level warranting a 100% evaluation), assess residuals such as scars or disfigurement, and determine functional impairment for rating purposes under DC 7833.
What the examiner evaluates:
- Diagnosis confirmation and ICD code for malignant melanoma
- Whether the melanoma is primary or metastatic/secondary
- Current active disease status versus remission
- Type and extent of treatment received (surgery, chemotherapy, radiation, immunotherapy, targeted therapy)
- Whether treatment is comparable to systemic malignancy treatment (systemic chemotherapy, radiation more extensive than to skin, or surgery more extensive than wide local excision)
- Date treatment was initiated and anticipated or actual date of treatment completion
- Presence of local recurrence or metastasis
- Residual scars from excision - location, type (linear, superficial non-linear, painful/unstable), and dimensions (length x width in centimeters)
- Disfigurement of the head, face, or neck resulting from the melanoma or its treatment
- Functional impairment of any body system caused by melanoma or its treatment
- Impact of the skin condition on occupational and daily functioning
- Associated conditions requiring separate DBQs (e.g., lymphedema, peripheral neuropathy)
Exam will involve both a structured interview about your medical history and treatment timeline, and a physical inspection of excision sites, scars, and affected skin areas. Bring all relevant oncology and dermatology records. The examiner will document findings on the Skin Diseases DBQ. If photos are taken at the time of examination, they will be submitted with the DBQ for rating consideration.
Typical duration: 15-30 minutes
Scar Measurement
Dimensions (length and width in centimeters), location (e.g., left upper extremity, head/face/neck), and type (linear, superficial non-linear, painful, or unstable) of excision scars from melanoma surgery
What to expect:
The examiner will visually inspect and physically measure any scars using a ruler or measuring tape. They will assess whether the scar is painful to touch or pressure, whether it is unstable (breaks down with minor trauma), and whether it is on an exposed body area.
Key thresholds:
- Painful or unstable scar of any size — Eligible for rating under DC 7804 (painful or unstable scars); even a single painful scar can warrant a compensable rating
- Superficial non-linear scar greater than 39 sq cm (6 sq in) on exposed surface — Eligible for higher rating under DC 7802
- Scar on head, face, or neck causing disfigurement — Rated separately under DC 7800 based on character of disfigurement
- Multiple scars from wide local excision plus skin grafting — May support separate ratings under DC 7801 (deep, non-linear) and DC 7805 (other scars with functional impairment)
Tips:
- Know the precise location of each scar before your exam - bring a written list
- Tell the examiner if any scar is painful to direct pressure, touch, or during temperature changes
- Report if any scar has ever broken open, ulcerated, or required treatment after healing
- If a scar limits movement (e.g., over a joint), specifically state that functional limitation
- Request that the examiner measure and document every scar, not just the largest one
Pain considerations: Pain from scars is critically important. A scar that causes pain - even intermittently - qualifies as a 'painful scar' under DC 7804. Describe pain on your worst days, not your average days. Include pain with clothing contact, weather changes, and activity.
Body Surface Area Assessment (if applicable)
Total body surface area and exposed body surface area affected by active skin disease (relevant if melanoma is associated with active skin involvement or satellite lesions)
What to expect:
If there are active skin manifestations beyond resolved excision sites, the examiner should document the percentage of total body surface area and exposed body surface area affected. This is a regulatory requirement per M21-1 for skin conditions rated on area of involvement.
Key thresholds:
- Active lesions on exposed surfaces — Exposed area involvement is weighted more heavily in rating criteria
Tips:
- Point out all active lesions, satellite nodules, or areas of skin involvement to the examiner
- Do not assume the examiner will find every affected area - assist by directing their attention
Pain considerations: Note any itching, burning, or pain associated with active skin involvement on your worst days.
Treatment Classification Assessment
Whether the treatment received or ongoing meets the threshold for a 100% evaluation - specifically: systemic chemotherapy, radiation more extensive than to the skin only, or surgery more extensive than wide local excision (e.g., sentinel lymph node biopsy, lymph node dissection, reconstructive surgery)
What to expect:
The examiner will ask detailed questions about your treatment history. They will document the type of surgery performed, whether radiation extended beyond the skin, and whether systemic agents (immunotherapy, targeted therapy, chemotherapy) were or are being used.
Key thresholds:
- Systemic chemotherapy (e.g., dacarbazine, temozolomide) — 100% rating from date of treatment onset
- Immunotherapy (e.g., pembrolizumab, nivolumab, ipilimumab) - note: VA has extended 100% treatment provisions to immunotherapy comparable to systemic malignancy treatment — 100% rating from date of treatment onset - confirm with your VSO whether your specific immunotherapy qualifies
- Targeted therapy (e.g., BRAF/MEK inhibitors such as vemurafenib, dabrafenib) — May qualify as treatment comparable to systemic malignancy - document and confirm with VSO
- Radiation more extensive than to the skin (e.g., nodal irradiation, adjuvant radiation to regional nodes) — 100% rating from date of treatment onset
- Surgery more extensive than wide local excision (e.g., sentinel lymph node biopsy, complete lymph node dissection, skin grafting, reconstructive flap surgery) — 100% rating from date of treatment onset
- Treatment completed with no recurrence or metastasis — 100% continues for mandatory 6-month period post-treatment; then rated on residuals (scars, disfigurement, functional impairment)
Tips:
- Bring a complete list of all treatments with dates: surgery type, radiation dates and fields, chemotherapy/immunotherapy/targeted therapy agents and dates
- Bring operative reports documenting exact type of surgery performed
- If you received a sentinel lymph node biopsy, document this - it is surgery beyond wide local excision
- If treatment is ongoing, the examiner should document the anticipated completion date
- Ask your oncologist to provide a letter summarizing your treatment in terms that align with the VA criteria
Pain considerations: Document all treatment-related side effects you experience, including fatigue, neuropathy, skin reactions, joint pain, and immune-related adverse events from immunotherapy.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Active malignant melanoma requiring treatment comparable to that used for systemic malignancies: systemic chemotherapy, radiation therapy more extensive than to the skin, or surgery more extensive than wide local excision. The 100% evaluation is assigned from the date of onset of such treatment and continues until a mandatory VA examination six months after treatment completion. If no local recurrence or metastasis is found at that examination, the rating is then based on residuals. |
CFR: Per 38 CFR 4.118 DC 7833: 'If a skin malignancy requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision, a 100-percent evaluation will be assigned from the date of onset of treatment.' The 100% continues through the mandatory exam 6 months post-treatment completion under - 3.105(e) provisions. |
| 0% | Malignant melanoma where treatment has been confined to the skin only (e.g., wide local excision without systemic treatment, sentinel node biopsy not performed, no radiation beyond skin, no systemic agents), or where the veteran is in remission following qualifying systemic treatment and the 6-month mandatory post-treatment examination shows no recurrence or metastasis. In these cases, the rating is based entirely on residuals: scars (DC 7801-7805), disfigurement of the head/face/neck (DC 7800), or functional impairment of affected body systems. |
CFR: Per 38 CFR 4.118 DC 7833: 'If treatment is confined to the skin, the provisions for a 100-percent evaluation do not apply.' And: 'If there has been no local recurrence or metastasis, evaluation will then be made on residuals.' Residuals are rated under DC 7800 (disfigurement, head/face/neck), DC 7801 (deep non-linear scars), DC 7802 (superficial non-linear scars), DC 7803 (linear scars), DC 7804 (painful or unstable scars), or DC 7805 (scars with functional impairment). |
100% Active malignant melanoma requiring treatment comparable to ...
Active malignant melanoma requiring treatment comparable to that used for systemic malignancies: systemic chemotherapy, radiation therapy more extensive than to the skin, or surgery more extensive than wide local excision. The 100% evaluation is assigned from the date of onset of such treatment and continues until a mandatory VA examination six months after treatment completion. If no local recurrence or metastasis is found at that examination, the rating is then based on residuals.
Key Symptoms
- Active malignant melanoma diagnosis
- Receiving or has received systemic chemotherapy
- Receiving or has received immunotherapy (e.g., checkpoint inhibitors) comparable to systemic malignancy treatment
- Receiving or has received targeted therapy (e.g., BRAF/MEK inhibitors)
- Radiation therapy beyond skin-only field (e.g., nodal radiation)
- Surgery beyond wide local excision (e.g., sentinel node biopsy, lymph node dissection, skin grafting, reconstruction)
- Documented active disease or treatment side effects
- Metastatic melanoma to any organ system
CFR: Per 38 CFR 4.118 DC 7833: 'If a skin malignancy requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision, a 100-percent evaluation will be assigned from the date of onset of treatment.' The 100% continues through the mandatory exam 6 months post-treatment completion under - 3.105(e) provisions.
0% Malignant melanoma where treatment has been confined to the ...
Malignant melanoma where treatment has been confined to the skin only (e.g., wide local excision without systemic treatment, sentinel node biopsy not performed, no radiation beyond skin, no systemic agents), or where the veteran is in remission following qualifying systemic treatment and the 6-month mandatory post-treatment examination shows no recurrence or metastasis. In these cases, the rating is based entirely on residuals: scars (DC 7801-7805), disfigurement of the head/face/neck (DC 7800), or functional impairment of affected body systems.
Key Symptoms
- Melanoma in complete remission with no recurrence
- No metastasis documented
- Treatment confined to wide local excision only
- Residual scars from excision (rated separately under scar DCs)
- No functional impairment beyond resolved excision site
CFR: Per 38 CFR 4.118 DC 7833: 'If treatment is confined to the skin, the provisions for a 100-percent evaluation do not apply.' And: 'If there has been no local recurrence or metastasis, evaluation will then be made on residuals.' Residuals are rated under DC 7800 (disfigurement, head/face/neck), DC 7801 (deep non-linear scars), DC 7802 (superficial non-linear scars), DC 7803 (linear scars), DC 7804 (painful or unstable scars), or DC 7805 (scars with functional impairment).
How to Describe Your Symptoms
Treatment Type and Extent
How to describe:
Be specific and precise about every treatment you received. Do not use vague terms. State the exact name of surgical procedures, the names of chemotherapy or immunotherapy agents, the radiation fields treated, and all dates. Differentiate between wide local excision alone versus any additional procedures such as sentinel lymph node biopsy or lymph node dissection.
Worst-day example:
“I underwent a wide local excision of a 2.5mm Breslow depth melanoma on my left upper back, followed by a sentinel lymph node biopsy that returned positive. I then had a complete axillary lymph node dissection and received adjuvant pembrolizumab immunotherapy infusions every 3 weeks for 12 months, completing treatment on [date]. During treatment I experienced severe fatigue, joint pain, immune-related colitis requiring steroid treatment, and was unable to work for [duration].”
What the examiner listens for:
Specific procedure names, treatment agent names, dates of treatment initiation and completion, whether treatment extended beyond the skin, current disease status (active vs. in remission), and treatment-related functional limitations.
Understatements to avoid:
Do not say 'they just removed it' or 'I had minor surgery.' A sentinel lymph node biopsy is surgery beyond wide local excision and may trigger the 100% provision. Do not omit immunotherapy or targeted therapy agents - these are critical to the rating determination.
Scar Pain and Instability
How to describe:
Describe pain at scar sites in terms of frequency, severity, and triggers. Note whether pain occurs with clothing contact, pressure, temperature changes, or spontaneously. Report any episodes of the scar breaking down, ulcerating, or requiring treatment after the initial healing period.
Worst-day example:
“On my worst days, the scar on my back from the wide local excision is intensely painful - I cannot wear anything that puts pressure on it, including a shirt collar or backpack. The pain is a 7 out of 10 and prevents me from sleeping on my back. The scar has broken open twice in the past year with minimal friction, requiring wound care.”
What the examiner listens for:
Pain with contact or pressure (qualifying for DC 7804), instability or breakdown of the scar (qualifying for DC 7804), limitation of motion if over a joint (DC 7805), and size of the scar in relation to rating thresholds for DC 7802.
Understatements to avoid:
Do not say 'the scar is mostly fine' if it causes you pain even occasionally. A scar that is painful even intermittently qualifies as a painful scar under DC 7804. Report your worst-day experience, not your best day.
Functional Impairment from Melanoma or Treatment
How to describe:
Describe how melanoma, surgery, or treatment has impaired your ability to use the affected body part, perform work duties, or complete daily activities. If lymph node dissection caused lymphedema, describe swelling, heaviness, and functional limitations in detail.
Worst-day example:
“After my axillary lymph node dissection, I developed chronic lymphedema in my left arm. On my worst days, my arm is so swollen and heavy that I cannot lift it above shoulder height, cannot type for more than 15 minutes without pain, and cannot carry groceries. The swelling requires daily compression garment use and manual drainage therapy.”
What the examiner listens for:
Residual functional impairment from surgery (e.g., lymphedema, limited range of motion, nerve damage), treatment side effects affecting body systems (e.g., peripheral neuropathy from chemotherapy, immune-related adverse events from immunotherapy), and how these impairments affect work and daily functioning.
Understatements to avoid:
Do not fail to report lymphedema, neuropathy, joint pain, chronic fatigue, or other systemic effects of treatment. These may support separate ratings under the appropriate body system diagnostic codes or additional SMC considerations.
Disfigurement of Head, Face, or Neck
How to describe:
If your melanoma was located on the head, face, or neck, describe the visual appearance of the residual scar or defect, including color changes, tissue distortion, loss of symmetry, and any psychological or social impact. Be factual and specific.
Worst-day example:
“The excision scar on my left cheek is approximately 4 centimeters long, raised, and hyperpigmented. It causes a visible tissue depression that distorts my facial symmetry. I have avoided social situations because of the appearance, and I experience significant emotional distress when I see my reflection.”
What the examiner listens for:
Location on head, face, or neck; visible characteristics of disfigurement; size and character of the scar; whether the scar is near or involves loss of anatomical structures (nose, ear, lip); and psychosocial impact.
Understatements to avoid:
Do not minimize disfigurement by saying 'it's not that bad.' The examiner must document objective findings, but your subjective experience of impact is also relevant. DC 7800 has multiple severity levels based on the character of disfigurement.
Disease Recurrence, Metastasis, and Ongoing Surveillance
How to describe:
Describe your ongoing surveillance schedule, any recurrences you have experienced, and any findings on imaging or biopsies. If you are under active monitoring for potential recurrence, that is relevant context.
Worst-day example:
“I completed immunotherapy 8 months ago. I am still undergoing PET scans every 6 months and full-body skin exams every 3 months due to the high-risk stage of my original melanoma. I have significant anxiety related to recurrence that affects my sleep and daily functioning. A recent lymph node on my right groin was identified as suspicious and a biopsy is pending.”
What the examiner listens for:
Active disease versus remission status, surveillance frequency indicating ongoing medical concern, recurrence history, documented metastasis to any organ system, and the psychological burden of ongoing surveillance.
Understatements to avoid:
Do not present yourself as 'cured' simply because treatment is complete. VA rates melanoma on residuals after treatment completion, but ongoing surveillance, risk of recurrence, and treatment side effects remain relevant. Report all of these accurately.
Common Mistakes to Avoid
Failing to document that surgery went beyond wide local excision
Many veterans know they had 'skin cancer surgery' but do not realize that a sentinel lymph node biopsy, lymph node dissection, skin graft, or reconstructive flap surgery constitutes surgery 'more extensive than wide local excision' - the legal threshold for the 100% evaluation under DC 7833.
Instead: Obtain your operative reports and review them before the exam. Bring copies to the appointment. Specifically tell the examiner: 'My surgery included a sentinel lymph node biopsy and complete axillary lymph node dissection, which I understand is more extensive than wide local excision.' Know the exact name of every procedure you underwent.
Impact: 100%
Not mentioning immunotherapy or targeted therapy by name
Veterans sometimes describe their treatment as 'the cancer pills' or 'the infusions' without specifying the agent. Immunotherapy agents (pembrolizumab, nivolumab, ipilimumab) and BRAF/MEK targeted therapies are systemic agents that may qualify as treatment comparable to systemic malignancy treatment, triggering the 100% provision. If not documented specifically, the examiner may not apply the 100% provision.
Instead: Know the names of every medication you received for your melanoma. Bring a complete medication list from your oncologist. Specifically state: 'I received pembrolizumab (Keytruda) immunotherapy infusions every 3 weeks for 12 months, which I understand is systemic treatment comparable to chemotherapy.'
Impact: 100%
Describing scars as healed and non-problematic when they are actually painful
Veterans commonly minimize scar symptoms, particularly if the scar is not visually dramatic. However, any scar that is painful - even intermittently - qualifies as a 'painful scar' under DC 7804, which is separately ratable. Failing to report this leaves a compensable condition undocumented.
Instead: Report all scar symptoms accurately, including intermittent pain with clothing contact, pressure, or weather changes. State your worst-day experience. Use specific language: 'This scar is painful when touched, when wearing a seatbelt, and when the temperature drops. On my worst days, the pain is a 6/10.'
Impact: Scar rating under DC 7804
Not reporting treatment-related complications as separate potential disabilities
Melanoma treatment - particularly lymph node dissection and immunotherapy - commonly causes secondary conditions (lymphedema, peripheral neuropathy, immune-related adverse events, chronic fatigue) that may be independently ratable or support higher combined ratings. Veterans who focus only on the melanoma itself may miss these.
Instead: Report every persistent symptom related to your melanoma treatment, including lymphedema, neuropathy, fatigue, joint pain, gastrointestinal issues from immunotherapy, and hormonal changes. Ask your VSO whether these should be claimed as secondary conditions at the same time.
Impact: Secondary/associated conditions
Attending the exam without records of treatment dates
The 100% evaluation is assigned from the 'date of onset of treatment.' Without precise treatment dates, the effective date for the 100% rating may be delayed or incorrectly established, potentially costing the veteran months of back pay.
Instead: Bring a written timeline of your melanoma treatment: date of diagnosis, date of each surgery, date systemic treatment began, date treatment was completed or anticipated completion. Provide copies to the examiner and retain copies for yourself.
Impact: 100% effective date
Assuming the examiner will find all scars without direction
C&P exams are typically brief. An examiner may examine the primary excision site without checking for additional scars from graft donor sites, lymph node surgery sites, port placement sites, or satellite lesion excisions. Unmeasured scars cannot be rated.
Instead: Before the exam, make a written list of every scar location on your body related to melanoma treatment. At the exam, actively direct the examiner: 'I also have a scar at [location] from [procedure]. Can you examine and measure that one as well?'
Impact: Scar ratings under DC 7801-7805
Not requesting the mandatory 6-month post-treatment examination if it was not scheduled
After completing qualifying systemic treatment, VA is required to conduct a mandatory examination approximately 6 months post-treatment to assess the veteran's status. If this exam was not scheduled, the veteran may remain at 100% indefinitely or the rating may be improperly reduced without the required examination.
Instead: Track your treatment completion date. If a VA exam was not scheduled within approximately 6-7 months of completing treatment, contact your VSO or VA Regional Office to request the mandatory examination. Your 100% rating cannot be reduced without this examination and proper notice under - 3.105(e).
Impact: 100% continuation and transition to residuals rating
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to record your C&P examination in many states - check your state's laws on one-party or two-party consent for audio recording before the exam.
- You have the right to receive a copy of the completed DBQ through your VA records - request this via MyHealtheVet or a formal records request after the exam.
- You have the right to submit a written statement correcting factual errors in the DBQ if you believe the examiner inaccurately documented your condition, treatment type, or scar findings.
- Under 38 CFR - 3.105(e), your 100% rating (if applicable) cannot be reduced without a mandatory examination and proper advance written notice from VA, giving you an opportunity to respond.
- You have the right to a new or additional C&P examination if the original DBQ is found to be inadequate, incomplete, or based on an inaccurate factual premise - your VSO can help you challenge an insufficient exam.
- You have the right to bring a VSO, accredited claims agent, or attorney to your C&P exam to observe (though they typically may not actively participate in the medical examination itself).
- You have the right to submit buddy statements (lay statements from family, friends, or colleagues) corroborating your symptom descriptions, functional limitations, and treatment history.
- VA's duty to assist requires that the agency help you obtain relevant records (including private medical records with your authorization) - you do not have to obtain all records independently.
- You have the right to request an Independent Medical Opinion (IMO) from a private physician if you believe the C&P examiner's conclusions are inaccurate or insufficiently supported.
- Under the PACT Act and related legislation, veterans exposed to toxic substances may have additional presumptive service connection considerations - consult your VSO about whether any environmental exposure during service is relevant to your melanoma claim.
- If treatment is ongoing, VA should not reduce your 100% rating without conducting the mandatory 6-month post-treatment examination required under - 3.105(e) - any premature reduction is appealable.
Related Conditions
- Scars (Painful or Unstable) Residual condition directly resulting from melanoma excision surgery; rated separately under DC 7804 when scars are painful or break down with minor trauma. May be ratable in addition to or following the 100% melanoma rating.
- Scars (Superficial Non-Linear) Residual condition from melanoma excision, graft donor sites, or lymph node surgery incisions; rated under DC 7802 based on total square centimeter area on exposed surfaces.
- Disfigurement of Head, Face, or Neck Applicable when melanoma excision on the head, face, or neck results in visible disfigurement; rated separately under DC 7800 based on severity and character of disfigurement.
- Lymphedema Secondary condition frequently caused by axillary, inguinal, or cervical lymph node dissection for melanoma staging or treatment; potentially separately ratable under the appropriate vascular diagnostic code.
- Peripheral Neuropathy May develop as a secondary condition from chemotherapy used in melanoma treatment or as an immune related adverse event from checkpoint inhibitor immunotherapy; separately ratable under neurological diagnostic codes.
- Malignant Skin Neoplasms (Other Than Malignant Melanoma) Related diagnostic code DC 7818 governs other malignant skin neoplasms with nearly identical rating criteria; relevant if the veteran has both melanoma and other skin malignancies or if the diagnosis is reclassified.
- PTSD / Adjustment Disorder Psychological conditions arising from a cancer diagnosis and treatment including fear of recurrence, treatment related trauma, and impact on quality of life may be separately ratable if they meet diagnostic criteria and are nexused to service connected melanoma.
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.