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C&P Exam Prep: Malignant Skin Neoplasms (Other Than 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 document the nature, extent, active status, treatment history, and residual effects of malignant skin neoplasms (other than melanoma) for VA disability rating purposes under 38 CFR 4.118, DC 7818. The examiner will determine whether the cancer is active or in remission, what treatments have been used, and how residual effects such as scars or disfigurement should be separately rated.
What the examiner evaluates:
- Type, location, and number of malignant skin neoplasms (e.g., basal cell carcinoma, squamous cell carcinoma, Merkel cell carcinoma)
- Whether each neoplasm is a primary cancer or a metastatic lesion
- Current active vs. remission status of each neoplasm
- Whether treatment required systemic chemotherapy, extensive X-ray therapy beyond the skin, or surgery more extensive than wide local excision
- Date of diagnosis and anatomical location of each neoplasm
- Complete treatment history including surgery type, radiation therapy, chemotherapy, immunotherapy, and antineoplastic agents
- Residual scars, disfigurement of the head, face, or neck, or functional impairment resulting from the neoplasm or its treatment
- Presence of local recurrence or metastasis
- Functional impairment caused by the condition or treatment
- Whether the veteran is regularly followed at a clinic
- Impact of the condition on occupational and daily functioning
Exam typically includes a physical skin examination of all affected areas and a structured interview about diagnosis history, treatment course, and current symptoms. Bring all pathology reports, operative reports, and oncology treatment records. The examiner will physically inspect scars, disfigurement areas, and any active lesions. Each distinct malignant neoplasm may be documented separately on the DBQ.
Typical duration: 15-30 minutes
Scar/Disfigurement Documentation
Size (length and width in centimeters), location, type (linear, superficial non-linear, painful, unstable), and surface area of scars resulting from excision or treatment of the malignant neoplasm
What to expect:
The examiner will physically measure scars using a ruler or measuring tape, note their location relative to anatomical landmarks, and classify them by type. Scars on the head, face, or neck will be evaluated under DC 7800 (disfigurement) or DCs 7801-7805 (scars). The examiner may take photographs.
Key thresholds:
- Greater than 39 sq cm superficial non-linear scar — Higher rating potential under DC 7802; document exact dimensions
- Painful or unstable scar (any size) — Qualifies for rating under DC 7804 regardless of size; be explicit about pain
- Scar on head, face, or neck causing disfigurement — Rated under DC 7800; number and type of disfiguring characteristics directly drive rating percentage
- Deep, nonlinear scar limiting motion — May be rated under DC 7801 or as functional impairment; document range of motion limitation
Tips:
- Show all scars, including those from biopsies, Mohs surgery, excisions, skin grafts, and lymph node removal
- Point out any scar that is painful to touch, tender, or causes burning sensations
- Identify scars that are adherent to underlying tissue or restrict movement
- Do not minimize scar pain - if a scar hurts when pressed or during activity, say so explicitly
- If a scar on the face or neck causes cosmetic disfigurement, describe how it affects your appearance and daily social interactions
Pain considerations: Scar pain is a separate rating criterion under DC 7804. Describe pain as it occurs on your worst days - burning, shooting, hypersensitivity to clothing contact, or pain with movement. Pain that limits function, causes sleep disruption, or affects employment should be explicitly stated.
Total Body Surface Area (TBSA) and Exposed Surface Area Documentation
The percentage of total body surface area and exposed body surface area affected by active skin disease or residual skin changes, required per M21-1 for skin condition DBQs
What to expect:
The examiner will document what percentage of the body surface is affected by current skin manifestations or treatment-related skin changes. This is especially relevant if the malignancy has caused widespread skin involvement or treatment has caused diffuse skin effects.
Key thresholds:
- Any percentage of exposed body surface area affected — Required documentation; higher percentages support higher disability ratings for residual skin conditions
Tips:
- If you have multiple sites of excision or radiation damage, help the examiner understand the full scope by identifying each location
- If your treatment caused skin effects across a broad area, describe the extent accurately
- Point to all affected areas - do not assume the examiner will find them all without direction
Pain considerations: Not applicable for this measurement type.
Functional Impairment Assessment
How the malignant neoplasm, its treatment, or residual effects limit the veteran's physical functioning, including range of motion limitations from scars, lymphedema, nerve damage, or weakness from surgery
What to expect:
The examiner may ask about limitations in reaching, gripping, walking, or other functions depending on the location of the neoplasm. If scars restrict joint movement, range of motion testing may be performed.
Key thresholds:
- Functional limitation from scar tissue or surgical damage — Rated as impairment of function under DC 7818; may warrant separate rating for the affected body part
Tips:
- Describe any limitations in movement, grip strength, or activities caused by surgical scars or radiation damage
- Mention if lymph node removal has caused lymphedema or swelling
- If peripheral nerve damage occurred from surgery or radiation, describe numbness, tingling, or weakness accurately
Pain considerations: Functional impairment from scars includes pain-limited range of motion. Describe how pain restricts what you can do, not just the anatomical limitation.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Active malignant skin neoplasm requiring therapy comparable to that used for systemic malignancies: systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. A 100% evaluation is assigned from the date of onset of such treatment and continues with a mandatory VA examination six months after completion of antineoplastic treatment. |
CFR: Per 38 CFR 4.118 DC 7818: If a skin malignancy requires therapy comparable to that used for systemic malignancies - systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision - a 100% evaluation will be assigned from the date of onset of treatment. Note: If treatment is confined to the skin only, the 100% evaluation provisions do not apply. |
| 0% | After completion of antineoplastic treatment with no local recurrence or metastasis, the evaluation is based entirely on residuals. Residuals are rated under DC 7800 (disfigurement of head, face, or neck), DC 7801 (deep nonlinear scar), DC 7802 (superficial nonlinear scar), DC 7803 (unstable or painful scar), DC 7804 (painful scar), DC 7805 (other scar effects), or as impairment of function. There is no fixed percentage for residuals under DC 7818 - the rating is entirely determined by the applicable residual diagnostic codes. If treatment was confined to the skin only, the 100% evaluation never applies. |
CFR: Per 38 CFR 4.118 DC 7818: If there has been no local recurrence or metastasis, evaluation will be made on residuals. Rate as disfigurement of head, face, or neck (DC 7800), scars (DCs 7801-7805), or impairment of function. Note: If treatment is confined to the skin, the provisions for a 100% evaluation do not apply - the condition is rated on residuals from the outset. |
100% Active malignant skin neoplasm requiring therapy comparable ...
Active malignant skin neoplasm requiring therapy comparable to that used for systemic malignancies: systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision. A 100% evaluation is assigned from the date of onset of such treatment and continues with a mandatory VA examination six months after completion of antineoplastic treatment.
Key Symptoms
- Active malignancy requiring systemic chemotherapy (e.g., IV or oral targeted chemotherapy agents)
- Radiation therapy extending beyond the skin (e.g., treatment of lymph nodes or internal structures)
- Surgery more extensive than wide local excision (e.g., radical excision, lymph node dissection, amputation)
- Immunotherapy or biological agents used for systemic cancer treatment (e.g., checkpoint inhibitors, high-dose interferon)
- Evidence of active disease or ongoing antineoplastic treatment at time of exam
CFR: Per 38 CFR 4.118 DC 7818: If a skin malignancy requires therapy comparable to that used for systemic malignancies - systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision - a 100% evaluation will be assigned from the date of onset of treatment. Note: If treatment is confined to the skin only, the 100% evaluation provisions do not apply.
0% After completion of antineoplastic treatment with no local r ...
After completion of antineoplastic treatment with no local recurrence or metastasis, the evaluation is based entirely on residuals. Residuals are rated under DC 7800 (disfigurement of head, face, or neck), DC 7801 (deep nonlinear scar), DC 7802 (superficial nonlinear scar), DC 7803 (unstable or painful scar), DC 7804 (painful scar), DC 7805 (other scar effects), or as impairment of function. There is no fixed percentage for residuals under DC 7818 - the rating is entirely determined by the applicable residual diagnostic codes. If treatment was confined to the skin only, the 100% evaluation never applies.
Key Symptoms
- No active malignancy, no local recurrence, no metastasis
- Residual surgical scars from excision or Mohs surgery
- Residual disfigurement of head, face, or neck
- Functional limitation from scar tissue, nerve damage, or lymphedema
- Radiation-related skin changes (fibrosis, telangiectasia, atrophy)
- Pain or instability at scar site
- Cosmetic disfigurement affecting daily life or employment
CFR: Per 38 CFR 4.118 DC 7818: If there has been no local recurrence or metastasis, evaluation will be made on residuals. Rate as disfigurement of head, face, or neck (DC 7800), scars (DCs 7801-7805), or impairment of function. Note: If treatment is confined to the skin, the provisions for a 100% evaluation do not apply - the condition is rated on residuals from the outset.
How to Describe Your Symptoms
Active Malignancy and Treatment Intensity
How to describe:
Clearly state the specific type of skin cancer (e.g., squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma), all locations, dates of diagnosis, and every treatment modality used. Distinguish between treatments confined to the skin (simple excision, topical treatments, superficial radiation) and treatments that extend beyond the skin (systemic chemotherapy, lymph node dissection, deep radiation fields).
Worst-day example:
“I was diagnosed with squamous cell carcinoma on my left cheek in [year] and underwent a radical neck dissection with removal of 22 lymph nodes, followed by 35 sessions of radiation that included the neck and submandibular nodes, and six cycles of systemic cisplatin chemotherapy. On my worst days during treatment, I could not eat, had severe fatigue, and required hospitalization for dehydration.”
What the examiner listens for:
Whether the treatment modality qualifies for the 100% evaluation under DC 7818 - specifically systemic chemotherapy, radiation beyond skin fields, or surgery beyond wide local excision. The examiner will document each treatment type, dates, and current status.
Understatements to avoid:
Do not simply say 'I had surgery to remove it.' Specify the extent - wide local excision versus radical excision versus Mohs surgery versus lymph node dissection. Each matters significantly for rating purposes.
Scar Pain and Sensitivity
How to describe:
Describe the quality, frequency, and triggers of scar pain. Use specific language: burning, shooting, stabbing, hypersensitive to touch, pain with clothing contact, weather-related pain, or pain that wakes you at night. Indicate which scars are painful and how pain affects function.
Worst-day example:
“On my worst days, the scar on my neck from the lymph node dissection feels like it is on fire and tightens to the point where I cannot turn my head to check blind spots while driving. Even the collar of my shirt causes significant pain and I have to wear only soft V-neck shirts.”
What the examiner listens for:
Any scar that is painful on direct pressure or with movement, unstable, adherent, or causes functional limitation qualifies for rating under DCs 7804 or 7805. The examiner needs to document this to ensure it is captured in the DBQ.
Understatements to avoid:
Do not say 'my scar is fine' or 'it doesn't bother me much.' If it hurts at all - even occasionally - describe it accurately and completely. Understating scar pain is the single most common cause of underrating for this condition.
Disfigurement of Head, Face, or Neck
How to describe:
Describe the visual appearance and location of any disfigurement - skin discoloration, tissue loss, asymmetry, contracture, visible scarring, hair loss at the scar site, or changes in skin texture. Explain how the disfigurement affects your self-image, social interactions, and employment.
Worst-day example:
“The scar on my face from the Mohs surgery has left a visible depression and discoloration that causes strangers to stare. I avoid social situations because I am self-conscious. My supervisor commented on my appearance, and I have stopped attending client-facing meetings.”
What the examiner listens for:
The number and severity of disfiguring characteristics under DC 7800 - tissue loss, gross distortion, multiple scars, skin discoloration, or abnormal skin texture on the head, face, or neck. Each characteristic contributes to the rating percentage.
Understatements to avoid:
Do not minimize the cosmetic impact by saying 'it's not that bad.' Describe the objective appearance accurately and how it has changed your life. The examiner rates what they observe and what you report.
Functional Impairment from Treatment Residuals
How to describe:
Describe any loss of function caused by surgery, radiation, or chemotherapy - including limited range of motion from scar tissue, lymphedema, numbness from nerve damage, weakness in the affected limb or area, difficulty swallowing or speaking if head and neck were treated, or fatigue from ongoing treatment.
Worst-day example:
“After my radical neck dissection, I have persistent shoulder drop and weakness from spinal accessory nerve damage. I cannot raise my right arm above shoulder height, which prevents me from performing overhead work. I also have chronic lymphedema in my right arm that causes significant swelling and tightness every day.”
What the examiner listens for:
Any functional impairment that can be separately rated - shoulder weakness, limited cervical range of motion, lymphedema, neuropathy, or swallowing dysfunction. These may support additional ratings beyond the skin neoplasm itself.
Understatements to avoid:
Do not fail to mention functional limitations because you think they are 'separate' from the skin cancer. They are direct residuals of treatment and should be described in detail at this exam.
Recurrence, Metastasis, and Ongoing Surveillance
How to describe:
Describe your ongoing monitoring schedule, any history of local recurrence, regional lymph node involvement, or distant metastasis. Include dates of recurrence, retreatment, and current surveillance frequency. If you have been told you are cancer-free, say so - but also describe what monitoring you still undergo.
Worst-day example:
“My squamous cell carcinoma recurred twice - first in [year] and again in [year] - and on the second recurrence it had spread to two cervical lymph nodes, requiring a second neck dissection. I now see my oncologist every three months for surveillance, and each visit brings significant anxiety about recurrence.”
What the examiner listens for:
History of recurrence or metastasis is critical for determining whether the condition should still be rated at 100% or transitioned to a residuals-based evaluation. The examiner must document the current status accurately.
Understatements to avoid:
Do not omit prior recurrences or metastatic episodes. Each episode of recurrence or spread may restart the 100% evaluation period and affects the overall disability picture.
Common Mistakes to Avoid
Failing to distinguish treatment extent - saying 'I had surgery' without specifying whether it was a simple excision or a more extensive procedure
The 100% evaluation under DC 7818 applies only when surgery is more extensive than wide local excision. If you do not describe the actual surgical procedure (e.g., radical excision, lymph node dissection, flap reconstruction), the examiner may default to documenting only 'surgery' which could result in a residuals-only rating
Instead: Bring operative reports and describe the surgery in specific terms: 'I had a Mohs surgery with three stages,' or 'I had a radical neck dissection with removal of 28 lymph nodes,' or 'I underwent a sentinel lymph node biopsy followed by regional lymphadenectomy'
Impact: 100% vs. residuals
Not reporting scar pain because it feels minor or intermittent
Painful scars qualify for rating under DC 7804 regardless of size. Even mild or intermittent scar pain, if real and accurate, supports a compensable rating. Veterans who underreport scar pain receive 0% for a condition that should be rated
Instead: Describe all scar pain accurately - burning, sensitivity to touch, clothing contact pain, cold-weather pain, or pain with movement. Report how often it occurs and what your worst days feel like
Impact: 0% vs. compensable scar rating
Treating each skin cancer as a single condition when multiple primaries exist
Per M21-1, each malignant skin neoplasm is considered a separate primary cancer (e.g., a basal cell carcinoma on the nose and a squamous cell carcinoma on the arm are two separate conditions). Veterans who do not distinguish them may lose separate ratings
Instead: Bring a complete list of every skin cancer diagnosis with dates, locations, and pathology reports. Ensure the examiner documents each one separately on the DBQ
Impact: Multiple separate ratings vs. single rating
Assuming a completed treatment means the exam is just a formality with no significant rating
After antineoplastic treatment ends, the VA must conduct a mandatory examination six months post-treatment. The residuals-based rating that follows can still be significant if scars, disfigurement, or functional impairment are properly documented
Instead: Come prepared to thoroughly document all residuals - scars, disfigurement, functional limitations, and ongoing symptoms - at the six-month post-treatment examination
Impact: Post-treatment residuals rating
Not mentioning psychological impact or functional limitations from disfigurement
The DBQ specifically asks about the impact of the skin condition on functioning. Disfigurement that causes social withdrawal, employment avoidance, or psychological distress supports both the skin rating and potentially a separate mental health claim
Instead: Describe how disfigurement has changed your social behavior, employment activities, and self-confidence. If you have developed anxiety or depression related to your cancer or its appearance, mention this and consider a separate mental health claim
Impact: DC 7800 disfigurement rating and potential separate mental health rating
Failing to bring pathology reports, operative reports, and oncology records to the exam
M21-1 requires that all pathology reports identifying the type of cancer and organ involved be available. Without documentation, the examiner may not be able to confirm diagnosis details, treatment extent, or recurrence history accurately
Instead: Bring organized copies of all relevant records: pathology reports for each diagnosis, surgical operative notes, radiation treatment summaries, chemotherapy records, and current oncology follow-up notes
Impact: All rating levels
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 request that the C&P examination be recorded (audio or video) in most states. Notify the VA in writing before the exam that you intend to record. Check your state's consent laws - most require only one-party consent.
- You have the right to bring a VSO representative, attorney, or claims agent to the examination as an observer.
- You have the right to submit a buddy statement or personal statement describing your symptoms before or after the examination.
- You have the right to request a copy of the completed Disability Benefits Questionnaire (DBQ) after the examination.
- You have the right to submit additional medical evidence, including private medical opinions, to supplement or rebut the C&P examiner's findings.
- You have the right to request a new or additional examination if you believe the original examination was inadequate, incomplete, or based on inaccurate information.
- Under the PACT Act, certain malignant skin cancers may qualify as presumptive conditions for veterans exposed to burn pits, Agent Orange, radiation, or other toxic exposures. Ask your VSO if your cancer may qualify for presumptive service connection.
- Per M21-1, each malignant skin neoplasm is considered a separate primary cancer entitled to its own separate rating - you have the right to have each diagnosed cancer evaluated individually.
- A mandatory VA examination must occur six months after completion of antineoplastic treatment. You have the right to ensure this examination is scheduled and completed, as it determines your post-treatment residuals-based rating.
- Per 38 CFR 3.105(e), any reduction in your disability rating following the six-month post-treatment mandatory examination is subject to specific procedural protections before the reduction becomes effective.
- You have the right to a clear written notice from the VA explaining any rating decision, including the specific evidence and criteria used to make that decision.
Related Conditions
- Scars (Deep, Nonlinear) Directly rated as a residual of malignant skin neoplasm treatment under DC 7818; surgical excision scars from cancer removal are rated under DC 7801 if deep and nonlinear
- Scars (Superficial, Nonlinear) Directly rated as a residual of malignant skin neoplasm treatment under DC 7818; superficial scars from excision are rated under DC 7802 based on area affected
- Painful or Unstable Scars Directly rated as a residual of malignant skin neoplasm treatment; any scar from cancer surgery that is painful to palpation or unstable qualifies for separate rating under DC 7804
- Disfigurement of the Head, Face, or Neck Primary residual rating mechanism for DC 7818 when the skin cancer or its treatment causes disfigurement of the head, face, or neck; rated based on number and severity of disfiguring characteristics
- Malignant Melanoma Closely related skin malignancy rated under a separate diagnostic code (DC 7833); rated similarly to DC 7818 but explicitly excluded from DC 7818's scope
- Benign Skin Neoplasms Rated under DC 7819 when the neoplasm is confirmed benign; also rated as disfigurement or scars per residuals, but without the 100% active treatment provision
- Peripheral Neuropathy May develop as a secondary condition from chemotherapy (chemotherapy induced peripheral neuropathy) or from surgical nerve damage during cancer excision; potentially separately ratable
- Lymphedema May develop as a secondary residual of lymph node dissection performed during malignant skin neoplasm treatment; separately ratable as impairment of function
- Depression or Anxiety May develop secondary to a cancer diagnosis or as a result of disfigurement; potentially separately ratable as a secondary mental health condition
- Hypothyroidism May develop as a secondary condition from radiation therapy to the head and neck area used to treat skin malignancies; potentially separately ratable
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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.