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C&P Exam Prep: Scars (Burn / Disfigurement / Painful)
DBQ Overview
Interview + Physical- Form Name
- scars
- Form Code
- scars
- 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 location, dimensions, characteristics, and functional impact of service-connected scars - particularly burn scars or scars causing disfigurement of the head, face, or neck - so that a VA rater can assign a disability percentage under 38 CFR 4.118, Diagnostic Code 7800.
What the examiner evaluates:
- Number, type, and precise location of each scar (head/face/neck vs. trunk vs. extremities)
- Visible or palpable tissue loss associated with each scar
- Gross distortion or asymmetry of facial features: nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips
- Number of disfigurement characteristics present (hyperpigmentation, hypopigmentation, abnormal texture, induration/inflexibility, elevated or depressed surface contour, adherence to underlying tissue)
- Whether scars are painful or unstable (prone to breakdown)
- Approximate total area of scarring per body region in cm-
- Scar dimensions - length and width at widest point - for each individual scar
- Deformity of auricle (complete loss, loss of - one-third, or loss of < one-third of substance)
- Tissue loss or distortion involving the eye, eyelid, or other periorbital structures
- History, cause, origin, and course of each scar
- Impact of scarring on daily functioning, occupation, and social interaction
The examiner will conduct a full visual and tactile inspection of all claimed scar sites. Wear clothing that allows easy exposure of all affected areas. Bring a written list of every scar location with approximate dimensions if known. The examiner may take photographs; this is standard and does not require your consent to deny the exam, but you may note their existence in your own records.
Typical duration: 15-30 minutes
Individual Scar Dimensions (Length - Width)
The size of each discrete scar at its longest length and widest width in centimeters, which determines whether the scar meets area thresholds for higher ratings under DC 7801/7802 and informs the overall documentation under DC 7800.
What to expect:
The examiner will use a ruler or tape measure directly on the skin. They will press on the scar to assess elevation or depression and will note whether the borders are regular or irregular.
Key thresholds:
- < 39 cm- total area — Superficial, non-painful scars below this threshold generally do not receive a separate rating; accurate documentation still required
- > 39 cm- total area (non-linear superficial scar) — Meets threshold for rating under DC 7802 at 10%
- 6 or more disfigurement characteristics present — Supports 80% rating under DC 7800 (combined with tissue loss)
- 4-5 disfigurement characteristics present — Supports 50% rating under DC 7800 (combined with tissue loss)
- 2-3 disfigurement characteristics present — Supports 30% rating under DC 7800 (combined with tissue loss)
- 1 disfigurement characteristic present — Supports 10% rating under DC 7800 (combined with tissue loss)
Tips:
- Know the approximate size of each scar before the exam - use a ruler at home and write it down
- If a scar has grown or changed in size since last measured, say so explicitly
- If multiple small scars are clustered together, ask the examiner to document total combined area
Pain considerations: If pressure from the measuring instrument causes pain, state this aloud during measurement. Pain on palpation supports a painful scar finding.
Disfigurement Characteristics Assessment (7800 Head/Face/Neck)
Counts the number of the seven recognized disfigurement characteristics present: (1) hyperpigmentation, (2) hypopigmentation, (3) abnormal texture, (4) induration and inflexibility, (5) surface contour elevated on palpation, (6) surface contour depressed on palpation, (7) adherence to underlying tissue. Also assesses distortion or asymmetry of named facial features.
What to expect:
The examiner will visually inspect pigmentation changes, palpate for firmness or tethering, and compare bilateral facial features for symmetry. They will assess nose, chin, forehead, eyes (with eyelids), ears (auricles), cheeks, and lips individually.
Key thresholds:
- 3+ features grossly distorted/asymmetrical + tissue loss — 80%
- 2 features grossly distorted/asymmetrical + tissue loss — 50%
- 1 feature grossly distorted/asymmetrical + tissue loss — 30%
- 6+ disfigurement characteristics (with tissue loss) — 80%
- 4-5 disfigurement characteristics (with tissue loss) — 50%
- 2-3 disfigurement characteristics (with tissue loss) — 30%
- 1 disfigurement characteristic (with tissue loss) — 10%
Tips:
- Characteristics from multiple scars on the head/face/neck COUNT TOGETHER - per Note 5 of DC 7800, they need not come from a single scar
- Bring photographs taken on your worst days if scarring appearance changes (e.g., with heat, cold, or physical activity)
- Explicitly point out hypopigmented or hyperpigmented patches that the examiner might overlook in standard clinical lighting
- Induration (hardness/firmness) and inflexibility can be subtle - actively communicate tightness, restricted movement, or skin pulling sensations
Pain considerations: Not directly applicable to this measurement, but note that painful scars on the face/head are separately documentable under DC 7804 or 7805 and should be reported.
Painful/Unstable Scar Documentation
Whether each scar is painful to touch, spontaneously painful, or unstable (i.e., subject to recurrent breakdown, ulceration, or open lesions). Painful and unstable scars carry independent rating significance under DC 7804.
What to expect:
The examiner will apply light and firm palpation to each scar and ask about spontaneous pain, pain with clothing contact, pain with temperature changes, and history of breakdown or ulceration.
Key thresholds:
- 5 or more painful/unstable scars — 30% under DC 7804
- 2-4 painful/unstable scars — 20% under DC 7804
- 1 painful/unstable scar — 10% under DC 7804
Tips:
- Report pain during the palpation exam - do not stay silent when the examiner touches a scar
- Describe spontaneous pain that occurs without any touch (e.g., burning, stabbing, or aching)
- Document any history of skin breakdown at the scar site, even if it healed
- Note whether certain clothing, weather, or activities trigger pain at the scar site
Pain considerations: This is the central measurement for this test. Pain at rest, pain with touch, and pain during temperature changes should all be communicated clearly and separately.
Auricle (Ear) Deformity Assessment
The degree of structural loss or deformity to the ear auricle caused by burn scars or other scarring, rated under the ear disfigurement criteria within DC 7800.
What to expect:
The examiner will visually compare both auricles and document any partial or complete structural loss. They will note whether deformity involves less than one-third, one-third or more, or complete loss of the auricle substance.
Key thresholds:
- Complete loss of auricle — Higher rating under ear disfigurement criteria; contributes to overall DC 7800 feature count
- Deformity with loss of - 1/3 of auricle substance — Contributes to feature distortion count for DC 7800 rating
- Deformity with loss of < 1/3 of auricle substance — Still documentable as feature involvement
Tips:
- If one or both ears are affected, point this out clearly at the start of the exam
- Note whether the deformity affects hearing canal function (may support separate audiology claim)
- Bring photos showing the ear deformity at its most visible angle if the exam room lighting is poor
Pain considerations: If the auricle or surrounding area is painful to touch or when wearing glasses/headgear, report this during the exam.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 80% | Visible or palpable tissue loss AND either gross distortion or asymmetry of THREE OR MORE named facial features or paired sets of features (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips), OR six or more characteristics of disfigurement. |
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with distortion of forehead, nose, and both cheeks simultaneously; or six characteristics such as hypopigmentation, abnormal texture, induration, elevated contour, depressed contour, and adherence all present on head/face/neck scars. |
| 50% | Visible or palpable tissue loss AND either gross distortion or asymmetry of TWO named facial features or paired sets of features, OR four or five characteristics of disfigurement. |
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with asymmetry of left and right cheeks; or four characteristics such as hypopigmentation, abnormal texture, depressed contour, and adherence to underlying tissue. |
| 30% | Visible or palpable tissue loss AND either gross distortion or asymmetry of ONE named facial feature or paired set of features, OR two or three characteristics of disfigurement. |
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with gross asymmetry of the nose alone; or two characteristics such as hypopigmentation and induration/inflexibility. |
| 10% | Visible or palpable tissue loss AND either gross distortion or asymmetry of one feature, OR one characteristic of disfigurement. |
CFR: Per 38 CFR 4.118, DC 7800: One characteristic such as hypopigmentation alone; or deformity of auricle with loss of less than one-third of the substance. |
80% Visible or palpable tissue loss AND either gross distortion ...
Visible or palpable tissue loss AND either gross distortion or asymmetry of THREE OR MORE named facial features or paired sets of features (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips), OR six or more characteristics of disfigurement.
Key Symptoms
- Visible tissue loss (skin, subcutaneous tissue, or underlying structure missing)
- Gross asymmetry or distortion of 3+ facial features
- Six or more of the seven disfigurement characteristics simultaneously present
- Severe hyperpigmentation and/or hypopigmentation over large facial areas
- Marked induration and inflexibility restricting facial expression or movement
- Significant scar adherence to underlying facial tissue (bone, muscle, tendon)
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with distortion of forehead, nose, and both cheeks simultaneously; or six characteristics such as hypopigmentation, abnormal texture, induration, elevated contour, depressed contour, and adherence all present on head/face/neck scars.
50% Visible or palpable tissue loss AND either gross distortion ...
Visible or palpable tissue loss AND either gross distortion or asymmetry of TWO named facial features or paired sets of features, OR four or five characteristics of disfigurement.
Key Symptoms
- Tissue loss with distortion of two features (e.g., nose and cheeks, or both eyelids)
- Four to five disfigurement characteristics present
- Significant color change (hypo- or hyperpigmentation) combined with abnormal texture and induration
- Scar tethering visible when patient smiles, opens mouth, or moves facial muscles
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with asymmetry of left and right cheeks; or four characteristics such as hypopigmentation, abnormal texture, depressed contour, and adherence to underlying tissue.
30% Visible or palpable tissue loss AND either gross distortion ...
Visible or palpable tissue loss AND either gross distortion or asymmetry of ONE named facial feature or paired set of features, OR two or three characteristics of disfigurement.
Key Symptoms
- Tissue loss with distortion of a single feature (e.g., nose, one ear, or both lips)
- Two or three disfigurement characteristics present
- Visible color change (hypo- or hyperpigmentation) plus one other characteristic
- Partial auricle deformity with loss of one-third or more of substance
CFR: Per 38 CFR 4.118, DC 7800: Tissue loss with gross asymmetry of the nose alone; or two characteristics such as hypopigmentation and induration/inflexibility.
10% Visible or palpable tissue loss AND either gross distortion ...
Visible or palpable tissue loss AND either gross distortion or asymmetry of one feature, OR one characteristic of disfigurement.
Key Symptoms
- At least one visible disfigurement characteristic (e.g., isolated hyperpigmentation, abnormal texture, or elevated/depressed contour)
- Minor auricle deformity with loss of less than one-third of substance
- Isolated adherence to underlying tissue without major visible distortion
CFR: Per 38 CFR 4.118, DC 7800: One characteristic such as hypopigmentation alone; or deformity of auricle with loss of less than one-third of the substance.
How to Describe Your Symptoms
Pain and Tenderness
How to describe:
Describe the type of pain (burning, stabbing, aching, electric, throbbing), when it occurs (constant, with touch, with clothing contact, with temperature changes, with pressure), and its intensity on your worst days using a 0-10 scale. Specify which scar or scars are painful.
Worst-day example:
“On my worst days, the scar on my left cheek has a constant burning pain rated 7 out of 10. Even the collar of my shirt rubbing against it causes a sharp, stabbing pain. Cold weather makes it feel like it is on fire again. I have had to stop wearing certain clothing because of the contact pain.”
What the examiner listens for:
Spontaneous pain, allodynia (pain from non-painful stimuli like clothing), pain at rest, pain reproducible on palpation, and history of the scar breaking down or ulcerating.
Understatements to avoid:
Do not say 'it's just a little sore sometimes.' Instead, describe the specific character, frequency, and severity of pain, and how it changes your behavior.
Visible Disfigurement and Pigmentation Changes
How to describe:
Describe every visible change: areas that are lighter (hypopigmentation) or darker (hyperpigmentation) than surrounding skin, areas of abnormal texture (rough, shiny, leathery, bumpy), raised scars (hypertrophic or keloid), and sunken scars (atrophic or depressed). Be specific about which facial features are involved and how they look different from the unaffected side.
Worst-day example:
“The scar across my forehead is noticeably white compared to my normal skin tone, and the texture feels rough and leathery - people stare at it in public. My left earlobe is partially missing and the remaining tissue is thickened and dark. When I am hot or exert myself, the area turns red and stands out even more.”
What the examiner listens for:
Specific named features affected, bilateral vs. unilateral involvement, patient-reported changes in appearance over time, and whether disfigurement causes social withdrawal or psychological distress.
Understatements to avoid:
Do not minimize visible changes by saying 'it's not that bad.' The examiner's job is to document what is there; your job is to make sure nothing is missed. Point out every color change and texture difference, even subtle ones.
Tissue Loss and Structural Distortion
How to describe:
Explain whether the scar involves actual missing tissue - skin, fat, muscle, or cartilage - and how this changes the shape or symmetry of the affected area. Compare the affected feature to the unaffected side or to normal anatomy.
Worst-day example:
“The burn scar on my nose caused tissue loss on the right side - the tip of my nose is pulled to the right and looks sunken compared to the left side. My nostril on that side is partially collapsed, which affects my breathing. The tissue underneath feels hard and tethered to the bone.”
What the examiner listens for:
Palpable absence of subcutaneous tissue, visible asymmetry of named features, functional consequences of tissue loss (e.g., impaired nostril airflow, incomplete eye closure, restricted mouth opening).
Understatements to avoid:
Do not assume the examiner can see all tissue loss. If the loss is internal (e.g., missing fat under the skin surface), describe the sunken or hollow feeling. Show how the affected area moves differently than the unaffected side.
Induration, Inflexibility, and Tightness
How to describe:
Describe the scar as hard, stiff, or tight. Explain whether the tightness limits facial expression, restricts opening the mouth, affects blinking or eye closure, or causes pulling sensations when you move.
Worst-day example:
“The scar over my jaw is so tight and hard that I cannot open my mouth fully - I can only open it about halfway. When I try to smile, the scar pulls the corner of my mouth downward and to the left. The skin feels like leather and will not move freely.”
What the examiner listens for:
Restricted range of facial or neck movement, tethering of the scar to underlying fascia or bone on palpation, patient demonstration of restricted expression or movement.
Understatements to avoid:
Do not describe inflexibility only when directly asked. Demonstrate the restriction by opening your mouth, smiling, raising your eyebrows, or turning your neck during the exam.
Functional and Psychosocial Impact
How to describe:
Describe how the scars affect your daily life, employment, and social interactions. Include difficulty with eating, speaking, blinking, sunlight sensitivity, skin breakdown with physical activity, and any psychological effects such as avoidance of public situations.
Worst-day example:
“On my worst days I refuse to leave the house because of the stares and comments. I have turned down job interviews because the disfigurement is so visible. Eating in public is embarrassing because my lips do not close properly over the affected side, and food sometimes escapes. I cannot wear a standard uniform collar because contact with the neck scar causes constant pain.”
What the examiner listens for:
Concrete examples of functional limitations, occupational impact, social avoidance, and activities of daily living affected by both the pain and visible disfigurement.
Understatements to avoid:
Do not say 'I just deal with it.' The DBQ specifically asks for the impact of scars on the veteran's life. If psychosocial impact is significant, say so clearly. This supports a separate mental health claim if not already filed.
Scar Instability and Skin Breakdown
How to describe:
Describe any history of the scar reopening, forming sores, ulcerating, draining, or breaking down - especially with physical activity, friction, or pressure. Include frequency and how long episodes last.
Worst-day example:
“The scar on my neck breaks down about once every two months when I wear any shirt with a collar. It opens into a raw sore that takes about two weeks to heal, and during that time I have to keep it bandaged and cannot do physical activity that makes me sweat.”
What the examiner listens for:
History of recurrent breakdown documented in medical records, current evidence of active ulceration or crusting, and patient report of activities that trigger breakdown.
Understatements to avoid:
Do not omit past episodes of breakdown just because the scar appears intact on exam day. The examiner should document the history of instability, not just the current appearance.
Common Mistakes to Avoid
Failing to disclose all scar locations - only mentioning the most obvious scar
VA rates each anatomically distinct scar separately. Scars on the trunk or extremities are rated under different diagnostic codes (DC 7801, 7802) in addition to DC 7800 for head/face/neck. Omitting body scars means losing potential separate ratings.
Instead: Before the exam, create a written inventory of every scar by location, approximate size, and characteristics. Bring this list to the exam and provide it to the examiner at the start.
Impact: All levels - missed scars mean missed ratings
Not reporting pain during palpation - staying quiet when the examiner touches a scar
The examiner documents what is observed and reported. If you do not say 'that is painful' when the scar is touched, the examiner may record no tenderness, which eliminates the painful scar rating.
Instead: Verbally report pain the moment you feel it during palpation. Say 'that hurts' or 'that is tender' clearly so it is documented.
Impact: 10-30% for painful/unstable scars under DC 7804
Describing your 'average day' rather than your worst day
Per M21-1 guidance, the VA rates the degree of disability present, and the DBQ specifically asks about the impact of scars. Describing only your best or average presentation underrepresents your actual disability level.
Instead: When asked how the condition affects you, explicitly describe your worst day. You may say 'on my worst days- and provide specific examples of maximum functional limitation.
Impact: All levels - worst-day reporting can be the difference between adjacent rating tiers
Assuming the examiner can see all disfigurement characteristics - failing to point out subtle findings
Hypopigmentation and hyperpigmentation can be subtle in certain lighting. Induration may not be obvious without patient guidance. The examiner may not palpate every area unless directed.
Instead: Actively guide the examiner to each characteristic. Say 'this area here has lighter skin' or 'if you press here it feels very hard compared to normal skin.' Point, do not assume.
Impact: 30-80% - each additional characteristic can move the rating tier
Not mentioning that disfigurement characteristics come from multiple scars collectively, not a single scar
Note 5 of DC 7800 explicitly states that characteristics need not come from a single scar. Veterans and sometimes examiners mistakenly believe all characteristics must be on one scar, which artificially lowers the count.
Instead: If you have multiple scars on the head, face, or neck each contributing different characteristics, explicitly state this. Say 'The hypopigmentation is from the scar on my forehead, but the induration and elevated contour are from the separate scar on my cheek - together they represent multiple characteristics.'
Impact: 30-80% - this is the most common reason for under-rating at DC 7800
Failing to mention the service connection history and origin of each scar
The DBQ asks for the history, cause, origin, and course of each scar. If this is not documented, the rater may have difficulty confirming service connection, especially for scars not previously claimed.
Instead: Prepare a brief narrative for each scar: when it happened, where you were serving, what caused it, how it was treated in service, and how it has changed since. Bring service treatment records if possible.
Impact: All levels - affects service connection, not just rating percentage
Not connecting scar-related disfigurement to psychosocial and occupational impact
The DBQ has a specific field asking about the impact of scars on the veteran's life. If left blank or minimized, this limits the record's support for a higher rating and for any related mental health claim.
Instead: Clearly describe how the disfigurement affects your employment, social activities, relationships, and mental health. Be specific and concrete rather than vague.
Impact: Supports rating at all levels and related mental health claims
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 have all claimed scars physically examined - the examiner must inspect each scar site, not merely review records.
- You have the right to request a copy of the completed DBQ and examination report after the exam is finalized.
- You have the right to record your C&P examination in most states - check state law and facility policy, then notify the examiner before beginning.
- You have the right to submit supplemental evidence - including private medical opinions, photographs, and buddy statements - if you believe the VA examination was inadequate.
- You have the right to request a new C&P examination if the original examination report is found to be inadequate per M21-1 criteria (e.g., fails to document scar location, type, and dimensions).
- Under 38 CFR 3.303 and the benefit of the doubt standard (38 CFR 3.102), if there is an approximate balance of evidence for and against service connection for a scar, it must be resolved in your favor.
- Per Note 5 of DC 7800, disfigurement characteristics from multiple scars on the head, face, or neck count together - you have the right to have all characteristics considered collectively, not per-scar.
- You have the right to be rated under the most favorable diagnostic code - if your scars qualify under both DC 7800 and DC 7801/7802/7804, the VA must apply the code that yields the higher rating, and DC 7805 allows separate rating of disabling effects not captured by the primary code.
- You have the right to submit a Notice of Disagreement (NOD) and request a Higher-Level Review or Board of Veterans' Appeals hearing if you disagree with the rating decision.
- You have the right to a trauma-informed examination environment - if you have PTSD or other service-connected mental health conditions related to the circumstances of your scarring, you may request a specific examiner or a support person be present.
Related Conditions
- Scars - Superficial, Non-Linear (Other Than Head/Face/Neck) DC 7802 rates superficial non linear scars on the trunk or extremities by total area; often rated alongside DC 7800 when scarring affects both the head/face/neck and body.
- Scars - Linear (Deep or Superficial) DC 7801 rates deep non linear scars and DC 7803 rates superficial linear scars; veterans with both head/face and body scarring may have multiple scar DCs rated simultaneously.
- Scars - Painful or Unstable DC 7804 separately rates painful or unstable scars regardless of location; a scar rated under DC 7800 for disfigurement may also receive an additional rating under DC 7804 if it is painful or prone to breakdown.
- Scars - Other Effects (DC 7805) DC 7805 allows separate rating of any disabling effects of scarring not captured by DC 7800 7804 (e.g., restricted joint motion from scar contracture, nerve damage). Always consider 7805 when scars cause functional impairment beyond appearance.
- PTSD / Mental Health Conditions Significant facial disfigurement frequently causes or worsens PTSD, major depressive disorder, social anxiety, or adjustment disorders. If psychosocial impact is prominent, a separate or secondary mental health claim should be considered.
- Hearing Loss / Tinnitus Auricle deformity from burn scars can affect the external auditory canal and contribute to conductive hearing loss; veterans with ear scarring should also be evaluated for audiological conditions.
- Vision Conditions / Eye Disorders Scarring involving the eyelids or periorbital area can cause incomplete eye closure (lagophthalmos), corneal exposure, dry eye, or visual disturbance; these may support separate ophthalmologic claims.
- Musculoskeletal - Neck / Cervical Spine Burn scars and scar contractures of the neck can restrict cervical range of motion; if neck movement is impaired, a separate musculoskeletal rating under the appropriate DC may be warranted in addition to DC 7800.
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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.