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C&P Exam Prep: Scars (Burn / Disfigurement / Painful)

DC 7801 skin 38 CFR 4.118

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 number, location, dimensions, characteristics, and functional impact of all service-connected scars for accurate VA disability rating under 38 CFR 4.118. The examiner will assess whether scars are painful, unstable, have skin loss, involve disfigurement of the head/face/neck, or limit function.

What the examiner evaluates:

  • Location of each scar (body region, laterality, specific anatomical site)
  • Scar type: burn, surgical, traumatic, linear, or superficial non-linear
  • Scar dimensions: length and width in centimeters at widest point
  • Total surface area in square centimeters for all scars per body region
  • Whether scars are painful on direct pressure or examination
  • Whether scars are unstable (break down repeatedly without trauma)
  • Skin loss over or around the scar
  • Surface contour: elevated (hypertrophic/keloid) or depressed on palpation
  • Abnormal texture: irregular, atrophic, firm, indurated, or inflexible
  • Pigmentation changes: hyperpigmentation or hypopigmentation
  • Adherence of scar to underlying tissue
  • Underlying soft tissue missing
  • Disfigurement of head, face, or neck features: nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips
  • Tissue loss or distortion of eyes, eyelids, ears (auricles)
  • Anatomical loss of eye or complete loss of auricle
  • Impact of scars on occupational functioning and daily activities
  • History of scar including cause, origin, and course of treatment

The examiner will visually inspect and physically palpate each scar. Measurements will be taken with a ruler or tape measure in centimeters. Photographs may be taken. If scars are on the head, face, or neck, close attention will be paid to facial feature involvement. Be prepared to remove clothing to expose all affected areas. Bring a list of all scars with their locations to ensure none are overlooked.

Typical duration: 15-30 minutes

Scar Dimension Measurement

Length and width at the widest point of each individual scar, reported in centimeters (cm). Total surface area is calculated per body region and overall.

What to expect:

The examiner will use a ruler or flexible measuring tape to measure each scar in two dimensions. They may press on the scar to assess pain, texture, and adherence. They will record measurements for up to five or more scars individually.

Key thresholds:

  • Greater than 39 sq cm (e.g., approximately 6.3 cm x 6.3 cm) per scar or combined area — Superficial non-linear scars exceeding 39 sq cm on head/face/neck or 144 sq cm on trunk/extremities trigger higher rating consideration under DC 7802/7804
  • Painful scar of any size — Painful scars are rated at minimum 10% regardless of size under DC 7804; ensure pain is documented at the exam
  • Unstable scar (breaks down with or without trauma) — Unstable scars are rated at minimum 10% under DC 7802; document frequency of breakdown episodes
  • Head/face/neck scar with 1 disfigured feature or 2-3 characteristics — 10% rating under DC 7800
  • Head/face/neck scar with 2 disfigured features or 4-5 characteristics — 50% rating under DC 7800
  • Head/face/neck scar with 3+ disfigured features or 6+ characteristics — 80% rating under DC 7800

Tips:

  • Measure your own scars before the exam and write down the dimensions so you can confirm the examiner measures them accurately
  • If you have multiple scars in the same body region, ensure all are measured - do not allow the examiner to stop after measuring only the largest one
  • Scars that are hidden under hair, clothing folds, or in skin creases are still ratable - point them out proactively
  • For scars on the head/face/neck, specifically tell the examiner which facial features are affected (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips)
  • Total area calculations matter for trunk and extremity scars - make sure all scars in the same region are included in the combined total

Pain considerations: Pain on direct pressure during palpation is a critical rating factor under DC 7804. Tell the examiner immediately and clearly if pressing on the scar causes pain. Do not minimize pain out of politeness. Describe the character of pain (burning, sharp, aching, shooting) and whether it is constant or triggered by touch, clothing friction, temperature changes, or activity. Report your pain on your worst typical day, not on the day of the exam if that day happens to be better than usual.

Scar Characteristic Assessment

Physical characteristics of each scar that contribute to disfigurement ratings under DC 7800, including surface contour, texture, pigmentation, adherence, and tissue loss.

What to expect:

The examiner will visually inspect and palpate each scar for the following characteristics: (1) surface contour elevated on palpation (hypertrophic or keloid), (2) surface contour depressed on palpation (atrophic), (3) abnormal texture (irregular, atrophic, firm, indurated, inflexible), (4) hyperpigmentation, (5) hypopigmentation, (6) scar adherent to underlying tissue, (7) underlying soft tissue missing.

Key thresholds:

  • 2-3 characteristics of disfigurement present — 10% rating under DC 7800 (head/face/neck)
  • 4-5 characteristics of disfigurement present — 50% rating under DC 7800 (head/face/neck)
  • 6+ characteristics of disfigurement present — 80% rating under DC 7800 (head/face/neck)

Tips:

  • Multiple scars can collectively contribute to the count of disfigurement characteristics - all scars on the head/face/neck count together
  • Bring photographs of your scars taken on days when they appear most prominent (e.g., after physical activity, in direct lighting) to supplement in-person examination
  • Tell the examiner about induration and inflexibility - areas where the scar feels hard, tight, or restricts movement of the overlying skin
  • Hypopigmentation (lighter patches) and hyperpigmentation (darker patches) both count as separate characteristics of disfigurement
  • If your scar has both an elevated area and a depressed area, both contour characteristics may apply

Pain considerations: Scar induration and inflexibility can cause pain and functional limitation that extends beyond the visible scar. Describe any tightness, pulling sensation, restriction of movement, or increased sensitivity to temperature or touch. These functional impacts support a higher rating and should be communicated even if the examiner does not specifically ask.

Estimate

Rating Criteria Breakdown

80% Burn scar(s) or other scar(s) of the head, face, or neck wit ...

Burn scar(s) or other scar(s) of the head, face, or neck with visible or palpable tissue loss AND either gross distortion or asymmetry of THREE OR MORE features or paired sets of features (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips); OR with SIX OR MORE characteristics of disfigurement.

Key Symptoms

  • Visible or palpable tissue loss on head, face, or neck
  • Gross distortion or asymmetry affecting 3 or more facial features
  • Six or more of the following characteristics: surface contour elevated, surface contour depressed, abnormal texture, hyperpigmentation, hypopigmentation, scar adherent to underlying tissue, underlying soft tissue missing, other
  • Involvement of nose AND chin AND forehead (or other 3+ feature combinations)
  • Multiple facial features disfigured simultaneously

CFR: 38 CFR 4.118, DC 7800: 'With visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement - 80'

50% Burn scar(s) or other scar(s) of the head, face, or neck wit ...

Burn scar(s) or other scar(s) of the head, face, or neck with visible or palpable tissue loss AND either gross distortion or asymmetry of TWO features or paired sets of features; OR with FOUR OR FIVE characteristics of disfigurement.

Key Symptoms

  • Visible or palpable tissue loss on head, face, or neck
  • Gross distortion or asymmetry of 2 facial features or paired sets
  • Four or five characteristics of disfigurement present
  • Deformity of auricle with loss of one-third or more of the auricle
  • Tissue loss/distortion involving 2 facial structures

CFR: 38 CFR 4.118, DC 7800: 'With visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement - 50'

30% Burn scar(s) or other scar(s) of the head, face, or neck wit ...

Burn scar(s) or other scar(s) of the head, face, or neck with visible or palpable tissue loss AND either gross distortion or asymmetry of ONE feature or paired set of features; OR with TWO OR THREE characteristics of disfigurement. Also applicable to superficial non-linear scars of the trunk or extremities covering 144 sq cm or more under DC 7804.

Key Symptoms

  • Visible or palpable tissue loss on head, face, or neck
  • Gross distortion or asymmetry of one facial feature
  • Two or three characteristics of disfigurement present
  • Deformity of auricle with loss of less than one-third of auricle
  • Large superficial non-linear scar on trunk or extremity (144+ sq cm)

CFR: 38 CFR 4.118, DC 7800: 'With visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features, or; with two or three characteristics of disfigurement - 10' (Note: 30% is the threshold for DC 7804 superficial non-linear scars covering 144+ sq cm on trunk/extremities)

10% Burn scar(s) or other scar(s) of the head, face, or neck wit ...

Burn scar(s) or other scar(s) of the head, face, or neck with one or two characteristics of disfigurement. Also applicable to: (DC 7802) unstable or painful scars of any size and location; (DC 7804) superficial non-linear scars of the trunk/extremities exceeding 39 sq cm but less than 144 sq cm. Note: Painful scars rated under DC 7804 receive a minimum 10% regardless of size.

Key Symptoms

  • One or two characteristics of disfigurement on head/face/neck
  • Any scar that is painful on examination or pressure
  • Any scar that is unstable (recurrently breaks down)
  • Superficial non-linear scar on trunk or extremity 40-143 sq cm
  • Loss of skin covering over scar area
  • Scar causing itching, burning, or sensitivity with clothing contact

CFR: 38 CFR 4.118, DC 7800: 'With one or two characteristics of disfigurement - 10'. DC 7802: 'Unstable or painful scar(s) - 10 minimum'. DC 7804: 'Superficial non-linear scar(s), other than head, face, or neck, exceeding 39 sq cm - 10'.

How to Describe Your Symptoms

Pain from Scars

How to describe:

Describe pain in specific, concrete terms: location, character (burning, sharp, aching, throbbing, shooting), intensity on a 0-10 scale, duration (constant vs. intermittent), and triggers (touch, clothing friction, temperature changes, pressure, activity). Specify whether pain prevents you from wearing certain clothing, engaging in physical activity, or sleeping comfortably.

Worst-day example:

“On my worst days, the burn scar on my left forearm feels like it is on fire even without touching it. Just the friction of my shirt sleeve against it causes a 7 out of 10 burning pain that lasts for hours. I have to wear loose-fitting clothing and avoid direct sunlight on that area because any heat makes it significantly worse.”

What the examiner listens for:

The examiner needs to document whether the scar is 'painful on examination' for DC 7804/7802 eligibility. They are listening for clear confirmation that pressing on or touching the scar causes pain. They also note whether the pain is spontaneous or only elicited by pressure.

Understatements to avoid:

Do not say 'it bothers me sometimes' or 'it is a little sensitive.' Instead, say 'it is painful when pressed' or 'it hurts when my clothing rubs against it.' Avoid minimizing language. The DBQ has a specific checkbox for painful scars - you want that box checked.

Unstable Scar Characteristics

How to describe:

Describe how often the scar breaks down, bleeds, forms open sores, or weeps fluid. Note whether this happens spontaneously or with minimal trauma such as light scratching, bending, or stretching. Describe how long healing takes, whether it requires wound care or bandaging, and whether it has required medical treatment.

Worst-day example:

“At least two or three times a month, the scar on my right thigh opens up on its own - I wake up to find it bleeding or wet. It takes 10 to 14 days to fully close each time, and during that period I have to keep it bandaged and limit my physical activity to prevent further breakdown.”

What the examiner listens for:

Frequency of breakdown episodes, whether the scar requires treatment when it breaks down, and whether the instability has been documented in medical records. Examiners are looking for evidence that this is a chronic, recurrent problem rather than a one-time event.

Understatements to avoid:

Do not say 'it heals on its own' without also mentioning how often it breaks down and how long healing takes. Do not omit the frequency of breakdown - this is critical for the unstable scar diagnosis under DC 7802.

Disfigurement of Head, Face, or Neck

How to describe:

Identify each specific facial feature affected (nose, chin, forehead, eyes including eyelids, ears including auricles, cheeks, lips) and describe exactly how the scar has altered the appearance or function of that feature. Describe visible tissue loss, asymmetry, or distortion that others notice or that affects your self-image and social interactions.

Worst-day example:

“The burn scar on my right cheek has pulled my lower eyelid downward on that side, causing it to look asymmetrical compared to my left eye. The scar on my chin has caused a noticeable indentation where tissue is missing. When I meet new people, they frequently stare at or ask about my face, and I have withdrawn from social activities because of how my appearance has changed.”

What the examiner listens for:

Specific facial features affected, presence of tissue loss, degree of asymmetry or distortion, and the psychosocial impact of disfigurement. The examiner must document which features from the statutory list (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips) are affected and to what degree.

Understatements to avoid:

Do not simply say 'my face looks different.' Instead, specifically name each feature affected and describe the visible change. Do not omit effects on eyelids (which count separately from eyes) or auricles (outer ear structures). Characteristics from multiple scars count together toward the disfigurement rating - mention all scars in the head/face/neck region.

Functional Impact and Daily Life Limitations

How to describe:

Describe how your scars limit specific daily activities, occupational tasks, recreational activities, and personal care. Include limitations caused by pain, tightness, itching, sensitivity, disfigurement-related psychological distress, or physical restriction of movement. Quantify limitations where possible (e.g., 'I can only stand for 20 minutes before the scar on my leg becomes too painful').

Worst-day example:

“The scar contracture on my neck limits how far I can turn my head - I cannot look left more than about 45 degrees without sharp pulling pain. This prevents me from driving safely and has required me to request a workplace accommodation. On my worst days, the itching and tightness are so severe that I cannot concentrate on work and have to leave early.”

What the examiner listens for:

Specific occupational and functional limitations, whether the veteran has sought workplace accommodations, whether daily activities of personal care (bathing, dressing, grooming) are affected, and the overall burden of the scar on quality of life. The DBQ has a dedicated section for describing the impact of scars on the veteran's functioning.

Understatements to avoid:

Do not say 'I manage okay' if you have adapted your lifestyle to work around scar limitations. The adaptations themselves are evidence of functional impairment. Describe what you can no longer do, or can only do with difficulty, that you could do before the injury.

Skin Loss and Surface Characteristics

How to describe:

Describe any areas where the normal outer layer of skin is absent, thin, fragile, or regularly breaks down over the scar. Note the presence of tight, inflexible, or hardened scar tissue (induration) that limits skin movement. Describe any color changes compared to surrounding skin - areas that are lighter (hypopigmentation) or darker (hyperpigmentation).

Worst-day example:

“The skin over my burn scar on the upper back is so thin and fragile that any pressure from a backpack or tight clothing causes it to tear. The scar tissue itself is extremely hard and does not flex normally - I can feel it pulling when I reach forward or raise my arms. The scar is noticeably much lighter than my surrounding skin and has never regained any color.”

What the examiner listens for:

The examiner is specifically checking each of the seven recognized characteristics of disfigurement: elevated contour, depressed contour, abnormal texture, hyperpigmentation, hypopigmentation, adherence to underlying tissue, and missing soft tissue. The more characteristics that are clearly documented, the higher the potential rating.

Understatements to avoid:

Do not assume the examiner will notice subtle pigmentation changes or texture differences without your input. Point out every visible characteristic. If part of the scar is elevated and another part is depressed, both may be documented. Do not minimize induration by calling it just 'stiff' - describe it as 'hard, inflexible tissue that does not move normally.'

Common Mistakes to Avoid

Prep Checklist

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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 most states - check your state law before the appointment and notify the examiner at the start if you choose to record.
  • You have the right to request a new C&P examination if you believe the original exam was inadequate, the examiner was not qualified, or the report did not accurately reflect your condition.
  • You have the right to submit private medical opinions, buddy statements, and lay statements as evidence to supplement or rebut the C&P examiner's findings.
  • You have the right to submit photographs of your scars as supporting evidence - VA M21-1 adjudication procedures explicitly recognize photographs as relevant evidence for skin and scar claims.
  • You have the right to have all scars measured and documented individually, not just the most prominent scar - ensure the examiner examines every service-connected scar.
  • You have the right to a rating based on your worst-day presentation, not only how you appeared on the day of the exam - verbally communicate your typical worst-day symptoms.
  • You have the right to a rating that accounts for all characteristics of disfigurement from multiple scars combined - per 38 CFR 4.118 Note 5, characteristics from multiple scars are counted together.
  • You have the right to an additional separate rating under DC 7805 for any disabling effects of your scars (such as joint limitation from contracture) not captured in your primary scar rating.
  • You have the right to be evaluated in person for a skin/scar condition unless a records-based review is clearly appropriate and you agree to it.
  • You have the right to request that your claim file (C-file) be reviewed by the examiner before the exam to ensure they have full knowledge of your service history and treatment records.

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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.