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

DC 7803 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 nature, location, dimensions, characteristics, and functional impact of all service-connected scars and disfigurement for accurate disability rating under 38 CFR 4.118. The examiner will assess each scar individually and collectively to determine applicable diagnostic codes and rating percentages.

What the examiner evaluates:

  • Location of every scar (head/face/neck vs. trunk/extremities) and precise anatomical site
  • Scar type: burn scar, linear scar, superficial non-linear scar, deep non-linear scar
  • Scar dimensions: length and width in centimeters at widest point
  • Total area of scarring per body region in square centimeters
  • Painful or unstable characteristics of each scar
  • Characteristics of disfigurement: surface contour (elevated or depressed on palpation), abnormal texture, hypopigmentation, hyperpigmentation, induration and inflexibility, adherence to underlying tissue, underlying soft tissue missing
  • Features of the head, face, or neck involved: nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips
  • Gross distortion or asymmetry of facial features
  • Tissue loss or distortion affecting eyes, eyelids, or auricles
  • Complete loss of auricle or deformity with loss of one-third or more of the substance
  • Burn scar details: head/face/neck burn scars and trunk/extremity burn scars documented separately
  • Whether scars are associated with underlying soft tissue damage
  • Impact on occupational functioning and daily activities
  • History including cause, origin, and course of all scars
  • Whether veteran is regularly seen at a clinic for the condition

The exam is primarily a physical inspection combined with a structured interview. The examiner will visually inspect and physically palpate all scars. Bring a written list of every scar with precise locations, dimensions (if known), and symptoms so no scar is overlooked. The exam may be conducted by a physician, nurse practitioner, or physician assistant. You have the right to request that the exam be recorded in most states.

Typical duration: 15-30 minutes

Scar Dimensions (Length x Width)

The examiner measures each scar's length and width at the widest point in centimeters to determine total area and applicable rating thresholds.

What to expect:

The examiner will use a measuring tool (ruler or tape measure) and physically measure each scar. They will record dimensions for up to five or more individual scars on the DBQ, with additional scars listed in the 'additional scars' fields.

Key thresholds:

  • 144 sq. in. (929 sq. cm.) or greater total area — 10% under DC 7802 for non-head/face/neck scars without underlying soft tissue damage
  • 39 sq. cm. or greater per scar — Triggers deeper review for painful/unstable classification and possible higher evaluation
  • Less than 39 sq. cm. — Non-scar DBQ may be sufficient if scar is not painful/unstable; ensure Scars DBQ is used for accurate documentation

Tips:

  • Measure or estimate your scars at home before the exam and write down the dimensions to verify accuracy during the exam.
  • If scars vary in size depending on activity, temperature, or inflammation, note your typical range.
  • Ensure the examiner measures EVERY scar, not just the largest or most visible one.
  • If you have overlapping or adjoining scars, ask the examiner whether they are being counted together or separately, as total area matters.
  • Bring a body diagram marked with all scar locations to ensure completeness.

Pain considerations: If a scar is painful during measurement or palpation, immediately and clearly inform the examiner. Pain on palpation is a critical rating factor and directly supports a painful scar finding under DC 7804.

Palpation for Surface Contour and Characteristics

Physical palpation determines whether scars are elevated, depressed, adherent to underlying tissue, indurated, inflexible, or associated with missing underlying soft tissue - all of which are formal 'characteristics of disfigurement' that affect the rating percentage.

What to expect:

The examiner will press on and around each scar with their fingers to assess texture, mobility, elevation/depression, and flexibility. They will check for adherence to deeper structures and note abnormal texture, pigmentation changes, and induration.

Key thresholds:

  • 6 or more characteristics of disfigurement — 80% under DC 7800 (head/face/neck)
  • 4-5 characteristics of disfigurement — 50% under DC 7800 (head/face/neck)
  • 2-3 characteristics of disfigurement — 30% under DC 7800 (head/face/neck)
  • 1 characteristic of disfigurement — 10% under DC 7800 (head/face/neck)

Tips:

  • Know and name the seven characteristics of disfigurement: (1) surface contour elevated on palpation, (2) surface contour depressed on palpation, (3) abnormal texture, (4) hypopigmentation, (5) hyperpigmentation, (6) induration and inflexibility, (7) underlying soft tissue missing.
  • Multiple scars can combine their characteristics to meet a higher rating threshold - characteristics do not need to come from a single scar.
  • Tell the examiner if the scar feels tight, rigid, or restricts your movement.
  • Point out any color changes (lighter or darker than surrounding skin) - these are formal characteristics.
  • If the scar has been surgically revised or treated, explain what it looked like before treatment and its current state.

Pain considerations: If palpation causes pain, burning, tenderness, or electric shock-like sensations, verbalize this clearly and describe the pain's quality, intensity (0-10 scale), radiation, and duration after stimulation ceases.

Facial Feature Distortion Assessment

For head, face, and neck scars, the examiner assesses gross distortion or asymmetry of named features: nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, and lips. Number of features affected drives the rating percentage.

What to expect:

The examiner will visually inspect your face from multiple angles and compare symmetry between left and right sides. They will specifically document each named feature affected and characterize the nature of the distortion.

Key thresholds:

  • 3 or more features/paired sets grossly distorted plus visible/palpable tissue loss — 80% under DC 7800
  • 2 features/paired sets grossly distorted plus visible/palpable tissue loss — 50% under DC 7800
  • 1 feature/paired set grossly distorted plus visible/palpable tissue loss — 30% under DC 7800
  • Complete loss of auricle — Rated separately per ear; can contribute to overall disfigurement rating
  • Deformity of auricle with loss of one-third or more of substance — Rated separately; contributes to feature count

Tips:

  • Take clear photographs of your face from front, both sides, and at angles that show the distortion most clearly. Bring printed photos to the exam.
  • If your disfigurement is worse in certain lighting conditions, consider bringing photos taken in that lighting.
  • Note any functional effects: does eyelid distortion affect vision? Does lip/cheek distortion affect eating or speaking?
  • Ask friends or family to describe how your facial appearance has changed - their observations can support your claim.
  • Paired sets of features (e.g., both eyes, both ears, both cheeks) count as one feature or paired set for rating purposes.

Pain considerations: Note whether facial movements (smiling, chewing, opening mouth wide) cause pain or are restricted due to scar tightness or induration.

Estimate

Rating Criteria Breakdown

80% Burn scar(s) or disfigurement of head, face, or neck with vi ...

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 3 or more features or paired sets of features (nose, chin, forehead, eyes including eyelids, ears/auricles, cheeks, lips), OR (b) six or more characteristics of disfigurement. Characteristics may be from multiple scars combined.

Key Symptoms

  • Visible tissue loss across multiple facial regions
  • Gross asymmetry or distortion of 3+ named facial features
  • Six or more disfigurement characteristics present (elevated, depressed, abnormal texture, hypopigmentation, hyperpigmentation, induration/inflexibility, missing underlying soft tissue)
  • Severe disfigurement visible from normal social distances
  • Significant restriction of facial movement due to scar contracture

CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of three or more features or paired sets of features, or six or more characteristics of disfigurement. Per Note (5): characteristics may be caused by one or multiple scars combined.

50% Burn scar(s) or disfigurement of head, face, or neck with vi ...

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 2 features or paired sets of features, OR (b) four or five characteristics of disfigurement. Characteristics may come from multiple scars combined.

Key Symptoms

  • Visible tissue loss affecting two named facial features or paired feature sets
  • Four or five disfigurement characteristics present across one or more scars
  • Noticeable asymmetry requiring second glances from others
  • Moderate restriction of facial movement
  • Disfigurement affecting two distinct facial zones

CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of two features or paired sets of features, or four or five characteristics of disfigurement.

30% Burn scar(s) or disfigurement of head, face, or neck with vi ...

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 1 feature or paired set of features, OR (b) two or three characteristics of disfigurement.

Key Symptoms

  • Tissue loss visible or palpable in one named facial feature area
  • Two or three disfigurement characteristics present
  • Asymmetry noticeable upon close inspection
  • Single feature distorted (e.g., nose, chin, forehead, one eye area, one ear, cheek, or lip)

CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of one feature or paired set of features, or two or three characteristics of disfigurement.

10% Burn scar(s) or disfigurement of head, face, or neck with vi ...

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of one feature or one characteristic of disfigurement. Also applies to non-head/face/neck scars without underlying soft tissue damage totaling 144 sq. in. (929 sq. cm.) or greater (DC 7802). Painful or unstable scars regardless of location are rated at minimum 10% under DC 7804.

Key Symptoms

  • Minimal but documented facial tissue loss with one disfigurement characteristic
  • Total non-head body scar area of 929 sq. cm. or greater without soft tissue involvement
  • Any painful scar - pain upon direct pressure, spontaneous pain, or burning
  • Any unstable scar with frequent loss of skin covering
  • Scar that is consistently tender to palpation

CFR: DC 7800: one characteristic of disfigurement. DC 7802: area of 144 sq. in. or greater for scars without underlying soft tissue damage. DC 7804: painful or unstable scars rated at 10% regardless of location.

How to Describe Your Symptoms

Pain Characteristics

How to describe:

Describe the quality (burning, stabbing, aching, electric, throbbing), intensity on a 0-10 scale, frequency (constant vs. intermittent), duration, triggers (pressure, clothing contact, temperature changes, activity), and what worsens or relieves the pain. State clearly whether the scar hurts when touched, when clothing rubs it, spontaneously at rest, or only during specific activities.

Worst-day example:

“On my worst days, the burn scar on my forearm feels like it is on fire constantly. Any clothing that touches it feels like sandpaper, and even a light brush from my sleeve sends a sharp, electric pain shooting up my arm. At night the burning keeps me awake for hours. I rate the pain 8 out of 10 on bad days.”

What the examiner listens for:

Documentation of pain on direct pressure (required for DC 7804 painful scar rating), spontaneous pain, pain triggered by activity, and descriptors that support neuropathic or scar-tissue pain patterns. The examiner needs to check boxes for painful scars and describe which specific scars are painful.

Understatements to avoid:

Do not say 'it bothers me a little' or 'I manage it okay.' Accurately describe your worst pain experience. Do not minimize by saying 'it only hurts sometimes' without specifying that 'sometimes' means daily or multiple times per week.

Scar Instability and Skin Loss

How to describe:

Describe how often the scar breaks down, blisters, opens, weeps, or loses the surface layer of skin. Note whether this happens spontaneously, with minor trauma, or with activity. State how long each episode lasts and how frequently it occurs per month or year.

Worst-day example:

“At least three or four times a month, my scar on my lower leg develops a blister that breaks open and weeps fluid for several days. The skin is so fragile there that even gently pulling on a sock can tear the surface. Last month it opened twice and I had to keep it bandaged for a week each time.”

What the examiner listens for:

Frequency of skin breakdown, whether episodes are truly 'unstable' (defined as loss of covering of skin over the scar), medical treatment sought for episodes, and interference with daily activity. This directly supports DC 7804 or DC 7801 (unstable scar) ratings.

Understatements to avoid:

Do not omit skin breakdown episodes because they healed quickly. An unstable scar is defined by frequent loss of skin covering, not by whether you needed a hospital visit.

Disfigurement Characteristics and Appearance

How to describe:

Describe each visible and palpable characteristic: whether the scar is raised above the surrounding skin, sunken below it, feels hard and inflexible, has unusual texture (rope-like, bumpy, smooth when it should not be), is lighter or darker than surrounding skin, feels stuck to the underlying muscle or bone, or has areas where the fat or tissue beneath the skin is clearly missing.

Worst-day example:

“The burn scar on my cheek is noticeably raised and firm - I cannot pinch it or move it independently because it is adhered to the tissue underneath. It is significantly darker than the rest of my face and has a rough, bumpy texture. When I open my mouth wide, the scar pulls and distorts the corner of my lip upward. People often ask what happened to my face.”

What the examiner listens for:

Specific named characteristics of disfigurement that appear on the DBQ checklist: surface contour elevated, surface contour depressed, abnormal texture, hypopigmentation, hyperpigmentation, induration and inflexibility, underlying soft tissue missing, adherence to underlying tissue. Each confirmed characteristic contributes to the rating tier.

Understatements to avoid:

Do not simply say 'it looks different.' Name what is different: the color, the texture, whether it is raised or sunken, whether it moves when you press it, whether the underlying tissue feels normal. The examiner needs specific observable findings to check the correct boxes.

Facial Feature Distortion

How to describe:

For head, face, or neck scars, specifically name which facial feature is distorted: nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, or lips. Describe the nature of the distortion: pulled to one side, flattened, missing a portion, asymmetric compared to the other side. Describe how it affects function (vision, hearing, eating, speaking) and social interaction.

Worst-day example:

“The scarring around my left eye has pulled my lower eyelid downward so it no longer closes fully. At night I must use eye drops and tape my eye partially shut. When I look in a mirror, my left eye sits noticeably lower than my right. In stores or at work, people stare and sometimes ask what happened, which causes significant emotional distress.”

What the examiner listens for:

Identification of specific named facial features that are grossly distorted or asymmetric, whether the distortion is accompanied by visible or palpable tissue loss, how many distinct features are affected, and functional consequences. Each affected feature or paired set of features advances the rating tier for DC 7800.

Understatements to avoid:

Do not describe facial distortion only in passing or as 'a little uneven.' Gross distortion is a legal term under 38 CFR - describe the full extent of misalignment, asymmetry, or structural change, and how noticeable it is to others at a normal conversational distance.

Functional and Occupational Impact

How to describe:

Describe how the scars limit your ability to work, perform daily activities, engage socially, wear certain clothing, exercise, or participate in recreational activities. Include psychological impact (avoidance of social situations, embarrassment, depression, PTSD triggers related to the appearance or pain of scars).

Worst-day example:

“Because of the extensive burn scarring on my arms and neck, I cannot wear short sleeves in public without strangers making comments or staring. I have declined promotions that require client-facing meetings. I avoid swimming, the gym, and family events. The pain in my scars after prolonged activity means I cannot work a full 8-hour shift without needing to rest and elevate my arm.”

What the examiner listens for:

Occupational impairment, social avoidance, need for accommodations, limitations on physical activity, psychological sequelae from disfigurement, and any treatment (compression garments, desensitization therapy, topical medications) that documents ongoing management of the condition.

Understatements to avoid:

Do not say 'I get by.' Accurately describe what you cannot do or what you sacrifice to manage the condition. The DBQ specifically asks about impact on the veteran's daily life and occupational functioning - this section directly influences the examiner's narrative.

History of Cause and Origin

How to describe:

Clearly state where, when, and how the scar was caused in relation to military service. Describe the original injury (burn, shrapnel, blast, surgical incision, blast overpressure, chemical exposure, etc.), treatment received in service, and the course from injury to present. Connect each scar to a specific in-service event or treatment if possible.

Worst-day example:

“On [date/location], I sustained second and third degree burns to my forearm and neck during a vehicle fire in [country]. I was treated at [military hospital], underwent skin grafting, and was medically evacuated. My service treatment records from [year] document the burn injury and subsequent surgeries. The scars have been present continuously since service.”

What the examiner listens for:

A coherent, consistent history that connects the scar to service - this feeds the nexus analysis in the DBQ. The examiner documents the history in the narrative fields and may note whether the claimed etiology is consistent with the physical findings.

Understatements to avoid:

Do not be vague about the cause. Even if records are incomplete, provide the most accurate description you can. If you have buddy statements or photographs from service, reference them. Do not allow the examiner to skip this section or record only 'as per records.'

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 request that the C&P examination be recorded (audio or video) in most states - check your state's consent laws before the exam.
  • You have the right to have a VSO representative or accredited claims agent accompany you to the exam in most circumstances.
  • You have the right to submit additional evidence (photographs, personal statements, private medical opinions) after the C&P exam and before a rating decision is issued.
  • You have the right to request a copy of your completed DBQ/C&P exam report through a records request or through your eFolder.
  • You have the right to challenge an inadequate exam - per M21-1, a scar exam must document location, type, and dimensions for each scar to be sufficient for rating purposes.
  • You have the right to request a new or supplemental examination if the original exam was inadequate, failed to address all claimed scars, or did not reflect your current level of impairment.
  • You have the right to submit a Nexus letter or Independent Medical Opinion (IMO) from a private physician if you disagree with the examiner's findings.
  • If you have scarring on both the head/face/neck AND the body, you may be entitled to separate ratings under multiple diagnostic codes simultaneously - the ratings are not exclusive.
  • Characteristics of disfigurement from multiple scars may be combined to meet rating thresholds - the VA cannot require all characteristics to come from a single scar per Note (5) of DC 7800.
  • You have the right to report pain during palpation and have that pain documented - do not remain silent during physical examination if palpation causes discomfort.
  • You have the right to describe your condition as it presents on your worst typical days, not your best days, consistent with M21-1 adjudication policy.
  • If you believe your claim was decided with an inadequate exam, you may file a Supplemental Claim with new and relevant evidence, a Higher-Level Review, or appeal to the Board of Veterans' Appeals.

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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.