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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 number, location, dimensions, type, and characteristics of service-connected scars in order to assign an accurate disability rating under 38 CFR 4.118 diagnostic codes 7800-7805. The examiner will assess whether scars are painful, unstable, adherent, disfiguring, or associated with soft tissue damage, and will document their impact on daily functioning.
What the examiner evaluates:
- Exact anatomical location of each scar (head/face/neck vs. trunk/extremities)
- Scar dimensions: length and width at widest point in centimeters
- Total surface area affected in square centimeters
- Whether scars are painful on examination or by history
- Whether scars are unstable (i.e., breakdown with routine activity)
- Presence of disfigurement characteristics (hyperpigmentation, hypopigmentation, abnormal texture, elevated or depressed contour, adherence to underlying tissue, induration/inflexibility, missing soft tissue)
- Number of qualifying disfigurement characteristics present
- Burn scar depth and involvement of head, face, or neck
- Presence of facial disfigurement features (forehead, cheeks, nose, chin, lips, eyes/eyelids, ears/auricles)
- Whether scar is both painful AND unstable (triggers 10% add-on)
- Functional impact and history of the condition
The exam will include a visual inspection and palpation of each scar. You will be asked to undress or expose affected areas. The examiner will likely use a ruler or measuring device to document scar dimensions. Bring a list of all scars with their approximate locations if you have multiple. The exam may be conducted in person or via telehealth; an in-person exam is strongly preferred for accurate scar measurement and characterization.
Typical duration: 15-30 minutes
Scar Dimensions (Length - Width)
The physical size of each individual scar, measured at the longest length and widest width in centimeters. This determines whether scars meet area thresholds for rating under DC 7801 (with soft tissue damage) and DC 7802 (without soft tissue damage).
What to expect:
The examiner will use a ruler or tape measure and physically measure each scar. They will record the length and width at the widest point. For irregular or grouped scars, they may calculate an approximate total area.
Key thresholds:
- Less than 39 sq cm total area — May still qualify under DC 7804 if painful or unstable; does not qualify for area-based rating under 7801/7802
- 39-144 sq cm (6-22 sq inches) — Qualifies for 10% under DC 7801 or 7802 depending on soft tissue involvement
- 144-576 sq cm (22-90 sq inches) — Qualifies for 20% under DC 7801 (with soft tissue damage)
- Greater than 929 sq cm (144 sq inches) — Qualifies for maximum area-based rating under DC 7802 at 10%; higher percentages under DC 7801 with soft tissue damage
Tips:
- Measure your own scars beforehand and write down approximate dimensions - this helps you confirm the examiner measured correctly
- If scars have grown or changed, mention this to the examiner
- Multiple small scars in proximity may be measured collectively
- Keloid or hypertrophic scars may appear smaller than their actual functional impact suggests - describe functional limitations separately
Pain considerations: Pain during measurement or palpation should be immediately and clearly communicated to the examiner. State the location, character (burning, stabbing, aching), and intensity on a 0-10 scale.
Palpation for Pain and Instability
Whether direct pressure or routine activity causes pain at the scar site, and whether the scar surface breaks down (becomes open or ulcerated) with minimal trauma. Unstable scars are those that do not continuously maintain a covering of skin.
What to expect:
The examiner will press on or around each scar with a gloved finger and ask whether you experience pain. They may ask about your history of scar breakdown, skin tears, or open wounds at the scar site. This is a subjective and objective evaluation.
Key thresholds:
- 1 painful or unstable scar — 10% under DC 7804
- 2-4 painful or unstable scars — 20% under DC 7804
- 5 or more painful or unstable scars — 30% under DC 7804
- Scar is BOTH painful AND unstable — Add 10% to the evaluation based on total count - this is a critical bonus rating
Tips:
- Do NOT stay silent if the examiner touches a painful area - speak up immediately
- Bring a written log of dates when your scar has been painful, infected, or has broken open
- Describe your worst days, not just your average days
- If clothing or activities trigger scar pain, say so explicitly
Pain considerations: Pain is a primary rating driver under DC 7804. Describe the character, frequency, triggers, and intensity of pain. If your scars cause pain during sleep, with temperature changes, with touch from clothing, or with pressure, all of these are relevant and should be stated.
Disfigurement Characteristic Count (Head/Face/Neck Only)
For scars of the head, face, or neck (DC 7800), the number of disfigurement characteristics present determines the rating. Characteristics include: hyperpigmentation, hypopigmentation, abnormal texture, surface contour elevated on palpation, surface contour depressed on palpation, adherence to underlying tissue, induration/inflexibility, missing underlying soft tissue, and tissue loss/distortion of specific facial features.
What to expect:
The examiner will visually inspect and palpate scars on the head, face, and neck. They will check each of the defined disfigurement characteristics and may note affected facial subunits such as the forehead, cheeks, nose, chin, lips, eyes, eyelids, or ears.
Key thresholds:
- 1 characteristic of disfigurement — 10% under DC 7800
- 2 characteristics of disfigurement — 30% under DC 7800
- 3 characteristics of disfigurement — 50% under DC 7800
- 4 or more characteristics of disfigurement — 80% under DC 7800 - maximum rating
Tips:
- Remember: characteristics can come from MULTIPLE scars combined (per Note 5 of DC 7800) - point this out if applicable
- Photograph your scars in good lighting before the exam to document color changes and texture
- Induration means the scar feels hard and stiff - describe this in your own words if present
- Color differences (darker or lighter patches) are formal disfigurement characteristics - point them out clearly
Pain considerations: If any disfigurement scar on the head, face, or neck is also painful or unstable, it can be separately rated under DC 7804 in addition to DC 7800. Ensure you report pain separately.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 80% | Under DC 7800, four or more characteristics of disfigurement of the head, face, or neck. This is the maximum rating for scar disfigurement of the head, face, or neck. Per Note 5, the four characteristics can come from one or multiple scars combined. |
CFR: A veteran with extensive facial burn scarring showing hypopigmentation, depressed surface contour, missing underlying soft tissue, and tissue distortion of the nose across multiple scars qualifies for 80% under DC 7800 per Note 5. |
| 50% | Under DC 7800, three characteristics of disfigurement of the head, face, or neck. This rating is specific to scars of the head, face, or neck and requires three of the defined characteristics of disfigurement to be present (from any combination of scars in that region). |
CFR: A veteran with a facial burn scar showing hyperpigmentation, surface elevation, and abnormal texture - even across multiple small scars - qualifies for 50% under DC 7800. Per Note 5, these three characteristics need not come from a single scar. |
| 30% | Five or more painful or unstable scars (DC 7804), OR two to four scars that are BOTH painful AND unstable (triggering the +10% add-on), OR a scar of the head/face/neck with two characteristics of disfigurement (DC 7800). Under DC 7800, 30% applies to two characteristics on the head, face, or neck. |
CFR: A burn survivor with five separate burn scars on the trunk and extremities, each of which is painful to palpation, would qualify for 30% under DC 7804. Alternatively, a veteran with a facial burn scar showing both hyperpigmentation and abnormal texture qualifies at 30% under DC 7800. |
| 20% | Two to four painful or unstable scars (DC 7804). This rating requires that multiple distinct scars qualify individually as painful or unstable. If any qualifying scar is both painful AND unstable, add 10% to reach 30%. |
CFR: A veteran with two surgical scars from service-connected procedures, both of which are tender on palpation, qualifies for 20% under DC 7804. |
| 10% | One painful or unstable scar (DC 7804). Alternatively, a scar of the head, face, or neck with one characteristic of disfigurement (DC 7800). Or a scar not of the head/face/neck with soft tissue damage covering 39 sq cm or more (DC 7801), or without soft tissue damage covering 144 sq inches or more (DC 7802). |
CFR: A single surgical or traumatic scar that is consistently tender when touched or that has opened at least once without significant trauma qualifies at this level under DC 7804. |
80% Under DC 7800, four or more characteristics of disfigurement ...
Under DC 7800, four or more characteristics of disfigurement of the head, face, or neck. This is the maximum rating for scar disfigurement of the head, face, or neck. Per Note 5, the four characteristics can come from one or multiple scars combined.
Key Symptoms
- Four or more disfigurement characteristics present on the head, face, or neck
- Severe facial burn scarring with multiple visible deformities
- Tissue loss or distortion of eye, eyelid, nose, lip, chin, cheek, or ear/auricle
- Complete loss of an auricle or deformity with loss of one-third or more of the substance
- Combined hypopigmentation, texture change, adherence, and induration in the same region
CFR: A veteran with extensive facial burn scarring showing hypopigmentation, depressed surface contour, missing underlying soft tissue, and tissue distortion of the nose across multiple scars qualifies for 80% under DC 7800 per Note 5.
50% Under DC 7800, three characteristics of disfigurement of the ...
Under DC 7800, three characteristics of disfigurement of the head, face, or neck. This rating is specific to scars of the head, face, or neck and requires three of the defined characteristics of disfigurement to be present (from any combination of scars in that region).
Key Symptoms
- Three distinct disfigurement characteristics visible on head, face, or neck
- For example: hyperpigmentation + elevated surface contour + abnormal texture
- Multiple burn scars of the face with combined characteristics
- Tissue distortion of a facial feature combined with color and texture changes
CFR: A veteran with a facial burn scar showing hyperpigmentation, surface elevation, and abnormal texture - even across multiple small scars - qualifies for 50% under DC 7800. Per Note 5, these three characteristics need not come from a single scar.
30% Five or more painful or unstable scars (DC 7804), OR two to ...
Five or more painful or unstable scars (DC 7804), OR two to four scars that are BOTH painful AND unstable (triggering the +10% add-on), OR a scar of the head/face/neck with two characteristics of disfigurement (DC 7800). Under DC 7800, 30% applies to two characteristics on the head, face, or neck.
Key Symptoms
- Five or more distinct scars that are painful or have broken down
- Multiple scar sites with combined pain and instability
- Two disfigurement characteristics on the head, face, or neck
- Widespread scar involvement with functional limitations
- Scars that are both adherent and painful simultaneously
CFR: A burn survivor with five separate burn scars on the trunk and extremities, each of which is painful to palpation, would qualify for 30% under DC 7804. Alternatively, a veteran with a facial burn scar showing both hyperpigmentation and abnormal texture qualifies at 30% under DC 7800.
20% Two to four painful or unstable scars (DC 7804). This rating ...
Two to four painful or unstable scars (DC 7804). This rating requires that multiple distinct scars qualify individually as painful or unstable. If any qualifying scar is both painful AND unstable, add 10% to reach 30%.
Key Symptoms
- Two or more separate scar sites that are painful on palpation
- Two or more scars with history of breakdown or ulceration
- Mix of painful and unstable scars totaling 2-4
- Recurring skin breakdown at multiple scar sites
CFR: A veteran with two surgical scars from service-connected procedures, both of which are tender on palpation, qualifies for 20% under DC 7804.
10% One painful or unstable scar (DC 7804). Alternatively, a sca ...
One painful or unstable scar (DC 7804). Alternatively, a scar of the head, face, or neck with one characteristic of disfigurement (DC 7800). Or a scar not of the head/face/neck with soft tissue damage covering 39 sq cm or more (DC 7801), or without soft tissue damage covering 144 sq inches or more (DC 7802).
Key Symptoms
- Pain upon palpation of one scar
- One episode of scar breakdown (opening, ulceration, or skin loss)
- One disfigurement characteristic on head/face/neck
- Scar that is tender to touch or pressure from clothing
CFR: A single surgical or traumatic scar that is consistently tender when touched or that has opened at least once without significant trauma qualifies at this level under DC 7804.
How to Describe Your Symptoms
Scar Pain
How to describe:
Describe the character of pain (burning, stabbing, throbbing, aching, hypersensitivity), its location at each scar, frequency (constant vs. intermittent), severity on a 0-10 scale, and what makes it worse (touch, temperature, clothing friction, pressure, activity). Distinguish between baseline daily pain and peak pain during flare-ups.
Worst-day example:
“On my worst days, the burn scar on my left forearm feels like it is on fire. Even a light bedsheet touching it at night wakes me up. The pain radiates about two inches around the scar and is a constant burning 7/10 that spikes to 9/10 if anything presses against it. I cannot wear long sleeves without padding the area.”
What the examiner listens for:
The examiner needs to document whether pain is present on palpation AND by history. Describe both. Note that pain does not need to be reproduced during the exam itself - your credible history of pain is medically and legally sufficient.
Understatements to avoid:
Do not say 'it only bothers me sometimes' or 'it's not that bad.' If you experience pain at all, even occasionally, communicate when and how. Underselling pain frequency can result in a denial of the DC 7804 rating altogether.
Scar Instability (Breakdown)
How to describe:
Explain whether your scar has ever broken open, ulcerated, developed a wound, or lost its skin covering without significant trauma - for example, from normal daily activities like walking, dressing, or light exercise. Describe the frequency, how long it takes to heal, and whether it recurs in the same location.
Worst-day example:
“The scar on my right thigh has broken open three times in the past year. The last time it happened I was just putting on pants - no fall, no injury. It took four weeks to close and I had to use wound dressings every day. It has left a darkened area where the skin grew back thinner.”
What the examiner listens for:
The examiner must document whether the scar is 'unstable,' meaning it does not continuously maintain a normal skin covering. Any history of recurring breakdown is critical. Bring treatment records, photos, or a written log of breakdown episodes.
Understatements to avoid:
Do not minimize breakdown episodes by saying 'it was just a little open sore.' A scar that breaks open with routine activity legally qualifies as unstable, regardless of the size of the opening. State each episode clearly and separately.
Disfigurement Characteristics
How to describe:
Describe visible changes to your skin at each scar site. Use specific language: 'The scar is darker than my surrounding skin' (hyperpigmentation), 'The scar is lighter/whiter than my skin' (hypopigmentation), 'The scar feels rough or bumpy to the touch' (abnormal texture), 'The scar is raised and firm' (elevated contour with induration), 'The scar is sunken in' (depressed contour), 'The scar feels stuck down and does not move freely' (adherence), 'There is a hollow or divot where tissue is missing' (missing soft tissue).
Worst-day example:
“The burn scar on my left cheek has been discolored dark brown since my injury - much darker than my normal skin. The surface is rough and uneven, and when I press on it, it is hard and does not flatten. It is also depressed at the center, creating a sunken appearance. My nose was partially distorted when the scar contracted during healing.”
What the examiner listens for:
The examiner is counting the number of defined characteristics to assign the correct rating. Make sure each characteristic is mentioned distinctly. Do not bundle them - say each one separately so it is documented individually in the DBQ.
Understatements to avoid:
Do not simply say 'it looks different' or 'the scar is ugly.' Use the specific terminology that maps to the DBQ checkboxes: hyperpigmentation, hypopigmentation, abnormal texture, elevated contour, depressed contour, adherence, induration, missing soft tissue. The examiner needs to check specific boxes.
Functional and Daily Life Impact
How to describe:
Explain how your scars limit your ability to perform work, self-care, social interactions, sleep, or physical activities. For facial scars, describe social and psychological impacts honestly. For extremity scars, describe limitations on gripping, lifting, bending, or walking. This supports the functional impairment narrative required by M21-1.
Worst-day example:
“The scarring on my face has made me avoid public situations. I have stopped attending family events because strangers stare, and I have had coworkers ask about my appearance. I no longer wear short sleeves due to the scars on my arms, even in summer heat, because the exposure causes me anxiety. The scar on my knee limits how far I can bend my leg, making it difficult to kneel or use stairs.”
What the examiner listens for:
The examiner will document functional impact in the DBQ field asking about impact on daily activities. This narrative can support ratings for related conditions such as depression secondary to scarring, or joint limitation secondary to burn scar contracture.
Understatements to avoid:
Do not minimize psychological or social impacts by saying 'I manage okay.' The VA considers functional impairment broadly. If you have adjusted your life around your scars, those adjustments are themselves evidence of functional limitation.
History and Origin of Each Scar
How to describe:
Be prepared to describe how and when each scar occurred, where you were stationed or what duty you were performing, and how it was treated in service and after. The examiner will document this in the history fields. Be specific but consistent with your service records.
Worst-day example:
“I received this burn injury during a vehicle fire in Iraq in 2006. I was treated at the combat support hospital for second-degree burns to my forearms and left leg. I was evacuated and received skin grafting at Landstuhl. The scars have been present since then and have progressively worsened in terms of sensitivity and breakdown.”
What the examiner listens for:
The examiner needs to link the scar to a specific service event or incident. If records are incomplete, your lay statement about the origin is still probative evidence. Per M21-1, if there is reasonable doubt about service connection for a scar, the benefit of the doubt goes to the veteran.
Understatements to avoid:
Do not say 'I think' or 'I'm not sure' about the origin if you do remember - be clear and direct. If you truly do not remember details, say so honestly rather than guessing incorrectly.
Common Mistakes to Avoid
Not reporting all scars, only the most obvious ones
Under DC 7804, the count of painful or unstable scars directly determines the rating percentage. Missing even one or two qualifying scars can mean the difference between 10%, 20%, and 30%.
Instead: Before your exam, make a complete written inventory of every scar on your body, including small ones, surgical scars from service-connected procedures, and scars that are only occasionally symptomatic. Bring this list to the exam.
Impact: 10%-30%
Failing to report that a scar is BOTH painful AND unstable
When a scar qualifies as both painful and unstable, there is a mandatory 10% add-on to the base DC 7804 rating per Note 2. If you only describe one characteristic, the examiner may not document both, and you lose the add-on.
Instead: For each scar, explicitly state: 'This scar is painful when touched AND it has broken open on these specific dates.' Use both words: painful and unstable.
Impact: 10% add-on at all DC 7804 levels
Assuming characteristics of disfigurement from multiple scars cannot be combined
Many veterans believe they need one large scar with four characteristics to reach 80% under DC 7800. Per Note 5 of DC 7800, characteristics from multiple scars of the head, face, or neck can be combined to meet the threshold.
Instead: Point out each characteristic across all scars of your head, face, and neck separately. Say: 'This scar has hyperpigmentation, this other scar has abnormal texture, and this third scar has elevated contour.' The examiner should document all characteristics from all scars in the region.
Impact: 50%-80% under DC 7800
Not bringing documentation of scar breakdown episodes
Unstable scar ratings depend heavily on the history of skin breakdown. Without documentation, the examiner may have no basis to check the 'unstable' box, resulting in a lower or no DC 7804 rating.
Instead: Bring photographs of open or healing scars, treatment records from primary care or wound care clinics, and a written timeline of breakdown episodes including approximate dates and circumstances.
Impact: 10%-30% under DC 7804
Describing pain only as it is on the exam day rather than reporting worst-day severity
Scar pain fluctuates. If you happen to have a good day on exam day and minimize your pain, the examiner's documentation will reflect that, potentially leading to an underrated condition.
Instead: Explicitly state your worst-day pain level and frequency. Say: 'Today is a moderate day for me. On my worst days, my pain is a 9/10 and I cannot tolerate any contact with the scar area. This happens approximately X days per month.'
Impact: 10%-30% under DC 7804
Not mentioning scars on the head, face, or neck separately from body scars
Scars of the head, face, or neck are rated under a completely different diagnostic code (DC 7800) with potentially much higher rating percentages (up to 80%). If you do not clearly identify facial scars, the examiner may evaluate everything under DC 7804.
Instead: Separately identify any scars on your head, face, or neck at the start of the exam. Say: 'I have burn scars on my face and neck which I want to make sure are evaluated for disfigurement under the separate facial scar criteria.'
Impact: 10%-80% under DC 7800
Forgetting to mention the functional impact on adjacent joints for burn scars
Burn scars that cause contracture can also limit range of motion of nearby joints. This may entitle you to additional ratings for joint limitation, or eligibility for automobile adaptive equipment allowance. If not mentioned, the examiner will not document it.
Instead: Tell the examiner if any scar limits how far you can bend a joint, restricts your reach, or causes you to change your posture or movement. Ask whether a separate musculoskeletal evaluation for joint limitation may be warranted.
Impact: Additional ratings for joint limitations
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 an in-person C&P examination rather than a records-only review, particularly for scars that require physical measurement and palpation.
- You have the right to record your C&P examination in most states - notify the examiner at the start of the appointment.
- You have the right to review the completed DBQ after the examination by requesting it through VA.gov or a FOIA/Privacy Act request.
- You have the right to challenge an inadequate examination. Per M21-1, a scar exam is insufficient if it fails to identify the scar's location, type, and dimensions. You may request a new or supplemental examination.
- You have the right to submit buddy statements, personal statements, and lay evidence describing your scar symptoms and history. Your lay testimony is competent evidence for observable symptoms like pain and skin changes.
- You have the right to the benefit of the doubt: if there is an approximate balance of evidence for and against service connection for a scar, the VA must resolve the doubt in your favor per 38 U.S.C. 5107(b).
- You have the right to bring a VSO representative, attorney, or claims agent to accompany and observe your C&P examination.
- If your scar is both painful and unstable, you are entitled to the 10% add-on under Note 2 of DC 7804 in addition to the base rating - this is not discretionary.
- Characteristics of disfigurement under DC 7800 may come from multiple scars of the head, face, or neck - the VA is required to apply Note 5 when evaluating facial scarring.
- You have the right to file a Higher-Level Review or Board of Veterans' Appeals appeal if you believe your rating is incorrect due to an inadequate or inaccurate examination.
Related Conditions
- Burn Scars of the Head, Face, or Neck Separate diagnostic code (DC 7800) for scars of the head, face, or neck rated by disfigurement characteristics up to 80%. Can be rated concurrently with DC 7804 for the same scars if they are also painful or unstable.
- Burn Scars with Underlying Soft Tissue Damage (Not Head/Face/Neck) Diagnostic code DC 7801 rates burn scars of the trunk or extremities that involve damage to underlying soft tissue, based on total area affected. Can be rated alongside DC 7804.
- Burn Scars Without Soft Tissue Damage (Not Head/Face/Neck) Diagnostic code DC 7802 rates burn scars of the trunk or extremities without underlying soft tissue damage, based on total area. Maximum 10% rating. Can be rated alongside DC 7804.
- Depression or PTSD Secondary to Scarring/Disfigurement Mental health conditions caused or aggravated by visible scarring or disfigurement may be separately service connected as secondary conditions. Facial disfigurement in particular is associated with depression, social anxiety, and PTSD.
- Joint Limitation Secondary to Burn Scar Contracture Burn scars overlying joints can cause contracture and limited range of motion, separately ratable under musculoskeletal diagnostic codes. Per M21 1, full thickness or deep partial thickness scars limiting extremity motion may also affect automobile adaptive equipment eligibility.
- Skin Grafts as Residuals of Burns Skin graft donor and recipient sites may both be ratable as scars. Donor site scars are often overlooked. Document all graft sites and evaluate them separately under the appropriate scar diagnostic code.
- Keloid Scarring Keloid scars are elevated, firm, and may extend beyond the original wound margins. They commonly display induration, abnormal texture, and elevated surface contour multiple disfigurement characteristics and may also be painful, supporting both DC 7800 (if facial) and DC 7804 ratings.
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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.