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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 all service-connected scars and assess any associated pain, disfigurement, or functional limitation for disability rating under 38 CFR - 4.118.
What the examiner evaluates:
- Location of each scar (head/face/neck, trunk, upper/lower extremities)
- Type of scar (burn scar, non-linear superficial, linear, painful, unstable)
- Dimensions of each scar (length and width at widest point in centimeters)
- Surface contour (elevated, depressed, or flat on palpation)
- Characteristics of disfigurement (tissue loss, distortion of facial features, hyperpigmentation, hypopigmentation, abnormal texture, induration, inflexibility, scar adherent to underlying tissue)
- Presence and nature of pain on palpation or with movement
- Presence of ulceration or loss of skin covering over the scar
- Total approximate area affected per body region (in cm-)
- Burn scar characteristics including depth, contracture, and involvement of facial features or ear auricles
- Impact on occupational functioning and daily activities
- Veteran's subjective history of the scar including cause, origin, and course
You will be asked to expose all affected body areas so the examiner can physically inspect and measure each scar. Wear clothing that allows easy access to all scar locations. The examiner may photograph scars. You have the right to request exam recording in most states. A same-sex chaperone can be requested.
Typical duration: 15-30 minutes
Scar Dimensions Measurement
Length and width (in centimeters) at the widest part of each individual scar. Used to determine if non-linear superficial scars exceed 39 cm- threshold and to document extent of burn scars.
What to expect:
The examiner will use a ruler or measuring tape to measure the length and width of each scar in centimeters. They will record dimensions for each scar individually. For burn scars over larger body areas, they will estimate total area in cm-.
Key thresholds:
- Greater than 39 cm- — Non-linear superficial scar >39 cm- qualifies for compensable rating under DC 7802
- 6 or more disfigurement characteristics — 80% rating under DC 7800 for head/face/neck scars
- 4 or 5 disfigurement characteristics — 50% rating under DC 7800 for head/face/neck scars
- 2 or 3 disfigurement characteristics — 30% rating under DC 7800 for head/face/neck scars
- 1 characteristic of disfigurement — 10% rating under DC 7800 for head/face/neck scars
Tips:
- Know the approximate size of each scar before the exam - measure with a ruler at home if possible
- If scars fluctuate in size due to inflammation, describe your typical worst-day presentation
- Multiple smaller scars may be considered together for total area calculations
- Ensure the examiner measures ALL scars, not just the most prominent one
Pain considerations: If a scar is painful to touch or palpation, clearly state this when the examiner begins measuring. The pain response itself is a ratable characteristic.
Disfigurement Characteristics Assessment (Head/Face/Neck)
The number of recognized characteristics of disfigurement present under DC 7800, which directly drives the rating percentage. Characteristics include: tissue loss, gross distortion or asymmetry of facial features, surface contour abnormality, hyperpigmentation, hypopigmentation, abnormal texture, induration, inflexibility, scar adherent to underlying tissue, and missing underlying soft tissue.
What to expect:
The examiner will visually inspect and palpate scars on the head, face, and neck, checking for each recognized characteristic. They will document which specific facial features are involved (nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips) and note any tissue loss, distortion, or asymmetry.
Key thresholds:
- Tissue loss + distortion/asymmetry of 3+ features OR 6+ characteristics — 80% under DC 7800
- Tissue loss + distortion/asymmetry of 2 features OR 4-5 characteristics — 50% under DC 7800
- Tissue loss + distortion/asymmetry of 1 feature OR 2-3 characteristics — 30% under DC 7800
- 1 characteristic of disfigurement — 10% under DC 7800
Tips:
- Under Note (5) of the rating schedule, characteristics from multiple scars may be combined - make sure to point this out if you have multiple facial scars
- Be specific about which features are distorted: nose shape, eyelid position, auricle deformity, lip asymmetry
- If your ear (auricle) has lost more than one-third of its substance, this is a specific ratable finding
- Hyperpigmentation and hypopigmentation each count as separate characteristics - mention both if present
- Induration (hardness/firmness) and inflexibility are separate characteristics - describe both independently if applicable
Pain considerations: Pain is not itself a disfigurement characteristic under DC 7800 but is separately ratable. If head/face/neck scars are painful, this can be separately evaluated under DC 7804 or 7805.
Painful Scar Assessment
Whether scars are painful on palpation or with use/movement, which qualifies for a compensable rating under DC 7804 (at least 10%). Pain is assessed by palpation and veteran report.
What to expect:
The examiner will press on each scar and ask if it is tender or painful. They will ask you to describe the nature, location, and frequency of pain. They will document all painful scars separately by location.
Key thresholds:
- Painful on palpation (any scar) — At minimum 10% rating under DC 7804 per painful scar location
- Unstable scar (history of breakdown/ulceration) — Separately ratable under DC 7801 in addition to pain
Tips:
- If a scar is only occasionally painful, describe your worst-day pain level and frequency
- Describe pain both at rest and during activity or palpation
- Note if pain wakes you from sleep or limits specific daily activities
- Each anatomically distinct painful scar may be separately ratable - do not let the examiner consolidate multiple painful scars without individually documenting each
- Describe pain character: burning, stabbing, aching, electric, hypersensitivity to touch (allodynia)
Pain considerations: Pain is the primary basis for DC 7804 ratings. Be specific: describe intensity on a 0-10 scale on your worst day, frequency (constant vs. intermittent), triggers (clothing contact, temperature changes, physical activity), and any radiation of pain to surrounding areas.
Unstable Scar Assessment
Whether scars have a documented history of breakdown, ulceration, or loss of skin covering, which qualifies for rating under DC 7801 based on area involved.
What to expect:
The examiner will inspect scars for current or healed breakdown and ask about history of ulceration. They will measure total area of unstable scars and document location of any loss of skin covering.
Key thresholds:
- Unstable scar with area >144 cm- — 30% under DC 7801
- Unstable scar with area 72-144 cm- — 20% under DC 7801
- Unstable scar with area <72 cm- — 10% under DC 7801
Tips:
- Bring photographs if your scar has had ulcerations or breakdown in the past - the examiner captures a snapshot in time
- Describe how often breakdown occurs and what triggers it
- Note if the skin over the scar is thin, fragile, or has broken down in the past 12 months
- If you use dressings or wound care, bring documentation of this treatment
Pain considerations: Unstable scars that are also painful should be noted to the examiner - both characteristics may apply simultaneously and both should be documented.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 80% | Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of three or more 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: Veteran with burn scars affecting forehead, cheeks, and eyelids with palpable tissue loss and documented distortion of eye opening and lip movement, with additional findings of hyperpigmentation, abnormal texture, and induration - total of six or more characteristics. |
| 50% | Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of two facial features or paired sets of features; OR four or five characteristics of disfigurement. |
CFR: Per 38 CFR - 4.118 DC 7800: Veteran with nose and cheek disfigurement from burn scars with palpable tissue loss, combined with hyperpigmentation and induration - total of four characteristics and two feature areas affected. |
| 30% | Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of one facial feature or paired set of features; OR two or three characteristics of disfigurement. |
CFR: Per 38 CFR - 4.118 DC 7800: Veteran with chin scar causing palpable tissue loss and distortion of chin shape, combined with hypopigmentation - 2 characteristics and 1 feature affected. |
| 10% | Burn scar(s) of the head, face, or neck with one characteristic of disfigurement. Also: Non-linear superficial scar(s) exceeding 39 cm- (DC 7802); or painful scar(s) on any body location (DC 7804 - at least 10% per location); or unstable scar(s) with area under 72 cm- (DC 7801). |
CFR: Per 38 CFR - 4.118: A non-linear superficial scar on the forearm measuring 8 cm x 6 cm (48 cm-) qualifies for 10% under DC 7802. A scar on the lower leg that is painful on direct pressure or clothing contact qualifies for 10% under DC 7804. |
80% Burn scar(s) of the head, face, or neck with visible or palp ...
Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of three or more 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 on head, face, or neck
- Gross distortion or asymmetry of 3+ facial features
- Six or more disfigurement characteristics present (e.g., tissue loss, hyperpigmentation, hypopigmentation, abnormal texture, induration, inflexibility, adherence, elevated/depressed contour)
- Severe facial asymmetry affecting multiple features
- Complete loss of ear auricle
CFR: Per 38 CFR - 4.118 DC 7800: Veteran with burn scars affecting forehead, cheeks, and eyelids with palpable tissue loss and documented distortion of eye opening and lip movement, with additional findings of hyperpigmentation, abnormal texture, and induration - total of six or more characteristics.
50% Burn scar(s) of the head, face, or neck with visible or palp ...
Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of two facial features or paired sets of features; OR four or five characteristics of disfigurement.
Key Symptoms
- Visible or palpable tissue loss affecting head, face, or neck
- Gross distortion or asymmetry of exactly 2 facial features
- Four or five disfigurement characteristics present
- Significant facial asymmetry
- Deformity of auricle with loss of one-third or more of its substance
CFR: Per 38 CFR - 4.118 DC 7800: Veteran with nose and cheek disfigurement from burn scars with palpable tissue loss, combined with hyperpigmentation and induration - total of four characteristics and two feature areas affected.
30% Burn scar(s) of the head, face, or neck with visible or palp ...
Burn scar(s) of the head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of one facial feature or paired set of features; OR two or three characteristics of disfigurement.
Key Symptoms
- Visible or palpable tissue loss affecting head, face, or neck
- Gross distortion or asymmetry of exactly 1 facial feature
- Two or three disfigurement characteristics present
- Hyperpigmentation or hypopigmentation combined with texture changes
- Scar adherent to underlying tissue on face
CFR: Per 38 CFR - 4.118 DC 7800: Veteran with chin scar causing palpable tissue loss and distortion of chin shape, combined with hypopigmentation - 2 characteristics and 1 feature affected.
10% Burn scar(s) of the head, face, or neck with one characteris ...
Burn scar(s) of the head, face, or neck with one characteristic of disfigurement. Also: Non-linear superficial scar(s) exceeding 39 cm- (DC 7802); or painful scar(s) on any body location (DC 7804 - at least 10% per location); or unstable scar(s) with area under 72 cm- (DC 7801).
Key Symptoms
- One characteristic of disfigurement on head/face/neck
- Non-linear superficial scar exceeding 39 cm- in area
- Scar(s) that are painful on palpation
- Unstable scar with area under 72 cm-
- Hyperpigmentation or hypopigmentation alone on face
- Superficial scar with abnormal texture on exposed areas
CFR: Per 38 CFR - 4.118: A non-linear superficial scar on the forearm measuring 8 cm x 6 cm (48 cm-) qualifies for 10% under DC 7802. A scar on the lower leg that is painful on direct pressure or clothing contact qualifies for 10% under DC 7804.
How to Describe Your Symptoms
Pain Description
How to describe:
Describe the exact character, location, frequency, and triggers of pain from each scar. Use specific language: burning, stabbing, aching, electric, hypersensitivity, tenderness to light touch or clothing contact. Rate your worst-day pain on a 0-10 scale and your average daily pain separately.
Worst-day example:
“On my worst days, the scar on my left forearm feels like it is on fire - even the weight of a shirt sleeve causes sharp, burning pain that I would rate 8 out of 10. This happens at least 3-4 times per week and can last for hours. I have to cut the sleeves off shirts or wear compression wraps to tolerate it.”
What the examiner listens for:
Whether pain is consistent with the scar location and type, whether it is constant or episodic, what activities or stimuli trigger it, and whether it limits function. The examiner documents this in the pain description field of the DBQ.
Understatements to avoid:
Do not say 'it bothers me sometimes' or 'it's not that bad.' Say specifically: 'It is painful when touched, when clothing rubs against it, in cold weather, and when I try to sleep on that side.' Vague descriptions may result in no painful scar finding.
Disfigurement and Appearance Changes
How to describe:
Be objective and specific about visible changes. Identify each affected facial feature by name. Describe the nature of the change: tissue is missing, the feature is asymmetrical compared to the other side, the skin color is darker/lighter than surrounding skin, the skin texture is rough/bumpy/hardened, or the area is contracted.
Worst-day example:
“My right eyelid does not fully close due to scar tissue pulling it downward. My left cheek has a sunken appearance where tissue was lost, and the skin there is visibly darker than the surrounding areas. My nose has a slight deviation to the right from the burn injury that was not there before service.”
What the examiner listens for:
Number and identity of facial features affected, whether tissue is visibly or palpably missing, whether asymmetry is gross (obvious, marked) versus subtle, and how many total disfigurement characteristics are present across all scars combined.
Understatements to avoid:
Do not minimize asymmetry by saying 'it's barely noticeable.' The standard is whether it exists, not whether it is extreme. Also do not assume the examiner will count all characteristics - point out each one explicitly: 'I also have hypopigmentation here, and the skin texture is abnormal here.'
Functional Impact of Scars
How to describe:
Describe how the scars affect your ability to perform work duties, daily activities, sleep, and social interaction. Include limitations on clothing choices, avoidance of activities due to pain or exposure, and psychological impact of visible disfigurement.
Worst-day example:
“On my worst days, I cannot wear long pants because the scars on my legs are too painful with any fabric contact. I avoid public settings because of the stares I receive. I cannot perform my job as a mechanic because gripping tools causes severe pain in my hand scar. I sleep poorly because lying on my back puts pressure on the trunk scars.”
What the examiner listens for:
Whether the scars cause demonstrable limitations beyond cosmetic appearance, including occupational impairment, activity restriction, and psychosocial impact. This feeds into the DBQ's functional impact section.
Understatements to avoid:
Do not say 'I manage fine.' Describe what you have had to change, adapt, or stop doing because of your scars. If you have had to change jobs, modify your wardrobe, avoid social situations, or use assistive measures, say so explicitly.
History and Origin of Scars
How to describe:
Clearly state the in-service event or exposure that caused each scar. Include the approximate date, location (country/installation/unit if possible), nature of the injury (burn, IED blast, shrapnel, vehicle accident, chemical exposure), and any treatment received in service.
Worst-day example:
“In [year], while deployed to [location], I sustained burns to my face and arms when [specific event]. I was treated at [medical facility] and have records of the initial treatment. The scars have been present continuously since that time and have not changed significantly except for increased pain in cold weather.”
What the examiner listens for:
A credible, consistent history that connects the scars to a specific service event or period. The examiner documents this in the history/cause section of the DBQ.
Understatements to avoid:
Do not be vague about the origin. Do not say 'I got hurt in the military.' Say: 'I was burned when [specific incident] on [approximate date] while serving with [unit] in [location].' If you lack exact details, approximate dates and locations are acceptable - just be consistent with your service records.
Burn Scar Specific Characteristics
How to describe:
For burn scars specifically, describe the depth and extent at time of injury if known (partial vs. full thickness), any skin grafting or surgical revisions, presence of contracture (tightening that limits movement), and any ongoing treatments such as compression garments or scar massage.
Worst-day example:
“My burn scars cover approximately 25% of my trunk. The scars are thick, tight, and inelastic - I cannot fully bend forward because the skin on my abdomen pulls and feels like it will tear. I wear compression garments daily. In cold weather, the tightness is significantly worse and I cannot stand upright for more than 20 minutes.”
What the examiner listens for:
Depth of burn (full thickness scars are more ratable), presence of contracture and what motion it limits, whether skin grafting was performed and whether grafts are stable, and whether burn scars affect the head/face/neck (separately ratable under DC 7800) versus trunk/extremities.
Understatements to avoid:
Do not describe burn scars the same way as routine surgical scars. Emphasize the contracture, tightness, and functional limitation. If the burns affected your face, enumerate each facial feature affected separately rather than describing it as 'my face was burned.'
Common Mistakes to Avoid
Failing to mention all scars present
Veterans often focus on their most significant scar and fail to disclose smaller or less prominent scars. Each ratable scar - including painful scars anywhere on the body - deserves individual documentation.
Instead: Before the exam, make a complete list of every scar you believe is related to your service, including location, approximate size, and symptoms. Present this list to the examiner at the start of the exam and ask that each be examined and documented.
Impact: Can result in completely missed ratings for painful or disfiguring scars not examined
Minimizing pain by describing only average or 'good day' symptoms
VA ratings are intended to capture the full range of disability, including worst-day functioning. Describing only mild or infrequent symptoms results in a rating that does not reflect true impairment.
Instead: Per M21-1 guidance, describe your symptoms on your worst days. Explicitly state: 'On my worst days, this is how I am affected...' Provide both average and worst-day descriptions.
Impact: Directly affects whether a scar qualifies as 'painful' under DC 7804 and the overall functional impact rating
Not pointing out every individual disfigurement characteristic
Rating under DC 7800 is driven by counting the number of distinct characteristics. If the veteran does not explicitly draw the examiner's attention to each characteristic (e.g., pointing out both hyperpigmentation AND abnormal texture as separate findings), the examiner may document fewer than are present.
Instead: Review the list of recognized characteristics beforehand: surface contour (elevated or depressed), hyperpigmentation, hypopigmentation, abnormal texture, induration and inflexibility, scar adherent to underlying tissue, missing soft tissue. Tell the examiner which ones you believe are present and ask them to evaluate each one.
Impact: Directly determines the rating percentage under DC 7800 (10%, 30%, 50%, or 80%)
Not bringing photographs of scars when they vary in appearance
Scars can look better on an exam day than on typical days - especially burn scars that become more inflamed or contracted in cold weather or with exertion. A single-point-in-time exam may underrepresent the true severity.
Instead: Bring photographs that show the scars at their worst appearance - with any redness, swelling, breakdown, or contracture visible. Offer them to the examiner and request they be included in the exam record.
Impact: Can affect ratings across all scar diagnostic codes - particularly unstable and painful scars
Allowing multiple scars to be grouped under one rating without individual documentation
Each anatomically distinct painful scar may be separately ratable under DC 7804, and each scar in a distinct body region may be separately rated under other DCs. Combining all scars into a single entry may result in a lower combined rating.
Instead: Ask the examiner to document each scar individually with its own location, dimensions, and characteristics. Be aware that the DBQ has fields for multiple scars (Scar 1 through Scar 5 and additional). Do not let all scars be collapsed into one entry.
Impact: Can affect combined rating percentage - especially when multiple painful scars exist on different body parts
Not describing the functional impact of contracture or scar tightness
Burn scars that limit range of motion due to contracture may be separately ratable under the affected joint's diagnostic code, in addition to the scar rating. If you do not mention the limitation, the examiner will not document it.
Instead: For any burn scar near a joint (knee, elbow, shoulder, fingers, ankle), describe specifically how the scar tightness or contracture limits your ability to bend, extend, or move that joint. Ask if a separate joint DBQ or range of motion assessment is warranted.
Impact: Can result in missing a separate joint rating that would add to the combined disability percentage
Failing to clarify that multiple scars collectively create disfigurement characteristics under Note (5)
Under 38 CFR - 4.118 Note (5), disfigurement characteristics from multiple scars can be combined to reach a rating threshold - they do not all need to come from a single scar. Veterans and examiners alike sometimes miss this, resulting in artificially lower ratings.
Instead: If you have multiple facial scars, explicitly state: 'I understand that under Note (5), characteristics from all my scars can be combined. Please document all characteristics across all facial scars and consider them collectively.' Then enumerate all characteristics present across all scars.
Impact: Can be the difference between a 10% and 30%, or 30% and 50%, rating under DC 7800
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 record your C&P examination in most states - notify the examiner at the start of the session.
- You have the right to request a same-sex examiner or chaperone during physical inspection.
- You have the right to request a copy of the completed DBQ after the examination.
- If the examination is inadequate - for example, if the examiner did not measure all scars, failed to document pain, or did not examine all claimed scar locations - you have the right to request a new examination. Per M21-1, a scar DBQ must identify location, type, and dimensions for each scar to be sufficient for rating.
- You have the right to submit a personal statement (VA Form 21-4138) supplementing the exam findings at any time before a rating decision is issued.
- Under 38 U.S.C. - 5103A, the VA has a duty to assist you in obtaining evidence, including ordering an adequate examination. An insufficient exam must be returned for correction.
- You have the right to have all characteristics of disfigurement from multiple scars considered collectively under 38 CFR - 4.118 Note (5) - you may invoke this right explicitly during your examination.
- You have the right to claim secondary service connection for psychological conditions (such as PTSD, depression, or social anxiety) caused or aggravated by your service-connected disfigurement.
- You have the right to present photographs and lay statements as evidence of your condition, particularly when scars vary in severity and may appear better on the day of examination.
- You have the right to a higher-level review or Board of Veterans' Appeals hearing if you disagree with the rating assigned based on the C&P exam findings.
Related Conditions
- Burn Scars of the Head, Face, or Neck Rated separately under DC 7800 based on number of disfigurement characteristics and facial features affected. Scars on the head, face, or neck are rated under DC 7800; DC 7805 covers disabling effects not captured by DCs 7800 7804.
- Unstable Scars Rated under DC 7801 based on total area of unstable (ulcerating or breaking down) scars. Can be rated concurrently with painful scars under DC 7804 if the same scar is both unstable and painful.
- Non-Linear Superficial Scars Rated under DC 7802 based on total area of non linear superficial scars greater than 39 cm . Evaluated on the same DBQ as DC 7804 and 7805 scars.
- Painful or Unstable Scars DC 7804 applies to scars that are painful on palpation or that have a history of breakdown. Each separately located painful scar may be individually rated. DC 7805 covers disabling effects not otherwise captured.
- Peripheral Neuropathy (Scar-Related) Burn scars and deep lacerations can cause peripheral nerve damage resulting in neuropathy, hypersensitivity, or anesthesia in the affected area. May be separately rated under 38 CFR 4.120 if documented neurological findings are present.
- Joint Range of Motion Limitation from Burn Scar Contracture Burn scars near joints that cause contracture limiting range of motion may qualify for a separate rating under the applicable musculoskeletal diagnostic code for that joint, in addition to the scar rating.
- Major Depressive Disorder / Adjustment Disorder (Secondary to Disfigurement) Significant facial disfigurement or extensive body scarring can cause or aggravate psychiatric conditions. Secondary service connection may be established under 38 CFR 3.310 if the mental health condition is caused or worsened by the service connected scars.
- PTSD The traumatic events that caused burn injuries (combat, explosions, accidents) frequently also cause PTSD. Both conditions may be separately rated. Visible reminders of the injury through scarring can perpetuate PTSD symptoms and should be noted in mental health evaluations.
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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.