Skip to main content
Estimate

These guides are AI-generated educational summaries — not legal or medical advice.

C&P Exam Prep: Skin Diseases (Dermatitis / Psoriasis / Acne)

DC 7806 skin 38 CFR 4.118

DBQ Overview

Interview + Physical
Form Name
Skin_Diseases
Form Code
Skin_Diseases
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, severity, extent, and treatment history of your skin condition in order to assign an accurate disability rating under the General Rating Formula for the Skin (38 CFR 4.118). The examiner will assess what percentage of your total body surface area (TBSA) and exposed body surface area (EBSA) is affected, how the condition responds to treatment, and whether systemic or constitutional symptoms are present.

What the examiner evaluates:

  • Specific skin diagnosis (dermatitis, eczema, psoriasis, acne, chloracne, etc.) and ICD code
  • Total body surface area (TBSA) affected - expressed as a percentage
  • Exposed body surface area (EBSA) affected - expressed as a percentage
  • Specific body regions involved: face/neck, intertriginous areas (axilla, anogenital), palms, soles, mucous membranes
  • Whether the condition is currently active or in remission
  • Type and intensity of current and past treatments (topical, systemic, biologics, phototherapy, immunosuppressives)
  • Whether the condition requires systemic therapy (corticosteroids, immunosuppressives, biologics, retinoids)
  • Frequency and severity of flare-ups or episodic outbreaks
  • Presence of constitutional symptoms (fever, weight loss, fatigue)
  • Presence of complications: erythroderma, palmar/plantar involvement, mucosal involvement, scarring alopecia
  • Impact on daily functioning, work, and social activities
  • History of the condition including onset date and relationship to military service

You will undergo a visual skin examination of affected areas. Be prepared to undress partially so the examiner can inspect all affected body areas. Bring all current medications including topical creams, ointments, and prescription bottles. Bring photographs of your skin during flare-ups if available, as the condition may be in partial remission on exam day. The examiner will ask about your history, treatments, and functional impact.

Typical duration: 15-30 minutes

Total Body Surface Area (TBSA) Affected

The percentage of your entire skin surface covered by the active skin condition. This is a critical rating factor under the General Rating Formula for the Skin.

What to expect:

The examiner will visually inspect your entire body and estimate what percentage of all skin is affected. A common clinical method uses the 'Rule of Nines' (each arm = 9%, each leg = 18%, trunk front = 18%, trunk back = 18%, head = 9%). Be prepared to show all affected areas, including areas covered by clothing.

Key thresholds:

  • Less than 5% TBSA — Associated with lower ratings; topical therapy only
  • 5-20% TBSA — May support moderate rating; systemic therapy considerations apply
  • Greater than 20% TBSA — Supports higher rating levels; likely requires systemic or intensive therapy
  • Generalized involvement — Supports 60% rating under erythroderma/exfoliative dermatitis criteria

Tips:

  • Show ALL affected areas including scalp, ears, behind knees, groin, buttocks, and other areas normally covered
  • If your condition fluctuates, tell the examiner what it looks like on a bad day and describe peak coverage
  • Bring photos from flare-up periods to document maximum extent
  • Do not use heavy moisturizers or topical treatments the morning of the exam that might temporarily improve appearance

Pain considerations: Describe any pain, burning, stinging, or itching associated with lesions. Note whether skin is cracked, bleeding, or weeping, as this affects functional impact and rating.

Exposed Body Surface Area (EBSA) Affected

The percentage of skin that is typically exposed to public view (face, neck, hands, forearms, lower legs) that is affected. Per M21-1, the DBQ must record both TBSA and EBSA as separate percentages.

What to expect:

The examiner will separately assess how much of the skin visible in everyday public settings (without long sleeves/pants) is affected. This is relevant because conditions affecting highly visible areas like the face and hands may have greater occupational and social impact.

Key thresholds:

  • Face and neck less than 40% affected — Lower rating tier for acne/chloracne under DC 7828
  • Face and neck 40% or more affected — Higher rating tier for acne/chloracne under DC 7828
  • Intertriginous areas involved — Specifically noted on DBQ; affects acne and dermatitis rating considerations

Tips:

  • Clearly identify when face, neck, hands, and forearms are affected - these are highly visible areas
  • Note whether your occupation requires appearance in front of others, which amplifies functional impact
  • Distinguish between permanent lesions/scarring and fluctuating active lesions

Pain considerations: If lesions on hands or feet limit grip, fine motor skills, or walking, describe this in detail as it may support secondary functional impairment claims.

Treatment Intensity Assessment

The level of medical intervention required to manage the condition - a key rating driver. Higher-intensity treatments (systemic corticosteroids, biologics, immunosuppressives) support higher ratings.

What to expect:

The examiner will ask about every treatment you have used: topical creams/ointments, oral medications, injections, phototherapy (UVB, PUVA), biologics (Humira, Dupixent, Skyrizi, etc.), corticosteroids, retinoids, antihistamines, and procedures. They will note medication names, frequency, duration, and which condition each is used for.

Key thresholds:

  • Topical therapy only — Typically supports 10% rating
  • Systemic therapy (oral medications, phototherapy) — Typically supports 30% rating
  • Systemic therapy + frequent relapses or extensive involvement — Supports 60% rating
  • Constant or near-constant systemic treatment required — Supports 60% rating level

Tips:

  • Bring a complete medication list including all topical and oral prescriptions
  • Bring all medication bottles including OTC treatments recommended by your doctor
  • Document how long you have been on each treatment and whether it fully controls your symptoms
  • If you have used biologics, note the specific biologic name, dosing frequency, and how long you have been on it
  • If you have undergone phototherapy, document how many sessions and dates

Pain considerations: Note any adverse effects from medications (e.g., corticosteroid side effects, photosensitivity from PUVA) as these represent additional burden of treatment.

Estimate

Rating Criteria Breakdown

60% The highest rating under the General Rating Formula for the ...

The highest rating under the General Rating Formula for the Skin. Requires: 40% or more of the entire body OR 40% or more of exposed areas affected, OR; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Also applicable for generalized involvement with systemic manifestations (erythroderma/exfoliative dermatitis with systemic manifestations).

Key Symptoms

  • Extensive involvement covering 40%+ of total body surface or exposed areas
  • Constant or near-constant use of systemic medications (daily oral corticosteroids, continuous biologic therapy, etc.)
  • Erythroderma or exfoliative dermatitis with systemic manifestations (fever, chills, weight loss)
  • Generalized skin involvement without systemic manifestations
  • Condition severely impacts ability to work, perform self-care, or participate in activities
  • Palmar and/or plantar involvement with frequent disabling episodes
  • Mucosal involvement
  • Recurrent hospitalizations or emergency treatments for skin condition

CFR: General Rating Formula for the Skin: 60% - 40 percent or more of the entire body or 40 percent or more of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. For erythroderma/exfoliative dermatitis: generalized involvement of the skin with systemic manifestations such as fever, weight loss, or hypoalbuminemia.

30% At least 20% but less than 40% of the entire body OR at leas ...

At least 20% but less than 40% of the entire body OR at least 20% but less than 40% of exposed areas affected, OR; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

Key Symptoms

  • Moderate to extensive skin involvement (20-39% TBSA or EBSA)
  • Requires periodic oral or injectable medications (corticosteroids, immunosuppressives, retinoids)
  • Systemic therapy used for 6+ weeks total in the past year
  • Frequent or prolonged flare-ups requiring treatment escalation
  • Significant itching, scaling, cracking, or pain over larger body areas
  • Phototherapy (UVB or PUVA) required
  • Biologic medication initiated but not yet reaching constant-use threshold

CFR: General Rating Formula for the Skin: 30% - at least 20 percent, but less than 40 percent, of the entire body or at least 20 percent, but less than 40 percent, of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

10% At least one of the following: (1) less than 5% of the entir ...

At least one of the following: (1) less than 5% of the entire body or less than 5% of exposed areas affected, and; (2) no more than topical therapy required during the past 12-month period. This is the entry-level compensable rating for most skin conditions evaluated under the General Rating Formula.

Key Symptoms

  • Small localized patches affecting less than 5% TBSA
  • Condition managed with topical creams, ointments, or lotions only
  • No systemic medications required
  • Mild itching, scaling, or redness in limited areas
  • Condition may be intermittent or persistent but limited in extent

CFR: General Rating Formula for the Skin: 10% - at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. NOTE: The 10% criteria also applies when less than 5% TBSA with only topical therapy needed.

0% No active skin condition present, or condition is entirely i ...

No active skin condition present, or condition is entirely in remission without requiring any ongoing treatment. Note: A 0% rating still establishes service connection, which is important for future claims and secondary conditions.

Key Symptoms

  • Condition completely resolved or in full remission
  • No current treatment required
  • No symptoms at time of evaluation

CFR: Under the General Rating Formula for the Skin, conditions that have resolved or require no treatment are rated 0%. Service connection should still be established.

How to Describe Your Symptoms

Extent and Distribution of Skin Involvement

How to describe:

Describe the specific body areas affected using anatomical terms. Quantify coverage as best you can: 'My psoriasis covers both arms from wrist to shoulder, my entire scalp, my lower back, and behind both knees - probably about 30-40% of my body on a bad day.' Distinguish between your condition on your best day versus your worst day, and explain that the exam may show you on a better day than usual.

Worst-day example:

“On my worst days, my eczema covers my entire forearms, the backs of both hands, my neck, chest, and abdomen. The skin is red, weeping, and cracking - I estimate it covers about 40% of my body. I cannot wear certain clothing, I bleed when I scratch, and I have to sleep with gloves on to prevent scratching open wounds overnight.”

What the examiner listens for:

Specific body regions, percentage estimates of coverage, whether TBSA and EBSA differ significantly, whether involvement is constant or episodic, description of lesion type (plaque, vesicle, crust, scale), and whether special areas like palms, soles, face, genitals, or mucous membranes are affected.

Understatements to avoid:

Do not say 'just a little rash here and there' or 'it comes and goes.' Be specific and quantify. Do not downplay coverage on exam day by saying 'it's not too bad right now' without explaining what it looks like at its worst.

Treatment Burden and Medication Requirements

How to describe:

List every medication you use in sequence: 'I use Triamcinolone cream twice daily on my arms, Clobetasol foam on my scalp nightly, and I take Methotrexate 15mg weekly by mouth. I've been on Dupixent injections every two weeks for the past 18 months because topicals alone didn't control it. Before biologics, I had two courses of oral prednisone last year - one for 3 weeks in February and one for 4 weeks in August.' Be specific about duration, frequency, and what each medication is for.

Worst-day example:

“Despite being on a biologic injection every two weeks and using two different prescription topical steroids daily, I still have flares that require oral prednisone. Last year I needed systemic steroids for about 10 weeks total. My dermatologist recently added a second biologic because the first one stopped working as well.”

What the examiner listens for:

Whether topical-only or systemic treatment is required, duration of systemic therapy in the past 12 months (threshold: 6 weeks for 30%, constant for 60%), types of systemic agents used, whether biologics are ongoing, whether phototherapy has been used, and treatment failures or escalations.

Understatements to avoid:

Do not omit any medication - even OTC antihistamines or moisturizers your doctor recommended. Do not say 'I just use some cream' if you are also on oral medications or injections. Do not fail to mention past treatments you have tried and discontinued due to side effects or inadequate control.

Flare-Up Pattern and Frequency

How to describe:

Describe the pattern of your condition: 'My psoriasis is never fully clear - even on good days I have patches on my elbows and scalp. I have major flares about 4-6 times per year where coverage increases dramatically, usually triggered by stress, infections, or weather changes. Flares last 3-6 weeks and require me to increase my medications. During flares, I miss work and cannot perform physical tasks.' Include triggers, duration of flares, and what remission actually looks like for you.

Worst-day example:

“During a bad flare, my psoriasis covers my entire torso, arms, and legs - the plaques crack and bleed, I cannot bend my elbows or knees without pain, I cannot wear a uniform or work clothes without pain and embarrassment, and I lose sleep every night from itching. These flares happen at least monthly and last 2-4 weeks even with treatment.”

What the examiner listens for:

Whether the condition is truly episodic or chronic, frequency and duration of exacerbations, what triggers flares, whether flares respond to treatment escalation, and whether remission is complete or partial.

Understatements to avoid:

Do not describe only your current state if you are in a relative remission. Explicitly tell the examiner: 'Today is actually a better day than usual. Let me describe what this looks like at its worst.' Do not omit triggers like stress, heat, sweat, or allergen exposures common in military settings.

Functional Impact and Daily Life Limitations

How to describe:

Describe how your skin condition limits what you can do: 'I cannot use my hands for extended tasks because the eczema on my palms cracks and bleeds. I cannot wear gloves required for my job. I avoid social situations because of the visible lesions on my face and neck. I cannot exercise because sweat triggers severe flares. I wake up at night from itching 3-4 times per week and am chronically sleep-deprived. My dermatologist has documented that my condition is affecting my ability to work.'

Worst-day example:

“During a flare I cannot type on a keyboard, cannot grip tools, cannot wear a shirt without pain, and cannot concentrate at work because of constant itching and pain. I have called out sick from work an average of 2 days per month over the past year specifically because of my skin condition. I avoid public settings because strangers stare and make comments about my skin.”

What the examiner listens for:

Work limitations, attendance impacts, activity restrictions, sleep disruption, social withdrawal, limitations in self-care, emotional and psychological impact, and any accommodations required at work or home.

Understatements to avoid:

Do not minimize functional impact. The DBQ specifically asks about impact on work, daily activities, and social functioning. Saying 'it doesn't really bother me that much' when you have significant functional limitations will hurt your rating. Be specific and concrete.

Systemic and Constitutional Symptoms

How to describe:

If you have any systemic symptoms associated with your skin condition, describe them clearly: 'During severe flares I develop a low-grade fever, feel fatigued and unwell for days, and have lost weight. My joints ache when my psoriasis is active. I have noticed my lymph nodes are sometimes swollen during bad flares.' For psoriasis specifically, note any joint involvement (psoriatic arthritis) as this may be separately ratable.

Worst-day example:

“When my eczema covers a large portion of my body, I feel systemically unwell - I run fevers up to 101-F, feel exhausted, have chills, and have been treated in urgent care twice for secondary skin infections requiring antibiotics. My albumin was low on bloodwork during my worst episode.”

What the examiner listens for:

Fever, weight loss, hypoalbuminemia, lymphadenopathy, secondary infections, joint pain (for psoriasis), and whether the skin condition has systemic manifestations that elevate the rating to erythroderma level or support separate secondary claims.

Understatements to avoid:

Do not fail to mention joint symptoms if you have psoriasis - psoriatic arthritis is separately ratable under DC 5009 or similar. Do not omit secondary skin infections that required antibiotics or hospitalization.

Common Mistakes to Avoid

Prep Checklist

0/20 complete

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's recording consent laws before the exam.
  • You have the right to bring a representative, friend, or family member to the examination as a witness.
  • You have the right to receive a copy of your completed DBQ and C&P examination report through your VA claims file (VBMS) or by request.
  • You have the right to submit additional evidence (photographs, private medical records, buddy statements, personal statements) at any time during the claims process, including after the C&P exam.
  • You have the right to request an additional examination if the initial exam is inadequate, incomplete, or does not address all claimed conditions.
  • You have the right to obtain an Independent Medical Examination (IME) or nexus letter from a private physician and submit it as evidence to rebut a VA examiner's opinion.
  • Under M21-1 guidance, the Skin Diseases DBQ must document TBSA and EBSA as separate percentages - if these are missing from the completed DBQ, the exam report may be considered insufficient for rating purposes and you can request a supplemental exam.
  • You have the right to appeal a rating decision through the Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals lanes under the AMA appeals system.
  • For psoriasis (DC 7816), complications such as psoriatic arthritis and nail/oral mucosal manifestations must be rated separately - if not addressed in the exam, you have the right to file separate claims for these secondary conditions.
  • If your condition was not fully visible on exam day, you have the right to submit photographs and written statements documenting your worst-day presentation as evidence.

Get Personalized C&P Exam Preparation

Upload your medical records for AI-powered prep that maps YOUR symptoms to the exact DBQ fields your examiner will evaluate.

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.