Veterans with eczema often accept a low rating because the exam happened on a clear skin day. DC 7806 is written in the alternative: the percentage of body affected or the weeks of systemic therapy over the past 12 months, whichever is higher, controls. A veteran with modest visible involvement but months of oral steroids can outrank the clear day exam on the treatment measure alone.
How VA rates eczema and dermatitis
Eczema (atopic dermatitis) and similar skin conditions are rated under diagnostic code 7806 in the skin schedule (38 CFR 4.118). The rating looks at two measures: how much of the body is affected, and what kind of treatment the condition requires over the year.
The percentage levels
- 0 percent: less than 5 percent of the entire body or of exposed areas affected, and no more than topical therapy in the past 12 months.
- 10 percent: 5 to 20 percent of the body or of exposed areas, or intermittent systemic therapy (such as corticosteroids or immunosuppressive drugs) for a total of less than six weeks in the past 12 months.
- 30 percent: 20 to 40 percent of the body or of exposed areas, or systemic therapy for a total of six weeks or more, but not constantly, over the past 12 months.
- 60 percent: more than 40 percent of the body or of exposed areas, or constant or near constant systemic therapy over the past 12 months.
Body surface area or systemic therapy, whichever is higher
Like several codes, 7806 is written in the alternative: you can qualify by the percentage of body affected or by the amount of systemic therapy, and the higher result controls. A veteran with limited visible involvement who needs months of oral steroids or an immunosuppressant can rate higher on the treatment measure than on the area measure.
What counts as systemic therapy
This has been heavily litigated. Systemic therapy means treatment that acts on the whole body, classically oral or injected corticosteroids and immunosuppressive drugs. Whether certain widely applied topical corticosteroids can count has been the subject of Federal Circuit decisions, so the safest record clearly documents any oral or injected systemic treatment and how many weeks it was used. The duration of systemic therapy is what sets the 10, 30, and 60 percent levels apart.
Flares and timing matter
Skin conditions wax and wane, and an exam on a clear day can understate them. The criteria look back over the past 12 months, so photographs during flares, the treatment record, and the prescription history all help capture the true extent rather than a single calm snapshot.
The nuances most veterans miss
- 7806 uses the higher of body surface area or systemic therapy, so the treatment record can outrank a clear-day exam.
- The weeks of systemic therapy set the level, so document all courses of systemic treatment, including oral or injected corticosteroids, immunosuppressive drugs, and any other whole-body therapy, along with their duration.
- What counts as systemic therapy has been litigated, so make sure all systemic treatment is clearly recorded, including the route of administration, since the regulatory language uses "such as" and does not limit qualifying therapy to any single delivery method.
- The criteria look back 12 months, which is why flare photos and the full year of records matter.
- Scars or disfigurement from the condition can be separately rated under their own skin codes.