Eczema VA Rating: Dermatitis and DC 7806 Criteria

Eczema and dermatitis rating table (DC 7806)

The table below lists every rating percentage and criterion for Diagnostic Code 7806 under the General Rating Formula for the Skin in 38 CFR 4.118, plus the predominant disability instruction and DC 7817 for generalized exfoliative dermatitis (erythroderma).

Under the veteran-alone compensation schedule effective 2025-12-01, 10% pays $180.42 per month, 30% pays $552.47, and 60% pays $1,435.02.

What changed in the August 13, 2018 skin rating revision

Effective August 13, 2018 (83 FR 32592, published July 13, 2018; technical correction at 83 FR 38663), the VA revised 38 CFR 4.118 in five ways affecting DC 7806:

1. Unified the General Rating Formula for the Skin: Consolidated DC 7806 with DCs 7809, 7813–7816, 7820–7822, and 7824 under one formula.
2. Codified systemic vs. topical therapy in 38 CFR 4.118(a): Following Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017)—which reversed a 2016 CAVC ruling on topical steroid creams—the VA added 38 CFR 4.118(a) defining systemic therapy as treatment administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy as treatment administered through the skin.
3. Expanded qualifying systemic therapies: Explicitly added biologics, retinoids, phototherapy, photochemotherapy, and PUVA alongside corticosteroids and other immunosuppressive drugs.
4. Added “Characteristic lesions involving…” to each tier: Clarified that surface-area evaluations require visible characteristic lesions rather than lesion-free itching.
5. Codified the coexistent skin rule in 38 CFR 4.118(b): Two or more skin conditions combine under 38 CFR 4.25 only if separate areas of skin are involved; otherwise only the highest evaluation applies.

How the VA measures body surface area and exposed areas

The first pathway to a 10%, 30%, or 60% rating under DC 7806 is the percentage of skin covered by characteristic lesions, including erythema (redness), papules, vesicles (blisters), oozing, crusting, scaling, excoriation (raw skin from scratching), fissuring (deep cracks), and lichenification (thickened, leathery skin).

Examiners estimate the percentage of the entire body affected using two clinical methods:

• The Rule of Nines: Divides adult body surface area into multiples of 9%: head and neck (9%), each upper extremity (9% each, or 18% total), anterior trunk (18%), posterior trunk (18%), each lower extremity (18% each, or 36% total), and perineum/genitalia (1%).
• The Palmar Method: For scattered plaques of nummular, atopic, or contact dermatitis, the veteran’s palm (including fingers) represents roughly 1% of total body surface area. Five palm-sized patches of active eczema equal about 5% of total body surface area, crossing the threshold for a 10% rating.

The General Rating Formula gives equal weight to the percentage of exposed areas affected (<5% for 0%, 5% to <20% for 10%, 20% to 40% for 30%, and >40% for 60%). On Section 4A of the Skin Diseases Disability Benefits Questionnaire (DBQ), the VA defines exposed body area as the face, neck, and hands. Because those regions represent under 15% of total body surface area, dyshidrotic hand eczema or contact dermatitis covering half of both hands may represent only 2% of the entire body (0% on a whole-body basis) but 20% to 40% of exposed areas, warranting a 30% rating.

Systemic therapy vs. topical therapy under 38 CFR 4.118(a)

The second pathway to a compensable eczema rating—and the primary route to 30% or 60% when medication suppresses visible lesions—is the duration of qualifying treatment over the past 12-month period.

Under 38 CFR 4.118(a) and the General Rating Formula for the Skin, qualifying systemic therapies include:

• Oral or injectable corticosteroids: Oral prednisone or methylprednisolone tapers and intramuscular steroid injections (such as triamcinolone acetonide / Kenalog).
• Injectable biologics: Subcutaneous biologics for atopic dermatitis, such as dupilumab (Dupixent) or tralokinumab (Adbry).
• Oral immunosuppressants and systemic JAK inhibitors: Oral cyclosporine, methotrexate, azathioprine, mycophenolate mofetil, upadacitinib (Rinvoq), or abrocitinib (Cibinqo).
• Oral retinoids: Systemic vitamin A derivatives such as alitretinoin or acitretin.
• Clinical phototherapy and photochemotherapy: In-office UVB phototherapy, photochemotherapy, and PUVA.

Adjudicators sum the cumulative duration of systemic therapy required over the past 12 months:

• Less than 6 weeks total (10% rating): One or two short oral steroid tapers or a single steroid injection over the past year warrants 10%.
• 6 weeks or more, but not constantly (30% rating): Cumulative oral steroid courses totaling 42+ days, a multi-month UVB phototherapy regimen, or several months of oral immunosuppressants over the past year warrants 30%.
• Constant or near-constant systemic therapy (60% rating): Year-round maintenance biologic injections (such as Dupixent every two weeks), continuous daily oral immunosuppressants or JAK inhibitors, or ongoing year-round phototherapy over the past 12 months warrants 60%, even if visible lesions stay below 5%.

Under 38 CFR 4.118(a), any treatment applied directly to the skin—including topical corticosteroids (clobetasol, betamethasone, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus), and topical PDE4/JAK inhibitors (crisaborole, ruxolitinib cream)—is topical therapy and does not count toward systemic therapy duration. Similarly, unlike DC 7825 (chronic urticaria) and DC 7827 (erythema multiforme), where 38 CFR 4.118 explicitly lists antihistamines, DC 7806 requires corticosteroids, immunosuppressants, biologics, retinoids, phototherapy, or comparable systemic immunosuppressive treatments rather than oral antihistamines alone.

Alternative ratings: disfigurement (DC 7800), scars (DC 7804), and erythroderma (DC 7817)

The General Rating Formula instructs raters to evaluate DC 7806 as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805) when those residuals represent the predominant disability:

• Head, face, or neck disfigurement (DC 7800): Under Note (1) to DC 7800, hypo- or hyper-pigmentation exceeding 6 sq. in. (39 sq. cm.), abnormal skin texture (irregular, atrophic, shiny, scaly) exceeding 6 sq. in., or indurated, inflexible skin exceeding 6 sq. in. on the head, face, or neck each count as a characteristic of disfigurement (1 = 10%, 2–3 = 30%, 4–5 = 50%, 6+ = 80%). See our VA rating for scars guide.
• Unstable or painful scars (DC 7804): Chronic scratching or deep hand/foot fissures leaving painful scars or unstable skin (frequent loss of skin covering) are rated at 10% (1–2 scars), 20% (3–4), or 30% (5+), plus 10% under Note (2) if both unstable and painful.
• Erythroderma / exfoliative dermatitis (DC 7817): Generalized exfoliative skin involvement is rated under DC 7817 at up to 100% with systemic manifestations (fever, weight loss, or hypoproteinemia) and constant/near-constant systemic therapy or documented failure of two or more treatment regimens.

Service connection and secondary conditions (38 CFR 3.303, 3.310, and 3.317)

Veterans establish service connection for eczema or dermatitis through three pathways:

1. Direct service connection (38 CFR 3.303): Requires a current diagnosis, evidence of in-service skin symptoms or exposure (such as contact with JP-8 jet fuel, hydraulic fluids, solvents, permethrin-treated uniforms, chemical-protective gear, or field hygiene extremes), and a medical nexus. Under 38 CFR 3.303(b), lay evidence of continuous recurring rashes since service can support chronicity.
2. Gulf War undiagnosed skin signs or symptoms (38 CFR 3.317): Under 38 CFR 3.317(b)(2), Southwest Asia theater veterans with chronic unexplained “signs or symptoms involving skin” lasting 6 months or more may qualify for presumptive service connection.
3. Secondary service connection (38 CFR 3.310): Eczema may be claimed secondary to another service-connected condition—such as stasis dermatitis from chronic venous insufficiency, contact dermatitis from a prosthetic limb or brace, or dermatitis permanently aggravated beyond its natural progression (38 CFR 3.310(b)) by service-connected PTSD or depression with a medical nexus.

Conversely, service-connected eczema may support secondary claims under 38 CFR 3.310(a) when supported by a medical nexus:

• Secondary skin infections (DC 7820 / DC 7813): Compromised skin barriers and scratching may cause recurrent cellulitis, impetigo, or fungal infections (combinable under § 4.118(b) only on separate skin areas).
• Scarring and disfigurement (DCs 7800–7805): Permanent scars or pigmentary changes.
• Mental health conditions (38 CFR 4.130): Secondary depression, anxiety, or sleep impairment from nocturnal itching and visible lesions.
• Steroid side effects or associated atopic conditions: Prolonged systemic steroid therapy may cause or aggravate secondary hypertension, diabetes, or cataracts, and a specialist can assess whether co-occurring atopic conditions such as asthma are medically linked.

What to expect at a C&P exam (Skin Diseases DBQ)

During a VA C&P exam, the clinician completes the Skin Diseases Disability Benefits Questionnaire (DBQ):

• Sections 1 & 2 (Diagnosis and History): Records the dermatitis/eczema diagnosis, ICD code, onset, course, and whether the condition is resolved.
• Sections 3A & 3B (12-Month Treatment Log): Lists medications (corticosteroids/immunosuppressives, antihistamines, retinoids, biologics) and light therapies (UVB phototherapy, PUVA) used in the past 12 months, the route of administration (topical vs. systemic), and total 12-month duration (<6 weeks, 6 weeks or more, but not constant, or Constant/near-constant).
• Sections 4A & 4B (Visible Characteristic Lesions and Body Area): Identifies visible lesions (erythema, scaling, vesicles, crusting, excoriation, fissuring, lichenification) and checks the percentage tier (None, <5%, 5% to <20%, 20% to 40%, or >40%) for Total Body Area and Total Exposed Body Area (face, neck, and hands).
• Sections 7, 8, & 9 (Scars and Functional Impact): Notes scarring (triggering a Scars/Disfigurement DBQ) and occupational limitations.

Bring a 12-month pharmacy log documenting every systemic steroid taper, injection, biologic, or phototherapy course, along with dated, unretouched color photos of active flare-ups.

Combined ratings, the § 4.118(b) rule, and accredited help

Approved eczema ratings combine with your other service-connected disabilities under 38 CFR 4.25, which you can calculate with our VA combined rating calculator. Under 38 CFR 4.118(b), two or more skin ratings combine only if they affect separate areas of skin; otherwise only the highest rating applies. A standalone DC 7806 rating does not receive the 10% bilateral factor under 38 CFR 4.26, though separate zone-based scar or functional ratings under DCs 7801, 7802, or 7805 on paired extremities do qualify.

If your claim was denied or underrated, Veterans Service Organizations (VSOs) such as the DAV, VFW, and American Legion provide free assistance, and VA-accredited claims agents or attorneys handle appeals. No representative can guarantee an outcome; verify accreditation through the VA Office of General Counsel Accreditation Search.