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VA Rating Assistant

DC 7819 · 38 CFR 4.118

Benign Skin Neoplasm C&P Exam Prep

To evaluate the nature, location, size, number, and functional or cosmetic impact of benign skin neoplasms for VA disability rating purposes under 38 CFR 4.118, Diagnostic Code 7819. The examiner determines whether the neoplasm is benign or malignant, whether it is primary or secondary/metastatic, its current status (active or in remission), and any residuals or complications resulting from treatment.

Format:
Interview + Physical
Typical duration:
15-30 minutes
DBQ form:
Skin_Diseases (Skin_Diseases)
Examiner:
Dermatologist or appropriate clinician

What the examiner evaluates

  • Specific diagnosis and ICD code for the benign neoplasm (e.g., sebaceous cyst, lipoma, neurofibroma, pilomatrixoma)
  • Whether neoplasm is benign versus malignant and primary versus secondary/metastatic
  • Location, size, number, and distribution of neoplasms across the body
  • Whether neoplasm affects exposed areas (face, neck, hands, arms) versus non-exposed areas
  • Current status: active, in remission, or treatment completed
  • Treatments received: surgery, radiation, chemotherapy, other procedures
  • Surgical scars or residuals from excision
  • Any associated symptoms such as pain, bleeding, ulceration, or limitation of function
  • Impact on activities of daily living, employment, and social functioning
  • Whether the veteran requires ongoing monitoring or follow-up treatment
  • History including onset, course, and any previous resolution of the condition

Exam will include both an interview component covering history and symptoms and a physical examination of the skin. Ensure all affected areas are accessible for inspection. Wear clothing that can be easily adjusted to expose affected areas. The examiner will document lesion characteristics and any scars from prior treatment.

Measurements and tests

Lesion Size Measurement

What it measures: The physical dimensions (length, width, depth/height) of each benign neoplasm in centimeters, which helps establish the burden of disease and impact on function or appearance.

What to expect: The examiner will use a ruler or measuring tape to document the size of each lesion. Multiple lesions may each be measured individually.

Critical thresholds

  • Lesion affecting exposed area (face, neck, hands) Exposure location may increase functional or cosmetic impairment rating consideration
  • Multiple vs. single lesion Number and distribution affects overall disability assessment and may trigger evaluation under analogous codes
  • Post-excision scar present Scars from treatment may be separately rated under DC 7800-7805, potentially increasing overall combined rating

Tips

  • Know the approximate size of each lesion before the exam; review any prior dermatology notes
  • Point out any lesions that are not immediately visible or are in covered areas
  • Mention if lesions have grown larger over time, as this is relevant to current status
  • Report any lesions that were previously removed and the location of resulting scars

Pain considerations: Although benign skin neoplasms are not musculoskeletal conditions, report any pain, tenderness, or pressure discomfort associated with the neoplasm, especially if located over bony prominences or in areas subject to friction or clothing pressure.

Body Surface Area and Location Documentation

What it measures: The percentage of body surface involved and whether affected areas are exposed (cosmetically or functionally significant) versus non-exposed, which influences how the examiner characterizes impairment.

What to expect: The examiner will visually survey all skin surfaces and document which anatomical regions are affected. You may be asked to partially disrobe so the examiner can view all lesions.

Critical thresholds

  • Involvement of face or neck (exposed area) Cosmetic disfigurement may trigger evaluation under DC 7800 (scars, disfigurement) in addition to or instead of DC 7819
  • Involvement of hands or forearms May affect manual dexterity and occupational functioning, supporting higher functional impairment
  • Intertriginous or mucosal involvement Increases complexity and treatment burden; noted specifically on DBQ

Tips

  • Bring a list or diagram showing all known lesion locations
  • Disclose all areas even if you feel they are minor; let the examiner decide their significance
  • Mention areas that become symptomatic with activity, heat, or clothing friction
  • Report any mucosal involvement (mouth, genitalia) as this is specifically documented on the DBQ

Pain considerations: Describe any functional limitations caused by lesion location, such as difficulty gripping objects due to hand lesions, restricted range of motion near joints, or discomfort while sitting due to lesions on buttocks or thighs.

Scar Assessment (Post-Treatment Residuals)

What it measures: The size, character, and functional or cosmetic impact of any scars resulting from excision or other treatment of benign neoplasms. Scars may be independently ratable under DC 7800-7805.

What to expect: The examiner will inspect and measure surgical scars, noting whether they are superficial or deep, whether they are painful or unstable, and whether they cause limitation of motion or disfigurement.

Critical thresholds

  • Painful or unstable scar Qualifies for separate rating under DC 7804 (unstable scars) or DC 7801 (painful scars), potentially 10% or higher
  • Disfiguring scar on face, head, or neck May qualify under DC 7800 for ratings up to 80% depending on disfigurement severity
  • Scar limiting range of motion May warrant separate musculoskeletal rating in addition to skin rating

Tips

  • Specifically report all scars from prior excisions, biopsies, or other dermatological procedures
  • Describe whether scars are tender to touch, itch chronically, break down or ulcerate
  • Note if scars are raised (hypertrophic or keloid) versus flat or depressed
  • Report any limitation of movement caused by scar tissue tethering

Pain considerations: If scars are painful, describe the type of pain (burning, sharp, aching), frequency, and what aggravates it (clothing contact, pressure, temperature changes).

Rating criteria by percentage

0%

Under 38 CFR 4.118, DC 7819, benign skin neoplasms are rated by analogy to the nearest condition in the rating schedule that most closely approximates the symptoms and impairment. A 0% rating is typically assigned when the neoplasm is present but causes no appreciable functional or cosmetic impairment, requires no ongoing treatment, and produces no disabling symptoms. The condition is service-connected but non-compensable.

Key symptoms

  • Asymptomatic or minimally symptomatic benign neoplasm
  • No functional limitation
  • No cosmetic disfigurement requiring treatment
  • No current or recent treatment required
  • Stable lesion with no growth or complications

From 38 CFR: A small, stable sebaceous cyst or lipoma that is asymptomatic and located in a non-exposed, non-functional area. No treatment required. No scars from prior procedures.

10%

Rated by analogy to skin conditions causing at least mild but definite impairment. This level typically applies when the benign neoplasm causes intermittent symptoms (pain, tenderness, bleeding), requires periodic treatment, results in a scar with some cosmetic or functional impact, or is located in a functionally or cosmetically significant area. Analogous to conditions rated 10% under the skin schedule.

Key symptoms

  • Intermittent pain or tenderness at lesion site
  • Occasional bleeding or ulceration
  • Lesion requiring periodic monitoring or treatment
  • Post-excision scar that is mildly symptomatic or cosmetically noticeable
  • Lesion in exposed area causing social or cosmetic concern
  • Lesion causing occasional functional limitation

From 38 CFR: A painful lipoma over the shoulder blade that causes discomfort with certain movements and required one excision leaving a 3 cm scar. A sebaceous cyst on the face that has required incision and drainage twice in the past year.

20%

Rated by analogy when the benign neoplasm or its treatment residuals cause moderate functional or cosmetic impairment. This level may apply when there are multiple lesions, repeated treatments, meaningful scarring, or significant limitation of function. Consider analogous rating to eczema or other skin conditions at 20% under 38 CFR 4.118 if symptoms warrant.

Key symptoms

  • Multiple benign neoplasms requiring ongoing management
  • Frequent recurrence after excision
  • Significant scarring affecting function or appearance
  • Neoplasm causing limitation of joint motion or functional restriction
  • Condition requiring use of prescription medications or repeated procedures
  • Significant cosmetic disfigurement affecting occupational or social functioning

From 38 CFR: Multiple neurofibromas over the torso and extremities requiring repeated monitoring and occasional excision, with several post-surgical scars. A large lipoma compressing a nerve causing paresthesia and functional limitation. Repeated pilomatrixomas requiring multiple surgeries leaving disfiguring scars on the face.

30%

Rated by analogy when the benign neoplasm or its sequelae cause severe or disabling impairment. This level may apply by analogy to conditions such as extensive scarring, disfigurement with systemic or marked functional consequences, or neurofibromatosis with significant neurological or functional involvement. The examiner will document the analogy basis.

Key symptoms

  • Extensive or disfiguring lesions covering significant body surface area
  • Neoplasm causing nerve compression with documented neurological deficits
  • Severe cosmetic disfigurement substantially affecting social and occupational function
  • Condition requiring systemic treatment (immunosuppressives, biologics) for management
  • Chronic pain or functional disability significantly limiting activities of daily living
  • History of malignant transformation requiring active surveillance

From 38 CFR: Extensive neurofibromatosis (Type 1) with numerous cutaneous tumors covering large body surface areas, some causing nerve compression and functional deficits. Giant congenital nevi requiring repeated surgeries with extensive scarring and chronic wound care needs.

Describing your symptoms accurately

Pain and Tenderness

How to describe it: Describe the exact location, quality (sharp, burning, aching, pressure), frequency, and severity of pain on a 0-10 scale. Explain what activities or conditions trigger or worsen the pain and how it affects your daily life. Distinguish between pain at the neoplasm site itself and pain radiating from it (e.g., nerve compression).

Example: On my worst days, the lipoma on my upper back causes a constant burning pressure pain rated 7 out of 10 that prevents me from wearing a backpack, sitting in a standard chair, or sleeping on my back. The pain wakes me up at night and I have to take over-the-counter pain medication, which only partially helps.

Examiner listens for: Specific pain characteristics that support functional impairment, frequency consistent with chronic condition, correlation between lesion location and reported functional limitations, and use of pain management strategies.

Avoid: Do not say 'it bothers me sometimes' or 'it is not that bad.' Instead, provide specific frequency, severity scale ratings, and concrete examples of activities you cannot perform or must modify because of the pain.

Functional Limitation

How to describe it: Describe specific activities you cannot perform or must modify due to the neoplasm. Include work tasks, household activities, recreational activities, and self-care. Be specific about how the location and size of the lesion creates the limitation.

Example: The sebaceous cyst on my neck becomes inflamed and swollen approximately twice a month. During these flare-ups, I cannot turn my head fully to the right, which prevents me from safely driving. The inflammation lasts 3-5 days and requires hot compresses and antibiotics.

Examiner listens for: Concrete functional restrictions tied to the neoplasm's location and characteristics, frequency of limitation, impact on employment or occupational duties, and consistency between reported limitations and objective findings.

Avoid: Avoid minimizing limitations by saying 'I manage fine.' Describe your worst functional days accurately. Do not assume the examiner knows how the lesion's location affects your specific occupation or daily routine - explain it explicitly.

Treatment Burden and Side Effects

How to describe it: Describe all treatments you have received, their frequency, and any side effects or complications. Include surgeries, number of excisions, medications, and how treatment affects your daily life (time off work, recovery periods, medication side effects).

Example: I have had this cyst excised three times in four years and it keeps coming back. Each surgery requires a day off work, two weeks of wound care, and leaves a new scar. The recurring surgeries on my forearm have left a 6-centimeter hypertrophic scar that is constantly itchy, occasionally tears open when I do physical labor, and limits my ability to fully extend my arm.

Examiner listens for: Pattern of recurrence, cumulative treatment burden, complications from treatment (infection, scarring, nerve damage), medication side effects, and how treatment requirements affect occupational and daily functioning.

Avoid: Do not omit treatments you consider minor, such as incision and drainage procedures, cryotherapy, or topical medications. Every treatment is evidence of the condition's ongoing impact and severity.

Cosmetic and Psychosocial Impact

How to describe it: Describe how visible lesions or scars affect your self-confidence, social interactions, employment opportunities, and mental health. Be specific about how the cosmetic impact translates into concrete functional consequences.

Example: The multiple raised neurofibromas on my face and neck cause me significant anxiety in social situations. I have declined job interviews and promotional opportunities that involve client-facing work because of the visible lesions. I avoid social gatherings and have developed depression that I am being treated for, which I believe stems directly from the disfigurement.

Examiner listens for: Specific social or occupational avoidance behaviors, any psychiatric treatment related to the condition, concrete employment consequences, and the extent to which cosmetic impact translates to measurable functional impairment.

Avoid: Do not dismiss cosmetic impact as 'not a real disability.' Cosmetic disfigurement can support higher ratings and may also support secondary claims for anxiety or depression. Describe the real-world consequences of appearance-related concerns.

Recurrence and Active vs. Remission Status

How to describe it: Clearly communicate whether the neoplasm is currently active, growing, or has recurred after treatment. Describe the frequency of recurrence, time between episodes, and how quickly new lesions develop after treatment.

Example: My sebaceous cysts recur approximately every six months at the same location on my back. Even after complete excision, a new cyst forms within six to eight months. I am never truly in remission - I am always in some stage of a new cyst forming, getting infected, requiring treatment, and recovering from that treatment.

Examiner listens for: Pattern of recurrence that establishes the condition as chronic and active rather than resolved, frequency consistent with ongoing disease burden, and evidence that prior treatment has not resulted in permanent resolution.

Avoid: Do not describe your condition as 'cured' or 'treated' if it continues to recur. The examiner needs to understand that treatment has been ongoing and that remission is incomplete or temporary. The DBQ specifically asks about active versus remission status.

Common mistakes to avoid

Describing the condition as 'just a cyst' or minimizing its impact because it is benign

Why: Veterans often believe that because a neoplasm is benign (not cancer), it does not constitute a significant disability. However, benign neoplasms can cause substantial pain, functional limitation, and treatment burden that are fully compensable.

Do this instead: Focus on the functional and symptomatic impact regardless of the benign classification. Describe pain, treatment history, recurrence, and any limitations as thoroughly as you would for any other condition.

Impact: All levels - particularly prevents ratings above 0%

Failing to mention all lesion locations and only discussing the most prominent one

Why: Multiple neoplasms significantly increase the overall disability burden. The DBQ has specific fields for additional neoplasms and the examiner needs a complete picture to accurately assess severity.

Do this instead: Prepare a written list of all known lesions with their locations, approximate sizes, and symptom profiles. Bring this list to the exam and provide it to the examiner.

Impact: 10-30% - multiple lesions may support higher analogous ratings

Not disclosing surgical scars from prior excisions

Why: Post-excision scars can be independently rated under DC 7800-7805 and may result in additional separate ratings. Failing to report them means lost compensation.

Do this instead: Explicitly point out every scar from any dermatological procedure. Describe whether scars are painful, itchy, unstable, raised, or limiting range of motion.

Impact: Separate 10-80% scar rating may be missed entirely

Not reporting the condition is still active or recurrent because you had treatment

Why: The DBQ specifically documents whether the condition is active or in remission. If you frame the condition as resolved because you had surgery, the examiner may document it as in remission, which can result in a lower rating.

Do this instead: If your lesions recur or if you have residual symptoms from treatment, clearly state that the condition is ongoing and active. Describe the recurrence pattern with specific dates if possible.

Impact: Active vs. remission status directly affects rating assignment

Failing to connect the condition to occupational or functional impairment

Why: The DBQ asks specifically about impact on the veteran's skin conditions on daily activities and employment. Without this information, the rater has no basis for assigning a compensable rating based on functional loss.

Do this instead: Explicitly describe how the condition affects your ability to perform your job, complete household tasks, engage in recreational activities, or maintain social relationships. Be specific with examples.

Impact: 10-30% - functional impairment documentation is key to ratings above 0%

Not mentioning associated conditions like anxiety or depression related to cosmetic disfigurement

Why: Benign neoplasms causing visible disfigurement can lead to secondary psychiatric conditions that are separately ratable. Veterans often do not realize these secondary conditions may be connected to their skin condition.

Do this instead: If you have sought or received mental health treatment related to concerns about your skin condition's appearance or impact, disclose this. It may support a secondary claim for anxiety or depression.

Impact: Secondary condition claims at 10-70% may be missed

Not bringing documentation of treatment history to the exam

Why: The examiner relies on documented treatment history to establish the condition's chronic nature, recurrence pattern, and treatment burden. Without records, important history may not be captured in the DBQ.

Do this instead: Bring copies of all relevant medical records, including pathology reports confirming the benign diagnosis, surgical records, follow-up notes, and any specialist evaluations.

Impact: All levels - documentation supports benign vs. malignant classification and recurrence history

Prep checklist

  • critical

    Compile a complete lesion inventory

    Create a written list of every known benign neoplasm: location (use anatomical terms), approximate size, when first noted, whether it has changed over time, and symptoms associated with each. Include lesions that have been removed as well as current lesions.

    before exam

  • critical

    Gather all medical records related to the condition

    Collect pathology reports confirming benign diagnosis, surgical operative notes and pathology from all excisions, dermatology clinic notes, primary care notes documenting the condition, and any imaging (ultrasound, MRI) of neoplasms. Request records from all treating facilities including VA and private providers.

    before exam

  • critical

    Document your treatment timeline

    Create a chronological list of all procedures (excisions, incision and drainage, cryotherapy, laser treatment), dates of treatment, treating facilities, and outcomes including recurrence dates. Note any complications from treatment.

    before exam

  • recommended

    Photograph all current lesions and scars

    Take clear, well-lit photographs of all current neoplasms and post-treatment scars. Include a ruler or common object for scale. Date the photographs. Bring printed copies to the exam as a visual reference for the examiner.

    before exam

  • critical

    Write out a functional impact statement

    Prepare a written description of how the condition affects your daily life, employment, and activities. Include your worst-day descriptions for each significant symptom category: pain, functional limitation, cosmetic impact, and treatment burden. Practice articulating this clearly and specifically.

    before exam

  • critical

    Review the nexus between your military service and the condition

    Be prepared to explain how your benign skin neoplasm is connected to your military service. Know whether your claim is direct service connection (condition began during service), secondary service connection (caused by another service-connected condition), or presumptive (if applicable). Review your service treatment records for any documentation of the condition.

    before exam

  • recommended

    List all current medications and treatments

    Compile a complete medication list including prescription topicals, oral medications, and over-the-counter treatments used for the condition. Note the prescribing provider, dosage, frequency, and how long you have been taking each medication.

    before exam

  • recommended

    Identify all associated conditions or secondary effects

    Consider whether the benign neoplasm or its treatment has contributed to other conditions: psychiatric conditions (anxiety, depression) from disfigurement, nerve damage from excision, scarring limiting range of motion, or chronic pain. These may support additional or secondary claims.

    before exam

  • optional

    Research analogous rating codes

    Under DC 7819, benign skin neoplasms are rated by analogy. Review 38 CFR 4.118 to understand which conditions your neoplasm most closely resembles in terms of symptoms and impact. This knowledge helps you describe your condition in terms aligned with the rating schedule.

    before exam

  • critical

    Wear clothing that provides easy access to all affected areas

    Dress in loose, layered clothing that can be easily adjusted or removed to expose all lesion and scar locations. The examiner needs to visually inspect all affected areas. Wearing restrictive clothing may result in incomplete examination.

    day of

  • critical

    Do not treat or cover lesions before the exam

    Do not apply heavy dressings, bandages, or cosmetic cover-up to lesions or scars before the exam. The examiner needs to see the lesions in their natural state. If a lesion is currently inflamed or active, this is important for the examiner to observe.

    day of

  • critical

    Arrive prepared with your documentation

    Bring your lesion inventory list, treatment timeline, functional impact statement, photographs, and copies of key medical records. Organize them in a folder for easy reference during the exam.

    day of

  • recommended

    Consider your right to record the examination

    In most states, veterans have the right to record their C&P examination. Check your state's laws and VA policy. If permitted, bring a recording device or use your phone. Inform the examiner at the start of the appointment.

    day of

  • critical

    Describe your worst-day symptoms, not your best day

    Per M21-1 guidance, you should describe how the condition affects you on your worst days, not your average or best days. If your condition fluctuates, make sure to communicate both the range of severity and the frequency of your worst episodes.

    day of

  • critical

    Point out every lesion and scar proactively

    Do not wait for the examiner to discover lesions. Proactively identify the location of every neoplasm and every scar. If you have lesions in covered areas (scalp, groin, buttocks), specifically mention them so the examiner can decide whether to examine them.

    during exam

  • critical

    Describe each lesion's symptom profile separately

    For each lesion or group of lesions, describe the associated symptoms independently: Is this one painful? Does this one bleed? Has this one grown? For each scar: Is it tender? Does it limit movement? Is it cosmetically significant?

    during exam

  • critical

    Correct any inaccurate statements by the examiner

    If the examiner states something inaccurate (e.g., 'this appears fully resolved'), politely correct them with accurate information: 'Actually, this area recurred after excision and is currently in the early stages of forming again.' You have the right to ensure your history is accurately captured.

    during exam

  • recommended

    Specifically address impact on employment

    Volunteer information about how the condition affects your work. The DBQ has specific fields for functional impact. Do not assume the examiner will ask. State: 'This condition has affected my ability to work because...' and provide specific examples.

    during exam

  • critical

    Mention all prior and current treatments

    Ensure the examiner documents every treatment you have received, including the number of surgeries, any complications, current medications, and any ongoing monitoring requirements. The treatment burden directly informs the rating.

    during exam

  • critical

    Request a copy of the completed DBQ

    You have the right to obtain a copy of the completed DBQ. Request it through your VA MyHealtheVet account, your VSO, or by submitting a records request. Review it carefully for accuracy.

    after exam

  • recommended

    Document what occurred during the exam

    Immediately after the exam, write detailed notes about what the examiner asked, what you reported, what the examiner observed, and any statements the examiner made about the condition or rating. This documentation is important if you need to appeal.

    after exam

  • critical

    Review the DBQ for errors and submit a supplemental statement if needed

    When you receive the completed DBQ, compare it against your own notes. If the examiner documented your condition inaccurately, omitted significant findings, or failed to address functional impact, submit a written buddy statement or personal statement correcting the record.

    after exam

  • optional

    Consider whether to request an inadequate examination finding

    If the examiner failed to examine all lesions, did not review relevant records, or did not address all elements required by the DBQ, you or your VSO can submit a written request that the examination be deemed inadequate and a new examination ordered.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and complete examination. The examiner must review all relevant records and examine all affected body areas, not just the most prominent lesion.
  • You have the right to be examined by a qualified clinician competent in dermatology. If assigned to an unqualified examiner, you may request a dermatologist or appropriately qualified specialist.
  • In most states and under current VA policy, you have the right to record your C&P examination. Check your state's recording consent laws and notify the examiner before beginning.
  • You have the right to review and obtain a copy of the completed DBQ. Request it through MyHealtheVet, your VSO, or a formal records request.
  • You have the right to submit a written personal statement or buddy statements to supplement the exam record. These can correct inaccuracies or add context the examiner did not capture.
  • You have the right to challenge an inadequate examination. If the exam was not thorough, did not address all conditions, or did not review relevant evidence, you can request a new examination.
  • You have the right to have a VSO, accredited claims agent, or attorney assist you in preparing for the exam. Bring your representative's contact information and consider having them present if permitted.
  • Under the PACT Act and 38 CFR provisions, you have the right to benefit of the doubt when evidence is in approximate balance. If the evidence equally supports and denies your claim, VA must decide in your favor.
  • You have the right to have all relevant service treatment records, VA medical records, and private medical records reviewed before the examiner renders an opinion. Ensure you have submitted all records to VA prior to the exam.
  • You have the right to appeal any examination finding or rating decision. If the C&P exam was inadequate or the rating was incorrect, you can file a Supplemental Claim, request a Higher-Level Review, or appeal to the Board of Veterans' Appeals.

Related conditions

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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.