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VA Rating Assistant

DC 7803 · 38 CFR 4.118

Scars (Burn / Disfigurement / Painful) C&P Exam Prep

To document the nature, location, dimensions, characteristics, and functional impact of all service-connected scars and disfigurement for accurate disability rating under 38 CFR 4.118. The examiner will assess each scar individually and collectively to determine applicable diagnostic codes and rating percentages.

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

What the examiner evaluates

  • Location of every scar (head/face/neck vs. trunk/extremities) and precise anatomical site
  • Scar type: burn scar, linear scar, superficial non-linear scar, deep non-linear scar
  • Scar dimensions: length and width in centimeters at widest point
  • Total area of scarring per body region in square centimeters
  • Painful or unstable characteristics of each scar
  • Characteristics of disfigurement: surface contour (elevated or depressed on palpation), abnormal texture, hypopigmentation, hyperpigmentation, induration and inflexibility, adherence to underlying tissue, underlying soft tissue missing
  • Features of the head, face, or neck involved: nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips
  • Gross distortion or asymmetry of facial features
  • Tissue loss or distortion affecting eyes, eyelids, or auricles
  • Complete loss of auricle or deformity with loss of one-third or more of the substance
  • Burn scar details: head/face/neck burn scars and trunk/extremity burn scars documented separately
  • Whether scars are associated with underlying soft tissue damage
  • Impact on occupational functioning and daily activities
  • History including cause, origin, and course of all scars
  • Whether veteran is regularly seen at a clinic for the condition

The exam is primarily a physical inspection combined with a structured interview. The examiner will visually inspect and physically palpate all scars. Bring a written list of every scar with precise locations, dimensions (if known), and symptoms so no scar is overlooked. The exam may be conducted by a physician, nurse practitioner, or physician assistant. You have the right to request that the exam be recorded in most states.

Measurements and tests

Scar Dimensions (Length x Width)

What it measures: The examiner measures each scar's length and width at the widest point in centimeters to determine total area and applicable rating thresholds.

What to expect: The examiner will use a measuring tool (ruler or tape measure) and physically measure each scar. They will record dimensions for up to five or more individual scars on the DBQ, with additional scars listed in the 'additional scars' fields.

Critical thresholds

  • 144 sq. in. (929 sq. cm.) or greater total area 10% under DC 7802 for non-head/face/neck scars without underlying soft tissue damage
  • 39 sq. cm. or greater per scar Triggers deeper review for painful/unstable classification and possible higher evaluation
  • Less than 39 sq. cm. Non-scar DBQ may be sufficient if scar is not painful/unstable; ensure Scars DBQ is used for accurate documentation

Tips

  • Measure or estimate your scars at home before the exam and write down the dimensions to verify accuracy during the exam.
  • If scars vary in size depending on activity, temperature, or inflammation, note your typical range.
  • Ensure the examiner measures EVERY scar, not just the largest or most visible one.
  • If you have overlapping or adjoining scars, ask the examiner whether they are being counted together or separately, as total area matters.
  • Bring a body diagram marked with all scar locations to ensure completeness.

Pain considerations: If a scar is painful during measurement or palpation, immediately and clearly inform the examiner. Pain on palpation is a critical rating factor and directly supports a painful scar finding under DC 7804.

Palpation for Surface Contour and Characteristics

What it measures: Physical palpation determines whether scars are elevated, depressed, adherent to underlying tissue, indurated, inflexible, or associated with missing underlying soft tissue - all of which are formal 'characteristics of disfigurement' that affect the rating percentage.

What to expect: The examiner will press on and around each scar with their fingers to assess texture, mobility, elevation/depression, and flexibility. They will check for adherence to deeper structures and note abnormal texture, pigmentation changes, and induration.

Critical thresholds

  • 6 or more characteristics of disfigurement 80% under DC 7800 (head/face/neck)
  • 4-5 characteristics of disfigurement 50% under DC 7800 (head/face/neck)
  • 2-3 characteristics of disfigurement 30% under DC 7800 (head/face/neck)
  • 1 characteristic of disfigurement 10% under DC 7800 (head/face/neck)

Tips

  • Know and name the seven characteristics of disfigurement: (1) surface contour elevated on palpation, (2) surface contour depressed on palpation, (3) abnormal texture, (4) hypopigmentation, (5) hyperpigmentation, (6) induration and inflexibility, (7) underlying soft tissue missing.
  • Multiple scars can combine their characteristics to meet a higher rating threshold - characteristics do not need to come from a single scar.
  • Tell the examiner if the scar feels tight, rigid, or restricts your movement.
  • Point out any color changes (lighter or darker than surrounding skin) - these are formal characteristics.
  • If the scar has been surgically revised or treated, explain what it looked like before treatment and its current state.

Pain considerations: If palpation causes pain, burning, tenderness, or electric shock-like sensations, verbalize this clearly and describe the pain's quality, intensity (0-10 scale), radiation, and duration after stimulation ceases.

Facial Feature Distortion Assessment

What it measures: For head, face, and neck scars, the examiner assesses gross distortion or asymmetry of named features: nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, and lips. Number of features affected drives the rating percentage.

What to expect: The examiner will visually inspect your face from multiple angles and compare symmetry between left and right sides. They will specifically document each named feature affected and characterize the nature of the distortion.

Critical thresholds

  • 3 or more features/paired sets grossly distorted plus visible/palpable tissue loss 80% under DC 7800
  • 2 features/paired sets grossly distorted plus visible/palpable tissue loss 50% under DC 7800
  • 1 feature/paired set grossly distorted plus visible/palpable tissue loss 30% under DC 7800
  • Complete loss of auricle Rated separately per ear; can contribute to overall disfigurement rating
  • Deformity of auricle with loss of one-third or more of substance Rated separately; contributes to feature count

Tips

  • Take clear photographs of your face from front, both sides, and at angles that show the distortion most clearly. Bring printed photos to the exam.
  • If your disfigurement is worse in certain lighting conditions, consider bringing photos taken in that lighting.
  • Note any functional effects: does eyelid distortion affect vision? Does lip/cheek distortion affect eating or speaking?
  • Ask friends or family to describe how your facial appearance has changed - their observations can support your claim.
  • Paired sets of features (e.g., both eyes, both ears, both cheeks) count as one feature or paired set for rating purposes.

Pain considerations: Note whether facial movements (smiling, chewing, opening mouth wide) cause pain or are restricted due to scar tightness or induration.

Rating criteria by percentage

80%

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 3 or more features or paired sets of features (nose, chin, forehead, eyes including eyelids, ears/auricles, cheeks, lips), OR (b) six or more characteristics of disfigurement. Characteristics may be from multiple scars combined.

Key symptoms

  • Visible tissue loss across multiple facial regions
  • Gross asymmetry or distortion of 3+ named facial features
  • Six or more disfigurement characteristics present (elevated, depressed, abnormal texture, hypopigmentation, hyperpigmentation, induration/inflexibility, missing underlying soft tissue)
  • Severe disfigurement visible from normal social distances
  • Significant restriction of facial movement due to scar contracture

From 38 CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of three or more features or paired sets of features, or six or more characteristics of disfigurement. Per Note (5): characteristics may be caused by one or multiple scars combined.

50%

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 2 features or paired sets of features, OR (b) four or five characteristics of disfigurement. Characteristics may come from multiple scars combined.

Key symptoms

  • Visible tissue loss affecting two named facial features or paired feature sets
  • Four or five disfigurement characteristics present across one or more scars
  • Noticeable asymmetry requiring second glances from others
  • Moderate restriction of facial movement
  • Disfigurement affecting two distinct facial zones

From 38 CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of two features or paired sets of features, or four or five characteristics of disfigurement.

30%

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND either (a) gross distortion or asymmetry of 1 feature or paired set of features, OR (b) two or three characteristics of disfigurement.

Key symptoms

  • Tissue loss visible or palpable in one named facial feature area
  • Two or three disfigurement characteristics present
  • Asymmetry noticeable upon close inspection
  • Single feature distorted (e.g., nose, chin, forehead, one eye area, one ear, cheek, or lip)

From 38 CFR: Per 38 CFR 4.118 DC 7800: visible or palpable tissue loss with gross distortion or asymmetry of one feature or paired set of features, or two or three characteristics of disfigurement.

10%

Burn scar(s) or disfigurement of head, face, or neck with visible or palpable tissue loss AND gross distortion or asymmetry of one feature or one characteristic of disfigurement. Also applies to non-head/face/neck scars without underlying soft tissue damage totaling 144 sq. in. (929 sq. cm.) or greater (DC 7802). Painful or unstable scars regardless of location are rated at minimum 10% under DC 7804.

Key symptoms

  • Minimal but documented facial tissue loss with one disfigurement characteristic
  • Total non-head body scar area of 929 sq. cm. or greater without soft tissue involvement
  • Any painful scar - pain upon direct pressure, spontaneous pain, or burning
  • Any unstable scar with frequent loss of skin covering
  • Scar that is consistently tender to palpation

From 38 CFR: DC 7800: one characteristic of disfigurement. DC 7802: area of 144 sq. in. or greater for scars without underlying soft tissue damage. DC 7804: painful or unstable scars rated at 10% regardless of location.

Describing your symptoms accurately

Pain Characteristics

How to describe it: Describe the quality (burning, stabbing, aching, electric, throbbing), intensity on a 0-10 scale, frequency (constant vs. intermittent), duration, triggers (pressure, clothing contact, temperature changes, activity), and what worsens or relieves the pain. State clearly whether the scar hurts when touched, when clothing rubs it, spontaneously at rest, or only during specific activities.

Example: On my worst days, the burn scar on my forearm feels like it is on fire constantly. Any clothing that touches it feels like sandpaper, and even a light brush from my sleeve sends a sharp, electric pain shooting up my arm. At night the burning keeps me awake for hours. I rate the pain 8 out of 10 on bad days.

Examiner listens for: Documentation of pain on direct pressure (required for DC 7804 painful scar rating), spontaneous pain, pain triggered by activity, and descriptors that support neuropathic or scar-tissue pain patterns. The examiner needs to check boxes for painful scars and describe which specific scars are painful.

Avoid: Do not say 'it bothers me a little' or 'I manage it okay.' Accurately describe your worst pain experience. Do not minimize by saying 'it only hurts sometimes' without specifying that 'sometimes' means daily or multiple times per week.

Scar Instability and Skin Loss

How to describe it: Describe how often the scar breaks down, blisters, opens, weeps, or loses the surface layer of skin. Note whether this happens spontaneously, with minor trauma, or with activity. State how long each episode lasts and how frequently it occurs per month or year.

Example: At least three or four times a month, my scar on my lower leg develops a blister that breaks open and weeps fluid for several days. The skin is so fragile there that even gently pulling on a sock can tear the surface. Last month it opened twice and I had to keep it bandaged for a week each time.

Examiner listens for: Frequency of skin breakdown, whether episodes are truly 'unstable' (defined as loss of covering of skin over the scar), medical treatment sought for episodes, and interference with daily activity. This directly supports DC 7804 or DC 7801 (unstable scar) ratings.

Avoid: Do not omit skin breakdown episodes because they healed quickly. An unstable scar is defined by frequent loss of skin covering, not by whether you needed a hospital visit.

Disfigurement Characteristics and Appearance

How to describe it: Describe each visible and palpable characteristic: whether the scar is raised above the surrounding skin, sunken below it, feels hard and inflexible, has unusual texture (rope-like, bumpy, smooth when it should not be), is lighter or darker than surrounding skin, feels stuck to the underlying muscle or bone, or has areas where the fat or tissue beneath the skin is clearly missing.

Example: The burn scar on my cheek is noticeably raised and firm - I cannot pinch it or move it independently because it is adhered to the tissue underneath. It is significantly darker than the rest of my face and has a rough, bumpy texture. When I open my mouth wide, the scar pulls and distorts the corner of my lip upward. People often ask what happened to my face.

Examiner listens for: Specific named characteristics of disfigurement that appear on the DBQ checklist: surface contour elevated, surface contour depressed, abnormal texture, hypopigmentation, hyperpigmentation, induration and inflexibility, underlying soft tissue missing, adherence to underlying tissue. Each confirmed characteristic contributes to the rating tier.

Avoid: Do not simply say 'it looks different.' Name what is different: the color, the texture, whether it is raised or sunken, whether it moves when you press it, whether the underlying tissue feels normal. The examiner needs specific observable findings to check the correct boxes.

Facial Feature Distortion

How to describe it: For head, face, or neck scars, specifically name which facial feature is distorted: nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, or lips. Describe the nature of the distortion: pulled to one side, flattened, missing a portion, asymmetric compared to the other side. Describe how it affects function (vision, hearing, eating, speaking) and social interaction.

Example: The scarring around my left eye has pulled my lower eyelid downward so it no longer closes fully. At night I must use eye drops and tape my eye partially shut. When I look in a mirror, my left eye sits noticeably lower than my right. In stores or at work, people stare and sometimes ask what happened, which causes significant emotional distress.

Examiner listens for: Identification of specific named facial features that are grossly distorted or asymmetric, whether the distortion is accompanied by visible or palpable tissue loss, how many distinct features are affected, and functional consequences. Each affected feature or paired set of features advances the rating tier for DC 7800.

Avoid: Do not describe facial distortion only in passing or as 'a little uneven.' Gross distortion is a legal term under 38 CFR - describe the full extent of misalignment, asymmetry, or structural change, and how noticeable it is to others at a normal conversational distance.

Functional and Occupational Impact

How to describe it: Describe how the scars limit your ability to work, perform daily activities, engage socially, wear certain clothing, exercise, or participate in recreational activities. Include psychological impact (avoidance of social situations, embarrassment, depression, PTSD triggers related to the appearance or pain of scars).

Example: Because of the extensive burn scarring on my arms and neck, I cannot wear short sleeves in public without strangers making comments or staring. I have declined promotions that require client-facing meetings. I avoid swimming, the gym, and family events. The pain in my scars after prolonged activity means I cannot work a full 8-hour shift without needing to rest and elevate my arm.

Examiner listens for: Occupational impairment, social avoidance, need for accommodations, limitations on physical activity, psychological sequelae from disfigurement, and any treatment (compression garments, desensitization therapy, topical medications) that documents ongoing management of the condition.

Avoid: Do not say 'I get by.' Accurately describe what you cannot do or what you sacrifice to manage the condition. The DBQ specifically asks about impact on the veteran's daily life and occupational functioning - this section directly influences the examiner's narrative.

History of Cause and Origin

How to describe it: Clearly state where, when, and how the scar was caused in relation to military service. Describe the original injury (burn, shrapnel, blast, surgical incision, blast overpressure, chemical exposure, etc.), treatment received in service, and the course from injury to present. Connect each scar to a specific in-service event or treatment if possible.

Example: On [date/location], I sustained second and third degree burns to my forearm and neck during a vehicle fire in [country]. I was treated at [military hospital], underwent skin grafting, and was medically evacuated. My service treatment records from [year] document the burn injury and subsequent surgeries. The scars have been present continuously since service.

Examiner listens for: A coherent, consistent history that connects the scar to service - this feeds the nexus analysis in the DBQ. The examiner documents the history in the narrative fields and may note whether the claimed etiology is consistent with the physical findings.

Avoid: Do not be vague about the cause. Even if records are incomplete, provide the most accurate description you can. If you have buddy statements or photographs from service, reference them. Do not allow the examiner to skip this section or record only 'as per records.'

Common mistakes to avoid

Not disclosing every scar - only mentioning the most prominent one

Why: Rating is based on the total number of scars, their combined area, and the combined characteristics across all scars. A veteran with five small painful scars may rate higher than one with a single large non-painful scar.

Do this instead: Create a written list of every service-connected scar before the exam, noting its location, approximate size, and symptoms. Hand the list to the examiner and ask that each scar be documented on the DBQ. Bring a body diagram with all scars marked.

Impact: All levels - omitting scars can prevent reaching the area thresholds or characteristic counts needed for higher ratings

Saying the scar 'doesn't hurt that much' or 'only hurts when pressed hard'

Why: DC 7804 requires pain on direct pressure - pain that only occurs when pressed hard is still qualifying. Minimizing pain language can cause the examiner not to check the 'painful scar' box.

Do this instead: Accurately state: 'When the examiner presses directly on this scar, it is painful. It also hurts when clothing rubs it, when the temperature changes, and during activity.' Describe your worst typical experience, not your best day.

Impact: 10% minimum for painful/unstable scars under DC 7804

Not pointing out skin breakdown episodes to the examiner

Why: Unstable scars - defined by frequent loss of covering of skin - qualify for separate rating under DC 7801. If the examiner does not ask and you do not mention it, this characteristic will not be documented.

Do this instead: Proactively tell the examiner: 'This scar breaks down [X] times per month/year. The skin opens up and requires dressing changes.' Bring photos of the scar during breakdown episodes if you have them.

Impact: DC 7801 (unstable scars) - rated separately from painful scars

Failing to describe functional limitations caused by facial disfigurement

Why: The DBQ has a specific section asking about functional impact of scars on daily activities and occupational functioning. If you report only the cosmetic appearance and not functional consequences, the examiner may underestimate the severity.

Do this instead: Prepare specific examples of how disfigurement limits work, social interaction, or daily function. Include psychological impact such as social avoidance, depression, or PTSD symptoms triggered by appearance-related events.

Impact: DC 7800 50-80% range where functional impairment supports the highest credible rating

Describing scars only generally without specifying which facial features are affected

Why: For DC 7800, the rating percentage is determined by HOW MANY named features (nose, chin, forehead, eyes, ears, cheeks, lips) are distorted. If you say 'my whole face looks different' the examiner may not check individual feature boxes.

Do this instead: Name each distorted feature explicitly: 'My left ear is partially missing. My nose has been flattened and is asymmetric. My left cheek has visible tissue loss and is sunken.' Force the examiner to assess and document each named feature individually.

Impact: DC 7800 30-80% - each additional feature moves the rating up one tier

Not mentioning that scars on different body areas should each be rated separately

Why: Burn scars of the head/face/neck are rated under DC 7800. Burn scars of the trunk and extremities that are associated with underlying soft tissue damage are rated under DC 7801. Without soft tissue damage, trunk/extremity scars are rated under DC 7802. Painful scars anywhere are rated under DC 7804. All may be rated simultaneously.

Do this instead: Tell the examiner you have scars in multiple body regions and ask that each region be documented separately. Ensure the examiner completes the burn scar sections for both head/face/neck AND trunk/extremities if applicable.

Impact: Combined rating - veterans may receive separate ratings for DC 7800 and DC 7801/7802/7804 simultaneously

Wearing long sleeves, makeup, compression garments, or bandages that conceal scars during the exam

Why: The examiner needs to visually inspect and physically palpate all scars. Concealed scars may not be documented, and their characteristics cannot be assessed.

Do this instead: Arrive dressed to allow full exposure of all scar areas. If you use compression garments therapeutically, tell the examiner what lies beneath and remove the garment for inspection. Note that photographs in the file can supplement the examiner's observations.

Impact: All levels - undocumented scars receive no rating

Prep checklist

  • critical

    Create a comprehensive scar inventory

    Write down every service-connected scar: its precise anatomical location (e.g., 'anterior left forearm, 4 cm proximal to wrist'), approximate dimensions, scar type (burn, surgical, traumatic), whether it is painful, whether it breaks down, and any characteristics you have noticed (raised, sunken, color change, hard, stuck to underlying tissue). This list ensures no scar is missed during a brief 15-30 minute exam.

    before exam

  • critical

    Gather and organize all medical records related to your scars

    Collect service treatment records documenting the original injury, surgical reports for any scar revision or skin grafting, VA treatment records, private dermatology records, photographs taken at the time of injury and throughout treatment, and any buddy statements from witnesses to the original injury. Organize chronologically and bring copies to leave with the examiner if requested.

    before exam

  • critical

    Photograph all scars in multiple conditions

    Take clear, well-lit photographs of every scar from multiple angles before the exam. Include photos showing: the scar at rest, the scar being stretched or manipulated, any color changes, and if applicable, the scar during a breakdown episode (open/weeping). Per M21-1, photographs may be used for rating consideration. Bring printed copies to the exam.

    before exam

  • critical

    Research the seven formal characteristics of disfigurement

    Memorize and be able to identify in your own scars each of the seven characteristics: (1) surface contour elevated on palpation, (2) surface contour depressed on palpation, (3) abnormal texture, (4) hypopigmentation (lighter than surrounding skin), (5) hyperpigmentation (darker than surrounding skin), (6) induration and inflexibility, (7) underlying soft tissue missing. Also know the eight named facial features: nose, chin, forehead, eyes/eyelids, ears/auricles, cheeks, lips. Being able to articulate these in the examiner's language ensures accurate documentation.

    before exam

  • critical

    Prepare a written pain and symptom description for each scar

    For each painful scar, write: location, pain quality (burning/stabbing/aching/electric), pain intensity on worst days (0-10), triggers, frequency, duration, what worsens it, what relieves it, and how it limits daily activities. For unstable scars, document the frequency of skin breakdown episodes per month, how long they last, and what treatment is required. Bring this document to the exam.

    before exam

  • critical

    Prepare a functional impact statement

    Write a brief narrative describing how your scars affect your work, daily activities, social interactions, recreational activities, sleep, and psychological well-being. Include specific examples: jobs or tasks you cannot perform, social events you avoid, accommodations you have had to make, and any mental health treatment sought due to disfigurement. The DBQ specifically asks about functional impact and occupational effects.

    before exam

  • recommended

    Draw a body diagram marking all scar locations

    Use a front-and-back body outline and mark every scar with approximate location and size. Label each scar with a number or letter and reference your written inventory. This visual aid helps ensure the examiner documents all scars and does not skip any body region. It also demonstrates thoroughness and provides a reference if there are discrepancies in the exam report.

    before exam

  • recommended

    Check your state's laws on recording C&P exams

    Many states permit you to record the exam with or without consent. Research your state's recording laws. If permitted, consider bringing a small audio recorder or using your smartphone to record the session. Inform the examiner at the start if you intend to record. A recording can be valuable if you need to challenge an inadequate exam later.

    before exam

  • recommended

    Review your C-file or eFolder for prior scar documentation

    Request your C-file or access your eFolder through a VSO or eBenefits/VA.gov. Review all prior exam reports and medical opinions about your scars. Note any discrepancies, omissions, or changes from prior exams that should be updated. Being aware of what VA already has on file helps you correct or supplement the record.

    before exam

  • critical

    Dress to allow full inspection of all scar areas

    Wear loose-fitting, easily removable clothing that exposes your scars. Avoid compression garments, bandages, or makeup over scar areas if possible - or be prepared to remove them. For facial scars, do not apply concealer or foundation. For body scars, wear shorts, a tank top, or bring a change of clothes that allows exposure. The examiner must be able to see and touch every scar.

    day of

  • critical

    Bring all prepared documents and photographs

    Bring your scar inventory list, body diagram, pain/symptom descriptions, functional impact statement, medical records, and printed photographs. Offer a copy of your scar inventory to the examiner at the start of the exam. Request that it be included in the exam file.

    day of

  • recommended

    Arrive early and review your notes

    Arrive 15-20 minutes early to review your scar inventory and symptom descriptions. The exam may feel rushed - having notes in hand prevents you from forgetting key symptoms under stress. Re-read your worst-day examples before entering the exam room.

    day of

  • critical

    Verbalize pain immediately and specifically when the examiner palpates a scar

    When the examiner touches any scar, immediately state if it is painful: 'That is painful - I rate that pain a [X] out of 10. It feels burning and electric.' Do not wait to be asked. Immediate, specific pain responses during palpation are critical for DC 7804 painful scar documentation. The examiner must document pain on direct pressure to assign a painful scar rating.

    during exam

  • critical

    Ask the examiner to document EVERY scar on the DBQ

    If you have more than five scars, the DBQ has 'additional scars' fields. Politely ask the examiner to ensure all scars are listed. Say: 'I have [X] service-connected scars - I want to make sure each one is documented. I have a written list here.' If the examiner seems to be focusing on only one or two scars, gently redirect attention to the others.

    during exam

  • critical

    Describe your condition as it is on your worst typical days, not your best days

    Per M21-1 guidance, your rating should reflect your typical worst-day functional impairment, not how you feel on a particularly good day. If the examiner asks 'how are you doing today' and you are having a good day, clarify: 'Today is better than average. My typical worst days involve [specific symptoms].' This is your right and is consistent with VA rating policy.

    during exam

  • critical

    Name each facial feature that is distorted - do not allow generic descriptions

    If the examiner says 'you have some facial scarring' without naming specific features, say: 'Can you specifically document which features are affected? I have distortion of my [nose/chin/left ear/etc.].' Each named feature that is documented as grossly distorted with tissue loss advances your rating under DC 7800.

    during exam

  • recommended

    Disclose all functional and occupational limitations caused by your scars

    When asked about the impact of your scars, reference your prepared functional impact statement. Mention work restrictions, social avoidance, sleep disruption, need for accommodations, physical activity limitations, and psychological effects. The examiner must document functional impairment in the DBQ narrative sections.

    during exam

  • recommended

    Confirm the examiner is aware of both head/face/neck scars AND body scars if applicable

    If you have scars in multiple regions, confirm that the examiner will complete all applicable sections of the DBQ. Head/face/neck burn scars and trunk/extremity burn scars are documented in separate sections. Ask: 'Are you documenting my scars on the arms/trunk separately from my facial scars?'

    during exam

  • critical

    Document what happened in the exam immediately afterward

    As soon as you leave the exam, write down: what the examiner said, what they examined and what they appeared to skip, whether they asked about pain and skin breakdown, whether they measured your scars, and whether they seemed to review your records. This contemporaneous note may be important if you need to challenge an inadequate exam.

    after exam

  • critical

    Request a copy of the completed DBQ through your VSO or VA records request

    You are entitled to a copy of your C&P exam report. Request it through your VSO, or submit a records request after the exam report is uploaded to your eFolder. Review it carefully for accuracy: check that all scars are listed, dimensions are correct, characteristics are accurately reflected, and your pain/instability history is documented.

    after exam

  • recommended

    If the exam report is inadequate, request a new exam through your VSO

    Per M21-1, a scar exam report must identify each scar's location, type, and dimensions to be considered sufficient. If the report omits scars, fails to measure dimensions, does not address painful/unstable characteristics, or lacks a functional impact statement, it may be challenged as inadequate. Work with your VSO or accredited claims agent to request a supplemental exam or submit a nexus letter from a private clinician.

    after exam

  • optional

    Submit a personal statement (VA Form 21-4138) to supplement the exam record

    After reviewing the exam report, submit a written personal statement describing any symptoms, characteristics, or functional limitations that were not captured in the report. Include specific examples from your worst days. Reference the seven disfigurement characteristics and explain which apply to your scars. This statement becomes part of your claims file.

    after exam

Your rights during a C&P exam

  • You have the right to request that the C&P examination be recorded (audio or video) in most states - check your state's consent laws before the exam.
  • You have the right to have a VSO representative or accredited claims agent accompany you to the exam in most circumstances.
  • You have the right to submit additional evidence (photographs, personal statements, private medical opinions) after the C&P exam and before a rating decision is issued.
  • You have the right to request a copy of your completed DBQ/C&P exam report through a records request or through your eFolder.
  • You have the right to challenge an inadequate exam - per M21-1, a scar exam must document location, type, and dimensions for each scar to be sufficient for rating purposes.
  • You have the right to request a new or supplemental examination if the original exam was inadequate, failed to address all claimed scars, or did not reflect your current level of impairment.
  • You have the right to submit a Nexus letter or Independent Medical Opinion (IMO) from a private physician if you disagree with the examiner's findings.
  • If you have scarring on both the head/face/neck AND the body, you may be entitled to separate ratings under multiple diagnostic codes simultaneously - the ratings are not exclusive.
  • Characteristics of disfigurement from multiple scars may be combined to meet rating thresholds - the VA cannot require all characteristics to come from a single scar per Note (5) of DC 7800.
  • You have the right to report pain during palpation and have that pain documented - do not remain silent during physical examination if palpation causes discomfort.
  • You have the right to describe your condition as it presents on your worst typical days, not your best days, consistent with M21-1 adjudication policy.
  • If you believe your claim was decided with an inadequate exam, you may file a Supplemental Claim with new and relevant evidence, a Higher-Level Review, or appeal to the Board of Veterans' Appeals.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.