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

Scar Dimensions (Length - Width)

What it measures: The physical size of each individual scar, measured at the longest length and widest width in centimeters. This determines whether scars meet area thresholds for rating under DC 7801 (with soft tissue damage) and DC 7802 (without soft tissue damage).

What to expect: The examiner will use a ruler or tape measure and physically measure each scar. They will record the length and width at the widest point. For irregular or grouped scars, they may calculate an approximate total area.

Pain considerations: Pain during measurement or palpation should be immediately and clearly communicated to the examiner. State the location, character (burning, stabbing, aching), and intensity on a 0-10 scale.

Palpation for Pain and Instability

What it measures: Whether direct pressure or routine activity causes pain at the scar site, and whether the scar surface breaks down (becomes open or ulcerated) with minimal trauma. Unstable scars are those that do not continuously maintain a covering of skin.

What to expect: The examiner will press on or around each scar with a gloved finger and ask whether you experience pain. They may ask about your history of scar breakdown, skin tears, or open wounds at the scar site. This is a subjective and objective evaluation.

Pain considerations: Pain is a primary rating driver under DC 7804. Describe the character, frequency, triggers, and intensity of pain. If your scars cause pain during sleep, with temperature changes, with touch from clothing, or with pressure, all of these are relevant and should be stated.

Disfigurement Characteristic Count (Head/Face/Neck Only)

What it measures: For scars of the head, face, or neck (DC 7800), the number of disfigurement characteristics present determines the rating. Characteristics include: hyperpigmentation, hypopigmentation, abnormal texture, surface contour elevated on palpation, surface contour depressed on palpation, adherence to underlying tissue, induration/inflexibility, missing underlying soft tissue, and tissue loss/distortion of specific facial features.

What to expect: The examiner will visually inspect and palpate scars on the head, face, and neck. They will check each of the defined disfigurement characteristics and may note affected facial subunits such as the forehead, cheeks, nose, chin, lips, eyes, eyelids, or ears.

Pain considerations: If any disfigurement scar on the head, face, or neck is also painful or unstable, it can be separately rated under DC 7804 in addition to DC 7800. Ensure you report pain separately.

10%

One painful or unstable scar (DC 7804). Alternatively, a scar of the head, face, or neck with one characteristic of disfigurement (DC 7800). Or a scar not of the head/face/neck with soft tissue damage covering 39 sq cm or more (DC 7801), or without soft tissue damage covering 144 sq inches or more (DC 7802).

From 38 CFR: A single surgical or traumatic scar that is consistently tender when touched or that has opened at least once without significant trauma qualifies at this level under DC 7804.

20%

Two to four painful or unstable scars (DC 7804). This rating requires that multiple distinct scars qualify individually as painful or unstable. If any qualifying scar is both painful AND unstable, add 10% to reach 30%.

From 38 CFR: A veteran with two surgical scars from service-connected procedures, both of which are tender on palpation, qualifies for 20% under DC 7804.

30%

Five or more painful or unstable scars (DC 7804), OR two to four scars that are BOTH painful AND unstable (triggering the +10% add-on), OR a scar of the head/face/neck with two characteristics of disfigurement (DC 7800). Under DC 7800, 30% applies to two characteristics on the head, face, or neck.

From 38 CFR: A burn survivor with five separate burn scars on the trunk and extremities, each of which is painful to palpation, would qualify for 30% under DC 7804. Alternatively, a veteran with a facial burn scar showing both hyperpigmentation and abnormal texture qualifies at 30% under DC 7800.

50%

Under DC 7800, three characteristics of disfigurement of the head, face, or neck. This rating is specific to scars of the head, face, or neck and requires three of the defined characteristics of disfigurement to be present (from any combination of scars in that region).

From 38 CFR: A veteran with a facial burn scar showing hyperpigmentation, surface elevation, and abnormal texture - even across multiple small scars - qualifies for 50% under DC 7800. Per Note 5, these three characteristics need not come from a single scar.

80%

Under DC 7800, four or more characteristics of disfigurement of the head, face, or neck. This is the maximum rating for scar disfigurement of the head, face, or neck. Per Note 5, the four characteristics can come from one or multiple scars combined.

From 38 CFR: A veteran with extensive facial burn scarring showing hypopigmentation, depressed surface contour, missing underlying soft tissue, and tissue distortion of the nose across multiple scars qualifies for 80% under DC 7800 per Note 5.

Scar Pain

How to describe it: Describe the character of pain (burning, stabbing, throbbing, aching, hypersensitivity), its location at each scar, frequency (constant vs. intermittent), severity on a 0-10 scale, and what makes it worse (touch, temperature, clothing friction, pressure, activity). Distinguish between baseline daily pain and peak pain during flare-ups.

Example: On my worst days, the burn scar on my left forearm feels like it is on fire. Even a light bedsheet touching it at night wakes me up. The pain radiates about two inches around the scar and is a constant burning 7/10 that spikes to 9/10 if anything presses against it. I cannot wear long sleeves without padding the area.

Examiner listens for: The examiner needs to document whether pain is present on palpation AND by history. Describe both. Note that pain does not need to be reproduced during the exam itself - your credible history of pain is medically and legally sufficient.

Avoid: Do not say 'it only bothers me sometimes' or 'it's not that bad.' If you experience pain at all, even occasionally, communicate when and how. Underselling pain frequency can result in a denial of the DC 7804 rating altogether.

Scar Instability (Breakdown)

How to describe it: Explain whether your scar has ever broken open, ulcerated, developed a wound, or lost its skin covering without significant trauma - for example, from normal daily activities like walking, dressing, or light exercise. Describe the frequency, how long it takes to heal, and whether it recurs in the same location.

Example: The scar on my right thigh has broken open three times in the past year. The last time it happened I was just putting on pants - no fall, no injury. It took four weeks to close and I had to use wound dressings every day. It has left a darkened area where the skin grew back thinner.

Examiner listens for: The examiner must document whether the scar is 'unstable,' meaning it does not continuously maintain a normal skin covering. Any history of recurring breakdown is critical. Bring treatment records, photos, or a written log of breakdown episodes.

Avoid: Do not minimize breakdown episodes by saying 'it was just a little open sore.' A scar that breaks open with routine activity legally qualifies as unstable, regardless of the size of the opening. State each episode clearly and separately.

Disfigurement Characteristics

How to describe it: Describe visible changes to your skin at each scar site. Use specific language: 'The scar is darker than my surrounding skin' (hyperpigmentation), 'The scar is lighter/whiter than my skin' (hypopigmentation), 'The scar feels rough or bumpy to the touch' (abnormal texture), 'The scar is raised and firm' (elevated contour with induration), 'The scar is sunken in' (depressed contour), 'The scar feels stuck down and does not move freely' (adherence), 'There is a hollow or divot where tissue is missing' (missing soft tissue).

Example: The burn scar on my left cheek has been discolored dark brown since my injury - much darker than my normal skin. The surface is rough and uneven, and when I press on it, it is hard and does not flatten. It is also depressed at the center, creating a sunken appearance. My nose was partially distorted when the scar contracted during healing.

Examiner listens for: The examiner is counting the number of defined characteristics to assign the correct rating. Make sure each characteristic is mentioned distinctly. Do not bundle them - say each one separately so it is documented individually in the DBQ.

Avoid: Do not simply say 'it looks different' or 'the scar is ugly.' Use the specific terminology that maps to the DBQ checkboxes: hyperpigmentation, hypopigmentation, abnormal texture, elevated contour, depressed contour, adherence, induration, missing soft tissue. The examiner needs to check specific boxes.

Functional and Daily Life Impact

How to describe it: Explain how your scars limit your ability to perform work, self-care, social interactions, sleep, or physical activities. For facial scars, describe social and psychological impacts honestly. For extremity scars, describe limitations on gripping, lifting, bending, or walking. This supports the functional impairment narrative required by M21-1.

Example: The scarring on my face has made me avoid public situations. I have stopped attending family events because strangers stare, and I have had coworkers ask about my appearance. I no longer wear short sleeves due to the scars on my arms, even in summer heat, because the exposure causes me anxiety. The scar on my knee limits how far I can bend my leg, making it difficult to kneel or use stairs.

Examiner listens for: The examiner will document functional impact in the DBQ field asking about impact on daily activities. This narrative can support ratings for related conditions such as depression secondary to scarring, or joint limitation secondary to burn scar contracture.

Avoid: Do not minimize psychological or social impacts by saying 'I manage okay.' The VA considers functional impairment broadly. If you have adjusted your life around your scars, those adjustments are themselves evidence of functional limitation.

History and Origin of Each Scar

How to describe it: Be prepared to describe how and when each scar occurred, where you were stationed or what duty you were performing, and how it was treated in service and after. The examiner will document this in the history fields. Be specific but consistent with your service records.

Example: I received this burn injury during a vehicle fire in Iraq in 2006. I was treated at the combat support hospital for second-degree burns to my forearms and left leg. I was evacuated and received skin grafting at Landstuhl. The scars have been present since then and have progressively worsened in terms of sensitivity and breakdown.

Examiner listens for: The examiner needs to link the scar to a specific service event or incident. If records are incomplete, your lay statement about the origin is still probative evidence. Per M21-1, if there is reasonable doubt about service connection for a scar, the benefit of the doubt goes to the veteran.

Avoid: Do not say 'I think' or 'I'm not sure' about the origin if you do remember - be clear and direct. If you truly do not remember details, say so honestly rather than guessing incorrectly.