Skin Diseases (Dermatitis / Psoriasis / Acne) C&P Exam Prep

Total Body Surface Area (TBSA) Affected

What it measures: The percentage of your entire skin surface covered by the active skin condition. This is a critical rating factor under the General Rating Formula for the Skin.

What to expect: The examiner will visually inspect your entire body and estimate what percentage of all skin is affected. A common clinical method uses the 'Rule of Nines' (each arm = 9%, each leg = 18%, trunk front = 18%, trunk back = 18%, head = 9%). Be prepared to show all affected areas, including areas covered by clothing.

Pain considerations: Describe any pain, burning, stinging, or itching associated with lesions. Note whether skin is cracked, bleeding, or weeping, as this affects functional impact and rating.

Exposed Body Surface Area (EBSA) Affected

What it measures: The percentage of skin that is typically exposed to public view (face, neck, hands, forearms, lower legs) that is affected. Per M21-1, the DBQ must record both TBSA and EBSA as separate percentages.

What to expect: The examiner will separately assess how much of the skin visible in everyday public settings (without long sleeves/pants) is affected. This is relevant because conditions affecting highly visible areas like the face and hands may have greater occupational and social impact.

Pain considerations: If lesions on hands or feet limit grip, fine motor skills, or walking, describe this in detail as it may support secondary functional impairment claims.

Treatment Intensity Assessment

What it measures: The level of medical intervention required to manage the condition - a key rating driver. Higher-intensity treatments (systemic corticosteroids, biologics, immunosuppressives) support higher ratings.

What to expect: The examiner will ask about every treatment you have used: topical creams/ointments, oral medications, injections, phototherapy (UVB, PUVA), biologics (Humira, Dupixent, Skyrizi, etc.), corticosteroids, retinoids, antihistamines, and procedures. They will note medication names, frequency, duration, and which condition each is used for.

Pain considerations: Note any adverse effects from medications (e.g., corticosteroid side effects, photosensitivity from PUVA) as these represent additional burden of treatment.

0%

No active skin condition present, or condition is entirely in remission without requiring any ongoing treatment. Note: A 0% rating still establishes service connection, which is important for future claims and secondary conditions.

From 38 CFR: Under the General Rating Formula for the Skin, conditions that have resolved or require no treatment are rated 0%. Service connection should still be established.

10%

At least one of the following: (1) less than 5% of the entire body or less than 5% of exposed areas affected, and; (2) no more than topical therapy required during the past 12-month period. This is the entry-level compensable rating for most skin conditions evaluated under the General Rating Formula.

From 38 CFR: General Rating Formula for the Skin: 10% - at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. NOTE: The 10% criteria also applies when less than 5% TBSA with only topical therapy needed.

30%

At least 20% but less than 40% of the entire body OR at least 20% but less than 40% of exposed areas affected, OR; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

From 38 CFR: General Rating Formula for the Skin: 30% - at least 20 percent, but less than 40 percent, of the entire body or at least 20 percent, but less than 40 percent, of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period.

60%

The highest rating under the General Rating Formula for the Skin. Requires: 40% or more of the entire body OR 40% or more of exposed areas affected, OR; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. Also applicable for generalized involvement with systemic manifestations (erythroderma/exfoliative dermatitis with systemic manifestations).

From 38 CFR: General Rating Formula for the Skin: 60% - 40 percent or more of the entire body or 40 percent or more of exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. For erythroderma/exfoliative dermatitis: generalized involvement of the skin with systemic manifestations such as fever, weight loss, or hypoalbuminemia.

Extent and Distribution of Skin Involvement

How to describe it: Describe the specific body areas affected using anatomical terms. Quantify coverage as best you can: 'My psoriasis covers both arms from wrist to shoulder, my entire scalp, my lower back, and behind both knees - probably about 30-40% of my body on a bad day.' Distinguish between your condition on your best day versus your worst day, and explain that the exam may show you on a better day than usual.

Example: On my worst days, my eczema covers my entire forearms, the backs of both hands, my neck, chest, and abdomen. The skin is red, weeping, and cracking - I estimate it covers about 40% of my body. I cannot wear certain clothing, I bleed when I scratch, and I have to sleep with gloves on to prevent scratching open wounds overnight.

Examiner listens for: Specific body regions, percentage estimates of coverage, whether TBSA and EBSA differ significantly, whether involvement is constant or episodic, description of lesion type (plaque, vesicle, crust, scale), and whether special areas like palms, soles, face, genitals, or mucous membranes are affected.

Avoid: Do not say 'just a little rash here and there' or 'it comes and goes.' Be specific and quantify. Do not downplay coverage on exam day by saying 'it's not too bad right now' without explaining what it looks like at its worst.

Treatment Burden and Medication Requirements

How to describe it: List every medication you use in sequence: 'I use Triamcinolone cream twice daily on my arms, Clobetasol foam on my scalp nightly, and I take Methotrexate 15mg weekly by mouth. I've been on Dupixent injections every two weeks for the past 18 months because topicals alone didn't control it. Before biologics, I had two courses of oral prednisone last year - one for 3 weeks in February and one for 4 weeks in August.' Be specific about duration, frequency, and what each medication is for.

Example: Despite being on a biologic injection every two weeks and using two different prescription topical steroids daily, I still have flares that require oral prednisone. Last year I needed systemic steroids for about 10 weeks total. My dermatologist recently added a second biologic because the first one stopped working as well.

Examiner listens for: Whether topical-only or systemic treatment is required, duration of systemic therapy in the past 12 months (threshold: 6 weeks for 30%, constant for 60%), types of systemic agents used, whether biologics are ongoing, whether phototherapy has been used, and treatment failures or escalations.

Avoid: Do not omit any medication - even OTC antihistamines or moisturizers your doctor recommended. Do not say 'I just use some cream' if you are also on oral medications or injections. Do not fail to mention past treatments you have tried and discontinued due to side effects or inadequate control.

Flare-Up Pattern and Frequency

How to describe it: Describe the pattern of your condition: 'My psoriasis is never fully clear - even on good days I have patches on my elbows and scalp. I have major flares about 4-6 times per year where coverage increases dramatically, usually triggered by stress, infections, or weather changes. Flares last 3-6 weeks and require me to increase my medications. During flares, I miss work and cannot perform physical tasks.' Include triggers, duration of flares, and what remission actually looks like for you.

Example: During a bad flare, my psoriasis covers my entire torso, arms, and legs - the plaques crack and bleed, I cannot bend my elbows or knees without pain, I cannot wear a uniform or work clothes without pain and embarrassment, and I lose sleep every night from itching. These flares happen at least monthly and last 2-4 weeks even with treatment.

Examiner listens for: Whether the condition is truly episodic or chronic, frequency and duration of exacerbations, what triggers flares, whether flares respond to treatment escalation, and whether remission is complete or partial.

Avoid: Do not describe only your current state if you are in a relative remission. Explicitly tell the examiner: 'Today is actually a better day than usual. Let me describe what this looks like at its worst.' Do not omit triggers like stress, heat, sweat, or allergen exposures common in military settings.

Functional Impact and Daily Life Limitations

How to describe it: Describe how your skin condition limits what you can do: 'I cannot use my hands for extended tasks because the eczema on my palms cracks and bleeds. I cannot wear gloves required for my job. I avoid social situations because of the visible lesions on my face and neck. I cannot exercise because sweat triggers severe flares. I wake up at night from itching 3-4 times per week and am chronically sleep-deprived. My dermatologist has documented that my condition is affecting my ability to work.'

Example: During a flare I cannot type on a keyboard, cannot grip tools, cannot wear a shirt without pain, and cannot concentrate at work because of constant itching and pain. I have called out sick from work an average of 2 days per month over the past year specifically because of my skin condition. I avoid public settings because strangers stare and make comments about my skin.

Examiner listens for: Work limitations, attendance impacts, activity restrictions, sleep disruption, social withdrawal, limitations in self-care, emotional and psychological impact, and any accommodations required at work or home.

Avoid: Do not minimize functional impact. The DBQ specifically asks about impact on work, daily activities, and social functioning. Saying 'it doesn't really bother me that much' when you have significant functional limitations will hurt your rating. Be specific and concrete.

Systemic and Constitutional Symptoms

How to describe it: If you have any systemic symptoms associated with your skin condition, describe them clearly: 'During severe flares I develop a low-grade fever, feel fatigued and unwell for days, and have lost weight. My joints ache when my psoriasis is active. I have noticed my lymph nodes are sometimes swollen during bad flares.' For psoriasis specifically, note any joint involvement (psoriatic arthritis) as this may be separately ratable.

Example: When my eczema covers a large portion of my body, I feel systemically unwell - I run fevers up to 101-F, feel exhausted, have chills, and have been treated in urgent care twice for secondary skin infections requiring antibiotics. My albumin was low on bloodwork during my worst episode.

Examiner listens for: Fever, weight loss, hypoalbuminemia, lymphadenopathy, secondary infections, joint pain (for psoriasis), and whether the skin condition has systemic manifestations that elevate the rating to erythroderma level or support separate secondary claims.

Avoid: Do not fail to mention joint symptoms if you have psoriasis - psoriatic arthritis is separately ratable under DC 5009 or similar. Do not omit secondary skin infections that required antibiotics or hospitalization.