What is the VA Rating for Psoriasis?

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The VA rates psoriasis under 38 CFR § 4.118, Diagnostic Code (DC) 7816, with ratings ranging from 0% to 60% with breaks at 10% and 30% based on the severity of symptoms, percentage of the body affected, and type and duration of treatment required.

Psoriasis is a chronic autoimmune condition that causes rapid skin cell production, leading to the formation of thick, red, scaly patches on the skin.

These patches can be itchy and painful, and they commonly appear on the elbows, knees, scalp, and lower back.

Pro Tip: When applying for a VA disability rating for psoriasis, it’s crucial to document the extent of body coverage and the type and duration of treatments. Ever heard the phrase, “a picture is worth 1,000 words?” Use VA.gov to upload pictures of your skin condition for the C&P examiner and VA Rater to view. It’s the #1 best way to prove you have psoriasis and how much of your body it covers.

Summary of Main Points

• Psoriasis VA Rating: The VA rates psoriasis under 38 CFR § 4.118, Diagnostic Code (DC) 7816, with ratings ranging from 0% to 60% with breaks at 10% and 30% based on the severity of symptoms, percentage of the body affected, and type and duration of treatment required.

• Condition Overview: Psoriasis is a chronic autoimmune condition that causes rapid skin cell production, leading to the formation of thick, red, scaly patches on the skin, which can be itchy and painful. These patches commonly appear on the elbows, knees, scalp, and lower back.

• Severity of Symptoms and Evidence: Your final VA disability rating for psoriasis depends on the frequency, severity, and duration of symptoms and how they negatively impact your work, life, and social functioning. Documenting the extent of body coverage and the type and duration of treatments with comprehensive medical evidence is crucial. Upload photos in support of your VA claim.

• Psoriatic Arthritis VA Rating: The VA rates psoriatic arthritis under 38 CFR § 4.71a, Diagnostic Code (DC) 5002, with ratings from 10% to 100% with breaks at 20%, 40%, and 60%. The minimum VA rating for psoriatic arthritis with painful motion is 10%.

What is Psoriasis?

Psoriasis is a chronic skin disease characterized by a rash with itchy, scaly patches, commonly appearing on the knees, elbows, trunk, and scalp.

This results in the formation of thick, red patches covered with silvery scales, which can be itchy and sometimes painful.

It is a long-term condition with no cure, which can cause pain, disrupt sleep, and make it difficult to concentrate.

Psoriasis typically goes through cycles, flaring up for several weeks or months before subsiding.

Common triggers for those with a genetic predisposition include infections, skin injuries such as cuts or burns, and certain medications.

5 Types of Psoriasis:

• Plaque Psoriasis: The most common type, characterized by raised, inflamed, red lesions covered with silvery white scales.

• Guttate Psoriasis: Appears as small, dot-like lesions, often starting in childhood or young adulthood.

• Inverse Psoriasis: Presents as bright red, shiny lesions that appear in skin folds such as under the breasts, in the groin, or around the genitals and buttocks.

• Pustular Psoriasis: Characterized by white pustules (blisters of noninfectious pus) surrounded by red skin.

• Erythrodermic Psoriasis: A severe form that leads to widespread, fiery redness over most of the body, which can cause severe itching and pain.

Causes:

The exact cause of psoriasis isn’t fully understood, but it is believed to involve a combination of genetic predisposition and environmental factors.

The immune system mistakenly attacks healthy skin cells, leading to rapid cell turnover and buildup.

Factors that can trigger psoriasis or worsen symptoms include stress, infections, skin injuries, certain medications, and weather conditions.

Signs and Symptoms of Psoriasis:

• Patchy Rash: The appearance of the rash can vary significantly, ranging from small spots of dandruff-like scaling to large eruptions covering much of the body.

• Color Variation: Rashes tend to be shades of purple with gray scales on brown or black skin, and pink or red with silver scales on white skin.

• Scaling Spots: Small, scaling spots are commonly seen in children.

• Dry, Cracked Skin: The skin may become dry and cracked, which can sometimes bleed.

• Itching, Burning, or Soreness: Psoriasis can cause itching, burning sensations, or soreness.

• Cyclic Nature: The rashes typically flare up for a few weeks or months and then subside before potentially flaring up again.

• Thickened, Pitted, or Ridged Nails: Psoriasis can affect the nails, causing them to become thickened, pitted, or ridged.

• Swollen and Stiff Joints (Psoriatic Arthritis): Psoriasis can lead to psoriatic arthritis, which causes swollen and stiff joints.

Diagnosis:

Psoriasis is typically diagnosed based on a physical examination and medical history.

A dermatologist may take a biopsy to confirm the diagnosis and rule out other skin disorders.

Functional Impact:

Psoriasis can significantly impact quality of life, causing physical discomfort, emotional distress, and social isolation.

It is associated with an increased risk of other health conditions such as psoriatic arthritis, cardiovascular disease, diabetes, and depression.

Risk Factors for Psoriasis in Military Veterans

Military veterans may face unique risk factors that can increase their likelihood of developing or exacerbating psoriasis.

These factors include:

Stress and Mental Health Issues:

• Post-Traumatic Stress Disorder (PTSD): Veterans with PTSD are at a higher risk of developing psoriasis due to the chronic stress and psychological strain associated with this condition.

• Anxiety and Depression: High levels of stress, anxiety, and depression, which are common among veterans, can trigger or worsen psoriasis flare-ups.

Physical Trauma and Injuries:

• Koebner Phenomenon: Physical trauma or skin injuries, such as cuts, bruises, or burns, can lead to the development of psoriasis plaques at the site of the injury. This is known as the Koebner phenomenon.

• Combat-Related Injuries: Veterans who have sustained injuries during combat are at an increased risk of developing psoriasis due to the physical trauma experienced.

Environmental Exposures:

• Harsh Environments: Exposure to extreme weather conditions, such as intense heat or cold, during deployments can aggravate the skin and trigger psoriasis.

• Chemical Exposures: Contact with certain chemicals and pollutants, which may occur during military service, can contribute to skin irritation and the development of psoriasis.

Lifestyle Factors:

• Smoking: Veterans who smoke are at a higher risk of developing psoriasis. Smoking can also exacerbate existing psoriasis symptoms.

• Alcohol Consumption: Excessive alcohol consumption is a known trigger for psoriasis flare-ups and can interfere with treatment effectiveness.

Medication Use:

• Beta-Blockers: Medications used to treat high blood pressure and heart conditions, such as beta-blockers, can trigger or worsen psoriasis in some individuals.

• Anti-Malarial Drugs: Medications used to prevent or treat malaria, which veterans may be exposed to during deployments, can also trigger psoriasis.

Immune System Challenges:

• Compromised Immune System: Military veterans may have a compromised immune system due to various factors, including exposure to infectious diseases, which can increase the risk of autoimmune conditions like psoriasis.

How to Prove Service Connection for Psoriasis

To receive VA disability benefits for psoriasis, veterans must establish a service connection and prove the severity of symptoms.

#1. Current Diagnosis of Psoriasis

Obtain a Current Diagnosis: Ensure you have a medical diagnosis of psoriasis from a healthcare professional.

Documentation: Make sure this diagnosis is documented in your service treatment records, VA medical records, or private treatment records.

Recent Diagnosis: It is helpful to have a diagnosis within the past 12 months; however, it is not required.

Medical Records: Gather medical records from your doctor that clearly document the diagnosis, including any relevant evaluations and treatments.

#2. In-Service Event, Injury, Disease, Illness, or Exposure

Provide Evidence: Submit evidence of an event, injury, disease, illness, or exposure during military service that could have caused or aggravated psoriasis.

Detailed Records: Collect service medical records, incident reports, and personal statements detailing the in-service occurrence.

Examples: This could include exposure to harsh environments, stressful conditions, physical trauma, or use of certain medications during service.

#3. Nexus (Link or Connection)

Establish a Medical Nexus: Link the current diagnosis of psoriasis to the in-service event or injury.

Nexus Letter: Obtain a Nexus Letter from a qualified medical professional. This letter should explain how the in-service event likely caused or aggravated psoriasis.

#4. Severity of Symptoms

Provide Medical Evidence: Show the severity and impact of psoriasis symptoms on your work, life, and social functioning.

Detailed Records: Maintain detailed medical records and personal statements documenting the frequency, severity, and duration of your symptoms.

Impact Description: Describe how psoriasis affects your daily activities and any treatments or interventions you require.

Secondary Service Connection for Psoriasis

To establish a secondary service connection for psoriasis, veterans can demonstrate that their psoriasis is caused or aggravated by another service-connected condition.

Here’s a list of conditions that can cause or aggravate psoriasis in veterans:

Post-Traumatic Stress Disorder (PTSD)

PTSD can lead to chronic stress, which is known to trigger or worsen psoriasis flare-ups.

The body’s response to stress can include the release of pro-inflammatory chemicals, which may aggravate psoriasis symptoms.

Depression and Anxiety

Psychological stress from depression and anxiety can similarly increase inflammation and skin flare-ups.

Both conditions can lead to elevated levels of stress hormones, exacerbating psoriasis.

Infections

Infections such as streptococcal throat infections, HIV, and other bacterial or viral infections can trigger psoriasis by activating the immune system.

Streptococcal infections, in particular, are associated with guttate psoriasis.

Diabetes

Diabetes and psoriasis share common inflammatory pathways, and managing one condition can influence the severity of the other.

Poor blood sugar control can lead to increased inflammation, worsening psoriasis symptoms.

Liver Disease

Liver diseases, such as fatty liver disease, can affect the immune system and exacerbate psoriasis symptoms.

The liver’s impaired ability to filter toxins can increase systemic inflammation, impacting psoriasis.

Obesity

Obesity increases inflammation in the body, which can worsen psoriasis symptoms.

Fat tissue produces inflammatory cytokines that can trigger psoriasis flare-ups and increase disease severity.

Cardiovascular Disease

Psoriasis is linked to higher rates of cardiovascular disease, and the inflammation from psoriasis can aggravate heart conditions.

The systemic inflammation associated with both conditions can create a feedback loop, exacerbating symptoms.

Rheumatoid Arthritis

Rheumatoid arthritis involves autoimmune responses that can influence each other with psoriasis.

Both conditions are autoimmune in nature, and the presence of one can aggravate the other.

Crohn’s Disease and Ulcerative Colitis

Crohn’s disease and ulcerative colitis, both inflammatory bowel diseases, are associated with increased risk and severity of psoriasis.

The systemic inflammation present in these conditions can trigger or worsen psoriasis symptoms.

Certain Medications

Certain medications, particularly those used to treat other conditions, can have side effects that trigger or worsen psoriasis.

Beta-blockers for high blood pressure, anti-malarial drugs, and lithium for psychiatric conditions are examples that can exacerbate psoriasis.

Environmental Factors

Environmental factors such as extreme weather conditions and exposure to certain chemicals can irritate the skin and trigger psoriasis.

Harsh weather can dry out the skin, while chemicals can cause irritation, leading to flare-ups.

Smoking

Smoking is known to aggravate psoriasis.

It increases the risk of developing the condition and can worsen existing symptoms due to the pro-inflammatory effects of tobacco.

Excessive Alcohol Consumption

Excessive alcohol consumption can worsen psoriasis symptoms.

Alcohol can interfere with the immune system, increasing the risk of flare-ups and making treatment less effective.

Note: Alcoholism can be service connected on a secondary basis or as a symptom of another service connected disability.

VA Disability Rating for Psoriasis

The VA rates psoriasis using the 38 CFR, Part 4, the Schedule for Rating Disabilities, General Rating Formula for the Skin, under Diagnostic Code (DC) 7816.

This rating system is applied for several skin conditions and is based on the severity of the condition, the percentage of the body or exposed areas affected, and the type and duration of treatment required.

60% VA Rating for Psoriasis

Extensive Lesions or Systemic Therapy:

• Characteristic lesions covering more than 40% of the entire body or more than 40% of exposed areas.

• Constant or near-constant systemic therapy (e.g., corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs) required over the past 12-month period.

30% VA Rating for Psoriasis

Moderate Lesions or Periodic Systemic Therapy:

• Characteristic lesions covering 20% to 40% of the entire body or 20% to 40% of exposed areas.

• Systemic therapy required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

10% VA Rating for Psoriasis

Mild Lesions or Intermittent Systemic Therapy:

• Characteristic lesions covering at least 5% but less than 20% of the entire body, or at least 5% but less than 20% of exposed areas.

• Intermittent systemic therapy required for a total duration of less than 6 weeks over the past 12-month period.

0% VA Rating for Psoriasis

Minimal Lesions or Topical Therapy:

• Characteristic lesions covering less than 5% of the entire body or less than 5% of exposed areas.

• Only topical therapy required over the past 12-month period.

VA Rating for Psoriatic Arthritis

The VA rates psoriatic arthritis under 38 CFR § 4.71a, which is the schedule of ratings for the musculoskeletal system, from 10% to 100% with breaks at 20%, 40%, and 60%.

Psoriatic arthritis is categorized under Diagnostic Code 5002, the same code used for multi-joint arthritis (except post-traumatic and gout), 2 or more joints, as an active process.

The VA rates complications of psoriatic arthritis separately from psoriasis under the appropriate diagnostic code.

100% Rating for Psoriatic Arthritis

• Description: Total incapacitation due to severe symptoms of psoriatic arthritis, such as complete loss of joint function, constant severe pain, and systemic complications like fever, weight loss, and anemia.

• Impact: Complete inability to work and perform daily activities independently, requiring full-time medical care and support.

60% Rating for Psoriatic Arthritis

• Description: Severe symptoms with frequent incapacitating episodes, severe loss of weight, and anemia causing considerable health impairment.

• Impact: Major impact on daily life, requiring frequent medical attention and limiting the ability to work.

40% Rating for Psoriatic Arthritis

• Description: Symptoms causing definite health impairment, with incapacitating episodes occurring 3 or more times a year.

• Impact: Significant pain and limitations in movement, affecting the ability to perform everyday tasks.

20% Rating for Psoriatic Arthritis

• Description: One or two exacerbations a year in a well-established diagnosis causing moderate symptoms and limitations.

• Impact: Moderate impact on daily life and ability to function.

10% Rating for Psoriatic Arthritis

• Description: Although not listed in the rating formula, in accordance with the painful motion principle, any pain upon movement is rated at the minimum compensable rating, which is 10%.

• Impact: Minimal impact on daily life and ability to function. Pain upon movement regardless of limitation of range of motion.

Other Diagnostic Codes for Complications of Psoriasis

Complications such as psoriatic arthritis and other clinical manifestations (e.g., oral mucosa, nails) should be rated separately under the appropriate diagnostic code.

If the predominant disability involves disfigurement of the head, face, or neck, or scars, it should be rated under the respective diagnostic codes (7800, 7801, 7802, 7804, or 7805).

Here’s how the VA rates some of the other relevant conditions:

Psoriatic Arthritis

Diagnostic Code 5002:

• For active rheumatoid arthritis (and similar conditions like psoriatic arthritis), the VA rates from 20% to 100%, considering the frequency and severity of exacerbations, overall health impairment, and functional limitations.

Oral Mucosa Involvement

Diagnostic Code 7203:

• The VA rates stricture of the esophagus from 0% to 80%, with breaks at 30%, 50%, and 80%, based on the severity of swallowing difficulties and the impact on nutrition and overall health.

Nail Involvement

Diagnostic Code 7813:

• The VA rates dermatophytosis, which can include nail involvement, from 0% to 60% based on the extent of skin coverage and the necessity of systemic therapy like corticosteroids.

Skin Involvement (Psoriasis)

Diagnostic Code 7816:

• The VA rates psoriasis from 0% to 60%, with breaks at 10%, 30%, and 60%, based on the percentage of body area affected and the need for systemic therapy.

Scars or Disfigurement

Diagnostic Code 7800:

• The VA rates disfigurement of the head, face, or neck from 0% to 80%, with breaks at 10%, 30%, 50%, and 80%, depending on the severity of disfigurement and its impact on appearance.

Diagnostic Code 7801:

• The VA rates deep and nonlinear scars from 0% to 40%, with breaks at 10%, 20%, and 30%, based on the size and impact of the scars on function.

Diagnostic Code 7802:

• The VA rates superficial and nonlinear scars from 0% to 10%, based on the size of the scarred area.

Diagnostic Code 7804:

• The VA rates unstable or painful scars from 10% to 30%, with breaks at 10%, 20%, and 30%, depending on the number and severity of painful scars.

Diagnostic Code 7805:

• The VA rates other scars based on the limitation of function caused by the scar, which can range from 0% to 100% depending on the specific impact on the veteran’s ability to perform daily activities.

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