The VA rates basal cell carcinoma under 38 CFR § 4.118, General Rating Formula for the Skin, with ratings of 0%, 10%, 30%, or 60% based on the severity of symptoms, percentage of the body affected, and type and duration of treatment required.
However, if your basal cell carcinoma requires chemotherapy, radiotherapy, or surgery, then it is rated at 100% during the treatment periods.
If the basal cell carcinoma is actively malignant, it falls under Diagnostic Code 7819; if the condition is not actively malignant, it falls under Diagnostic Code 7818. Regardless of the diagnostic code used, the rating criteria still falls under the general rating formula for the skin.
Basal cell carcinoma is the most prevalent type of skin cancer, often manifesting as a painless raised area of skin that might appear shiny with small blood vessels running over it, primarily affecting sun-exposed areas.
Pro Tip: When submitting a VA claim for basal cell carcinoma, documenting the affected area’s size and location, along with the treatment duration and methods, is essential. Upload photographs of the affected skin at the time of claim submission to provide the C&P examiner and VA Rater with a clear view of the condition. This visual evidence is vital to demonstrate the presence and extent of basal cell carcinoma.
Table of Contents
Summary of Main Points
- Basal Cell Carcinoma VA Rating: The VA rates basal cell carcinoma under 38 CFR § 4.118, General Rating Formula for the Skin, 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. If the basal cell carcinoma is actively malignant, it falls under Diagnostic Code (DC) 7819; if the condition is not actively malignant, it falls under Diagnostic Code (DC) 7818.
- Condition Overview: Basal cell carcinoma is a common form of skin cancer that arises from the basal cells in the epidermis, typically due to prolonged exposure to ultraviolet (UV) radiation. It usually presents as a small, shiny bump or nodule on areas of the skin frequently exposed to the sun, such as the face, ears, neck, scalp, shoulders, and back. The condition can cause local damage if left untreated but rarely spreads to other parts of the body.
- Factors That Impact Your VA Rating: Your final VA disability rating for basal cell carcinoma 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 Photographic Evidence: When filing your claim for basal cell carcinoma, you should document the extent of body coverage and the type and duration of treatments. Uploading photographs at claim submission for the C&P examiner and VA Rater to view can be the best way to prove you have basal cell carcinoma and the severity of symptoms.
What is Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is the most common type of skin cancer, originating in the basal cells located in the lowest layer of the epidermis.
This condition primarily develops on sun-exposed areas of the body, such as the face, neck, and arms, and typically appears as open sores, red patches, pink growths, shiny bumps, or scars.
Key Characteristics
BCC commonly affects sun-exposed areas including the face, ears, neck, scalp, shoulders, and back.
The symptoms include persistent, non-healing sores, reddish patches that may crust or itch, shiny or pearly nodules, and scar-like areas. These lesions may bleed and develop a crust.
BCC tends to grow slowly and can become quite large if left untreated.
Once a BCC has developed, there is an increased risk of developing additional lesions in the future.
Causes
The exact cause of basal cell carcinoma is linked to cumulative and intense, occasional exposure to ultraviolet (UV) radiation from the sun or tanning beds.
Other contributing factors include:
- Veterans with fair skin, light-colored eyes, and hair, or a family history of skin cancer are at higher risk.
- Previous radiation treatment for other conditions can increase the risk of developing BCC.
- Veterans with weakened immune systems, such as organ transplant recipients, have a higher risk of developing BCC.
Treatment
Treatment options for basal cell carcinoma vary depending on the size, location, and depth of the tumor and may include:
- Procedures such as excisional surgery, Mohs surgery, curettage, and electrodessication are commonly used to remove the tumor.
- Treatments such as topical medications, photodynamic therapy, radiation therapy, and cryosurgery can be used in certain cases.
- In cases where BCC is advanced or metastasized, targeted therapies and immunotherapies may be used.
Prognosis
The prognosis for basal cell carcinoma is generally excellent, especially when detected and treated early.
However, if left untreated, BCC can cause significant local damage and disfigurement.
Regular skin examinations and prompt treatment of new or recurring lesions are crucial.
Impact on Quality of Life
Although basal cell carcinoma rarely spreads to other parts of the body, it can cause significant physical and cosmetic issues, leading to discomfort and emotional distress.
Early detection and treatment are essential to minimize the impact on a person’s quality of life.
Additional Notes
Using sunscreen, wearing protective clothing, and avoiding tanning beds are important steps in preventing basal cell carcinoma.
Regular dermatological check-ups are important for monitoring the skin and ensuring early detection of new lesions.
How to Prove Service Connection for Basal Cell Carcinoma
To receive VA disability benefits for basal cell carcinoma, veterans must establish a service connection and demonstrate the severity of their symptoms.
#1. Current Diagnosis of Basal Cell Carcinoma
Obtain a Current Diagnosis: Ensure you have a medical diagnosis of basal cell carcinoma from a healthcare professional.
Documentation: This diagnosis should be documented in your service treatment records, VA medical records, or private treatment records.
Recent Diagnosis: While it’s helpful to have a diagnosis within the past 12 months, it is not mandatory.
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 basal cell carcinoma.
Detailed Records: Collect service medical records, incident reports, and personal statements detailing the in-service occurrence.
Examples: This could include exposure to harsh sunlight, chemicals, or other carcinogens during service.
#3. Nexus (Link or Connection)
Establish a Medical Nexus: Link the current diagnosis of basal cell carcinoma 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 basal cell carcinoma. Here’s a great explainer on whether you need a Nexus Letter to support your VA claim.
#4. Severity of Symptoms
Provide Medical Evidence: Show the severity and impact of basal cell carcinoma 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 basal cell carcinoma affects your daily activities and any treatments or interventions you require.
VA Secondary Service Connection for Basal Cell Carcinoma
To establish a secondary service connection for basal cell carcinoma, veterans need to demonstrate that their condition is caused or aggravated by another service-connected condition.
Here are some common conditions that can cause or aggravate basal cell carcinoma in veterans:
1. Post-Traumatic Stress Disorder (PTSD)
Chronic stress and anxiety associated with PTSD can weaken the immune system, potentially increasing the risk of skin cancers, including basal cell carcinoma. The body’s stress response can lead to behaviors such as smoking or excessive sun exposure, both of which are risk factors for skin cancer.
2. Depression and Anxiety
High levels of stress, anxiety, and depression can negatively affect overall health, including the immune system’s ability to fight off cancerous changes in cells. Psychological stress can lead to poor lifestyle choices, such as neglecting skin protection or engaging in risky behaviors like tanning.
3. Autoimmune Disorders
Autoimmune disorders such as lupus or rheumatoid arthritis can increase the risk of skin cancer due to chronic inflammation and immunosuppressive treatments. These conditions can lead to changes in skin cells that may result in basal cell carcinoma.
4. Other Skin Conditions
Conditions like psoriasis or eczema can damage the skin and make it more susceptible to cancerous changes. Treatments for these conditions, such as phototherapy, can increase the risk of basal cell carcinoma due to increased exposure to ultraviolet (UV) light.
5. Immunosuppressive Therapy
Treatments involving immunosuppressive drugs for various conditions can reduce the body’s ability to fight off cancer cells, increasing the risk of basal cell carcinoma. Conditions like organ transplantation often require long-term immunosuppressive therapy, which can elevate the risk.
6. Environmental Exposures
Veterans may have been exposed to carcinogenic substances, such as chemicals or radiation, during their service, which can increase the risk of developing basal cell carcinoma. Prolonged exposure to UV light in certain deployments also increases this risk.
7. Chronic Inflammatory Conditions
Chronic inflammatory conditions, such as inflammatory bowel disease (Crohn’s disease or ulcerative colitis), can increase the risk of skin cancer due to prolonged inflammation and possible use of immunosuppressive treatments.
8. Genetic Predisposition
While not a direct result of military service, a genetic predisposition combined with service-related exposures or stressors can increase the likelihood of developing basal cell carcinoma.
9. Hormonal Imbalances
Hormonal changes or imbalances, potentially exacerbated by medications or conditions like thyroid disorders, can influence the development of skin cancers.
10. Lifestyle Factors
Smoking, excessive alcohol consumption, poor diet, and lack of exercise, often seen in veterans with PTSD or depression, can increase the risk of basal cell carcinoma.
VA Disability Rating for Basal Cell Carcinoma
The VA rates basal cell carcinoma under 38 CFR § 4.118, General Rating Formula for the Skin, with ratings of 0%, 10%, 30%, or 60% based on the severity of symptoms, percentage of the body affected, and type and duration of treatment required.
If you have active skin cancer that requires treatments such as chemotherapy, radiotherapy, or surgery, then a 100% VA rating is assigned during the period of intensive treatment and continues at least until a follow-up examination.
If the basal cell carcinoma is actively malignant, it falls under Diagnostic Code 7819; if the condition is not actively malignant, it falls under Diagnostic Code 7818.
Regardless of the diagnostic code used, the rating criteria still fall under the general rating formula for the skin:
100% VA Rating for Basal Cell Carcinoma
- If your basal cell carcinoma requires treatments such as chemotherapy, radiotherapy, or surgery, then a 100% VA rating is applied. The 100% rating remains in effect during periods of cancer treatment.
- This rating reflects the severity of the condition and the aggressive treatment needed to manage it.
60% VA Rating for Basal Cell Carcinoma
- Basal cell carcinoma with characteristic lesions involving more than 40% of the entire body or more than 40% of exposed areas, or requiring constant or near-constant systemic therapy such as corticosteroids, phototherapy, retinoids, biologics, or other immunosuppressive drugs over the past 12-month period.
- This reflects extensive symptoms that are widespread and require continuous aggressive treatment.
30% VA Rating for Basal Cell Carcinoma
- Basal cell carcinoma with characteristic lesions involving 20% to 40% of the entire body or 20% to 40% of exposed areas, or requiring systemic therapy for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.
- This indicates moderate severity with significant body coverage and periodic need for systemic treatment.
10% VA Rating for Basal Cell Carcinoma
- Basal cell carcinoma with characteristic lesions involving at least 5% but less than 20% of the entire body or at least 5% but less than 20% of exposed areas, or requiring intermittent systemic therapy for a total duration of less than 6 weeks over the past 12-month period.
- This reflects mild to moderate severity requiring occasional systemic therapy.
0% VA Rating for Basal Cell Carcinoma
- Basal cell carcinoma with characteristic lesions involving less than 5% of the entire body or less than 5% of exposed areas, requiring no more than topical therapy over the past 12-month period.
- This accounts for very mild symptoms, requiring only topical treatment and affecting a small area.
Pro Tip: When applying for a VA disability rating for basal cell carcinoma, it’s crucial to document the extent of the body affected and the type and duration of treatments. Ensure you have comprehensive medical evidence, including treatment records, to support your claim. Uploading photos of the affected areas can also help substantiate the extent and severity of the condition, influencing the rating decision.
Additional Notes:
- Complications and Separate Ratings: Complications from basal cell carcinoma, such as infections or other clinical manifestations, should be rated separately under the appropriate diagnostic code.
- Functional Impact: The final VA disability rating also considers how the symptoms impact your daily life, work, and social functioning.
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About the Author
Brian Reese
Brian Reese is one of the top VA disability benefits experts in the world and bestselling author of You Deserve It: The Definitive Guide to Getting the Veteran Benefits You’ve Earned (Second Edition).
Brian’s frustration with the VA claim process led him to create VA Claims Insider, which provides disabled veterans with tips, strategies, and lessons learned to win their VA disability compensation claim, faster, even if they’ve already filed, been denied, gave up, or don’t know where to start.
As the founder of VA Claims Insider and CEO of Military Disability Made Easy, he has helped serve more than 10 million military members and veterans since 2013 through free online educational resources.
He is a former active duty Air Force officer with extensive experience leading hundreds of individuals and multi-functional teams in challenging international environments, including a combat tour to Afghanistan in 2011 supporting Operation ENDURING FREEDOM.
Brian is a Distinguished Graduate of Management from the United States Air Force Academy, Colorado Springs, CO, and he holds an MBA from Oklahoma State University’s Spears School of Business, Stillwater, OK, where he was a National Honor Scholar (Top 1% of Graduate School class).
