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June 17, 2024

Squamous Cell Carcinoma VA Disability Rating Explained

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The VA rates squamous cell carcinoma under 38 CFR § 4.118, the 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 squamous cell carcinoma requires chemotherapy, radiotherapy, or surgery, then it is rated at 100% during the treatment periods.

If the squamous 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.

Squamous cell carcinoma is the second most common type of skin cancer, often presenting as a firm red nodule, a flat sore with a scaly crust, or a new sore or raised area on an old scar or ulcer.

Pro Tip: When submitting a VA claim for squamous 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 crucial to demonstrate the presence and extent of squamous cell carcinoma.

Summary of Key Points

  • VA Rating Criteria: Squamous cell carcinoma is rated under 38 CFR § 4.118 with ratings of 0%, 10%, 30%, or 60% based on the severity of symptoms, the percentage of the body affected, and the type and duration of treatment required.
  • 100% Rating for Skin Cancer: A 100% VA rating is applied if squamous cell carcinoma requires treatments such as chemotherapy, radiotherapy, or surgery during the treatment periods, reflecting the aggressive nature of the treatment.
  • Diagnostic Codes: Active squamous cell carcinoma falls under Diagnostic Code 7819; if not actively malignant, it falls under Diagnostic Code 7818, but the rating criteria remain under the general formula for the skin.
  • Pro Tip: When submitting a VA claim for squamous cell carcinoma, document the affected area’s size and location, treatment duration, and methods. Provide comprehensive medical evidence and photographs to support the claim and demonstrate the condition’s severity.

What is Squamous Cell Carcinoma?

Squamous Cell Carcinoma (SCC) is a common form of skin cancer that arises from the squamous cells, which are flat cells located in the outer part of the epidermis.

It’s the second most prevalent type of skin cancer after basal cell carcinoma.

SCC typically develops in areas frequently exposed to ultraviolet (UV) radiation from the sun, such as the face, ears, neck, lips, and backs of the hands.

Key Characteristics:

  • Appearance: SCC often appears as a firm red nodule, a flat sore with a scaly crust, or a new sore or raised area on an old scar or ulcer. It can also manifest as a rough, scaly patch on the skin that may be tender or bleed.
  • Growth: This type of cancer tends to grow slowly, but it can become invasive if not treated, spreading to other parts of the body and potentially causing serious complications.
  • Risk Factors: Prolonged exposure to UV radiation, either from the sun or tanning beds, increases the risk of developing SCC. Other risk factors include a history of sunburn, having fair skin, being older, having a weakened immune system, and exposure to certain chemicals or radiation.

Diagnosis and Treatment:

  • Diagnosis: Diagnosis is typically made through a skin examination and biopsy, where a small sample of the affected tissue is examined under a microscope.
  • Treatment: Treatment options depend on the size, location, and stage of the cancer and may include surgical removal, radiation therapy, cryotherapy (freezing the cancer cells), topical medications, or more advanced treatments like Mohs surgery, which involves the precise removal of cancerous tissue.

Prevention:

  • Sun Protection: To reduce the risk of SCC, it’s important to protect your skin from UV radiation by wearing sunscreen, seeking shade, and wearing protective clothing.
  • Regular Check-ups: Regular skin check-ups with a dermatologist are crucial, especially for individuals with high-risk factors.

How to Prove Service Connection for Squamous Cell Carcinoma

To receive VA disability benefits for squamous cell carcinoma, veterans must establish a service connection and demonstrate the severity of their symptoms.

1. Current Diagnosis of Squamous Cell Carcinoma

Ensure you have a medical diagnosis of squamous cell carcinoma from a healthcare professional.

This diagnosis should be documented in your service treatment records, VA medical records, or private treatment records.

While it’s helpful to have a diagnosis within the past 12 months, it is not mandatory.

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

Submit evidence of an event, injury, disease, illness, or exposure during military service that could have caused or aggravated squamous cell carcinoma.

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

This could include exposure to harsh sunlight, chemicals, or other carcinogens during service.

Link the current diagnosis of squamous cell carcinoma to the in-service event or injury.

Obtain a Nexus Letter from a qualified medical professional.

This letter should explain how the in-service event likely caused or aggravated squamous cell carcinoma.

4. Severity of Symptoms

Show the severity and impact of squamous cell carcinoma symptoms on your work, life, and social functioning.

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

Describe how squamous cell carcinoma affects your daily activities and any treatments or interventions you require.

Secondary Service Connection for Squamous Cell Carcinoma

To establish a secondary service connection for squamous cell carcinoma, veterans need to demonstrate that their condition is caused or aggravated by another service-connected condition.

Here are some conditions that can cause or aggravate SCC in veterans:

1. Post-Traumatic Stress Disorder (PTSD)

Impact: PTSD can lead to chronic stress and anxiety, which may weaken the immune system, potentially increasing the risk of various cancers, including SCC.

Behavioral Factors: Stress-related behaviors such as smoking and excessive sun exposure are risk factors for SCC.

2. Depression and Anxiety

Health Effects: These conditions can negatively impact overall health and the immune system, making the body less effective at fighting off cancerous changes in cells.

Lifestyle Choices: Stress and depression can lead to poor lifestyle choices, such as neglecting skin protection or engaging in high-risk behaviors like excessive tanning.

3. Autoimmune Disorders

Risk Factors: Conditions like lupus or rheumatoid arthritis involve chronic inflammation and the use of immunosuppressive treatments, both of which can increase the risk of SCC.

Cell Changes: These conditions can lead to cellular changes in the skin, predisposing it to cancer.

4. Other Skin Conditions

Vulnerability: Skin conditions like psoriasis or eczema can compromise skin integrity, making it more susceptible to cancerous changes.

Treatment Risks: Treatments for these conditions, such as phototherapy, can increase the risk of SCC due to UV exposure.

5. Immunosuppressive Therapy

Cancer Risk: Immunosuppressive drugs used for conditions like organ transplants can reduce the body’s ability to fight cancer cells, increasing the risk of SCC.

Long-Term Therapy: Prolonged use of these drugs can elevate cancer risk significantly.

6. Environmental Exposures

Carcinogenic Substances: Exposure to chemicals or radiation during military service can increase the risk of developing SCC.

UV Light Exposure: Long-term exposure to UV light, especially in certain deployments, is a significant risk factor for SCC.

7. Chronic Inflammatory Conditions

Inflammation Effects: Conditions like inflammatory bowel disease (Crohn’s disease or ulcerative colitis) involve chronic inflammation and immunosuppressive treatments, which can increase SCC risk.

8. Genetic Predisposition

Combined Risk: While genetic factors alone may not be service-related, they can increase SCC risk when combined with service-related exposures or stressors.

9. Hormonal Imbalances

Hormonal Influence: Hormonal changes or imbalances, possibly worsened by medications or conditions like thyroid disorders, can affect skin cancer development.

10. Lifestyle Factors

Behavioral Risks: Smoking, excessive alcohol consumption, poor diet, and lack of exercise, often linked to PTSD or depression, can elevate the risk of SCC.

VA Disability Rating for Squamous Cell Carcinoma

The VA rates squamous cell carcinoma under 38 CFR § 4.118, the 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 your squamous 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 Squamous Cell Carcinoma

  • Criteria: If your squamous 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.
  • Explanation: This rating reflects the severity of the condition and the aggressive treatment needed to manage it.

60% VA Rating for Squamous Cell Carcinoma

  • Criteria: Squamous 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.
  • Explanation: This reflects extensive symptoms that are widespread and require continuous aggressive treatment.

30% VA Rating for Squamous Cell Carcinoma

  • Criteria: Squamous 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.
  • Explanation: This indicates moderate severity with significant body coverage and periodic need for systemic treatment.

10% VA Rating for Squamous Cell Carcinoma

  • Criteria: Squamous 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.
  • Explanation: This reflects mild to moderate severity requiring occasional systemic therapy.

0% VA Rating for Squamous Cell Carcinoma

  • Criteria: Squamous 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.
  • Explanation: 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 squamous 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 squamous 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.

How to Get a 100% VA Rating for Skin Cancers

When skin malignancy, such as squamous cell carcinoma, requires extensive therapy like treatments for systemic malignancies, a 100% disability rating may be assigned.

Here’s a detailed breakdown of the criteria and process:

100 Percent VA Rating Criteria for Skin Cancer

If the treatment required for the skin malignancy is similar to that used for systemic malignancies, a 100% rating is warranted.

This includes:

Systemic Chemotherapy: Treatment involving the use of anti-cancer drugs that travel through the bloodstream to reach and affect cancer cells all over the body.

X-ray Therapy: Radiation treatment that is more extensive than what is typically used just for the skin.

Extensive Surgery: Surgical procedures that go beyond wide local excision (removal of the tumor with some surrounding healthy tissue).

Evaluation Process for Skin Cancer

Initial Assignment: A 100% evaluation is assigned from the start of intensive treatment.

Mandatory VA Examination: Six months after completing the antineoplastic (anti-cancer) treatment, a mandatory VA examination is conducted.

Reevaluation: Based on the results of this examination or any subsequent ones, the VA may adjust the disability rating according to the provisions of § 3.105(e). This section outlines the process for proposing and effectuating rating reductions.

Residuals Evaluation: If there has been no local recurrence or metastasis (spread of cancer to other parts of the body), the rating will then be based on the residual effects of the cancer and its treatment.

    Key Points

    100% Evaluation: Assigned during the period of intensive treatment and continues until the follow-up examination.

    Post-Treatment Examination: Occurs six months after treatment ends, determining if the 100% rating should continue or be adjusted.

    Residuals: If the cancer has not recurred or metastasized, the VA will rate the residual effects (e.g., scarring, functional limitations) rather than the cancer itself.

    Exclusion: If the treatment is confined to the skin and does not involve systemic therapies or extensive surgery, the 100% evaluation provision does not apply.

    Pro Tips for Skin Cancer in Veterans

    Ensure Documentation: Keep thorough records of all treatments, including systemic chemotherapy, extensive radiation, or surgeries beyond wide local excision.

    Follow-Up Exams: Be prepared for the mandatory VA examination six months after treatment, as it will determine the continuation or adjustment of your rating.

    Report Residuals: Document and report any ongoing symptoms or residual effects to ensure they are properly evaluated for your disability rating.

    VA Compensation for Squamous Cell Carcinoma

    Here are the VA compensation rates for squamous cell carcinoma for a veteran alone, adjusted for a 3.2% COLA increase:

    • 0%: Non-compensable at $0 per month
    • 10%: $171.23 per month
    • 30%: $524.31 per month
    • 60%: $1,361.88 per month
    • 100%: $3,737.85 per month

    These rates reflect the monthly tax-free benefits a veteran with no dependents can expect to receive based on their VA disability rating.

    Note: Your monthly pay rate will be even higher with dependents.

    About the Author

    Brian Reese
    Brian Reese

    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).

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