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§ 4.118 Schedule of ratings—skin.

Scars or disfigurement of head, face, or neck

Visible scarring or disfigurement on the head, face, or neck from burns or other causes.

What the rating means

VA rates burn scars, other scars, and disfigurement of the head, face, or neck under this code by measuring how many facial features are grossly distorted or asymmetrical and how many specific characteristics of disfigurement are present. A rating of 10% applies when one characteristic of disfigurement is present. A rating of 30% applies when there is visible or palpable tissue loss combined with gross distortion or asymmetry of one feature or paired set of features — such as the nose, chin, forehead, eyes including eyelids, ears, cheeks, or lips — or when two or three characteristics of disfigurement are present. A rating of 50% applies with tissue loss and distortion or asymmetry of two features or paired sets, or four or five characteristics. An 80% rating applies with tissue loss and distortion or asymmetry of three or more features or paired sets, or six or more characteristics. The eight characteristics are defined in the regulation. Tissue loss of the auricle and anatomical loss of an eye are rated separately under their own diagnostic codes. Other disabling effects of scars — such as pain, instability, or nerve injury — are evaluated separately and then combined with this rating.

Evidence that helps

Medical records and examination findings are central to establishing a rating under this code. A VA or private examiner's report should document whether there is visible or palpable tissue loss and identify which facial features — nose, chin, forehead, eyes, ears, cheeks, or lips — show gross distortion or asymmetry. The examiner should also measure and describe any scars present, noting length, width at the widest point, whether the surface is elevated or depressed, and whether the scar is adherent to underlying tissue. Findings about skin pigmentation changes, abnormal skin texture, missing soft tissue, or indurated and inflexible skin — and the size of any affected area — help establish which characteristics of disfigurement apply and how many are present. The regulation specifically allows VA to consider unretouched color photographs when evaluating these criteria, so photographs taken at different times can be relevant. If you have pain, limited movement, or nerve-related symptoms from the scar, records documenting those effects separately can support evaluation under additional diagnostic codes.

Secondary conditions

Conditions that are often caused or made worse by this one. If you have any of these, they may be claimable as secondary service connection.