The skin compensation and pension exam is short and largely visual, which is exactly why it carries so much risk for veterans with intermittent conditions. The examiner documents what is in front of them, and the rating largely follows that document.
Knowing what gets recorded lets you make sure the record is complete rather than hoping it will be.
What the examiner does
The exam is generally built around the Skin Diseases Disability Benefits Questionnaire, or the Scars questionnaire where scars are at issue. The examiner typically:
- Confirms the diagnoses at issue and reviews the claims file
- Inspects affected areas and estimates the percentage of the entire body affected
- Separately estimates the percentage of exposed areas affected - head, face, neck, and hands
- Records the treatment used in the prior 12 months, distinguishing topical from systemic therapy and noting duration
- Measures scars, records depth and stability, and notes tenderness on examination
- Notes the functional impact, including any effect on work
The flare problem
Skin disease fluctuates. If your exam falls during a quiet period, the estimated coverage may be a fraction of your usual worst. 38 CFR 4.1 requires the rating to reflect the disability over time, but the examiner can only apply that principle to evidence that exists.
So bring the evidence. Dated photographs taken during flares, in good light, with something in frame for scale. A written log of flare dates, duration, and what the skin looked like. Treatment records covering the past year. Tell the examiner directly that the exam is falling between flares and ask that your photographs and flare history be noted in the report.
Getting treatment recorded correctly
The treatment section often determines the percentage, and it is the section most frequently recorded thin. Bring the actual prescription list with start and stop dates, not a recollection. Make clear which medications were topical and which were systemic, and how many total weeks of systemic therapy you had in the prior 12 months.
If you have had biologic infusions, bring the infusion records, which are often kept separately from the pharmacy record. Our eczema rating guide explains why the systemic therapy path so often produces a higher evaluation than coverage alone.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service or an already service-connected disability.
If scars are at issue
Point out every scar, not just the obvious one. Say plainly if a scar is tender when touched, because the painful-scar code turns on that finding and the examiner cannot record what you do not report. Ask that each scar be measured and that depth and stability be noted. Our scar rating guide covers what each measurement controls.
What the exam is not
The C&P examiner is not your treating provider and is not there to advocate. The report answers the questions the VA asked, and where a nexus opinion is requested, the examiner's opinion goes into the file alongside any independent opinion you have obtained. Our guide to the difference between a C&P exam and an independent medical opinion explains how the two are weighed.
Be accurate rather than dramatic. Overstating is easy to detect and damages credibility across the whole file; understating out of habit is just as costly. Describe your worst days and your typical days, and let the record carry the rest.
After the exam
Request a copy of the exam report and read it. If the coverage estimate or treatment history is wrong, that is correctable with evidence while the claim is still open. Our evidence guide covers what to submit, and reading your VA decision letter covers what the VA does with it.