Diagnostic Code 7815 · 38 CFR §4.118
DC 7815 covers bullous disorders — autoimmune conditions that cause blistering of the skin and sometimes mucous membranes. The main conditions include pemphigus vulgaris (where blisters form within the skin layers), bullous pemphigoid (where blisters form beneath the outer skin layer), and dermatitis herpetiformis (blistering associated with celiac disease). These conditions can be severely disabling, causing widespread painful blistering, skin breakdown, and increased infection risk. Veterans may develop these conditions related to environmental exposures, medications prescribed during service, or stress-triggered autoimmune activation.
| Rating | Criteria |
|---|---|
| 0% | Less than 5% of the body affected and no more than topical therapy in the past 12 months. |
| 10% | 5–20% of the body affected, OR intermittent systemic therapy for less than 6 weeks in the past 12 months. |
| 30% | 20–40% of the body affected, OR systemic therapy (corticosteroids or other immunosuppressives) for 6 weeks or more, not constantly, in the past 12 months. |
| 60% | More than 40% of the body affected, OR constant or near-constant systemic therapy required. |
Skin biopsy with immunofluorescence testing confirming the specific bullous disorder is essential. Blood tests for autoantibodies support the diagnosis. Treatment records showing the medications needed, especially immunosuppressive drugs, document severity. Photographs of blistering during active disease episodes are very helpful. Hospital records if the condition required inpatient care demonstrate the serious nature.
They can range from mild localized blistering to life-threatening widespread disease. Pemphigus vulgaris in particular can be very serious without treatment. Even with modern immunosuppressive therapy, these conditions often require lifelong treatment and significantly affect quality of life. The VA recognizes this severity in its rating criteria.
Stress is a recognized trigger for autoimmune flares, including bullous disorders. Military service stress, combined with environmental exposures, can trigger the initial onset or worsen existing disease. Documenting the timeline of symptom onset relative to service stressors supports the service connection claim.