Diagnostic Code 7808 · 38 CFR §4.118
Old World leishmaniasis is a parasitic skin disease caused by Leishmania species (most commonly L. major and L. tropica in the Middle East) and transmitted by the bite of infected sandflies. The classic presentation, well documented among veterans who deployed to Iraq, Afghanistan, Kuwait, and surrounding regions, is a slow-growing painless ulcer on exposed skin — face, neck, forearms, lower legs — that begins as a small red papule and gradually enlarges, crusts over, and leaves a depressed scar after months of healing. Service members nicknamed it the "Baghdad boil," and the Department of Defense recognized cutaneous leishmaniasis as a deployment-acquired condition during the OEF/OIF era. Beyond the cosmetic disfigurement, the lesions can become secondarily infected, can leave permanent scars on exposed areas, and in a small percentage of cases can recur or progress to mucocutaneous disease involving the nose, mouth, and throat. The VA rates DC 7808 within the dermatitis framework of 38 CFR §4.118, with severity tiers tied to body surface area affected and need for systemic therapy.
| Rating | Criteria |
|---|---|
| 0% | History of leishmaniasis with healed lesions, less than 5% of the entire body or less than 5% of exposed areas affected, AND no more than topical therapy required during the past 12-month period. |
| 10% | At least 5% but less than 20% of the entire body, OR at least 5% but less than 20% of exposed areas affected, OR intermittent systemic therapy (antiparasitic agents such as miltefosine or amphotericin B, or short courses of corticosteroids) required for less than 6 weeks during the past 12 months. |
| 30% | 20 to 40% of the entire body or 20 to 40% of exposed areas affected, OR systemic therapy required for 6 weeks or more but not constantly during the past 12 months. |
| 60% | More than 40% of the entire body or more than 40% of exposed areas affected, OR constant or near-constant systemic therapy required during the past 12 months. |
A confirmed diagnosis from a dermatologist or infectious disease specialist is the anchor. Confirmation is typically by skin biopsy showing the amastigote forms of the parasite on histopathology, by PCR identification of the Leishmania species, or by culture from a fresh lesion. Photographs of active lesions and of healed scars document the extent and the cosmetic residuals. Records of antiparasitic treatment (miltefosine, sodium stibogluconate, amphotericin B, paromomycin) demonstrate the management burden. Deployment records establishing time in an endemic region — Iraq, Afghanistan, Kuwait, Saudi Arabia, parts of North Africa, Southwest Asia generally — close the nexus. The Department of Defense leishmaniasis screening program produced records on many service members that can be obtained through the National Personnel Records Center.
Leishmaniasis is not on the formal presumptive list under the PACT Act in the same way as some respiratory cancers, but the Department of Defense and VA have long recognized deployment to endemic regions as the standard nexus pathway. Service connection runs through the deployment records plus the diagnosis. Some veterans with disseminated or visceral leishmaniasis have been service-connected on broader exposure theories under the burn pit and toxic-exposure framework.
Healed lesions still support service connection, and the rating shifts to the scar criteria. Small scars in unexposed areas may produce a 0% or 10% rating under DC 7808 alone. Significant facial or neck scars open the DC 7800 disfigurement code, which can produce ratings from 10% to 80% depending on the number and character of disfiguring features. Photographs of the current scars and a dermatology consult drive the evaluation.
Yes. The parasite can persist in skin tissue and lymph nodes for years, and reactivation can occur particularly with immunosuppression — chemotherapy, organ transplant medications, HIV. A new lesion in a veteran with a history of cutaneous leishmaniasis is treated as a recurrence of the original disease, which strengthens the case for ongoing service connection and supports rating increases when the new lesions are extensive.