Diagnostic Code 7816 · 38 CFR §4.118
Psoriasis is a chronic autoimmune skin condition that causes thick, scaly patches of skin that can be itchy, painful, and sometimes crack and bleed. It most commonly appears on the elbows, knees, scalp, and lower back, but can affect any part of the body. Stress, infections, and environmental factors can trigger flare-ups. Some veterans develop or worsen psoriasis during or after service due to stress, exposure to chemicals, or injuries to the skin. The VA rates psoriasis based on how much of your body is affected and what level of treatment you require.
| Rating | Criteria |
|---|---|
| 0% | Less than 5 percent of your entire body or less than 5 percent of exposed areas (head, face, neck, hands) are affected, and you only need topical therapy (creams and ointments applied directly to the skin). |
| 10% | At least 5 percent but less than 20 percent of your entire body is affected, or at least 5 percent but less than 20 percent of exposed areas are affected. Alternatively, you qualify at this level if you need intermittent systemic therapy such as corticosteroid pills or immunosuppressive drugs for less than six weeks during a 12-month period. |
| 30% | Twenty to 40 percent of your entire body or 20 to 40 percent of exposed areas are affected. You also qualify if you need systemic therapy like corticosteroids or immunosuppressives for six weeks or more during a 12-month period but not constantly. |
| 60% | More than 40 percent of your entire body or more than 40 percent of exposed areas are affected. You also qualify if you need constant or near-constant systemic therapy such as corticosteroids or immunosuppressives during the past 12 months. |
Photographs of your psoriasis during flare-ups are very helpful — especially if taken by your dermatologist with documentation of body surface area affected. Treatment records showing what medications you use and how often are essential. If you take systemic medications (pills, injections, or biologics), make sure every prescription refill is documented. A dermatologist letter estimating the percentage of body surface area affected during typical flare-ups can be decisive.
Yes, the VA considers both total body surface area and exposed area (head, face, neck, hands) separately. If your psoriasis primarily affects visible areas, you may qualify for a higher rating even if the total body percentage is lower.
Yes. Biologic drugs like adalimumab, etanercept, or secukinumab are systemic therapies. If you are on a biologic for psoriasis, that typically supports at least a 30 or 60 percent rating depending on duration of use.
Stress is a well-documented trigger for psoriasis flare-ups and can contribute to initial onset. If your psoriasis began during or soon after a stressful military period, a nexus letter connecting the stress to the onset can support your claim.