SCARS OF THE HEAD, FACE, OR NECK

MARCUS N. FULTON · 2026 · Case ID: A26040520

MIXED

Summary

The veteran, who served in the United States Army from June 2005 to March 2009, appeals the reduction of his disability rating for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars. The veteran was initially awarded a 10 percent rating for these conditions, which was subsequently reduced to noncompensable in February 2025. The Board found the reduction proper, noting that the scars had healed well, were in remission, and did not exhibit characteristics of disfigurement, pain, or instability, aligning with the criteria for a noncompensable rating. The Board also denied the veteran's claim for an increased rating, as the residual scarring did not meet the criteria for a higher evaluation under the applicable diagnostic codes, and no other disabling effects were documented. However, the case is remanded for further development regarding the veteran's claim for service connection for actinic keratosis. The veteran contends this condition is related to sun exposure and burn pit emissions during service. While the Agency of Original Jurisdiction (AOJ) made favorable findings regarding the diagnosis and conceded toxic exposure risk activity, the VA examiner failed to address the veteran's specific theory of sun exposure. This omission constitutes a duty to assist error, necessitating a remand for a proper medical opinion on the etiology of the actinic keratosis.

Rationale

Rating reduction from 10% to noncompensable was proper.; Scars healed well, in remission, not painful/unstable.; No characteristics of disfigurement met criteria for 10% rating.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251224-618096

Full Decision Text

Citation Nr: A26040520
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 251224-618096
DATE: April 30, 2026

ORDER

The rating reduction from 10 percent to noncompensable for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, was proper.

Entitlement to a compensable rating for squamous cell carcinoma in situ (scalp) with basal cell carcinoma (forehead) is denied.

REMANDED

Entitlement to service connection for actinic keratosis is remanded.

FINDINGS OF FACT

1. The Veteran's squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, showed actual improvement under the normal circumstances of life during the pertinent appeal period.

2. The Veteran's squamous cell and basal cell carcinoma were excised, in remission, and there is no evidence of recurrence or metastasis. The resulting scars are not painful, unstable, and have not been manifested by any characteristic of disfigurement.

CONCLUSIONS OF LAW

1. The rating reduction from 10 percent to noncompensable for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, was proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 38 C.F.R. §§ 3.102, 3.105, 3.344, 4.118, Diagnostic Code (DC) 7800, 7818.

2. The criteria for a compensable rating for squamous cell carcinoma in situ (scalp) with basal cell carcinoma (forehead) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.118, 4.3, DC 7800, 7818.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 2005 to March 2009.

These matters come before the Board of Veterans' Appeals (Board) on appeal from separate rating decisions issued in February 2025. In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the respective February 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim for actinic keratosis, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. The rating reduction from 10 percent to noncompensable for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, was proper

The Veteran was awarded service connection for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, in an October 2024 rating decision, evaluated as 10 percent disabling. In a February 2025 rating decision, his 10 percent rating was reduced to noncompensable. Currently, the Veteran is in receipt of a noncompensable rating for squamous cell carcinoma of the scalp and basal cell carcinoma of the forehead, and a noncompensable rating for scars associated with excisions of the carcinoma. The Veteran now argues that the reduction of the rating for his scars was improper and that an increased rating is warranted for his squamous cell carcinoma of the scalp and basal cell carcinoma of the forehead.

With regard to the propriety of a rating reduction, there is no question that a disability rating may be reduced; however, the circumstances under which rating reductions can occur are specifically limited and carefully circumscribed by regulations prom
February 2025 rating decision, his 10 percent rating was reduced to noncompensable. Currently, the Veteran is in receipt of a noncompensable rating for squamous cell carcinoma of the scalp and basal cell carcinoma of the forehead, and a noncompensable rating for scars associated with excisions of the carcinoma. The Veteran now argues that the reduction of the rating for his scars was improper and that an increased rating is warranted for his squamous cell carcinoma of the scalp and basal cell carcinoma of the forehead.

With regard to the propriety of a rating reduction, there is no question that a disability rating may be reduced; however, the circumstances under which rating reductions can occur are specifically limited and carefully circumscribed by regulations promulgated by the Secretary. Dofflemyer v. Derwinski, 2 Vet. App. 277, 280 (1992). In Brown v. Brown, 5 Vet. App. 413 (1993), the Court interpreted the provisions of 38 C.F.R. § 4.13 to require that in any rating reduction case, it must be ascertained, based upon a review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Moreover, 38 C.F.R. §§ 4.2 and 4.10 provide that in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but also that that improvement in a disability actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421. See also Stern v. McDonough, 34 Vet. App. 51 (2021) (discussing the two part analysis required by Brown). 38 C.F.R. § 3.344 (c) provides that the provisions of 38 C.F.R. § 3.344(a) and (b), which contain additional requirements relating to rating reductions, apply only to ratings that have continued for 5 years or more. Hanser v. McDonough, 56 F.4th 967 (Fed. Cir. 2022). 38 C.F.R. § 3.105 (e) contains procedures that the RO must follow when reducing compensation, including issuance of a proposed reduction in rating and an opportunity for presentation of additional evidence.

The AOJ reduced the disability rating for the Veteran's service-connected residual scarring, status post basal cell carcinoma under DCs 7818-7800 from 10 percent to 0 percent effective April 23, 2024. The Board notes that, because this rating reduction did not reduce the Veteran's overall VA disability compensation, the AOJ was not required to comply with the due process provisions for rating reduction claims found in § 3.105(e).

Skin Cancer

The Veteran's disability has been assigned a rating under DC 7818-7800 of 38 C.F.R. § 4.118. Under DC 7818, a nonmalignant melanoma is rated as disfigurement of the head, face, or neck under DC 7800, scars under (DCs 7801, 7802, 7803, 7804, or 7805), or impairment of function. A Note to DC 7818 states if a skin malignancy requires therapy that is comparable to that used for systemic malignancies, i.e., systemic chemotherapy, X-ray therapy more extensive than to the skin, or surgery more extensive than wide local excision, a 100-percent evaluation will be assigned from the date of onset of treatment, and will continue, with a mandatory VA examination six months following the completion of such antineoplastic treatment, and any change in evaluation based upon that or any subsequent examination will be subject to the provisions of 38 C.F.R. § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, evaluation will then be made on residuals. If treatment is confined to the skin, the provisions for a 100-percent evaluation do not apply.

Here, the Board notes that the Veteran has been service-connected for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead). The medical evidence of record, to include VA examinations and private treatment records indicate that the Veteran had an excision of both the scalp and forehead in April 2024. The medical evidence of record further documents the conditions as "in remission," with no recurrence or metastasis. See July 2024 and October 2024 VA Examinations. The residuals of the excision have been documented as scars of the forehead and scalp, resulting in ratings assigned under Diagnostic Code 7800.

Residual Scars

the skin, the provisions for a 100-percent evaluation do not apply.

Residual Scars

Under DC 7800 is used for scars of the head, face, or neck or other disfigurement of the head, face, or neck. A 10 percent rating is assigned for one characteristic of disfigurement, a 30 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement; a 50 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement; and an 80 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with six or more characteristics of disfigurement. 38 C.F.R. § 4.118, DC 7800.

Note (1) lists the 8 characteristics of disfigurement: scar 5 or more inches (13 or more cm.) in length; scar at least one-quarter inch (0.6 cm.) wide at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.). Id. Note (2) states to rate tissue loss of the auricle under DC 6207 (loss of auricle) and anatomical loss of the eye under DC 6061 (anatomical loss of both eyes) or DC 6063 (anatomical loss of one eye), as appropriate. Id. Note (3) states to take into consideration unretouched color photographs when evaluating under these criteria. Id. Note (4) states to separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply § 4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code. Id. Note (5): The characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. Id.

DC 7801 provides compensation for burn scars, and DC 7802 for scars not of the head, face, or neck; which are both inapplicable here.

Under DC 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating; three or four scars that are unstable or painful scars warrants a 20 percent rating; and five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118, DC 7804. Note (1) states an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) states scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC, when applicable.

Turning to the evidence of record, the Veteran
; and five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118, DC 7804. Note (1) states an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) states scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC, when applicable.

Turning to the evidence of record, the Veteran was initially assigned a 10 percent rating for his scars based on the findings of a July 2024 examination. At that time, the Veteran exhibited two scars. The examination report documented that the scars were the result of shaved biopsy of basal cell and squamous cell carcinoma in April 2024, which the examiner described as healing well with no pain or tenderness. On examination, scar one on the left superior forehead measured 4 x .5 cm., and scar two on posterior mid-parietal scalp measured 3 x 1 cm. The scars were not painful, tender, unstable, or with frequent loss of covering of skin over the scar. They did not impact his ability to work.

The reduced noncompensable rating was based on the findings of an October 2024 examination. The examiner described healed scars of the scalp and forehead, not painful or unstable. On examination, the Veteran's forehead scar measured 4 x .1 cm., and his scalp scar measured 3.5 x .1 cm. The scars were not painful, tender, unstable, or with frequent loss of covering of skin over the scar. They did not impact his ability to work.

Additional private treatment records document the April 2024 excisions, and describe the scars consistent with characteristics documented in the July and October 2024 VA examinations.

In this case, the Board finds that the reduction of the Veteran's rating from 10 percent to noncompensable was proper. Notably, the Veteran had one characteristic of disfigurement documented in the July 2024 examination, which was the size of his scalp scar, measuring 1 cm. in width. See 38 C.F.R. § 4.118, DC 7800, (Note) 1. At the time of the October 2024 examination, the scalp scar was found to be well healed and measured at .1 cm in width. As the size of the Veteran's scar was the only disfiguring characteristic warranting a 10 percent rating under DC 7800, its reduction in size alone establishes that an improvement in his disability had occurred.

The Board further finds that the evidence makes it reasonably certain the improvement in the scarring would be maintained under ordinary conditions of life. The Veteran has not asserted that his scars are painful or impact him functionally, and the VA examinations of record reflect the same. The record also indicates that the RO considered the entire record prior to proposing the reduction. Furthermore, the Board finds that the scarring, which has never been found or reported to be unstable, nor characterized by gross distortion or asymmetry of facial features or visible or palpable tissue loss, is by its nature not subject to temporary or episodic improvement.

Based on the foregoing, the Board finds that the rating reduction from 10 percent to noncompensable for squamous cell carcinoma in situ (scalp) and basal cell carcinoma (forehead) with scars, was proper.

2. Entitlement to a compensable rating for squamous cell carcinoma in situ (scalp) with basal cell carcinoma (forehead)

To the extent that the Veteran contends that an increased rating is warranted, as documented above, the only residual of the Veteran's squamous cell carcinoma and basal cell carcinoma are his noncompensable scars. Accordingly, a compensable rating cannot be assigned under DC 7818. Additionally, for the reasons discussed in detail above, a compensable rating is also not warranted under DC 7800 for the Veteran's scars.

The Board has also considered whether a higher rating is warranted under any other diagnostic code relevant to the Veteran's scars. However, the medical evidence has not shown, and neither has the Veteran reported any other pertinent physical findings, complications, conditions, signs and/or symptoms, such as muscle or nerve damage associated with any scar, or that his scars caused any functional impact. Thus, there is no evidence of other disabling effects or limitation of function that would warrant a higher and/or additional rating. Based on the foregoing, the Veteran's claim for an increased rating must also be denied.

REASONS FOR REMAND

Entitlement to service connection for actinic keratosis is remanded
also not warranted under DC 7800 for the Veteran's scars.

REASONS FOR REMAND

Entitlement to service connection for actinic keratosis is remanded.

The Veteran contends that he suffers from actinic keratosis that is related to active service. Specifically, he argues that he was exposed to burn pit emissions and experienced prolonged periods of unprotected sun exposure due to his service on the flight lines. See VA 21-526EZ, Fully Developed Claim, received October 18, 2024.

Under the AMA, the Board must remand to the Agency of Original Jurisdiction (AOJ) to correct pre-decisional duty to assist errors (including when the AOJ failed to make reasonable efforts to obtain VA treatment records or relevant federal or private treatment records, failed to obtain a VA examination, or provided an inadequate VA examination or opinion). 38 C.F.R. § 20.802(a).

The AOJ provided favorable findings in its February 2025 rating decision that the Veteran has been diagnosed with actinic keratosis and that his participation in a toxic exposure risk activity is conceded based on qualifying deployments to Iraq and Kuwait between March 2007 and June 2008. Under the AMA, the Board is bound by favorable findings by the AOJ in the absence of evidence of clear and unmistakable error. 38 C.F.R. § 3.104(c).

In this case, a VA medical opinion was obtained in February 2025. The examiner's opinion was limited to whether the Veteran's condition was related to exposure to toxins during his service in Southwest Asia. Despite noting that frequent or intense exposure to ultraviolet (UV) rays can cause actinic keratosis, the examiner failed to address the Veteran's theory that his prolonged exposure to the sun during service caused his condition.

The Board finds that the failure to obtain a medical opinion which addresses the Veteran's theory of entitlement is a pre-decisional duty to assist error requiring remand.

The matters are REMANDED for the following action:

1. Obtain an addendum medical opinion to determine the nature and etiology of his actinic keratosis. Access to the claims file must be made available to the VA examiner for review in conjunction with the examination. The need to schedule an in-person examination is left to the discretion of the examiner. The examiner should provide the following opinion:

Whether it is at least as likely as not that the Veteran's actinic keratosis had its onset in service or is related to an event, injury or disease incurred in service.

The examiner must address the Veteran's contention that his skin condition is related to sun exposure due to his service on the flight line. See VA 21-526EZ, Fully Developed Claim, received October 18, 2024.

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The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Marsh II, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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