MALIGNANT NEOPLASMS OF THE SKIN

DAVID L. WIGHT · 2026 · Case ID: A26040918

DENIED

Summary

The veteran, who served in the United States Army from June 1984 to December 2007 with multiple service periods, appeals the denial of a compensable evaluation for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, with residual scars. The agency of original jurisdiction (AOJ) had previously granted service connection for these conditions with a noncompensable evaluation effective August 10, 2022. The Board, however, denied a compensable evaluation, finding that the conditions did not meet the criteria for disfigurement under Diagnostic Code 7800. The Board reviewed multiple VA examinations from December 2021 and April 2022, which detailed the veteran's scars and skin conditions. These examinations noted various scars on the cheeks and scalp, with some hypopigmentation and tissue loss, but concluded that none met the specific criteria for disfigurement warranting a 10 percent rating or higher. The Board found the objective findings in the VA examinations more probative than the veteran's lay assertions regarding his symptoms. The evidence persuasively weighed against a compensable rating, and thus, the benefit-of-the-doubt rule did not apply. The case was remanded by the Court of Appeals for Veterans Claims (CAVC) for further discussion of the December 2021 and April 2022 VA examinations, which the Board addressed in this decision.

Rationale

VA examinations did not show at least one characteristic of disfigurement.; Scars were less than five inches in length and less than one-square inch in width.; Scars did not exhibit surface contour elevation/depression, adherence to underlying tissue, or abnormal skin characteristics exceeding six square inches.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7800

Docket No.

240308-426493

Full Decision Text

Citation Nr: A26040918
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 240308-426493
DATE: April 30, 2026

ORDER

Entitlement to a compensable evaluation for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp) is denied.

FINDING OF FACT

Throughout the period on appeal, the Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek are not manifested by at least one characteristic of disfigurement.

CONCLUSION OF LAW

The criteria for entitlement to a compensable evaluation for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7818-7800.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Army from: June 1984 to March 1988, June 1990 to July 1990, July 1990 to October 1990, November 1990 to May 1991, August 1991 to January 1992, February 1992 to June 1993, and June 1993 to December 2007.

In November 2023, the agency of original jurisdiction (AOJ) granted service connection for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp) with a noncompensable evaluation effective August 10, 2022.

In the March 2024 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 November 2023 AOJ decision on appeal for the claim related to squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek and the December 2023 AOJ decision on appeal for the claim in regard to pruritus of the bilateral forearms. 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In December 2025, the United States Court of Appeals for Veterans Claims (CAVC) issued a decision which adopted a Joint Motion for Partial Remand (JMPR). CAVC requested the Board to consider the December 2021 and April 2022 VA examinations when rating the Veteran's skin disability.

1. Entitlement to a compensable evaluation for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp) is denied.

The Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek is rated under Diagnostic Code 7818-7800 for malignant skin neoplasms (other than malignant melanoma). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R
face, status post excision, residual scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp) is denied.

The Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek is rated under Diagnostic Code 7818-7800 for malignant skin neoplasms (other than malignant melanoma). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Diagnostic Code 7800, rates for burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. 38 C.F.R. § 4.118.

Diagnostic Code 7818 includes a note which indicates that if a skin malignancy 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 § 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.

Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar 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 warrants a 30 percent rating. A scar 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 warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion 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 warrants an 80 percent rating. 38 C.F.R. § 4.118.

Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: (1) a scar 5 or more inches (13 or more centimeters) in length; (2) a scar at least one-quarter inch (0.6 centimeters) wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 square centimeters); (6) skin texture abnormal in an area exceeding six square inches (39 square centimeters); (7) underlying soft tissue missing in an area exceeding six square inches (39 square centimeters); and, (8) skin indurated and inflexible in an area exceeding six square inches (39 square centimeters). Id.

As a procedural starting point for this claim, in December 2021, the Veteran submitted a fully developed claim for cancer in the form of squamous cell of the skin and basal cell. Throughout the period on appeal, the Veteran underwent various VA examinations which are discussed below.

In December 2021, the Veteran underwent a skin diseases VA examination. The VA examiner noted a diagnosis for: squamous cell carcinoma and basal cell carcinomas of the head and face; seborrheic keratoses: face and scalp; and pruritus (bilateral forearms) due to unknown etiology. The VA examiner assessed that the Veteran's squamous and basal cell carcinoma manifested in less than 5 percent of the total body area. Also, the VA examiner indicated that the Veteran's condition comprised 5 percent to 19 percent of the exposed area.

In December 2021, the Veteran underwent a scars/disfigurement VA examination. The VA examiner noted a diagnosis for squamous and basal cell carcinomas of the head and face. The VA examiner indicated that five or
VA examination. The VA examiner noted a diagnosis for: squamous cell carcinoma and basal cell carcinomas of the head and face; seborrheic keratoses: face and scalp; and pruritus (bilateral forearms) due to unknown etiology. The VA examiner assessed that the Veteran's squamous and basal cell carcinoma manifested in less than 5 percent of the total body area. Also, the VA examiner indicated that the Veteran's condition comprised 5 percent to 19 percent of the exposed area.

In December 2021, the Veteran underwent a scars/disfigurement VA examination. The VA examiner noted a diagnosis for squamous and basal cell carcinomas of the head and face. The VA examiner indicated that five or more scars are painful. The VA examiner listed the following scars and corresponding measurements: left cheek, 9cm in length and .5cm in width (at widest part); right cheek, 7cm in length and .5cm in width (at widest part); multiple small areas on scalp from frozen removal of skin cell cancerous lesions, one larger than 2x2, 2cm in length and 2cm in width (at widest part); midcenter of scalp, above forehead, 1cm in length and 3cm in width (at widest part); and left temple, 2cm in length and 1.5cm in width (at widest part). The VA examiner commented that scars on scalp had hyperpigmentation and described them as "pink". The VA examiner remarked that the approximate total area of head, face, and neck with hypo or hyperpigmented areas are 10 squared centimeters.

In April 2022, the Veteran underwent a skin conditions VA examination. The VA examiner noted a diagnosis for tumors and neoplasms of the skin, including malignant melanoma. Specifically, the VA examiner mentioned that the Veteran has a diagnosis for squamous cell carcinoma and basal cell carcinoma of face and head. Moreover, the Veteran stated that he had treatment for a flare up of basal cell in January 2022 with his prescription creams and was seen for follow up in April 2022 and began another round of treatment with prescription cream at that time. Also, the VA examiner noticed scarring noted from basal and squamous cell carcinoma removal of bilateral cheeks and scalp, redness, and hypopigmentation of the scalp from seborrheic keratosis and basal and squamous cell carcinoma flare up and treatment. The VA examiner noted the following treatment or medications: hydrocortisone cream QD, calcipotriene cream QD, and flouracil cream QD. The VA examiner commented that all treatments were topical. In addition, the VA examiner remarked that the hydrocortisone cream QD was used for itching related to squamous and basal cell carcinoma and pruritus of bilateral forearms. The VA examiner remarked that the treatment had a duration of "constant/near-constant". The treatment of flouracil cream was a topical treatment for pre-cancerous and cancerous skin growths that was used for 6 weeks or more, but not constant. In addition, the VA examiner pointed out that the calcipotriene cream was used for psoriatic skin conditions (used in conjunction with flouracil to speed up treatment) and had a duration of 6 weeks or more, but not constant.

The VA examiner highlighted that the Veteran had a procedure of where places had to be cut out on bilateral cheeks and multiple places frozen off his head and forehead because of his squamous cell and basal cell carcinoma of scalp. The squamous and basal cell carcinoma lesions of face and head had a total body area and exposed area of 5 percent to 19 percent. The VA examiner noted the Veteran has a malignant neoplasm related to his diagnosis. The VA examiner indicated that the Veteran had surgery and had basal cell removed from right cheek, right and left jawline on multiple occasions. The VA examiner remarked that the total body is affected at a combined 20 percent because of the multiple skin conditions. In addition, a combined percentage of 10 percent is affecting the exposed areas (hands, face, and neck).

In April 2022, the Veteran underwent a scars/disfigurement VA examination. The VA examiner noted that the Veteran has scarring noted from squamous cell and basal cell carcinoma removal of the face and scalp. The VA examiner highlighted that none of the scars of the head, face, or neck are painful or unstable. These are the measurements for the scars: right cheek, 1cm of length and 0.5cm of width (at widest part); right jawline, 1cm of length and 0.5cm of width (at widest part); left cheek, 1cm of length and 0.5cm of width (at widest part); and scalp, 1
(hands, face, and neck).

In June 2023, the Veteran underwent a scars/disfigurement VA examination. The VA examiner noted a diagnosis for scar in the right jaw status post skin cancer excision and for a scar in the left cheek status post skin cancer excision. The VA examiner highlighted that the Veteran's scars of the head, face, or neck are not painful. Also, the VA examiner indicated that none of the scars of the head, face, or neck are due to burns. The VA examiner mentioned that the scar in the right jaw had a length of 3cm and a width (at widest part) of 0.2cm. Also, the VA examiner remarked that the scar in the left check had a length of 2cm and a width (at widest part) of 0.2cm.

In June 2023, the Veteran underwent a skin diseases VA examination. The VA examiner noted that the Veteran has a diagnosis for squamous cell carcinoma, basal cell carcinoma, and seborrheic keratosis. During the examination, the Veteran commented that he uses two creams mixed together but does not remember the name. The VA examiner indicated that the Veteran has not been treated with medication in the past twelve months for any skin condition. Also, the VA examiner mentioned that the Veteran has not had any treatments or procedures other than systemic or topical medications in the past twelve months for any skin condition. The VA examiner determined that the Veteran's seborrheic keratosis a visible exposed area and total body area of less than 5 percent. For the conditions of squamous cell carcinoma and basal cell carcinoma, the VA examiner pointed that there was no visible total body area or exposed area. The VA examiner remarked that the Veteran has a malignant neoplasm that is in remission due to an excision on the face (surgery). The VA examiner commented that the Veteran does not have any residual conditions or complications due to the neoplasm. The VA examiner highlighted that the Veteran's skin conditions cause scarring or disfigurement of the head, face, or neck.

In March 2025, the Board granted entitlement to service connection, on a direct basis, for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek. Also, the Board denied entitlement to a compensable evaluation from August 10, 2022, for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek. In essence, the Board indicated that for the period from August 10, 2022, the Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek are not manifested by at least one characteristic of disfigurement.

In March 2025, the AOJ in its rating decision adopted the March 2025 Board decision and granted entitlement to an earlier effective date of December 4, 2021, for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek.

In December 2025, CAVC adopted a JMPR and vacated the March 2025 Board decision that denied a compensable evaluation from August 10, 2022, for squamous cell carcinoma and basal cell carcinoma of the head and face, status post excision, residuals scars of right jaw and left cheek (claimed as squamous cell carcinoma and basal cell carcinomas of the head and face, seborrheic keratoses: face and scalp). CAVC indicated that the parties agreed that the Board erred in failing to discuss the December 2021 and April 2022 VA examinations.

Upon review of the evidence, the Board finds that entitlement to a compensable evaluation for
right jaw and left cheek.

Upon review of the evidence, the Board finds that entitlement to a compensable evaluation for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek is not warranted. The Board notes that after its March 2025 decision, the AOJ established an effective date of December 4, 2021, for the Veteran's service connected disability. Also, as mentioned above, CAVC requested for the Board to discuss the December 2021 and April 2022 VA examinations when evaluating the assigned rating for Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek.

It is important to reiterate that the Veteran's disability is rated under Diagnostic Code 7818-7800. Therefore, the basis for the rating assigned is Diagnostic Code 7800, which rates for burn scars of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. See, 38 C.F.R. § 4.27. Also, Diagnostic Code 7818 specifically instructs to be rated as disfigurement of the head, face, or neck (DC 7800), scars (DC's 7801, 78702, 7803, 7804, or 7805), or impairment of function. This disability is not rated under the General Rating Formula for the Skin which is applicable for Diagnostic Codes 7806, 7809, 7813-7816, 7820-7822 and 7824.

The December 2021, April 2022, and June 2023 VA examinations do not show that the Veteran has at least one characteristic of disfigurement. The Veteran's scars are less than five inches (13 centimeters) in length and less than one-square inch (0.6 centimeters) in width. Also, the Veteran's scars did not exhibit 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 in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; or skin indurated and inflexible in an area exceeding six square inches. Thus, a rating of 10 percent is not warranted. Equally, a rating of 30, 50, or 80 percent is not applicable because the evidence of record did not reflect that the Veteran has burn scars of the head, face, or neck; scars of the head face, or neck due to other causes; or other disfigurement of the head, face, or neck that has visible or palpable tissue loss and either gross distortion or asymmetry in lips with at least two or more characteristics of disfigurement.

The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek is not encompassed by Diagnostic Codes 7801 and 7802 because these codes are applicable to burn scars or scars not related to the head, face, or neck. Moreover, the Veteran's squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek are not unstable or painful. Thus, Diagnostic Code 7804 is not applicable. Furthermore, Diagnostic Code 7805 is not pertinent because the disabling effects manifested by the Veteran's condition have been considered by the rating provided in Diagnostic Code 7800.

The Board acknowledges the Veteran's lay assertions regarding his current symptomatology related to his service connected squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek. However, the Board finds while the Veteran is competent to report observable symptoms, in order to determine the precise severity of his squamous cell carcinoma and basal cell carcinomas of the head and face, status post exc
ision, residual scars of right jaw and left cheek are not unstable or painful. Thus, Diagnostic Code 7804 is not applicable. Furthermore, Diagnostic Code 7805 is not pertinent because the disabling effects manifested by the Veteran's condition have been considered by the rating provided in Diagnostic Code 7800.

The Board acknowledges the Veteran's lay assertions regarding his current symptomatology related to his service connected squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek. However, the Board finds while the Veteran is competent to report observable symptoms, in order to determine the precise severity of his squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek is a medically complex determination that cannot be based on lay observation alone. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Instead, such a determination must be made by a medical professional with appropriate expertise. Id. In this regard, the Board finds the objective findings contained in the VA examination reports to be more probative.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for squamous cell carcinoma and basal cell carcinomas of the head and face, status post excision, residual scars of right jaw and left cheek. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply.

38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Colon, Ivan M.

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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