1. Evaluation of Scars 38 CFR 4.118 (Revised) Final Rule Published September 23, 2008 Effective October 23, 2008

2. Summary of Changes Added introductory paragraph for 38 CFR 4.118 Revised the heading to DC 7800 and added new notes (4) and (5) Revised DC 7801, 7802, 7804 and 7805 Removed DC 7803

3. 38 CFR 4.118 Introductory Paragraph Veteran previously rated under DC 7800 through 7805 before October 23, 2008 can request review under revised criteria irrespective of whether disability has increased since last review.

4. Effective Date (38 CFR 3.114) If review requested, what will be the effective date of any increase if: A) Filed with 1 year of October 23, 2008? Date of change of law. B) Filed after October 23, 2009? 1 year earlier than date of claim. Note: In both cases, the “evidence must show that the claimant met all eligibility criteria for the liberalized benefit on the effective date of the liberalizing law”.

5. DC 7800 Heading changed from: (Old) Disfigurement of the head, face or neck: To: (New) 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:

6. DC 7800 cont. The rating criteria and notes (1), (2), and (3) remain in effect and unchanged. Note (1) – The 8 characteristics of disfigurement. Note (2) – Pertains to the eyes Note (3) – Requirement to take into consideration color photos.

7. DC 7800 cont. Note (4): [New] Separately evaluate disabling effects other that disfigurement …such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriated DC and apply 4.25 to combine the evaluation (s) with the evaluation under this DC

8. DC 7800 cont. Note (5): [New] 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.

9. DC 7801 Revised heading Old – Scars, other than head, face or neck, that are deep or that cause limited motion: New – Burn scar (s) or scar (s) due to other causes, not of the head, face, or neck, that are deep and nonlinear.

10. DC 7801 cont. Rating criteria remains in effect and unchanged. The old Note (2) is now the new Note (1) Note (1): [New} A deep scar is one associated with underlying soft tissue damage.

11. DC 7801 cont. The old Note (1) has been replaced by the new Note (2) which provides additional clarification not previously contained in the old Note (1). Note (2): [New] Summarization:

12. DC 7801 cont. A separate evaluation will be assigned for each qualifying scar or multiple scars affecting each of the four extremities or the posterior or anterior portions of the trunk. If a scar affects more than one extremity or portion of the trunk, separately evaluate each extremity using that portion of the scar that is on that extremity.

13. DC 7801 cont. Combine separate evaluations under 4.25 Qualifying scars are nonlinear, deep, and are not located on the head, face, or neck.

14. DC 7802 Revised heading: Old – Scars, other than head, face, or neck, that are superficial and that do not cause limited motion. New – Burn scar (s) or scar (s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear.

15. DC 7802 cont. Old rating criteria remains in effect and unchanged. Like DC 7801, DC 7802 old Note (2) is now new Note (1). Note (1): [New] – A superficial scar is one not associated with underlying soft tissue damage.

16. DC 7802 cont New Note (2) under DC 7802 is the same as the new Note (2) under DC 7801 except that qualifying scars are defined as scars that are nonlinear, superficial, and are not located on the head, face, or neck.

17. DC 7803 The old DC 7803 has been removed and incorporated into the new DC 7804.

18. DC 7804 Revised header Old – Scars, superficial, painful on examination ….. 10 New – Scar (s), unstable or painful: Five or more that are unstable or painful 30% Three or four ….. 20% One or two ……..10%

19. DC 7804 cont Old Notes (1) and (2) removed. Note (1) [New] – An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) [New] – 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.

20. DC 7804 cont Note (3) [New] – Scars evaluated under DC’s 7800, 7801, 7802, or 7805 may also receive an evaluation under this DC, when applicable.

21. DC 7805 Old – Scars, other; rate on limitation of function of affected part. New – Scars, other (including linear scars) and other effects of scars evaluated under DC’s 7800, 7801, 7802, and 7804: Evaluate any disabling effect (s) not considered in a rating provided under DC’s 7800-04 under an appropriate DC.

22. Practical Application EXERCISE