Don't Forget Your Scars: Painful and Unstable Scars (DC 7804)

What the VA OIG found

In a review issued October 21, 2026 (Report 25-03303-266), the VA Office of Inspector General looked at painful-scar decisions made June 1, 2024 – May 31, 2025. It estimated 38% of those decisions (about 17,900 cases) had at least one error, and at least 920 errors caused roughly $5.6 million in overpayments.

The main problems:

• Scars rated as painful based only on the veteran's report, without objective findings documented in the physical exam.
• Pyramiding — the same symptoms rated under more than one diagnostic code — not being caught.
• Older service-connected scars that later became painful not getting a separate painful-scar evaluation.

A follow-up check of 30 decisions from January 2026 found a 43% error rate. VBA agreed with all three OIG recommendations, including revising the Scars/Disfigurement exam form (DBQ).

What DC 7804 covers

Under 38 CFR 4.118, Diagnostic Code 7804 rates scars that are unstable or painful. An unstable scar is one where, for any reason, the skin covering it is frequently lost. Ratings depend on how many such scars you have: 10% for one or two, 20% for three or four, 30% for five or more, with an extra 10% if a scar is both painful and unstable.

This includes surgical scars from service-connected surgeries — for example, a knee, back, or shoulder surgery for a condition VA already service-connected. Those scars can be rated separately from the joint itself if they are painful or unstable. A scar that was rated 0% years ago can qualify if it has become painful since.

Getting pain documented on your exam

• Tell the examiner plainly that the scar hurts or is tender, where, and how often. Don't assume they'll ask.
• Ask them to examine and touch the scar, and to record what they observe (tenderness on palpation, skin breakdown, etc.). The OIG found subjective reports alone weren't enough.
• Bring a short log of flare-ups, skin breakdown, or clothing rubbing — our free symptom flare-up log works for this.
• Mention every scar, including small surgical and drain-site scars.
• Get a copy of your exam (DBQ) and check the scar section afterward.

Don't claim the same symptom twice

VA can't pay twice for the same symptom (38 CFR 4.14, "pyramiding"). Scar pain is separate from, say, limited knee motion — but if the same pain is already counted under another code, a second rating can be reversed later. When VA corrects an error like that, it can create an overpayment debt you have to repay. Be accurate and specific about which symptom belongs to which condition.

Already got a letter? See Got a VA debt letter? What to do next.

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