Acne

Acne is rated under 38 CFR § 4.118, Diagnostic Code 7828, and the ceiling is low. The single best rating the acne code itself can produce is 30 percent, and getting there requires deep acne over 40 percent or more of the face and neck. Most acne claims land at 0 or 10 percent. If you read the case as a single-code acne claim and stop there, that's usually the whole story: a small rating, or none at all.

The part most acne claims miss is the scarring. Acne that has cleared can still leave permanent disfigurement and scars on the face, and those are rated under separate codes that frequently pay more than the active acne ever could. The regulation lets the rater evaluate the condition as disfigurement of the head, face, or neck (DC 7800) or as scars (DC 7801 through 7805), whichever yields the higher evaluation. In Claim Raven's analysis, facial acne scarring is one of the more commonly under-claimed pieces of a skin file. A veteran focused on whether the acne is "active" can leave the higher-value scar rating sitting on the table.

There's also a separate pathway that some veterans qualify for and most don't know exists. Chloracne is its own diagnostic code, DC 7829, and it is an Agent Orange presumptive condition under 38 CFR § 3.309(e). For a veteran with qualifying herbicide exposure, that presumptive path can connect the condition without the usual nexus fight. This page walks through DC 7828 and what each tier pays, the deep-versus-superficial distinction that drives the whole rating, the scar and disfigurement alternative, the chloracne presumptive pathway, the C&P exam mechanics, and the evidence gaps I see across the dataset.

TL;DR

• Acne is rated under 38 CFR § 4.118, DC 7828. The rating turns on whether the acne is "deep" or superficial, and on the percent of the face and neck involved.
• Deep acne (deep inflamed nodules and pus-filled cysts) over 40 percent or more of the face and neck rates at 30 percent. Deep acne under 40 percent, or deep acne in areas other than the face and neck, rates at 10 percent. Superficial acne (comedones, papules, pustules, superficial cysts) of any extent rates at 0 percent.
• The acne code caps at 30 percent. That low ceiling is the central fact of an acne claim.
• Acne can also be rated as disfigurement of the head, face, or neck (DC 7800) or as scars (DC 7801 through 7805), whichever yields the higher evaluation. Facial scarring is commonly under-claimed and can outvalue the active acne rating.
• Chloracne is a distinct code, DC 7829, and is an Agent Orange presumptive condition under § 3.309(e). It must become at least 10 percent disabling within one year of herbicide exposure.
• Photographs documenting flares and scarring are the single most useful piece of evidence in an acne file.
• In Claim Raven's analysis of 674 BVA acne cases, 48.8 percent were denied, 35.0 percent remanded, and 16.2 percent granted. Of the 508 cases with a C&P adequacy determination, 52.2 percent had the exam flagged as inadequate.

DC 7828 and What Each Tier Pays

The acne code lives in the skin section of 38 CFR § 4.118. It is a short code with three tiers, and the rating is driven entirely by two variables: the type of acne (deep versus superficial) and the body area involved.

Deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck, 30% Deep acne affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck, 10% Superficial acne (comedones, papules, pustules, superficial cysts) of any extent, 0%

Two things drive the outcome. The first is whether the acne is "deep." Deep acne means deep inflamed nodules and pus-filled cysts, the nodulocystic kind that scars. Superficial acne means comedones (blackheads and whiteheads), papules, pustules, and superficial cysts. Superficial acne, no matter how widespread, rates at 0 percent under this code. That is a hard line, and it surprises veterans who have visible, persistent breakouts but no deep nodular component.

The second variable is location and extent. For the 30 percent tier, the deep acne has to cover 40 percent or more of the face and neck. Deep acne that covers less of the face and neck, or deep acne anywhere other than the face and neck (the back, chest, or shoulders, for example), drops to 10 percent. So a veteran with severe cystic acne across the back and chest but a relatively clear face is looking at a 10 percent rating under DC 7828, not 30, because the high tier is specific to the face and neck.

The note that matters here is that DC 7828 itself stops at 30 percent. There is no higher acne tier. That ceiling is why the scar and disfigurement alternative, covered below, is so often the more valuable analysis.

Deep Versus Superficial: The Distinction That Decides the Rating

The deep-versus-superficial line is the hinge of the entire acne rating, and it is the place where a sparse exam costs a veteran the most.

Deep acne is the nodulocystic form: inflamed nodules and pus-filled cysts that sit below the skin surface and tend to leave scarring. Superficial acne is the comedonal and papulopustular form: blackheads, whiteheads, small papules and pustules, and superficial cysts. Under DC 7828, superficial acne of any extent rates at 0 percent. Deep acne is the only form that produces a compensable rating.

This means the C&P examiner's characterization of the lesions is doing more work than almost anything else in the file. If the examiner records "scattered comedones and papules" the rating is 0 percent regardless of how much of the face is involved. If the examiner records "deep inflamed nodules and cysts" the door to 10 or 30 percent opens, and from there the only remaining question is the percentage of face and neck involved.

That percentage matters too. The jump from 10 to 30 percent depends on whether the deep acne covers 40 percent or more of the face and neck. This is an area estimate, and area estimates are exactly the kind of measurement that a rushed exam approximates or skips. A veteran with significant deep acne whose exam says nothing about the percentage of facial involvement can find the rating capped at 10 percent simply because the higher tier was never documented.

The practical takeaway is that the lesion type and the area of involvement both need to be in the record explicitly. A photograph during an active flare, showing deep cystic lesions across a measurable portion of the face, is worth more than a clinic note that calls the condition "acne" without describing it.

The Scar and Disfigurement Alternative, Which Often Pays More

This is the part of an acne claim that gets left on the table most often. Acne, especially the deep cystic form, leaves permanent scarring. The regulation does not force you to choose between rating the active acne and rating the damage it leaves. It directs that the condition be rated as disfigurement of the head, face, or neck under DC 7800, or as scars under DC 7801 through 7805, or as acne under DC 7828, whichever yields the higher evaluation.

DC 7800 covers disfigurement of the head, face, or neck, and it is graded on the "8 characteristics of disfigurement" plus the area of involvement. Those characteristics include things like surface contour elevated or depressed on palpation, skin texture abnormal over a measured area, hypo- or hyper-pigmentation, and adherent or indurated tissue. Facial acne scarring frequently checks several of these boxes. The DC 7800 tiers run substantially higher than the 30 percent ceiling on the acne code, which is why the disfigurement analysis can change the whole value of the claim.

The scar codes (DC 7801 through 7805) cover scars by type, location, size, and whether they are unstable or painful. A painful scar carries its own rating under DC 7804, and that is independent of the cosmetic disfigurement picture.

The reason this gets missed is structural. A claim filed as "acne" gets examined as acne, and the examiner characterizes active lesions and estimates facial involvement. The scarring, which is the more durable and often more disabling residual, never gets separately measured because no one framed the claim that way. Under Clemons v. Shinseki, the scope of a claim is defined by the symptoms a veteran describes and the conditions reasonably raised by the record, not just the diagnostic label on the form, so a record that documents facial scarring should pull the disfigurement and scar codes into the analysis. In practice it often doesn't, and the supplemental claim that adds the scar evidence is where the higher rating shows up.

If your acne has scarred your face, the disfigurement and scar codes are not a side issue. They may be the main event.

Chloracne and the Agent Orange Presumptive Pathway

Chloracne is not the same thing as common acne, and it does not share the acne code. It has its own diagnostic code, DC 7829, and a separate and important feature: it is an Agent Orange presumptive condition.

Chloracne is an acne-like eruption associated with exposure to certain chlorinated chemical compounds, including the dioxin contaminant in the herbicides used during the Vietnam era. Under 38 CFR § 3.309(e), chloracne is one of the conditions presumptively connected to herbicide exposure. The presumption carries a timing requirement: the chloracne (or other acneform disease consistent with chloracne) must become manifest to a degree of at least 10 percent disabling within one year of the date of the last herbicide exposure.

That timing rule is the catch. For a Vietnam-era veteran, the one-year window after exposure is decades in the past, which means the presumptive path requires evidence that the condition appeared and reached a compensable level within that window. A veteran who developed an acne-like eruption shortly after service in an exposed location, documented at the time, fits the presumption. A veteran whose acne first appeared years later generally does not get the presumption, though direct service connection on the facts remains available.

For a veteran with qualifying herbicide exposure, the chloracne pathway matters because it can establish service connection without the standard nexus battle. If you served in a location and period that qualifies for the herbicide presumption and you had an acne-like skin condition that emerged within that first year, the chloracne route under DC 7829 and § 3.309(e) is worth pursuing rather than defaulting to a generic acne claim under DC 7828. The two codes are close in their rating mechanics, but the presumptive connection is the real value of the chloracne pathway.

C&P Exam Mechanics: What the Examiner Has to Document

The skin C&P exam for acne follows the dermatology DBQ, and the rating depends almost entirely on what the examiner records. The examiner should document:

• The type of lesions present (deep inflamed nodules and cysts versus superficial comedones, papules, and pustules)
• The body areas involved, with particular attention to the face and neck
• An estimate of the percentage of the face and neck affected, because that is what separates the 10 and 30 percent tiers
• Whether scarring is present, and if so its location, size, and characteristics
• Any disfigurement characteristics relevant to DC 7800
• Treatment history, including systemic medication

A persistent problem with skin exams is timing. Acne flares and remits, and the exam captures one day. If the exam falls during a quiet period, the examiner records minimal active disease and the rating reflects that snapshot rather than the condition's worst presentation. This is the dermatology analogue to the flare-up problem in orthopedic claims, and it is why photographs taken during active flares are so important. The veteran's own dated photographs of the condition at its worst give the examiner and the rater factual evidence beyond the single clinic visit.

When the exam is thorough, documenting lesion type, area of facial involvement, and scarring, the rater has what they need to apply DC 7828 correctly and to consider the DC 7800 and scar alternatives. When the exam is sparse, calling the condition "acne" without characterizing the lesions or measuring the area, the rating defaults low and the scarring analysis never happens. Across the cases I've reviewed, the inadequate exam is a recurring driver of both denials and remands in acne claims.

Common Evidence Gaps in Acne Claims

A few patterns I see repeatedly across BVA decisions involving acne.

No photographs of active flares. Acne is a visual, episodic condition, and the C&P exam captures one moment. Without dated photographs showing the condition during an active flare, the examiner has only the day-of presentation to work with. A veteran whose exam falls during a quiet stretch can end up with a rating that doesn't reflect the deep cystic disease that shows up during flares.

Lesions never characterized as deep versus superficial. Because the entire rating hinges on whether the acne is deep or superficial, a record that just says "acne" or "facial breakouts" without describing nodular and cystic involvement points the rating toward 0 percent. The single most consequential line in the file is the one that classifies the lesion type, and it is frequently missing.

The scarring is never separately claimed. This is the biggest value leak. A veteran focuses on the active acne, the exam characterizes active lesions, and the permanent facial scarring, which can be rated under DC 7800 or the scar codes for a higher evaluation, is never measured or claimed. The higher-value analysis falls out of the file before it ever reaches the rater.

The chloracne and herbicide pathway is missed. A veteran with qualifying herbicide exposure files a generic acne claim under DC 7828 and never raises the chloracne presumptive route under DC 7829 and § 3.309(e). Where the facts support it, the presumptive path can establish service connection that a direct acne claim has to fight for.

Area of facial involvement not estimated. The jump from 10 to 30 percent depends on whether deep acne covers 40 percent or more of the face and neck. When the exam documents deep acne but never estimates the percentage, the rating defaults to the lower tier because the higher one was never supported.

I don't know the exact percentage of acne claims that carry each of these gaps. What I can say from Claim Raven's analysis of 674 BVA acne cases is that 48.8 percent were denied and 35.0 percent were remanded, leaving only 16.2 percent granted at the Board, the lowest grant share in this subset by a wide margin. And of the 508 cases with a C&P adequacy determination, 52.2 percent had the exam flagged as inadequate. That pattern is consistent with the gaps above. More than half the exams in this dataset were judged inadequate, and a denial rate near half tracks with claims that reach the Board on a thin record: lesions not characterized, area not measured, scarring not claimed. The cases that succeed tend to have photographs, a clear deep-acne characterization, and where relevant, a separate scar or disfigurement analysis.

Bottom Line

Acne ratings at the VA are constrained at the top. DC 7828 caps at 30 percent, and reaching even that requires deep cystic acne over 40 percent or more of the face and neck. Most acne claims land at 0 or 10 percent, and a claim read as nothing more than an acne claim usually ends there. The real value in many acne files is somewhere else: the permanent facial scarring, which can be rated as disfigurement under DC 7800 or as scars under DC 7801 through 7805, whichever pays more, and which is one of the most under-claimed pieces of a skin file. For veterans with herbicide exposure, the chloracne presumptive pathway under DC 7829 and § 3.309(e) can establish connection that a direct acne claim would have to fight for. The cases that maximize the outcome characterize the lesions as deep, document the area of facial involvement, photograph active flares, and separately claim the scarring. Same condition, different paper trail, different rating.

Related Conditions

Acne sits in the same skin-rating framework as several other conditions and shares its core proof issues with them. The scar and disfigurement analysis that often drives an acne claim is the same one that matters in skin cancer claims, where surgical scarring and disfigurement of the head, face, or neck frequently outvalue the underlying lesion code. Acne also overlaps in evidence terms with eczema, another episodic skin condition where the timing of the C&P exam and photographs of active flares decide the rating. And because the scar codes (DC 7801 through 7805) carry the disfigurement and painful-scar analysis, the dedicated scars page is worth reviewing alongside any acne claim with facial scarring. Veterans with more than one skin condition should also review the secondary conditions tool before assuming a single acne rating tells the whole story.

Methodology and Limitations

• Data source: Rating criteria quoted from 38 CFR § 4.118, DC 7828 (acne), with the alternative disfigurement code DC 7800 and scar codes DC 7801 through 7805, and the distinct chloracne code DC 7829. Agent Orange presumptive service connection from 38 CFR § 3.309(e). Claim-scope principle from Clemons v. Shinseki.
• Sample size: Patterns in this post are drawn from Claim Raven's analysis of 101,518 condition records drawn from the analyzed subset of Claim Raven's 501,000+ Board-decision library, including 674 acne cases. Within that acne subset, outcomes ran 48.8 percent denied, 35.0 percent remanded, and 16.2 percent granted. Of the 508 cases with a C&P adequacy determination, 52.2 percent had the examination flagged as inadequate. The dataset captures overall outcome rather than a per-tier (0, 10, 30 percent) breakdown, so I can't read the deep-versus-superficial split directly from it.
• Classification approach: Diagnostic code definitions drawn from the regulatory text. The deep-versus-superficial distinction and the area-of-involvement thresholds follow the language of DC 7828. The scar and disfigurement alternative follows the "whichever yields the higher evaluation" instruction in § 4.118.
• Limitations:
• Compensation tiers reflect the rating percentages set in 38 CFR § 4.118; payment amounts adjust annually with COLA.
• The chloracne presumption under § 3.309(e) carries a strict timing requirement (manifest to at least 10 percent within one year of last herbicide exposure) that many later-onset cases will not meet, even where direct service connection remains available.
• Whether acne is best rated under DC 7828, DC 7800, or the scar codes is fact-specific and turns on the individual record.
• Selection bias: BVA-level patterns reflect cases that appealed. Most acne claims resolve at the RO level and aren't in any BVA dataset.
• The C&P adequacy figure is based on the 508 cases in the subset that carried an adequacy determination, not all 674.
• These observations reflect patterns from the regulatory text and BVA decisions. They are not predictions of individual outcomes.