Psoriasis VA Rating

Psoriasis is rated under 38 CFR § 4.118, diagnostic code 7816, and the interesting part of the code isn't the body-area percentages everyone fixates on. It's the second prong. DC 7816 sends psoriasis to the General Rating Formula for the Skin, which rates on the greater of two things: how much skin is affected, or how aggressive the treatment is. A veteran with plaques on five percent of the body and a biologic injection every eight weeks can reach a higher rating off the treatment than off the visible skin. A claim built only on body area leaves that second prong undeveloped.

That gap matters because the criteria changed. Effective August 13, 2018, VA amended the skin criteria. The older text gave "corticosteroids or other immunosuppressive drugs" as its examples of systemic therapy; the current text also names biologics, phototherapy, retinoids, photochemotherapy and PUVA. Constant or near-constant systemic therapy over the past twelve months is the 60 percent criterion on its own, independent of body area. A veteran on adalimumab, ustekinumab, secukinumab, or methotrexate for a service-connected psoriasis has a 60 percent argument that has nothing to do with how clear the skin looks on exam day. The drug is the evidence.

This page walks through the DC 7816 criteria, the biologics path to 60 percent, the option to rate psoriasis as scars or disfigurement instead, psoriatic arthritis, the C&P exam, and why VA denies psoriasis claims. The most common outcome in the Board data is a remand, and the most common reason for those remands is an inadequate VA exam or opinion. That fits a disease that flares and clears, because a single in-clinic snapshot rarely captures it.

TL;DR

• Psoriasis is rated under 38 CFR § 4.118, DC 7816, which uses the General Rating Formula for the Skin. The criteria were amended effective August 13, 2018.
• The formula rates on the greater of two prongs: body area affected (or exposed-area percentage), or the duration of systemic therapy over the past 12-month period.
• Tiers: 60% for more than 40% of the body or exposed areas, or constant/near-constant systemic therapy; 30% for 20 to 40%, or systemic therapy 6 weeks or more but not constant; 10% for 5 to less than 20%, or systemic therapy less than 6 weeks; 0% for less than 5% and topical therapy only.
• The post-2018 text names biologics, phototherapy, retinoids, and PUVA as systemic therapy. A veteran on a biologic can reach 60% on the therapy prong even with limited visible body area. Creams applied to the skin are topical therapy, not systemic therapy.
• The formula also allows rating by disfigurement of the head, face, or neck under DC 7800, or by scars under DCs 7801, 7802, 7804, or 7805, depending upon the predominant disability.
• DC 7816 tells VA to rate psoriatic arthritis and other complications separately. Psoriatic arthritis can also be claimed as secondary to service-connected psoriasis under § 3.310.
• Document the drug name, the dosing schedule, and the total duration over the past twelve months. That is what the therapy prong turns on.
• A ruling is one issue the Board decided in one decision; one decision often rules on several issues. Across 683 decided Board rulings on psoriasis from 2021 to 2026, 24.5% were granted, 27.1% denied and 48.5% remanded, so remand is the most common outcome.

Psoriasis VA rating criteria (DC 7816)

The thing to understand about DC 7816 is that it gives you two independent ways to reach each rating level, and you take the higher one. DC 7816 says to evaluate psoriasis under the General Rating Formula for the Skin. That formula rates on body area or systemic therapy, and separately permits rating by disfigurement or scars depending upon the predominant disability.

Here are the body-area and systemic-therapy tiers under the current criteria.

In each tier, systemic therapy includes, but is not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs. Section 4.118(a) defines systemic therapy as treatment given through any route other than the skin (by mouth, injection, suppository, or intranasally), and topical therapy as treatment given through the skin.

Each level reads as an "or." You qualify by hitting either the body-area number or the therapy criterion. That structure is the whole game. A veteran can be at 60 percent on therapy and 10 percent on body area, and the rating is 60 percent.

The body-area measurement separates "entire body" from "exposed areas." VA's Skin Diseases DBQ defines the exposed body area as the face, neck, and hands. A veteran with concentrated plaques on the face, neck, and hands can hit the exposed-area percentage even when the whole-body percentage is lower, because the denominator is smaller. The examiner is supposed to record both.

If you have more than one skin condition, such as psoriasis and eczema, § 4.118(b) allows separate ratings only when they involve separate areas of skin. When two conditions affect the same area, VA uses only the highest evaluation.

Biologics and systemic therapy: the path to 60 percent

The August 13, 2018 amendment is the most important development in psoriasis rating, and it cuts in the veteran's favor. Before the amendment, the criteria gave "corticosteroids or other immunosuppressive drugs" as examples of systemic therapy. The litigation of that era ran the other way: in Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit held that the eczema code, which used the same wording, did not make every topical corticosteroid "systemic therapy." The amended rule now lists biologics, phototherapy, retinoids, photochemotherapy, and PUVA by name and defines systemic therapy by route. There is no longer an argument that a biologic is not systemic therapy.

This matters because of how psoriasis is actually treated in 2026. Biologic drugs are a common treatment for moderate-to-severe plaque psoriasis: TNF inhibitors such as adalimumab or etanercept, IL-17 inhibitors such as secukinumab or ixekizumab, IL-23 inhibitors such as guselkumab or risankizumab, and the IL-12/23 inhibitor ustekinumab. Methotrexate, cyclosporine, and acitretin (a retinoid) are the most commonly used non-biologic systemic drugs. Phototherapy is systemic therapy under the regulation as well.

The clinical reality and the rating consequence collide here. Biologics work. A veteran on an effective biologic can have clear or nearly clear skin. If the rater looks only at the body-area prong, that veteran might rate at 0 or 10 percent because the visible disease is minimal. But the drug that produced the clear skin is constant or near-constant systemic therapy, which is the 60 percent criterion on its own. VA said as much when it adopted the rule: if the condition requires constant or near-constant systemic therapy, then, "regardless of the extent of skin involvement at the time of examination, the veteran would be entitled to the highest evaluation."

The dosing schedule determines which therapy tier applies. A biologic dosed every eight or twelve weeks, taken throughout the year, supports a "constant or near-constant" argument for 60 percent, because the drug is continuously in effect even if the injections are intermittent. A short course of oral steroids during a single flare might only support the less-than-six-weeks tier at 10 percent. The total duration over the past twelve-month period is the measurement that the regulation cares about.

What this means practically: the pharmacy record is rating evidence. The prescription, the refill history, the infusion or injection log, the duration of the prescription over the past twelve months, all of it goes in the file. A claim built only on photographs of skin and a dermatologist's body-area estimate leaves the strongest prong of the code undeveloped.

Rating psoriasis as scars or disfigurement instead

DC 7816 does not lock you into the body-area-and-therapy framework. The skin formula also allows psoriasis to be rated as disfigurement of the head, face, or neck under DC 7800, or as scars under DCs 7801, 7802, 7804, or 7805, depending upon the predominant disability. When psoriasis has produced visible disfigurement or scarring, the question is which of those is the predominant disability.

DC 7800 rates disfigurement of the head, face, or neck on a set of eight characteristics, things like a scar five or more inches long, surface contour elevated or depressed on palpation, and, over an area larger than six square inches, hypo- or hyper-pigmentation or abnormal skin texture. The more characteristics present, the higher the rating, up to 80 percent for the most severe disfigurement affecting multiple features. Psoriasis on the face and scalp that has produced pigment changes, scaling, or texture abnormality across a large enough area can rate under DC 7800 when disfigurement is the predominant disability.

DCs 7801, 7802, 7804, and 7805 rate scars: scars with underlying soft tissue damage by area, scars without it by area, unstable or painful scars by count, and other disabling effects of scars. Psoriasis that has caused fixed scarring rather than active plaques may rate under these codes. The scars page walks through each one.

In most active psoriasis claims, the therapy prong is the higher path, because biologics push toward 60 percent regardless of appearance. The disfigurement and scar paths matter more for facial and scalp disease with cosmetic residuals, or for cases where systemic therapy is not in use. The point is to document all three so the rater can identify the predominant disability, which is what the code instructs.

Psoriasis and psoriatic arthritis ratings

Psoriatic arthritis is an inflammatory arthritis that often accompanies psoriasis; a 2019 review of 266 studies found it in about one in five people with psoriasis. DC 7816 itself says to "rate complications such as psoriatic arthritis and other clinical manifestations (e.g., oral mucosa, nails) separately under the appropriate diagnostic code." Under 38 CFR § 3.310, a condition that is caused or aggravated by a service-connected condition can be service-connected on a secondary basis (Allen v. Brown, 7 Vet. App. 439 (1995), for the aggravation prong). A veteran service-connected for psoriasis who develops psoriatic arthritis has a secondary-connection argument for the joint disease.

This is a meaningful rating expansion because the skin and the joints rate separately. Psoriasis rates under DC 7816 on the skin and therapy prongs. Psoriatic arthritis rates under the arthritis schedule in § 4.71a: DC 5002, which names psoriatic arthritis, rates the active joint disease at 20 to 100 percent, or VA rates the chronic joint residuals under DC 5003 and the affected joints' codes, whichever is higher. The psoriasis and psoriatic arthritis ratings then combine. A veteran with a 60 percent psoriasis rating on the therapy prong and a separate rating for psoriatic arthritis of the hands, spine, or other joints can build a substantially higher combined evaluation than the skin alone.

The nexus opinion for the secondary chain has to do the usual work: identify that the arthritis is psoriatic in type rather than ordinary osteoarthritis, connect it to the service-connected psoriasis, and address the medical mechanism. Psoriatic arthritis is a recognized comorbidity of psoriasis in the rheumatology literature, which makes the medical relationship easier to establish than many secondary chains, but the opinion still has to articulate it rather than assume it. A rheumatology workup distinguishing psoriatic arthritis from other arthritides is the strongest evidence.

The psoriasis C&P exam (skin diseases DBQ)

The psoriasis C&P exam follows VA's Skin Diseases DBQ. The examiner is supposed to record several things, and a skipped item is a common reason an exam does not hold up.

• The percentage of the entire body affected by characteristic lesions.
• The percentage of exposed areas (face, neck, and hands) affected, measured separately from the entire-body figure.
• The specific systemic therapy used, the drug name, and the total duration over the past twelve-month period.
• Whether the therapy is constant, near-constant, or intermittent.
• Any disfigurement of the head, face, or neck, with the DC 7800 characteristics noted.
• Any scarring, with location, type, and measurement.

The structural problem with psoriasis exams is timing. Psoriasis is a relapsing-remitting disease. It flares and it clears. An exam scheduled during a clear or treated period captures a body-area percentage that does not reflect the disability across the year. The body-area prong is a snapshot, and the snapshot is often misleading.

This is exactly why the therapy prong matters so much, and why developing it protects the claim against a bad exam date. The therapy prong is measured over the past twelve-month period, not on exam day. A veteran whose skin happens to be clear at the exam because the biologic is working still qualifies on the constant-therapy criterion. When the examiner records the body area but not the therapy, the rating defaults to the snapshot and the over-the-year picture falls out. If the examiner does not document the systemic therapy over the year, the 60 percent therapy criterion becomes an appeal issue instead of evidence in the initial decision. If the examiner records only a whole-body percentage, the exposed-area path is lost.

Use C&P exam prep for the skin DBQ and a flare log before the exam. Bring the pharmacy printout, dated photographs of active disease, and the treatment history so the examiner has the facts to record about therapy duration rather than relying on what the skin looks like that day. The secondary conditions tool helps map the psoriatic-arthritis chain before the exam.

Why VA denies psoriasis claims

Psoriasis claims fare about the same at the Board as the average claim. Across 683 decided Board rulings on psoriasis from 2021 to 2026, 24.5% were granted, 27.1% denied and 48.5% remanded. That grant rate is 0.2 points below the Board-wide 24.7 percent, and the remand share is 3.2 points above the Board-wide remand share of 45.3%.

Psoriasis is not on VA's presumptive lists, so service connection usually rests on in-service treatment or a medical opinion linking the disease to service. Too few psoriasis service connection claims were denied for a reliable breakdown of denial reasons, so the patterns below are qualitative reads of the decisions. Direct claims were the most common theory and were granted more often than claims argued as secondary or presumptive; the Board section below shows how each theory fared.

A few patterns I've noticed across BVA decisions involving psoriasis.

No link to service. The record shows psoriasis now, but no clinician explains how it relates to service, or the first treatment comes years after discharge with nothing in the record in between.

The exam was scheduled during a clear or treated period. Psoriasis flares and remits. A veteran with severe disease for nine months of the year can have a clear-looking exam in the off month. The body-area percentage recorded at that exam understates the disability, and without the therapy prong or flare documentation, the rating tracks the snapshot. I think this is a core driver behind the high remand share, and the remand data fits it: when the Board sends a psoriasis claim back, the most common reason is an inadequate VA exam or opinion.

The therapy prong is never developed. This is the big one. The claim gets built around photographs and a body-area estimate, and the systemic therapy goes unmentioned or under-documented. The drug name, the dosing schedule, and the total duration over the past twelve months are missing from the record, so the 60 percent therapy criterion never gets evaluated. The pharmacy printout, the prescription history, and the dermatology or rheumatology notes documenting the biologic are the fix.

Exposed-area percentage not measured separately. The examiner records only the whole-body figure. A veteran with concentrated facial, neck, and hand involvement can hit the exposed-area tier even when the whole-body number is lower, because the denominator is smaller. When the exam collapses both into one number, the higher exposed-area path disappears.

Psoriatic arthritis joint complaints not worked up. The veteran reports joint pain and stiffness, but no rheumatology referral distinguishes psoriatic arthritis from ordinary wear, so the separate joint rating under the arthritis framework never gets claimed. The skin rates and the joints don't.

No documentation of disfigurement or scarring residuals. Facial and scalp psoriasis can produce pigment changes and texture abnormality that would rate under DC 7800, but if the exam doesn't catalog the disfigurement characteristics, the alternative path the code provides goes unused.

I don't know exactly what percentage of psoriasis claims have one or more of these gaps. The cases that succeed tend to have the systemic therapy documented over the twelve-month period rather than relying on a single body-area snapshot. The Board section below shows the remand reasons, what happened after a remand, and the results by what the appeal asked for.

How to get a higher psoriasis rating

Build the therapy prong first. The body-area prong is a snapshot that a bad exam date can sink. The therapy prong is measured over the past twelve months and survives an exam where the skin happens to be clear. Get the pharmacy record, the prescription history, and the treating dermatologist or rheumatologist notes that name the drug, state the dosing schedule, and establish the duration. A biologic taken throughout the year supports the "constant or near-constant systemic therapy" criterion at 60 percent regardless of how the skin looks on exam day.

When the exam was scheduled during a clear period, you can argue that it did not capture a disease that flares, and VA noted in the 2018 rule that a veteran can ask for another examination if the skin disorder becomes more extensive than what an exam observed. Your own documentation fills the gap: photographs of flares with dates, a symptom log tracking how much of the year the disease was active and how much skin was involved at its worst, and records of the systemic therapy. A symptom tracker for psoriasis flares with dated flare photos and a treatment log gives the rater the over-the-year picture the single exam misses.

Document all three rating paths. Body area or therapy under DC 7816, disfigurement under DC 7800, scars under DCs 7801, 7802, 7804, or 7805. The code instructs the rater to choose depending upon the predominant disability, so the evidence has to support each path you want considered. And if there are joint symptoms, get a rheumatology workup to establish psoriatic arthritis as a separate, secondary-connected rating. An evidence checklist for skin claims should separate the body-area proof, the therapy proof, and the disfigurement proof into their own lanes.

Questions veterans ask about psoriasis

What is the highest VA rating for psoriasis?

60 percent under the General Rating Formula for the Skin, for lesions covering more than 40 percent of the entire body or of exposed areas, or for constant or near-constant systemic therapy over the past 12 months. If disfigurement of the head, face, or neck is the predominant disability, DC 7800 goes up to 80 percent.

Does a biologic count as systemic therapy for a psoriasis rating?

Yes. Since August 13, 2018, the skin criteria name biologics as systemic therapy, along with corticosteroids, phototherapy, retinoids, PUVA, and other immunosuppressive drugs. A biologic taken constantly or near-constantly over the past 12 months meets the 60 percent therapy criterion even if the skin looks clear at the exam.

Do steroid creams count as systemic therapy?

No. Section 4.118(a) defines systemic therapy as treatment given by any route other than the skin, such as by mouth or injection, and topical therapy as treatment given through the skin. Creams can still matter through the body-area prong when the psoriasis covers a large area.

Can I get separate VA ratings for psoriasis and psoriatic arthritis?

Yes. DC 7816 tells VA to rate psoriatic arthritis separately under the appropriate diagnostic code, and DC 5002 names psoriatic arthritis for the active joint disease. The two ratings then combine, as long as the same symptom is not counted twice.

Is psoriasis a presumptive condition for VA?

No. Psoriasis is not on VA's presumptive lists, including the lists for Agent Orange exposure, burn pit and other particulate matter exposure, and Gulf War service. You need evidence that it began in or was caused by service, or that a service-connected condition caused or worsened it.

What if my psoriasis is clear on the day of my C&P exam?

The therapy prong looks at the past 12 months, not exam day, so document the systemic therapy you took over that period. Bring dated photographs of flares and a treatment log. If the disease is more extensive than the exam recorded, you can ask VA for another examination.

Bottom Line

Psoriasis ratings under DC 7816 turn on a prong most claims never develop. The body-area percentage is the obvious path, and it is the path most exams measure, but it is a snapshot of a disease that flares and clears. The systemic-therapy prong is measured over the full year, and after the August 13, 2018 amendment, biologics and phototherapy are named in it explicitly. A veteran on a biologic for service-connected psoriasis has a 60 percent argument that does not depend on how the skin looks on exam day, because the drug itself is the constant systemic therapy the criterion describes. Add the alternative disfigurement and scar paths the code provides, plus a separately ratable psoriatic arthritis under § 3.310, and a single skin condition can support a substantially higher combined rating than a body-area snapshot would suggest. Same disease, different paper trail, different outcome.

Related Conditions

Psoriasis shares rating logic and proof patterns with eczema, which is rated under the same § 4.118 framework on body area and therapy, and with scars and skin cancer where disfigurement and scarring residuals come into play. Veterans with joint symptoms should review the psoriatic arthritis and arthritis pages and the secondary conditions tool, because psoriatic arthritis is a separately ratable inflammatory arthritis that frequently accompanies psoriasis. The common thread across these skin claims is that the C&P exam has to capture the disease across the year and document the systemic therapy, not just the appearance of the skin on a single day.

Methodology and Limitations

• Data source: Rating criteria from 38 CFR § 4.118, DC 7816 and the General Rating Formula for the Skin, as amended effective August 13, 2018 (83 FR 32592), compared with the text in force before that date. Alternative rating paths from DC 7800 (disfigurement of the head, face, or neck) and DCs 7801, 7802, 7804, and 7805 (scars). Secondary service connection from § 3.310, with aggravation under Allen v. Brown. Psoriatic arthritis rating framework from § 4.71a, DCs 5002 and 5003. The exposed-area definition is from VA's Skin Diseases DBQ.
• Medical sources: Psoriatic arthritis prevalence from Alinaghi and colleagues, Journal of the American Academy of Dermatology (2019), a review of 266 studies. Biologic drug classes from Wride and colleagues, "Biologics for Psoriasis," Dermatologic Clinics (2024). Non-biologic systemic drugs from Menter and colleagues, the joint AAD-NPF guideline, Journal of the American Academy of Dermatology (2020). The relapsing-remitting course from Campanati and colleagues, Biomedicines (2021).
• Board snapshot: From 2021 to 2026, the Psoriasis summary covers 683 decided Board rulings on psoriasis: 24.5% granted (including partial grants and mixed outcomes), 27.1% denied, and 48.5% remanded. Dismissed, withdrawn and moot rulings are excluded. These are appealed claims, not your personal odds.
• Sample size: Board figures in this post come from Claim Raven's read of every Board decision from 2021 to 2026 that it holds: 511,036 decisions containing 1,378,030 rulings. Of 750 Board rulings on psoriasis, 683 were decided (granted, denied or remanded); the rest were dismissed, withdrawn or closed another way. Board-wide, the grant rate on decided rulings is 24.7%, so psoriasis runs 0.2 points below it. The data captures the outcome of each ruling rather than a per-prong (body-area versus systemic-therapy) breakdown.
• Classification approach: Rating-prong definitions drawn from the regulatory text. The systemic-therapy analysis follows the post-2018 amended criteria. Outcome figures come from Claim Raven's read of Board decisions from 2021 to 2026.
• Limitations:
• The body-area-versus-therapy framework reflects the criteria amended effective August 13, 2018. VA said claims pending on that date would be considered under both the old and new criteria, with the more favorable applied; claims filed on or after it get only the new criteria.
• Whether a given dosing schedule supports "constant or near-constant" versus a shorter-duration therapy tier is a fact-specific determination that varies by case.
• The therapy prong is measured over the past twelve-month period, so the relevant evidence is the treatment history rather than the exam-day skin findings.
• Selection bias: BVA-level patterns reflect cases that appealed. Most psoriasis claims resolve at the RO level and aren't in any BVA dataset.
• The Board data records why the Board sent a ruling back, but not whether a flare-timed exam caused a particular remand.
• These observations reflect patterns from the regulatory text, case law, and BVA decisions. They are not predictions of individual outcomes.