Proposed Rule2025-18829
Objective Evidence of Pain for Painful Scars Under DC 7804
Primary source
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Published
September 29, 2025
Issuing agencies
Veterans Affairs Department
Abstract
The Department of Veterans Affairs (VA) proposes to revise 38 CFR 4.118, diagnostic code (DC) 7804 ("Scar(s), unstable or painful"), by adding a note clarifying that VA still requires objective evidence of pain when rating a scar as painful. The inclusion of this note would align with current policy and ensure consistent application of the rating criteria.
Full Text
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<title>Federal Register, Volume 90 Issue 186 (Monday, September 29, 2025)</title>
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[Federal Register Volume 90, Number 186 (Monday, September 29, 2025)]
[Proposed Rules]
[Pages 46542-46544]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-18829]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4
RIN 2900-AS37
Objective Evidence of Pain for Painful Scars Under DC 7804
AGENCY: Department of Veterans Affairs.
ACTION: Proposed rule.
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SUMMARY: The Department of Veterans Affairs (VA) proposes to revise 38
CFR 4.118, diagnostic code (DC) 7804 (``Scar(s), unstable or
painful''), by adding a note clarifying that VA still requires
objective evidence of pain when rating a scar as painful. The inclusion
of this note would align with current policy and ensure consistent
application of the rating criteria.
DATES: Comments must be received on or before November 28, 2025.
ADDRESSES: You may submit comments through <a href="http://www.regulations.gov">www.regulations.gov</a> under
RIN 2900-AS37. That website includes a plain-language summary of this
rulemaking. Instructions for accessing agency documents, submitting
comments, and viewing the rulemaking docket are available on
<a href="http://www.regulations.gov">www.regulations.gov</a> under ``FAQ.''
FOR FURTHER INFORMATION CONTACT: Chad Stodden and Leah Carey,
Regulations Analysts, VASRD Regulations Staff, Compensation Service,
Veterans Benefits Administration, (202) 461-9700.
SUPPLEMENTARY INFORMATION:
I. Background
As part of the revision of the VA Schedule for Rating Disabilities
(VASRD), VA proposes to revise 38 CFR 4.118, DC 7804 (``Scar(s),
unstable or painful''), by adding a note clarifying that rating
personnel must continue to require objective evidence of pain prior to
denoting a scar as painful. Since its inclusion in the VASRD, VA has
always required objective evidence of pain to assign a compensable
evaluation using this DC. Starting on April 1, 1946, VA titled DC 7804
``Scars, superficial, tender and painful on objective demonstration.''
See 29 FR 6718, 6748 (May 22, 1964) (adding the 1945 rating schedule,
which became effective April 1, 1946, to part 4 of 38 CFR). On August
30, 2002, VA subsequently retitled DC 7804 ``Scars, superficial,
painful on examination.'' Schedule for Rating Disabilities; the Skin,
67 FR 49590, 49596 (Jul. 31, 2002). Finally, VA changed the title
again, effective October 23, 2008, to ``Scar(s), unstable or painful.''
Schedule for Rating Disabilities; Evaluation of Scars, 73 FR 54708,
54710 (Sep. 23, 2008). The purpose of the most recent title change was
threefold. First, VA removed DC 7803, which VA had used to evaluate
unstable superficial scars, and moved its evaluation criteria into DC
7804; thus, it was necessary to update DC 7804's title to include
unstable scars. Id.; see also 73 FR 428, 430 (Jan. 3, 2008) (proposed
rule explaining the change). Second, VA removed the word
``superficial'' from the title of DC 7804 because VA wanted claims
processors to evaluate both superficial and deep scars using this DC.
Id.; see also 73 FR 430. Finally, VA removed the words ``on
examination'' because ``VA's disability ratings are based on relevant
medical evidence; as such, to include `on examination' in the title is
redundant.'' 73 FR 430.
During the time preceding the 2008 publication, traditional
examinations, which included an objective assessment of the condition,
were most frequently used in support of claims. Indeed, most relevant
medical evidence contained, and still contains, an objective aspect of
the evaluation. Podder, V., Lew, V., and Ghassemzadeh, S. ``SOAP
Notes,''
[[Page 46543]]
National Library of Medicine, <a href="http://www.ncbi.nlm.nih.gov/books/NBK482263/">www.ncbi.nlm.nih.gov/books/NBK482263/</a>
(last visited May 19, 2025); see also Lapum, J. et al. (2021),
Objective Assessment. Physical Examination Techniques: A Nurse's Guide.
<a href="https://pressbooks.library.torontomu.ca/ippa/chapter/chapter-1/">https://pressbooks.library.torontomu.ca/ippa/chapter/chapter-1/</a> (last
visited May 19, 2025). Therefore, the use of ``on examination'' within
the DC title would certainly represent an unnecessary redundancy.
Nevertheless, the removal of ``on examination'' from the title was not
intended to change the substantive rating criteria so as to eliminate
the requirement of objective evidence for assigning a compensable
evaluation for a painful scar. On the contrary, objective evidence of
pain remains a necessary component for evaluations under DC 7804, and
the VA disability examination includes visual inspection with palpation
of all scars. See Scars Disability Benefits Questionnaire, available at
<a href="http://www.benefits.va.gov/compensation/docs/scars.pdf">www.benefits.va.gov/compensation/docs/scars.pdf</a>. The reason that
objective evidence of pain is necessary for a compensable rating under
DC 7804 is because pain on evaluation or demonstration shows
persistence and chronicity of the effects of the disability upon the
person's ordinary activity and is consistent with occupationally
significant impairment. See 38 CFR 4.10.
II. Required Regulatory Update
Although VA previously removed the phrase ``on examination'' from
the DC title as an unnecessary redundancy, it is now apparent that an
added note re-confirming this longstanding requirement would provide
more clarity to veterans and rating personnel. The new note would
specify that pain must be confirmed by objective evidence upon
evaluation or demonstration. DC 7804 recognizes the impact of pain on
functional impairment indicative of occupationally significant
disabilities, and although VA accepts subjective evidence when
appropriate, VA requires objective indications to support the
subjective reports of pain to award a compensable evaluation under this
DC.
In sum, VA intends this proposed change to clarify VA's
longstanding policy, but does not intend to alter the substantive
rating criteria nor change the way VA compensates veterans under DC
7804. Rather, this rulemaking would merely reinforce and reaffirm VA's
original and longstanding requirement of objective evidence when
evaluating a painful scar under DC 7804.
Executive Orders 12866, 13563, and 14192
VA examined the impact of this rulemaking as required by Executive
Orders 12866 (Sept. 30, 1993) and 13563 (Jan. 18, 2011), which direct
agencies to assess all costs and benefits of available regulatory
alternatives and, if regulation is necessary, to select regulatory
approaches that maximize net benefits. The Office of Information and
Regulatory Affairs has determined that this rule is not a significant
regulatory action under Executive Order 12866. This rule is not an E.O.
14192 regulatory action because this rule is not significant under E.O.
12866.
Economic Impact: VA has determined that no transfers or costs are
associated with this rulemaking. The changes implemented through this
rulemaking will not impact benefit payments or the administration of
benefits. This rulemaking will allow VA to ensure all stakeholders are
better informed of the requirements and basis for compensable
evaluations under DC 7804. Additionally, it will enable VA to ensure
more accurate and consistent application of the rating criteria.
Regulatory Flexibility Act
The Secretary hereby certifies that this proposed rule would not
have a significant economic impact on a substantial number of small
entities as they are defined in the Regulatory Flexibility Act (5
U.S.C. 601-612). The factual basis for this certification is based on
the fact that no small entities or businesses evaluate disabilities for
VA benefits. Therefore, pursuant to 5 U.S.C. 605(b), the initial and
final regulatory flexibility analysis requirements of 5 U.S.C. 603 and
604 do not apply.
Unfunded Mandates
This proposed rule would not result in the expenditure by State,
local, and tribal governments, in the aggregate, or by the private
sector, of $100 million or more (adjusted annually for inflation) in
any one year.
Paperwork Reduction Act
This proposed rule contains no provisions constituting a collection
of information under the Paperwork Reduction Act of 1995 (44 U.S.C.
3501-3521).
List of Subjects in 38 CFR Part 4
Disability benefits, Pension, Veterans.
Signing Authority
Douglas A. Collins, Secretary of Veterans Affairs, approved this
document on September 24, 2025, and authorized the undersigned to sign
and submit the document to the Office of the Federal Register for
publication electronically as an official document of the Department of
Veterans Affairs.
Taylor N. Mattson,
Alternate Federal Register Liaison Officer, Department of Veterans
Affairs.
For the reasons stated in the preamble, the Department of Veterans
Affairs proposes to amend 38 CFR part 4 as set forth below:
PART 4--SCHEDULE FOR RATING DISABILITIES
Subpart B--Disability Ratings
0
1. The authority citation for part 4 continues to read as follows:
Authority: 38 U.S.C. 1155, unless otherwise noted.
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2. In Sec. 4.118, add new note (4) to the end of the entry for
diagnostic code 7804 to read as follows:
Sec. 4.118 Schedule of ratings--skin.
* * * * *
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Rating
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* * * * * * *
7804 Scar(s), unstable or painful: ..............
* * * * * * *
Note (4): Pain must be confirmed by objective ..............
evidence upon evaluation or demonstration..........
* * * * * * *
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[[Page 46544]]
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3. Amend Appendix A to part 4 by revising the entry for diagnostic code
7804 to read as follows:
Appendix A to Part 4--Table of Amendments and Effective Dates Since
1946
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Diagnostic
Sec. code No.
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* * * * * * *
7804 Criterion July 6, 1950; criterion September 22, 1978;
criterion and evaluation October 23, 2008; note 4
[EFFECTIVE DATE OF THE FINAL RULE].
* * * * * * *
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[FR Doc. 2025-18829 Filed 9-26-25; 8:45 am]
BILLING CODE 8320-01-P
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