Schedule of Ratings for the Skin

[Jason Perry]

Attached is the Schedule of Ratings for the Skin.

 

[AFpilot]

Does anyone know how they determine the percentage of affected skin for conditions requiring an estimation of % of skin affected (ie: cutaneous manifestation of collagen-vascular disease).

Is there a standardized chart that the dermatologists use? If so, does anyone know where you could find this chart? Or, do they measure individual scarring? Is it a WAG by the doctor?

Thanks.

 

[Jason Perry]

There are several formulas used to calculate skin surface area. Here is a link to several: http://www.globalrph.com/bsa2.htm

 

[AFpilot]

Thanks for the quick reply Jason. Do you know which system is standard for the VA / DoD (or USAF specifically)?

Also, how do they determine the percentage of the surface area is affected? For example: say you have burn scars on your forearm. Do they measure the exact surface area of the affected skin and then apply that to the pre-calculated total body surface area? Or, do they broadly say that the forearm represents 10% of the body. Therefore, if you have scaring on your forearm, 10% of your total surface area is affected.

Thanks again.

 

[Jason Perry]

I looked at the VA Clinician's Guide and there is no guidance about what formula to use.

The VA worksheets for the skin direct the examiner to,"Provide the percent affected of exposed areas. Provide the percent affected of the entire body."

The VA Worksheets are required to be used (or at least the information contained therein) by the DoD Components.

 

[AFpilot]

If anyone has the same question, I may have found an answer in DoD instruction 1332.39 enclosure 2, attachment 1, figure 4 (plate IV). It is a chart of the body with an estimated % surface area for each specific part. The copy I pulled from google was dated 1996 - so it may not be current.

Hope that helps. If you know where I can get my hands on a current copy, or if that is the current copy, it would be much appreciated. Thanks.

 

[Jason Perry]

AFpilot,

Thanks for posting, that brings up a really interesting issue...DoDI 1332.39 was rescinded as a result of the 2008 National Defense Authorization Act due to the fact that it improperly deviated from the VASRD (1996 was the most recent publication). BUT- I can see some people referencing it either out of habit or by not realizing it was rescinded....my thought is that if this is favorable to the member, fine...but, if the calculations using the formulas are more beneficial to the member, then they have to do the hard work and do the math!!

(Likely, cases with "close calls" as to percentage should be resolved via application of resolution of reasonable doubt rule...but the PEB may not apply this correctly).

 

[AFpilot]

Yeah, that is very interesting... The current AFI 36-3212 (Change 2, 27 November 2009) makes multiple references to the DoDI 1332.39. Luckily, application of the VASRD in the DoDI 1332.39 seems to (mostly) favor the disabled, at least from what I have read.