Skin conditions claimed for VA disability, from dermatitis, eczema and psoriasis to acne, chloracne, urticaria, vitiligo, hyperhidrosis, bullous disorders and skin cancers, are documented on this 12-page questionnaire. Two measurements carry most of the form: the percentage of total and exposed body area affected, and how long the Veteran used corticosteroids, immunosuppressives or other systemic treatments in the past 12 months.
The Veteran's treating or examining clinician completes the form and signs the Section XI examiner's certification. The Veteran completes no part of it.
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Skin Diseases Disability Benefits Questionnaire
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Item 4A asks whether the Veteran has a skin condition currently without visible characteristic lesions at the time of examination. The history in Section II and the treatment records in Section III, including medication duration over the past 12 months, then document the condition's course between flares.
Section III lists corticosteroids and other immunosuppressives, antihistamines, retinoids, sympathomimetics and other medications with route and duration, plus non-drug treatments in the past 12 months such as UVB phototherapy, each with the condition treated and date of the most recent treatment.