Veterans Affairs Department Seeks to Tighten Disability Requirements for Scars

On September 29, 2025, the Department of Veterans Affairs (VA) published a Proposed Rule (RIN 2900-AS37) in the Federal Register titled “Objective Evidence of Pain for Painful Scars.” The rule proposes to revise 38 CFR § 4.118, which governs the Schedule for Rating Disabilities: Skin, specifically Diagnostic Code (DC) 7804, the provision used to rate painful or unstable scars, found in the VA Schedule for Rating Disabilities (VASRD).

Under current federal policy, veterans may receive a compensable disability rating for scars that are either painful, unstable, or both. The VA now proposes to add a new note—Note (4)—clarifying that pain must be confirmed by “objective evidence upon evaluation or demonstration.” Yet the ambiguity prompting this clarification arises entirely from the VA’s own history of revisions to DC 7804—beginning with its 1946 title, “Scars, superficial, tender and painful on objective demonstration,” and culminating in the current “Scar(s), unstable or painful.” Now, the VA wants veterans, providers and examiners alike to know that scars are not presumed to be painful—they require objective evidence of pain.

Comments on the Proposed Rule can be submitted through Regulations.gov

via its "Submit a Public Comment" button and are due no later than November 28, 2025, at 11:59 p.m. EST. You may submit your comment anonymously if you choose.

Remember, the most effective comments—the ones the VA has little choice but to respond to—are grounded in facts, clearly written, and supported with citations. This is your opportunity to shape how the VA defines and applies the meaning of pain. Combat Veterans of America will continue tracking this rule and sharing updates that impact our community.

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The Clarification Problem the VA Wrote Itself Into

The VA acknowledges that when it removed the phrase “on examination” from the title “Scar(s), unstable or painful” in September 2008, the change was “not intended to alter the substantive rating criteria or eliminate the requirement of objective evidence” for a compensable evaluation. In other words, the VA never said pain was presumed for scars.

Which begs the question:

If the intent never changed, has the VA been issuing disability ratings for painful scars assuming pain rather than confirming it since 2008? And if so, does this “clarification” actually clarify anything—or does it reopen fifteen years of uncertainty about how pain has been defined, documented, and compensated?

Title's Timeline

• April 1, 1946: “Scars, superficial, tender and painful on objective demonstration.” 29 FR 6718, 6748 (May 22, 1964)

  
  

• August 30, 2002: “Scars, superficial, painful on examination.” Schedule for Rating Disabilities; the Skin, 67 FR 49590, 49596 (Jul. 31, 2002).

  
  

• October 23, 2008: “Scar(s), unstable or painful.” 73 FR 54708, 54710 (Sep. 23, 2008).

To date, “on examination” does not appear in any title throughout the VASRD, so the VA is correct that including it would now be redundant given that disability ratings are, by definition, based on relevant medical evidence. However, not every VA disability requires a clinical examination to establish entitlement or severity. In that light, the VA’s theory of redundancy—while technically accurate—fails to fully address the underlying issue it now seeks to clarify.

If one were to read the titles alone, it would appear that in 1946 scars were painful upon objective demonstration, in 2002 they became painful upon examination, and by 2008 they were simply painful. Obviously, determining or analyzing disabilities by title alone would be a foolish exercise—but it’s not entirely unreasonable to see how someone could incorrectly interpret the removal of those qualifiers as an intent to remove the requirement itself. And that, in many ways, explains the need for this Proposed Rule.

This, again, begs the question: how long has this been happening? In other words, what patterns or inconsistencies in claims, examinations, or rating decisions likely triggered the VA to issue this clarification now? If the agency has been approving ratings based on assumed pain for nearly two decades, the clarification may not resolve confusion—it may expose it.

Hypothetically, over the years, some examiners and regional offices may have accepted veteran testimony about pain (or tenderness) without robust objective examination findings. Others demanded more rigorous physical evidence. The inconsistency likely produced unpredictable results depending on location, which in turn prompts calls for a more uniform standard.

The VA may argue that this proposal will not alter the substantive rating criteria or affect compensation. But that’s only true in theory. In practice, if there has been a decades-long misunderstanding—or inconsistent application—of how painful scars are evaluated, then codifying a “clarification” now effectively redefines the evidentiary threshold. For veterans who have long relied on subjective reports of pain supported by credible testimony or medical documentation, this shift could narrow eligibility without ever admitting that the standard changed. In other words, even if the words in the Code remain the same, the interpretation of those words—and therefore the outcome of claims—can change dramatically.

The VA may insist that this clarification doesn’t change anything, but if veterans and examiners have understood the rule differently for nearly two decades, then changing the language now effectively moves the goalposts. Even if the policy hasn’t changed on paper, the practical effect could still be unfair—especially for veterans whose claims were evaluated under a looser or less clearly defined standard.

Public Comments

Here’s the civics lesson they don’t teach often enough: when a federal agency, in this case the U.S. Department of Veterans Affairs, proposes a rule—whether to create, remove, or “clarify” a regulation—the public must ordinarily be consulted first. There are limited exceptions, such as when a rule involves national security, internal agency management, or when the agency finds good cause to act without prior comment. Under the Administrative Procedure Act (APA), agencies like the VA are required to give citizens the chance to respond to proposed regulations before they take effect. Every comment submitted becomes part of the public record, and agencies must review and often respond to the issues raised before finalizing the rule. And no, you won’t be singled out publicly even if you include your name. That means this is the one moment where veterans, advocates, VSOs, and even clinicians can speak directly into the federal rulemaking process.

To date, this Proposed Rule has one comment by an anonymous author:

The VA manual (M21-1 V.iii.10.3.b. Objective Evidence of a Painful Scar) describes a scar under DC 7804 as "pain or tenderness" but the proposed update is only for "pain" not tenderness. Will tenderness be considered pain for the purposes of 7804 or will the manual be updated? The proposed note 4 is still too generic. "upon evaluation" - does that include a video completed evaluation? "Demonstration" is that lay testimony? Why not define it as more concrete? - "objective evidence of pain or tenderness is observable upon physical palpation of the scar"

The commenter notes that the VA’s own M21-1 Manual (V.iii.10.3.b) (updated Oct 02, 2025) defines a painful scar as one involving “pain or tenderness,” not just pain. The proposed rule, however, refers only to pain. That’s not a small detail. If the regulation formally drops the word tenderness from its language, will the VA continue to treat tenderness as evidence of pain for the purposes of DC 7804, or will it rewrite the manual to match?

The commenter also points out that the proposed Note (4) is vague. What does “upon evaluation” mean—does it include telehealth or video exams? And what counts as “demonstration”—is lay testimony enough? They suggest a clearer, stronger definition:

“Objective evidence of pain or tenderness is observable upon physical palpation of the scar.”

That phrasing matters. It reflects the VA’s own manual guidance (M21-1, Part V, Subpart iii, Chapter 10 - Skin Conditions), which instructs examiners not to assign a compensable evaluation for a painful scar unless there is objective indication supporting subjective reports of pain or tenderness. The Disability Benefits Questionnaire (DBQ) even includes a checkbox for whether a scar is tender to palpation—and when that box is checked, the VA considers pain to be objectively demonstrated.

This is exactly why the public comment process matters.

When a veteran, medical professional, or advocate takes the time to point out a contradiction between the VA’s proposed rule and its own operating manual, that’s not nitpicking—it’s governance at work. Regulations affect how human stories are translated into data points, ratings, and compensation. Dialogue on issues as sensitive as battle scars isn’t optional—it’s essential.