Skin conditions are more prevalent in veterans than in the general population, and the connection to military service is often well-supported by medical evidence. Environmental exposures, tropical deployments, chemical contact, prolonged use of military equipment, and the physical conditions of military life all contribute to dermatologic disease. Yet many veterans don't realize their skin condition may be service-connected.
Common Skin Conditions in Veterans
- Eczema (atopic dermatitis). Chronic inflammatory skin condition causing itching, redness, and scaling. Can be triggered or worsened by environmental irritants encountered during service.
- Contact dermatitis. Skin inflammation from direct contact with irritants or allergens — chemicals, solvents, fuels, cleaning agents, and materials used in military equipment.
- Psoriasis. Autoimmune condition causing thickened, scaly skin patches. Stress is a well-documented trigger, and many veterans report onset or worsening during or after high-stress service.
- Chloracne. A specific acneiform skin condition caused by exposure to chlorinated chemicals, including dioxins found in Agent Orange. Chloracne is a presumptive condition for Agent Orange-exposed veterans.
- Tinea (fungal infections). Chronic or recurrent fungal infections of the skin, feet, or groin acquired in tropical or field environments during service.
- Skin cancer. Melanoma and non-melanoma skin cancers linked to sun exposure during outdoor military duties, particularly in equatorial or high-altitude deployments.
- Scarring and disfigurement. Residual scarring from in-service injuries, burns, or surgical procedures.
Pathways to Service Connection
- Direct onset during service. Skin conditions first documented in service treatment records, even if they were treated and appeared to resolve. Many dermatologic conditions are chronic and relapsing — resolution during service doesn't mean the condition ended.
- Environmental and chemical exposure. Contact with JP-8 fuel, hydraulic fluid, solvents, pesticides, herbicides, and other occupational chemicals. Burn pit exposure. Contaminated water (Camp Lejeune presumptives include several cancers).
- Tropical and field conditions. Prolonged exposure to heat, humidity, and unsanitary field conditions promotes fungal infections, heat rash, and bacterial skin infections that can become chronic.
- Secondary to medications. Some medications prescribed for service-connected conditions cause photosensitivity, drug eruptions, or other dermatologic side effects.
- Secondary to PTSD. Stress-mediated dermatologic conditions including psoriasis flares, eczema exacerbations, and stress-related urticaria.
- Presumptive (Agent Orange). Chloracne and certain soft tissue sarcomas are presumptive for herbicide-exposed veterans.
What the Nexus Letter Should Address
- Any in-service documentation of skin complaints, treatment, or exposure to known dermatologic irritants.
- The current diagnosis with clinical documentation (dermatology records, biopsy results if applicable).
- The specific exposure or mechanism connecting military service to the condition.
- The chronic and relapsing nature of the condition, explaining why intermittent symptoms don't indicate resolution.
- Peer-reviewed literature on military dermatologic exposures.
The Key Point
Skin conditions are visible, documented, and often directly tied to military exposures. The nexus opinion should connect the specific exposure to the specific condition, and should emphasize the chronic nature of dermatologic disease — particularly when C&P examiners note periods of apparent remission as evidence against service connection.
Continue Reading: Dermatologic Claims in Detail
Occupational Skin Exposures in the Military
Military occupational specialties carry specific dermatologic risks that the nexus letter should identify:
- Mechanics and maintenance personnel. Daily contact with petroleum products, hydraulic fluid, solvents (MEK, acetone, trichloroethylene), lubricants, and cleaning agents. These chemicals strip the skin's protective barrier, causing chronic irritant contact dermatitis and increasing susceptibility to secondary infections.
- Aviation and flight line personnel. Exposure to JP-8 jet fuel (a known skin irritant and sensitizer), hydraulic fluid, de-icing chemicals, and exhaust. Studies of military aviation workers demonstrate elevated rates of dermatitis compared to unexposed personnel.
- Chemical, biological, radiological, nuclear (CBRN) personnel. Exposure to decontamination chemicals, protective equipment that traps moisture and heat, and potential contact with hazardous materials.
- Combat engineers and EOD. Exposure to explosive residues, demolition materials, and construction chemicals.
- All MOSs during deployment. Field hygiene limitations, prolonged wear of body armor and equipment (causing friction injuries, folliculitis, and intertrigo), insect repellent (DEET) and permethrin-treated uniforms, and limited access to skin care.
The Stress-Skin Connection
The relationship between psychological stress and skin disease is mediated by neuroendocrine and immune pathways. Stress hormones (cortisol, catecholamines) and neuropeptides released under chronic stress affect skin inflammation, barrier function, and immune response. Conditions with strong stress associations include:
- Psoriasis. Stress is one of the most commonly reported triggers for psoriasis flares. Studies demonstrate that psychological stress precedes disease exacerbation in 40-80% of psoriasis patients. The mechanism involves stress-induced release of pro-inflammatory cytokines and neuropeptides in the skin.
- Eczema/atopic dermatitis. Stress worsens eczema through increased scratching behavior (neurodermatitis), impaired skin barrier function, and altered immune response.
- Urticaria (hives). Chronic stress can trigger or worsen chronic urticaria through mast cell activation and neurogenic inflammation.
- Alopecia areata. Autoimmune hair loss triggered or exacerbated by psychological stress.
For veterans with service-connected PTSD or other mental health conditions, the nexus letter should cite the dermatologic literature on stress-mediated skin disease and explain the specific physiological mechanisms connecting the veteran's psychological condition to their skin condition.
Sun Exposure and Skin Cancer
Military service frequently involves prolonged outdoor sun exposure under conditions where adequate sun protection is impractical or unavailable. Infantry, artillery, naval deck crews, aviation ground crews, and any MOS involving outdoor duties accumulate significant ultraviolet radiation exposure over years of service.
The nexus opinion for skin cancer should address:
- The veteran's MOS and the outdoor exposure it entailed.
- Deployment locations and their UV index (equatorial, desert, high-altitude environments have higher UV exposure).
- The impracticality of consistent sunscreen use during field operations, combat, and training.
- The latency period between UV exposure and skin cancer development (often decades for melanoma and squamous cell carcinoma).
- The location of the cancer on sun-exposed body areas consistent with military uniform patterns (forearms, neck, face, ears).
Rating Skin Conditions
The VA rates skin conditions under Diagnostic Codes 7800-7833, depending on the specific condition. Key rating principles:
- Percentage of body surface area (BSA) affected. Many skin conditions are rated based on what percentage of the total body surface or exposed areas (face, neck, hands) is affected during flares.
- Treatment required. The level of treatment — topical therapy, systemic medication (immunosuppressants, biologics), or phototherapy — affects the rating. Veterans on systemic immunosuppressive therapy generally qualify for higher ratings.
- Frequency of flares. Skin conditions are often intermittent. The rating should reflect the condition during active disease, not during remission. C&P examinations ideally should be scheduled during a flare, or the examiner should estimate severity based on medical records and history.
- Scarring and disfigurement. Rated under DC 7800-7805 based on the number, size, and characteristics of scars (elevated, depressed, adherent, unstable, painful) and whether they affect the head, face, or neck.
The nexus letter should document the extent of involvement during flares, the treatment regimen, and the functional impact — including pain, itching, and social/occupational impairment.