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Need Advice Regarding Skull Injury


Hello Fellow Vets,

I've read the posts for a while but this is my first post. I hope I'm putting this in the correct topic area. I need some advice about an issue that is bouncing back and forth between VA and myself. The issue is regarding a skull injury I received while on active duty. The injury resulted in 20 square centimeters of skull being removed from the crown of my head by Air Force surgeons at Wilford Hall in San Antonio. I've never quite understood why, but they didn't put any type of plate or protection back in that area and as a result I have a depressed area about the size of the palm of my hand on one side of the crown of my head (where I have unfortunately since balded). It has always been an embarrasement to me as I have a rather large depressed flat spot where my skull should be rounded. I retired in 2007 and made claim for the skull loss + disfiguration. I even sent in a separate SSOC specifically asking that they consider the disfigurement. There is a table in the rating schedules for skull loss and it's stricly by amount lost. In January of 2010, I finally received a rating decision from VA and they gave me the 50% rating that 20 sq cm of skull loss calls for. However, there wasn't any mention made of the disfigurement, in spite of the fact that the VA examiner made note of and measured the disfigured area in his report. So, I sent in a notice of disagreement asking why the disfigurement wasn't considered. I received a letter back from VA asking me "What am I claiming, a skin disfigurement? The letter was basically asking, "How are we supposed to rate this?" My initial reaction was "Why are they asking me?" ,"Isn't figuring this out their job?" I sent in another SSOC re-describing the disfigurement and stating that I don't know which rating schedule applies here. Now, I have received another letter back from VA telling me that they don't understand and asking if I am claiming a skin disfigurement. I'm stuck here and don't know how to respond. I feel like their question is a set-up. If I answer, yes, that I am claiming a skin disfigurement, then they'll deny stating that there is nothing wrong with the skin in that area. If I respond, no, they'll deny stating that that was the only way they knew how to rate the disfigurement. DAV supposedly "represents" me, but they have done less than nothing for me. I can't ever get through to my rep, he doesn't return calls and even if I do get to speak with him, he won't give any advice. In my experience, DAV has been nothing more than a glorified forwarding service for my letters. It was actually easier when I used to try to deal with VA directly. So, I need some advice how to respond to VA. And can somebody please tell me, isn't this their job to figure out? Sorry for the length and thanks in advance.

Edited by Gena

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Welcome to Hadit. It seems to me that you are on the right track

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Thanks for the welcome, but on the right track? Wow, if I'm on the right track, I pity those on the wrong track. VA obviously has no clue how to rate my skull problem and has sent me a letter asking me how to rate it and I have absolutely no idea how to respond. At this point I'd be happy if somebody would just point me to the track.

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Sorry I am have said something that was not clear and I do not want to offend you. Its not you that is wrong it is the VA. You need to make up your mind to fight the VA.

Maybe someone else who understand VA better and the proper CFR's could chime in. I have known two Vets personally who were rated for skull disfigurements one had a metal plate and the other has a skull that had soft area with no bone like you. You also need to take a good look at secondary problems and the possibility of other things to rate.

Finally yes the VA is pretty much if you do not ask specifically they are not going to award your claim.

A gold mine of information can be found in BVA search just type in a phrase like skull injury or skull being removed

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Definately not offended Pete, just confused. It seems that skull disfigurations are not common enough to have their own category in the ratings schedules. For that reason, VA doesn't seem to know what to do with it and I don't know what to specifically ask for. Am I out of luck in a case like this?

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There are certainly awards for disfigurement at the BVA web site-


“The regulations for rating disabilities of the skin were

revised during the pendency of this appeal, effective October

23, 2008. However, those revised provisions are applicable

only to claims received on or after October 23, 2008.

Because the current claim was received prior to that date,

those revisions do not apply in this case. See 73 Fed. Reg.

54708 (Sept. 23. 2008). The applicable rating criteria in

this case are found in 38 C.F.R. § 4.118 (2003-2008), which

was in effect from August 30, 2002 to October 23, 2008.

The RO has rated the left lower lip scar under DC 7800 (2003-

2008). Under the rating criteria for DC 7800, scarring

causing disfigurement of the head face or neck is rated with

reference to the following 8 characteristics of


(1) Scar 5 or more inches (13 or more cm.) in length; (2)

Scar at least one-quarter inch (0.6 cm.) wide at widest part;

(3) Surface contour of scar elevated or depressed on

palpation; (4) Scar adherent to underlying tissue; (5) Skin

hypo-or hyper- pigmented in an area exceeding six square

inches (39 sq. cm.); (6) Skin texture abnormal (irregular,

atrophic, shiny, scaly, etc.) in an area exceeding six square

inches (39 sq. cm.); (7) Underlying soft tissue missing in an

area exceeding six square inches (39 sq. cm.); (8) Skin

indurated and inflexible in an area exceeding six square

inches (39 sq. cm.).

The rating criteria provide for a 10 percent rating where

there is one characteristic of disfigurement. A 30 percent

rating is warranted where there is visible or palpable tissue

loss and either gross distortion or asymmetry of one feature

or paired set of features (nose, chin, forehead, eyes

(including eyelids), ears (auricles), cheeks, lips), or; with

two or three characteristics of disfigurement. A 50 percent

rating is warranted for visible or palpable tissue loss and

either gross distortion or asymmetry of two features or

paired sets of features (nose, chin, forehead, eyes

(including eyelids), ears (auricles), cheeks, lips), or; with

four or five characteristics of disfigurement. Finally, a

maximum 80 percent rating is warranted for disfigurement of

the head, face, or neck with visible or palpable tissue loss

and either gross distortion or asymmetry of three or more

features or paired sets of features (nose, chin, forehead,

eyes (including eyelids), ears (auricles), cheeks, lips), or;

with six or more characteristics of disfigurement. 38 C.F.R.

§ 4.118, Diagnostic Code 7800 (effective August 30, 2002 to

October 23, 2008).

Also potentially applicable is DC 7804 (superficial scars

painful on examination), which provides for a 10 percent

rating regardless of the size or location of the scar.

In addressing the applicability of other diagnostic codes

pertaining to scars, the Board finds that DCs 7801 and 7802

are not applicable because they pertain specifically to scars

other than the head, face or neck. Similarly, DC 7803 is not

applicable as the Veteran's scar was determined to be stable

and without ulceration on VA examinations in June 2006 and

May 2009. Finally, DC 7805 is not applicable as the

Veteran's scar does not affect the limitation of motion of

any body part.”

I forget if this was awarded or not- but I feel that this case does spell out how they should rate disfigurement.

"I feel like their question is a set-up. If I answer, yes, that I am claiming a skin disfigurement, then they'll deny stating that there is nothing wrong with the skin in that area."

I dont feel that way-= I think they need to know if this is a formal disfigurement claim.

One thing about the VA- it seems you have to tell them exactly what you want because otherwise they cant work on a claim that doesnt seem to be a formal claim.

Pete is right- you could also search BVA under Disfigurement.

If you find that the above case or another one at BVA helps you explain to them how they should rate this-you could send them the case as evidence of how the BVA made a legal statement regarding the DCs and ratings of disfigurement-

or maybe better yet-

Just send them that part of the above rating info as to disfigurement with the 38 CFR citations-and you could state the hyperlink for this BVA case.

The VA does not consider BVA decisions as applicable to similiar cases if a vet is basically asking them for same award based on a BVA vets evidence that might even be the same as theirs.

However when the BVA cites a regulation,or if a claimant does, this is legal evidence that the VA should consider.

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