VA Disability for Hidradenitis Suppurativa: Rating & Evidence (2026)

What Hidradenitis Suppurativa Is

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, recurrent nodules, abscesses, draining sinus tracts, and scarring in areas rich in apocrine glands. The condition most commonly affects the axillae, groin, perianal area, inframammary folds, and gluteal cleft. Lesions progress through stages of nodule, abscess, sinus tract, and fibrosis, often with persistent drainage and severe pain.

HS is more than a skin disease. It is a systemic inflammatory disorder associated with metabolic syndrome, depression, chronic pain, and significant functional impairment. The unpredictable flares affect work attendance, mobility, hygiene, and quality of life. For veterans, HS often presents during or shortly after active duty when friction, heat, sweat, and limited hygiene conditions accelerate the disease.

Diagnostic Codes Used by Analogy

The VA schedule under 38 CFR 4.118 does not assign a unique code to HS. The rater selects the most closely analogous code based on the dominant clinical feature.

DC 7806 — Dermatitis or Eczema

This is the most commonly used code for HS when the rating turns on the extent of skin involvement. The tier structure is body-surface-area driven and supplemented by treatment intensity.

DC 7825 — Chronic Urticaria

This code applies when systemic immunosuppressive therapy is the dominant treatment modality. HS treated with biologics such as adalimumab (Humira), infliximab, or other TNF-alpha inhibitors often rates under DC 7825 because the therapy is what controls the disease.

Other Possible Codes

• DC 7820 (infections of the skin) when the dominant presentation is recurrent bacterial superinfection.
• DC 7804 (painful scars) for the scarring component, used in combination with the primary rating code.
• DC 7800 (disfigurement of head, face, or neck) when HS produces visible facial scarring or pigmentation changes.

Body Surface Area and the DC 7806 Tiers

Under DC 7806, the rating ladder is:

• 60% — More than 40% of the entire body or more than 40% of exposed areas affected, OR constant or near-constant systemic therapy with corticosteroids, other immunosuppressive drugs, retinoids, PUVA, or UVB during the past 12 months.
• 30% — 20% to 40% of the entire body or 20% to 40% of exposed areas affected, OR systemic therapy for six weeks or more (but not constantly) during the past 12 months.
• 10% — At least 5% but less than 20% of the entire body or at least 5% but less than 20% of exposed areas, OR intermittent systemic therapy of less than six weeks during the past 12 months.
• 0% — Less than 5% of the entire body or exposed areas affected, and no systemic therapy.

Systemic Therapy and the DC 7825 Pathway

When HS is managed primarily with systemic biologic therapy, the rater may apply DC 7825 (chronic urticaria) by analogy. The tier structure is:

• 60% — Recurrent episodes occurring at least four times during the past 12 months and requiring intramuscular or intravenous corticosteroids, sympathomimetics, or other immunosuppressive therapy for control.
• 30% — Recurrent episodes occurring at least four times during the past 12 months, requiring intermittent systemic immunosuppressive therapy for control.
• 10% — Recurrent episodes occurring at least four times during the past 12 months, responding to treatment with antihistamines or sympathomimetics.

For veterans on adalimumab (Humira) or other biologics maintained continuously to suppress HS, the 60% tier is often the closer analogous fit because the therapy is functionally constant immunosuppression. Documentation of the prescription, dose, and duration is critical.

Scarring as a Separate Rateable Condition

HS produces extensive scarring from chronic abscesses, sinus tracts, and surgical excisions. These scars can be separately compensated when they meet the criteria under DC 7800-7805.

• DC 7804 (painful or unstable scars): 10% for one or two scars, 20% for three or four, 30% for five or more. If one or more scars are both unstable and painful, add 10% to the evaluation.
• DC 7805: Scars (including linear scars) and other effects of scars rated under DC 7800-7804 evaluated for any disabling effects not considered in the rating under the other codes.
• DC 7800 (disfigurement of head, face, or neck): Higher ratings based on the eight characteristics of disfigurement when HS produces visible facial scarring.

Separate scar ratings are not pyramiding when they describe a distinct functional or aesthetic impairment from the underlying inflammatory disease.

Service-Connection Pathways

Direct Service Connection

Direct service connection is supported when service treatment records document HS onset or active treatment during active duty. Common in-service events include first nodule or abscess noted during routine physical, sick call visits for "boils" or "ingrown hairs" in the axillae or groin, surgical incision and drainage during service, or formal HS diagnosis by military dermatology.

Aggravation

HS can pre-exist enlistment in a mild form and worsen during service beyond its natural progression. Aggravation is supported when the medical opinion compares pre-service severity to in-service or post-service severity and identifies in-service factors that accelerated the disease. Common aggravating factors during service include:

• Friction from uniforms and gear (axillary HS from rucksack straps, web gear, body armor).
• Prolonged heat and sweat exposure (deployments in tropical or desert climates).
• Limited hygiene during field operations and deployments.
• Smoking (well documented as an HS accelerator; smoking patterns often intensified during service).

Secondary Service Connection

Under 38 CFR 3.310, HS may be granted secondary service connection when it is caused or aggravated by a service-connected condition. Common pathways include:

• Obesity-as-intermediary: a service-connected condition that causes weight gain, where obesity then causes or aggravates HS.
• Service-connected diabetes with skin manifestations and immune dysregulation that aggravate HS.
• Service-connected PTSD via smoking, weight gain, and stress-related immune dysregulation as recognized aggravators of HS.

Evidence That Supports the Record

• Dermatology consultation notes documenting diagnosis, Hurley staging (I, II, or III), and measured body surface area involvement.
• Service treatment records documenting in-service abscesses, incision and drainage procedures, or formal HS diagnosis.
• Pharmacy records showing systemic therapy: oral antibiotics (clindamycin, rifampin combinations), biologics (adalimumab), retinoids, or hormonal therapy.
• Surgical records from any excision, deroofing, or wide local excision procedures.
• Photographic documentation of active lesions and scarring.
• Hurley staging by a dermatologist (Stage I solitary abscesses; Stage II recurrent abscesses with sinus tract formation; Stage III diffuse involvement with multiple interconnected tracts and scarring).
• Pain documentation — frequency, intensity, and functional impact on work, sleep, and daily activities.
• Mental health records documenting depression or anxiety secondary to the chronic disease burden.

Common Mistakes to Avoid

• Missing the body surface area measurement. Without a documented BSA percentage, the rater defaults to the lowest tier under DC 7806.
• Treating HS as "skin infections." Recurrent boils are often misdiagnosed for years. A formal HS diagnosis with Hurley staging is the rating foundation.
• Ignoring the biologics question. If the veteran is on continuous adalimumab or another TNF-alpha inhibitor, that triggers the higher tiers under DC 7806 or DC 7825 independent of BSA at any given moment.
• Not claiming scars separately. Painful, unstable, or disfiguring scars are independently ratable.
• Skipping aggravation analysis when the condition pre-existed service. A clear comparison of pre-service vs in-service severity is the foundation of an aggravation claim.
• Failing to address secondary mental health. HS produces high rates of depression and anxiety; both may be separately service-connected as secondary to the skin disease.