DC 7801Skin ConditionsLast verified: APR 22, 2026

Secondary Conditions for Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage

Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage is a service-connected condition that can cause or aggravate 1 additional disability under 38 CFR § 3.310. Common secondaries include Major Depressive Disorder / Anxiety Disorder (Body Image). Each secondary requires medical nexus evidence linking it to the primary, documented in treatment records or a private nexus letter.

“Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected.”
— 38 CFR § 3.310(a), Disabilities that are proximately due to, or aggravated by, service-connected disease or injury
Evidence Strength:STRONGMODERATEEMERGING

Which secondary conditions are most common after Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage?

STRONG

Medical Rationale

Severe burn scars, particularly those affecting visible areas (face, neck, hands), produce significant psychological morbidity through disrupted body image, social avoidance, and chronic pain. The psychological impact follows a well-characterized trajectory: acute stress responses transition to chronic adjustment disorders, major depression, and social anxiety in 25-45% of burn survivors. The mechanism involves altered self-perception, perceived social stigmatization, and chronic nociceptive input from neuropathic scar pain — unmyelinated C-fibers regenerate abnormally within scar tissue, producing chronic burning and itching that independently contribute to sleep disruption and mood disturbance. Post-traumatic stress from the burn event itself compounds the body image distress.

Key Studies

Fauerbach JA et al. (2007) J Burn Care Res (psychological distress after major burn injury — longitudinal study); Van Loey NE & Van Son MJ (2003) J Burn Care Rehabil (psychopathology and psychological problems in burn patients — meta-analysis).

Filing Tips

Psychiatric evaluation documenting depression or anxiety diagnosis with explicit discussion of burn scar body image disturbance. Photographs of scars. Dermatology records documenting scar severity, location (visible vs. concealable), and associated pain/pruritus. Psychiatry nexus letter addressing the causal chain from disfiguring scars to psychological distress. Personal statement from the veteran describing social avoidance, relationship difficulties, and emotional impact. Consider mental health condition separately under DC 9434 or 9400 — this is rated independently of the scar ratings.

How do I file a secondary service connection claim?

File VA Form 21-526EZ and list the secondary condition as a new claimed disability, noting it is secondary to Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. Submit a nexus letter at the time of filing — the VA does not request nexus evidence on your behalf. An effective date of Intent to File (VA Form 21-0966) protects your start date for up to 12 months while you gather medical evidence.

Common Questions About Secondary Service Connection

What is a secondary service-connected condition?

A secondary service-connected condition is a disability that is proximately caused or chronically worsened by an already service-connected condition. The VA rates secondary conditions separately and combines them with the primary rating using the combined ratings table under 38 CFR § 4.25.

What legal standard applies to secondary service connection?

38 CFR § 3.310(a) governs secondary service connection. It states: "Disability which is proximately due to or the result of a service-connected disease or injury shall be service connected." Aggravation claims — where the primary condition worsens a pre-existing disability — are covered under § 3.310(b).

Which secondary conditions are most common after Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage?

The 1 secondary conditions documented for Burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage vary by evidence strength. The most strongly supported include: Major Depressive Disorder / Anxiety Disorder (Body Image). Evidence strength reflects the volume and quality of medical literature linking each secondary to the primary condition.

What evidence proves a secondary condition is caused by the primary?

The most reliable evidence is a private nexus letter from a treating physician or independent medical examiner that: (1) acknowledges the service-connected primary condition, (2) diagnoses the secondary condition, and (3) states to at least a 50% probability ("as likely as not") that the primary caused or aggravated the secondary. Treatment records documenting the progression are supporting evidence, not a substitute.

How does the VA rate secondary conditions?

Secondary conditions are rated under the same 38 CFR Part 4 diagnostic codes as any other condition. The VA then combines the primary and all secondary ratings using the combined ratings formula under § 4.25 — not simple addition. For example, a 50% primary and a 30% secondary combine to 65% (rounded to 70%), not 80%.

How do I file a secondary service connection claim?

File VA Form 21-526EZ and list the secondary condition as a new claimed disability, specifically noting it is secondary to your already service-connected primary condition. Submit a nexus letter and all relevant treatment records at the time of filing. If your primary claim is already decided, you can file for the secondary as a new claim at any time — the effective date will be the date of the new claim.

Can I add secondary conditions to an existing claim after it has been decided?

Yes. Secondary conditions can be added at any time as a new claim. The effective date for the secondary will generally be the date VA receives your new claim (or the date of an Intent to File, if filed within the preceding 12 months). If the secondary was improperly denied in an earlier rating decision, a Supplemental Claim or Higher-Level Review may allow an earlier effective date.

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