How Veterans Can Get a Lupus VA Rating

Lupus is a chronic autoimmune disorder that can cause damage to any organ or tissue in the body. Typically, lupus is an inherited condition, but it may also be triggered by stress or exposure to chemicals, toxins, and other pollutants. Veterans with a genetic predisposition to the disease are at a higher risk of developing lupus if exposed to traumatic events or environmental toxins during service. 

This article describes what lupus is, residual complications from lupus, and how veterans can get a lupus VA disability rating.

VA disability for lupus

Veterans may be at a higher risk of developing lupus due to increased exposure to environmental contaminants, chemicals, ultraviolet light, and high stress that can weaken the body’s immune system. However, the cause of lupus in most cases is unknown.

Because it is usually genetic, some veterans may find it difficult to prove their lupus was caused or worsened by military service, but it is possible. 

What is lupus?

The most common form of lupus is systemic lupus erythematosus (SLE). SLE occurs when the immune system attacks its own tissues, potentially causing inflammation of several parts of the body including the joints, heart, lungs, kidneys, blood cells, and brain. 

While lupus is a chronic illness with no cure, it usually cycles through active and dormant periods. During active flare-ups, systemic lupus can cause symptoms ranging from a mild skin rash to more severe problems. 

Other symptoms of SLE can include:

• Arthritis
• Fever
• Fatigue
• A butterfly rash across the nose and cheeks
• Scaly, round rashes on the body
• Sores
• Hair loss
• Headache
• Abdominal Pain
• Swelling in the feet and around the eyes 

A less common form of lupus is cutaneous lupus. This form of lupus specifically targets skin cells, leaving you with red, thick, and scaly rashes that might burn or itch. Usually, these rashes appear in sun-exposed areas of the body. 

Since systemic and cutaneous lupus affect different parts of the body in different ways, the VA rates them differently. Keep reading for more detailed information on how the VA rates lupus. 

VA Benefits for Lupus: How to Obtain the Highest Rating Explained by a Veterans Disability Lawyer

Systemic lupus VA rating

To assign a disability rating for systemic lupus, the VA uses diagnostic code 6350. The VA disability rating for systemic lupus can be 10%, 60%, or 100% and is determined by the severity and frequency of flare-ups.

In the chart below, the VA refers to flare-ups as “exacerbations.”

Description	VA Rating	Monthly payment (vet only)
Not to be combined with ratings under DC 7809 Acute, with frequent exacerbations, producing severe impairment of health	100%	$3,938.58
Exacerbations lasting a week or more, 2 or 3 times per year	60%	$1,434.02
Exacerbations once or twice a year or symptomatic during the past 2 years	10%	$180.42

Cutaneous lupus VA rating

Cutaneous lupus is rated using the General Rating Formula for the Skin. VA disability ratings for cutaneous lupus can be 0%, 10%, 30%, or 60% based on what percentage of the body is affected and how often treatment is required to manage symptoms. 

The VA defines systemic therapy as treatment administered through any route (orally, injection, suppository, intranasally) other than the skin, while topical therapy is defined as treatment administered through the skin.

Description	VA Rating	Monthly payment (vet only)
At least one of the following: Characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or Constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period	60%	$1,434.02
At least one of the following: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period	30%	$552.47
At least one of the following: Characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or At least 5 percent, but less than 20 percent, of exposed areas affected; or Intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period	10%	$180.42
No more than topical therapy required over the past 12-month period and at least one of the following: Characteristic lesions involving less than 5 percent of the entire body affected; or Characteristic lesions involving less than 5 percent of exposed areas affected	0%	None

Alternatively, depending on the prominent disability, cutaneous lupus may be rated as disfigurement of the head, face, or neck (DC 7800), or scars (DCs 7801, 7802, 7804, or 7805).

Lupus and related conditions

Some people with lupus may be more likely to develop other related conditions. Veterans who receive a diagnosis for any condition caused by service-connected lupus can file a claim for VA benefits secondary to lupus.

It’s important to pay attention to all your symptoms and get checked by a medical professional to be sure you haven’t developed any of the following:

• Cardiovascular disease. This is the number one cause of death in people with SLE, and it’s caused by inflammation of the heart and blood vessels. Heart disease can also lead to atherosclerosis and coronary artery disease. 
• Kidney disease. People may develop kidney disease if lupus attacks their kidneys. This can also lead to kidney failure. 
• Fibromyalgia. This condition can occur alone or secondary to lupus. Studies suggest that about 25% of people with lupus also have fibromyalgia. 

Is lupus a presumptive VA disability? 

The VA presumes that a chronic illness, including lupus, that started within one year after discharge is connected to your military service. This means the VA automatically presumes lupus stems from service regardless of where you served, and without requiring evidence of a direct connection.

If you didn’t receive a lupus diagnosis until more than one year after discharge, it could still be possible to prove your symptoms started within that one-year time frame. 

For example, if you develop lupus symptoms within one year after discharge but you weren’t diagnosed with lupus, it may be possible to use those medical records to show your lupus started within a year.

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TDIU for lupus

Flare-ups of lupus symptoms can make it difficult to perform daily tasks at home and at work. Imagine being at work, wearing a heavy uniform that irritates your rashes. Or, perhaps the headaches and fatigue make reading a computer screen or focusing during a meeting nearly impossible. 

Veterans with service-connected lupus who are unable to seek or hold gainful employment, total disability based on individual unemployability (TDIU) may be available. TDIU is a monthly benefit paid to veterans who are unable to work due to a service-connected disability. TDIU pays the same amount as a 100% rating, without the requirement of a 100% rating. 

To be eligible for TDIU at least one of these must be true:

• You have at least one service-connected disability rated at least 60% disabling OR
• You have two or more service-connected disabilities, with one rated at least 40% disabling and a combined rating of 70% or more. 

How Woods & Woods can help

If you have a service-connected condition that affects your ability to live and work comfortably, you deserve VA disability compensation. Contact Woods & Woods today for a free consultation to see how we can help. You only pay us if we win. 

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