When I was younger, I had a “Girls of Hawaiian Tropic” poster on my wall. If you are a U.S. male between the ages of eight and 80, you probably know these posters. As a teenager, that poster was better than coffee to wake me up in the morning! You might ask, what does this have to do with VA disability and skin cancer? Well, it will become clear soon.
I knew if I ever wanted to date one of those girls, I would need a tan. However often I tried, I could not get my skin to have that tanned, bronze glow. Probably because I am of English and Scottish ancestry, with a little Eastern Europe thrown in for that all-over pelt look.
Playing With Fire
When I was growing up, skin cancer had not been discovered yet. No one in my family, friends, nor acquaintances used sunscreen, and I’m not sure anyone had ever even heard of it. I had never heard of the VA either, except for my grandfather’s rants. I know they were out there, but while the VA sounded bad that tan sounded awesome!
Growing up, I spent a lot of time in the sun. I played outside, rain or shine. Bike riding, skateboarding, band camp (yeah, I was that guy), all were sun-drenched activities. As a teenager, I worked a lot of construction, framing houses, and the like. I usually wore a baseball cap, but rarely used sunscreen. Fast-forward to being in the Air Force, and the sun levels only went up.
My tech training was in Biloxi, Mississippi. On the beach. My first duty station was Travis AFB, California. Every summer, the forecast was 100 sunny and hot. And I spent days and centuries out in that sun.
I had gone with friends to spend the day at Lake Berryessa. We spent the day on a raft on the lake, drinking beer and swimming. By the next morning, my legs were purple and I could not put my uniform pants on. When I called my flight chief to explain why I would be at the doctor’s instead of work, he threatened to charge me with destruction of government property. I know now that’s BS, but as a young E-2, I dragged those pants over the blisters and hobbled my way to work.
I did finally go to sick-call, but I did it the next morning (I worked swing shift) so I wouldn’t get in trouble. The doc took pity on me, gave me some lidocaine skin cream, about a thousand 800mg Motrin, and a tube of SPF 50 sunscreen. I’d like to say the ordeal changed my life and I always wore sunscreen from that day forward. You all know that’s crap…
It wasn’t until I was in my 30s that I finally saw the doc for those strange scaly patches on my neck. He looked, looked again, and gave me a referral to see a dermatologist. The dermatologist looked at my neck, said “actinic keratosis“, then grabbed the liquid-nitrogen freezy-off thing used in cryotherapy and started in on me. When I left the office, I had about 10 newly-raised blisters from the freezing, and a couple of band-aids from the holes made by biopsy cuts.
A week or so later, I was sitting on the doctor’s table while she cut eight square inches of squamous cell carcinoma from my left forearm. If you have never seen the bare muscles contract in your arm, I highly do not recommend it. Gruesome pics are below.
Couple of years later, I was sitting in another dermatologist’s office while another freezy-thing made lots of blisters on my face and arms, and another few band-aids from biopsy cuts were applied on me.
A week later I am laying on another dermatologist’s table with drapes over my head and face, cautery guns and scalpels everywhere. That “pimple” on my forehead just happened to be basal-cell carcinoma, and now I have a third eye, right dead-center of my forehead. More gruesome pics ahead. Sigh…
In the year before retirement, I began getting my medical records in order. I gathered all the documentation from specialist providers and realized I had seen the dermatologist a LOT. I began the BDD (benefits delivery at discharge) process with a Disabled American Veterans representative. The BDD process allows separating servicemembers to apply for disability benefits up to 180 days before separation.
The DAV representative took all my records, pulled out a hard-copy form 21-526, and began asking me questions. In his words, “Tell me everything that bothers you, that has bothered you, and that is beginning to bother you. Start at the top of your head and go to the soles of your feet.” He questioned EVERYTHING. One of the questions had to do with scarring.
Now, I have a few scars from my time in service. Random accidents on the flightline and off. However, I have more scars from the removal of sun damage than anything else. The DAV rep questioned how many “skin anomalies” I had had removed. He asked about the types of “anomalies,” where they were, how they had been removed, etc. In fact, the day I sat down with him I had three healing “removals” on my face.
VA Disability and Skin Cancer
Turns out, the VA rates skin cancer by the coverage. Skin cancer is rated on the same scale as other skin conditions like eczema or psoriasis. Those conditions cover a percentage of the body, and disability ratings are decided by that. Also by the scars on the face and neck, and separately on the rest of the body. 38 CFR § 4.118 – Schedule of ratings – skin is the regulation that governs disability ratings for skin cancer and other skin conditions.
The DAV rep chronicled all my ailments, submitted the claim to the VA, and they scheduled me to see a QTC doctor for my examination.
The QTC doc whipped out this tiny little ruler and started measuring the scars on my face. Scars are measured by width, length, depth, or rise, and whether or not they are painful. Most of the scars on my face are painful to the touch, and most of them are around dime-sized. The one on my forearm from squamous cell carcinoma is over five inches long, half an inch wide, and has left a dent in my arm. All these things play into the rating.
Schedule of Ratings
I’m not going to try and explain all the nuances of VA ratings, but all those scars on my face added up. The ones on my arms and hands, as well. For the state of my face (don’t laugh), the VA awarded me a 10 percent rating.
According to the CFR:
“7800: Burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck:
With one characteristic of disfigurement
Scar at least one-quarter inch (0.6 cm.) wide at widest part. AND
Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.).”
When it came to my arms and body, the VA awarded 30 percent. Again, from the CFR,
“7801 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.”
There are too many variables to list for this rating, but it boils down to how many, how painful, and how big. The VA tallied up how many scars I got on active duty, figured out how much of my body has some sort of scarring, and which of them cause pain and discomfort.
Some people have a problem with conditions like skin cancer receiving a VA disability rating. They see disability as something received for combat injuries. If you have not been injured in combat, why should the VA give you any kind of rating, they ask. VA disability ratings are from conditions caused, or aggravated, by time in military service. I spent centuries in the sun, working the flightline, formations, and random duties. Even with sunscreen, a LOT of the sun’s rays made it through. Here, I have to mention that the 60th Med Group at Travis was instrumental in teaching me the importance of sunscreen.
Something I learned after seeing a dermatologist is that sun damage is cumulative. Sunburn or suntan leaves a trace after it has faded. Your skin remembers it, and stores it away. When I had the first keratosis removed from my face, the others were already there, lurking beneath the surface. My saga of “time to get something removed” is only beginning.
I wear sunscreen whenever I go out. I have boonie hats and sun shirts I wear. Now, I do not stay in the sun at all, if I can help it. But it doesn’t matter. All those years in the sun are biding their time, under my skin. The dermatologist says they will come out, in carcinomas, keratoses, and maybe melanoma; it’s simply a matter of when.
The VA says they know the Air Force kept me in the sun and compensated me for the damage.