7899-7820 Plantar warts

DBQ: Link to Index of DBQ/Exams by Disability for DC 7820 

Definition

Plantar warts are common, benign, contagious tumors of the upper skin layer occurring on the sole of the foot. Plantar warts are slightly elevated or flattened by pressure, and surrounded by hardened epithelium.

Etiology

A virus causes warts. The plantar wart is caused by the human papillomavirus (HPV) types 1, 2, 4, and 7. Warts may be transmitted by direct contact or by autoinoculation.

Signs & Symptoms

Plantar warts appear as slightly elevated or flattened on the sole of the foot. The warts are extremely tender, and are different from corns and calluses in that the wart has a tendency to have pinpoint bleeding when the surface is cut away.

Tests

Visual inspection and histological studies are tests used to diagnose the condition.

Treatment

Plantar warts require maceration with a 40% salicylic acid tape kept in place for several days, followed by debriding while the wart is still damp and soft. The wart is then destroyed by freezing or caustics such as 30 to 70% trichlorocetic acid. Other forms of destructive treatment may include: CO2 therapy, laser therapy, application of various acids, and snipping off of filiform warts. To prevent scaring, electrodesiccation, and laser surgery should possibly be avoided.

Residuals

Scarring from treatment may occur. Warts may persist for years and may recur at the same or different site.

Special Considerations

  • When 38 CFR 4.118 offers variable methods to evaluate a skin condition, assign a single evaluation using the criteria that results in the highest rating. 

  • Consider this condition pursuant to 38 CFR 4.27 and 38 CFR 4.20, when applicable. Analogous ratings are utilized when a specific disability is not listed in 38 CFR Part 4. Certain hyphenated codes do not necessarily denote analogous ratings – a hyphenated DC may also be used to identify the proper evaluation of a disability or a residual from disease. Diagnostic Codes (DCs) must be carefully selected as a condition specifically listed in the rating schedule may not be rated by analogy, unless otherwise directed (e.g., amyotrophic lateral sclerosis, multiple sclerosis).  When multiple DCs apply to a given disability, consider whether separate evaluations are warranted, and/or which DC will result in the most advantageous outcome for the claimant.

  • Do not routinely award SC for HPV infection as a medical nexus is required to establish an association between warts and in-service HPV infection.

Notes

  • 38 CFR 4.118 (a) For the purposes of this section, systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin.   

  • 38 CFR 4.118 (b) Two or more skin conditions may be combined in accordance with 38 CFR 4.25 only if separate areas of skin are involved. If two or more skin conditions involve the same area of skin, then only the highest evaluation shall be used.