Scars are described as fibrous tissue that replaces normal skin after some of the dermis is destroyed.

Causes of scars include: burns, surgical operations, cuts, or, less commonly, diseases.

Signs and symptoms of the condition depend on the underlying cause. Initially, a scar is usually red or purple and, with time, becomes white and glistening. Examples of scar tissue include, but are not limited to the following types:

• Keloids - form in the skin following trauma or surgical incision, and result in an elevated, solid, thickened red scar that may grow for an extensive amount of time.

• Cicatrix - are scars left by a healed wound that lack color, and are less elastic than normal tissue.

Physical examination alone is adequate to diagnose many skin disorders, e.g., scars. However, if, for example, the underlying cause is disease or burns, diagnostic studies may have to be conducted to further evaluate the condition. Additional studies may include microscopic examinations, and culture and sensitivity tests.

Corticosteroid injections into the scar have been effective in some patients. In addition, surgical or laser therapy have been tried to remove the scars, as well as specific medications that interrupt collagen development. Finally, grafting may be used to cover imperfections from burns, trauma, or surgery.

Scars following skin disorders or surgery are usually noticeable and disfiguring causing body image disturbances, which may require counseling.

• To properly rate disability, accurate measurements of scar size/area,limitations in motion, amount of tissue loss, and distortion of symmetry of facial features must be available.

• Multiple scars may not be added together to meet the width of scarring requirement.

• The 8 characteristics of disfigurement, for purposes of evaluation under §4.118, are:

  • Scar 5 or more inches (13 or more cm.) in length.

  • Scar at least one-quarter inch (0.6 cm.) wide at widest part.

  • Surface contour of scar elevated or depressed on palpation.

  • Scar adherent to underlying tissue.

  • Skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.).

  • Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.).

  • Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.).

  • Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

• Rate tissue loss of the auricle under DC 6207 (loss of auricle) and anatomical loss of the eye under DC 6061 (anatomical loss of both eyes) or DC 6063 (anatomical loss of one eye), as appropriate.

• Take into consideration unretouched color photographs when evaluating under these criteria.

• Separately evaluate disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, under the appropriate diagnostic code(s) and apply §4.25 to combine the evaluation(s) with the evaluation assigned under this diagnostic code.

• The characteristic(s) of disfigurement may be caused by one scar or by multiple scars; the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation.