Unstable Scar
Service-incurred wounds, burns, and surgeries producing painful, unstable, or neuropathic residual scars.
38 CFR diagnostic codes 7800, 7801, 7802, 7804, 7805
Peer-reviewed evidence (16)
The verified studies behind an Unstable Scar claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Wolf SE, Kauvar DS, Wade CE, Cancio LC, Renz EP, Horvath EE, White CE, Park MS, Wanek S, Albrecht MA, Blackbourne LH, Barillo DJ, Holcomb JB. Comparison between civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom. Ann Surg. 2006;243(6):786-92; discussion 792-5. PMID:16772782. doi:10.1097/01.sla.0000219645.88867.b7.
- Foster MA, Moledina J, Jeffery SLA. Epidemiology of U.K. military burns. J Burn Care Res. 2011;32(3):415-20. PMID:21422938. doi:10.1097/BCR.0b013e318217fa13.
- Niedzielski LS, Chapman MT. Changes in burn scar contracture: utilization of a severity scale and predictor of return to duty for service members. J Burn Care Res. 2015;36(3):e212-9. PMID:25501771. doi:10.1097/BCR.0000000000000148.
- Finnerty CC, Jeschke MG, Branski LK, Barret JP, Dziewulski P, Herndon DN. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016;388(10052):1427-1436. PMID:27707499. doi:10.1016/S0140-6736(16)31406-4.
- Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1-2):113-25. PMID:20927486. doi:10.2119/molmed.2009.00153.
- Tredget EE, Shupp JW, Schneider JC. Scar Management Following Burn Injury. J Burn Care Res. 2017;38(3):146-147. PMID:28338518. doi:10.1097/BCR.0000000000000548.
- Greer N, Sayer N, Kramer M, Koeller E, Velasquez T. Prevalence and Epidemiology of Combat Blast Injuries from the Military Cohort 2001-2014. Department of Veterans Affairs (US) — VA Evidence Synthesis Program; 2016. PMID:28813129. Available at: https://pubmed.ncbi.nlm.nih.gov/28813129/.
- Singh AK, Ditkofsky NG, York JD, Abujudeh HH, Avery LA, Brunner JF, Sodickson AD, Lev MH. Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing. Radiographics. 2016;36(1):295-307. PMID:26761543. doi:10.1148/rg.2016150114.
- Ogawa R, Akita S, Akaishi S, Aramaki-Hattori N, Dohi T, Hayashi T, Kishi K, Kono T, Matsumura H, Muneuchi G, Murao N, Nagao M, Okabe K, Shimizu F, Tosa M, Tosa Y, Yamawaki S, Ansai S, Inazu N, Kamo T, Kazki R, Kuribayashi S. Diagnosis and Treatment of Keloids and Hypertrophic Scars-Japan Scar Workshop Consensus Document 2018. Burns Trauma. 2019;7(39). PMID:31890718. doi:10.1186/s41038-019-0175-y.
- Miletta NR, Donelan MB, Hivnor CM. Management of trauma and burn scars: the dermatologist's role in expanding patient access to care. Cutis. 2017;100(1):18-20. PMID:28873104.
- Ngaage M, Agius M. The Psychology of Scars: A Mini-Review. Psychiatr Danub. 2018;30(Suppl 7):633-638. PMID:30439862.
- Hong YK, Chang YH, Lin YC, Chen B, Guevara BEK, Hsu CK. Inflammation in Wound Healing and Pathological Scarring. Adv Wound Care (New Rochelle). 2023;12(5):288-300. PMID:36541356. doi:10.1089/wound.2021.0161.
- Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2022;9(9):CD011642. PMID:36161591. doi:10.1002/14651858.CD011642.pub2.
- Goodwin B, Mitchell J, Major E, Podwojniak A, Brancaccio H, Rusinak K, King M, Tahir H. The efficacy of topical 8% capsaicin patches for the treatment of postsurgical neuropathic pain: a systematic review. Pain Manag. 2024;14(10-11):591-598. PMID:39589498. doi:10.1080/17581869.2024.2433931.
- Fredman R, Edkins RE, Hultman CS. Fat Grafting for Neuropathic Pain After Severe Burns. Ann Plast Surg. 2016;76 Suppl 4:S298-303. PMID:26678099. doi:10.1097/SAP.0000000000000674.
- Kline CM, Lucas CE, Ledgerwood AM. Directed neurectomy for treatment of chronic postsurgical neuropathic pain. Am J Surg. 2013;205(3):246-8; discussion 248-9. PMID:23357521. doi:10.1016/j.amjsurg.2012.10.010.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
Build your Unstable Scar documentation
Generate and review your claim documents free — grounded in sources like these. When you want the nexus opinion signed, a licensed provider can review and sign it.
Generate your documentation — freeEducational information about the evidentiary standard — not legal or medical advice, and never a prediction about any claim.