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Evidence checklist

Chloracne

DC 782938 CFR § 4.118Skin

Evidence strength

Mark what you already have below and your evidence strength appears here.

Target
Saved locally
01

Specialist opinion

Highest value0 of 2 collected
Dermatology diagnosis confirming chloracneCritical

A dermatologist should confirm the specific diagnosis of chloracne, which differs from regular acne. It typically shows comedones behind the ears and on the face.

Private provider · independent opinion
Nexus opinion linking chloracne to chemical exposureCritical

A medical opinion connecting your chloracne to dioxin or Agent Orange exposure. For presumptive claims, the condition must have appeared within one year of last exposure.

Private provider · independent opinion
02

C&P examination

0 of 1 collected
Documentation of deep acne extent on face and neckCritical

The examiner should document whether deep cystic lesions affect less than or more than 40% of your face and neck.

VA-scheduled · request a copy on VA.govHow to get this →
03

Treatment records

0 of 1 collected
Medical records showing onset within one year of exposure

Records showing when your chloracne first appeared. For presumptive service connection, it must have started within one year of your last herbicide exposure.

VA or private records · written request
04

Lay statements

0 of 2 collected
Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

You or a witness · VA Form 21-4138 or 21-10210How to get this →
05

Benefits questionnaire

0 of 1 collected
Completed DBQ Skin DiseasesCritical

A standardized VA form documenting the type and extent of chloracne lesions, exposure history, and onset date.

Provider-completed · VA DBQ formHow to get this →
06

Service records

0 of 2 collected
Documentation of Agent Orange or dioxin exposureCritical

Service records showing you served in Vietnam or were exposed to Agent Orange, dioxin, or other chlorinated chemicals. Chloracne is a presumptive condition for Agent Orange exposure.

NPRC / milConnect · SF-180
Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.

NPRC / milConnect · SF-180

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