Do You Qualify for a VA Rating for Fibromyalgia?

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Do you qualify for a VA rating for Fibromyalgia?

We’re here to help answer this question and more to help determine whether you are owed VA disability compensation.

Many veterans develop fibromyalgia during their military service due to repetitive injuries, infection, stress, and traumatic events.

Keep reading to learn more about the VA disability ratings for fibromyalgia, how to submit a fibromyalgia VA claim, what to do with a denied fibromyalgia VA claim, and more!

VA Rating for Fibromyalgia

Service-connected fibromyalgia is eligible for a VA rating of 10%, 20%, or 40%. To receive the appropriate fibromyalgia VA rating, it’s important to get to the doctor and first get a diagnosis. After a fibromyalgia diagnosis, you likely will require continuous medication to help ease the symptoms and improve your quality of life.

Fibromyalgia in Veterans

Diagnosing fibromyalgia isn’t always straightforward because there is no specific test to determine whether you have the condition.

In addition, symptoms can vary from person to person, with the main symptoms being chronic pain and fatigue, common in many health conditions. While the condition generally results in widespread pain, other symptoms of fibromyalgia in veterans include:

• Chronic headaches
• Pain in soft tissues
• Irritable bowel syndrome
• Chronic fatigue syndrome
• Sleep disturbances

How to Get Service-Connected for a VA Rating for Fibromyalgia

To receive disability benefits and a VA disability rating for Fibromyalgia, you must meet the following criteria:

1. A current diagnosis 
2. An in-service event, injury, or illness
3. A medical nexus (i.e., link) between the current diagnosis and the in-service event, injury, or illness

How to File a VA Disability Claim for Fibromyalgia

1. Gather your evidence and supporting documents (i.e., VA medical records, hospital records, private medical records, hospital reports, and supporting statements)
2. Submit your VA Form 21-526EZ claim online, in person at your local regional VA office, or by mail to:

Department of Veterans Affairs
Claims Intake Center
PO Box 4444
Janesville, WI 53547-4444

PRO TIP: If you plan on applying for VA disability using a paper form, you should first submit an intent to file form, which gives you time to gather the necessary evidence and documentation—and could qualify you for additional compensation.  

How the VA Rates Fibromyalgia

The VA rates fibromyalgia at 10%, 20%, and 40%, depending on the severity and frequency of your condition.

Service-related fibromyalgia with constant symptoms and infrequent relief will receive a higher rating.

Your fibromyalgia VA disability percentage will determine your monthly disability compensation.

Fibromyalgia VA Rating Chart

The VA rates fibromyalgia under Title 38 of the Code of Federal Regulations, § 4.71a, under diagnostic code 5025.

If you develop fibromyalgia while on active duty or your service worsened a pre-existing condition, you may be eligible for the following disability benefits.

VA Fibromyalgia Rating Criteria

DC 5025, Fibromyalgia	VA Rating for Fibromyalgia
Widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms that are constant, or nearly so, and refractory to therapy	40%
With widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms that are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time	20%
Widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms that require continuous medication for control	10%

VA C&P Exam for Fibromyalgia

A Compensation & Pension (C&P) exam helps the VA determine if you have a service-connected disability and if your time on active duty is the culprit.

While the VA recognizes fibromyalgia as a service-connected condition, you still must prove your military service caused your condition.

During your VA claim exam for fibromyalgia, the examiner may ask about the following:

• Identifying tender or trigger points
• Musculoskeletal areas involved
• Muscle strength in involved areas

TDIU and Fibromyalgia

To qualify for Total Disability Individual Unemployability (TDIU) Benefits based on your fibromyalgia diagnosis, you must have one or more secondary conditions to attain a combined rating of at least 70%.

In addition, one of your secondary conditions must have at least a 40% rating.

Secondary Service Connection for Fibromyalgia

You may be eligible for additional VA benefits if you have a secondary service connection for fibromyalgia. That is if your fibromyalgia is secondary to another already service-connected condition.

Secondary Conditions to Fibromyalgia

Alternatively, other VA-rateable conditions can be secondary to your service-connected fibromyalgia. VA secondary conditions to fibromyalgia include sleep apnea, IBS, ankylosing spondylitis, and migraines.

You’ll receive a combined rating for both disabling conditions if you qualify for a secondary condition. However, your combined disability rating can’t exceed 100%.

VA Fibromyalgia DBQ

You can use a disability benefits questionnaire for fibromyalgia to help collect necessary medical evidence from your healthcare provider to help process your claim.

A DBQ helps support your claims for disability benefits; however, you must pay for any costs associated with obtaining the form.

While a DBQ doesn’t guarantee a favorable disability rating, it can help lead you in a positive direction.

VA Disability Benefits Questionnaire (DBQ) Explained

Fibromyalgia and Gulf War Veterans

Fibromyalgia is a presumptive illness for Gulf War Veterans. The VA presumes that some health conditions, including Fibromyalgia, were caused by active duty military service. As a presumptive illness, veterans do not have to prove an in-service event when filing a fibromyalgia VA disability claim.

VA Disability Rating for Fibromyalgia: Frequently Asked Questions (FAQS) 

Is Fibromyalgia a Presumptive Condition?

Yes, your service-connected fibromyalgia may be considered a presumptive condition if you served in the Gulf War.

Suppose you are a Gulf War veteran with fibromyalgia. In that case, the VA will assume your military service caused your condition, and you only need to meet the service requirements for the presumption.

Are There VA Disability Benefits for Fibromyalgia

Yes. If you received a fibromyalgia diagnosis and qualify for a fibromyalgia VA disability rating, you are eligible for the following:

• Tax-free monthly compensation payments
• Healthcare benefits
• Dependent benefits
• Life insurance and more

The special monthly compensation fibromyalgia brings will vary depending on your individual VA rating.

Can I Appeal a VA Ratings Decision for Fibromyalgia?

Yes, you can file an appeal if your VA claim is denied and you feel you deserve a VA rating for fibromyalgia.

If the VA decision was dated on or after February 19, 2019, you have three options to continue your case: 

• File a Supplemental Claim
• Request a Higher-Level Review 
• Appeal to the Board of Veterans’ Appeals 

If you eagerly await the fibromyalgia rating VA assigns, you can check the status online.

NEED MORE ASSISTANCE?

Most veterans are underrated for their disabilities and, therefore, not getting their due compensation. If you need help proving your service-connected fibromyalgia, we are here for you. At VA Claims Insider, we help you understand and take control of the claims process, so you can get the rating and compensation you’re owed by law. 

If you’ve filed your VA disability claim and have been denied or have received a low rating—or you’re unsure how to get started—reach out to us! Our process takes the guesswork out of filing a VA disability claim and supports you in building a fully developed claim (FDC)—so you can increase your rating FAST! Take advantage of a FREE VA Claim Discovery Call. Learn what you’ve been missing—so you can FINALLY get the disability rating and compensation YOU DESERVE!