Veterans living with fibromyalgia face a unique challenge: the daily struggle to manage chronic pain and fatigue, as well as the frustrating battle to receive fair compensation from the Department of Veterans Affairs (VA). Despite fibromyalgia being recognized as a service-connected disability, many veterans find their claims for benefits denied or underpaid. Understanding the reasons for these issues and finding solutions is crucial for veterans who deserve the benefits they have earned.
How the VA Rates Fibromyalgia
Fibromyalgia is recognized by the Veterans Affairs (VA) under 38 CFR § 4.71a and has a diagnostic code of 5025. The VA’s rating schedule provides for three possible evaluations based on the severity of symptoms:
- 40%: For widespread musculoskeletal pain and tender points that are constant or nearly so and resistant to therapy.
- 20%: When symptoms occur episodically with exacerbations often triggered by environmental or emotional stress or overexertion, but are present more than one-third of the time.
- 10%: When symptoms require ongoing medication for control.
It is worth noting that fibromyalgia can only be rated at 40% or below under this diagnostic category, even if it leads to severe functional limitations, unless secondary conditions such as depression, anxiety, or sleep disorders are separately connected to service.
Why Fibromyalgia Claims Are Frequently Underrated
1. Invisible Symptoms, Insufficient Evidence
Fibromyalgia does not have definitive laboratory tests or imaging results, so it is diagnosed mainly through clinical evaluation and the exclusion of other conditions. This can lead to VA raters viewing it as “subjective” or “unverifiable”. Without thorough medical documentation, including treatment records, physician statements, and evidence of tender point examinations, claims are often downgraded or denied.
2. Failure to Link to Military Service
To qualify for benefits, veterans must prove that their fibromyalgia began during active duty or was exacerbated by service. Many veterans develop symptoms years after discharge, making it harder to establish a connection. However, under 38 U.S.C. § 1110, a service connection can still be established with credible testimony from lay witnesses (e.g., friends) and medical opinions linking the current diagnosis to in-service events such as trauma, exposure, or chronic stress.
3. Overlooking Secondary Conditions
Fibromyalgia often occurs alongside other conditions, such as PTSD, migraines, irritable bowel syndrome or chronic fatigue. These conditions can be rated separately. If they are not claimed or documented, the veteran’s overall disability rating can suffer. The VA requires consideration of secondary service connections under 38 CFR § 3.310. However, many veterans are unaware of these requirements and do not apply for benefits.
4. Misapplication of the Rating Criteria
Some VA examiners mistakenly require “tender point” testing using outdated ACR criteria from 1990, even though the American College of Rheumatology has updated its guidelines in 2010 and 2016 to focus on the widespread pain index and symptom severity. Using obsolete standards can result in inaccurate assessments and lower ratings.
How to Strengthen Your Fibromyalgia Claim
- Document everything: Keep detailed records of pain levels, flare-ups, medications, and how symptoms affect your daily activities.
- Obtain an expert opinion: Ask your rheumatologist or other medical provider to write a letter stating that your fibromyalgia is related to your military service.
- Include related conditions: Don’t limit your claim to just fibromyalgia – include any other mental or physical health conditions that may be related.
- Act quickly if your claim is denied: If your application is denied, you have one year to file an appeal under the Veterans Affairs Appeals Modernization Act.
You Don’t Have to Fight Alone
At Tabak Law LLC, we specialize in helping veterans across the country to secure the full range of benefits they are entitled to, including for complex and invisible conditions such as fibromyalgia. Our team of experienced attorneys understands the unique challenges associated with proving service connection for chronic pain conditions.
If your fibromyalgia claim has been denied or underestimated, don’t lose hope. Contact Tabak Law for a free consultation today. We are proud to stand with those who have served and are dedicated to turning hardship into hope through skilled and compassionate legal assistance.