Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
Fibromyalgia (fibrositis, primary fibromyalgia syndrome) is rated under 38 CFR 38 CFR § 4.71a, Diagnostic Code 5025, from 10% to 40% based on the frequency and functional severity of symptoms. The maximum 40% rating requires: That are constant, or nearly so, and refractory to therapy. Most claims establish the 10% or 20% rating before reaching the top tier.
What are the VA rating criteria for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
That require continuous medication for control
Note: Symptoms are episodic, present one-third of the time or less. Diagnosis requires meeting ACR criteria (widespread pain + tender point count or symptom severity score).
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
That are constant, or nearly so, and refractory to therapy
Note: The 40% rating is the maximum for fibromyalgia under DC 5025. Refractory to therapy means symptoms persist despite adequate treatment trials.
“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”
Which conditions are commonly secondary to Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
View 5 secondary conditions linked to Fibromyalgia (fibrositis, primary fibromyalgia syndrome)
Medical rationale, evidence strength, and filing tips — rated under 38 CFR § 3.310
Common Questions About Fibromyalgia (fibrositis, primary fibromyalgia syndrome) VA Ratings
What is the VA rating range for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
The VA rates Fibromyalgia (fibrositis, primary fibromyalgia syndrome) under Diagnostic Code 5025 at 10%, 20%, 40%. The minimum 10% rating requires: That require continuous medication for control. The maximum 40% rating requires: That are constant, or nearly so, and refractory to therapy.
Which 38 CFR diagnostic code does the VA use for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
The VA rates Fibromyalgia (fibrositis, primary fibromyalgia syndrome) under Diagnostic Code (DC) 5025, governed by 38 CFR 38 CFR § 4.71a. The diagnostic code establishes the specific rating tiers and severity criteria the VA examiner applies.
What is the difference between a 10% and a 40% rating for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
A 10% rating requires: That require continuous medication for control. A 40% rating requires: That are constant, or nearly so, and refractory to therapy. The difference typically reflects the frequency, severity, or functional impact of the condition as documented in medical records and C&P examination findings.
Can Fibromyalgia (fibrositis, primary fibromyalgia syndrome) qualify for TDIU (Total Disability Individual Unemployability)?
Veterans rated for Fibromyalgia (fibrositis, primary fibromyalgia syndrome) may qualify for TDIU if the condition — alone or in combination with other service-connected disabilities — prevents substantially gainful employment. A single disability rated at 60% or higher (or multiple disabilities combining to 70%, with one at 40%) can support a TDIU claim under 38 CFR § 4.16.
What evidence do I need to establish service connection for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
Service connection for Fibromyalgia (fibrositis, primary fibromyalgia syndrome) requires three elements: (1) a current diagnosis of the condition, (2) an in-service event, injury, or disease, and (3) a medical nexus linking the current diagnosis to that in-service occurrence. A nexus letter from a treating or independent medical examiner is the most reliable nexus evidence.
Which conditions are commonly secondary to Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
Fibromyalgia (fibrositis, primary fibromyalgia syndrome) is associated with 5 documented secondary conditions. Secondary conditions caused or aggravated by a service-connected disability are ratable under 38 CFR § 3.310. See the secondary conditions page for the full list with medical rationale and evidence strength ratings.
What is the C&P exam like for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
A Compensation & Pension (C&P) exam for Fibromyalgia (fibrositis, primary fibromyalgia syndrome) uses a Disability Benefits Questionnaire (DBQ) specific to the body system involved. The examiner documents the frequency, severity, and functional impact of your symptoms. Bring all relevant treatment records and be prepared to describe your worst-day symptoms — the examiner rates your condition based on the full clinical picture, not a single visit.
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