Fibromyalgia (fibrositis, primary fibromyalgia syndrome) — VA Rating Criteria (38 CFR DC 5025)
The VA rates Fibromyalgia (fibrositis, primary fibromyalgia syndrome) 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. Related conditions in the Musculoskeletal body system share this rating framework.
What are the VA rating criteria for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
That require continuous medication for control
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
“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)?
How does the VA rate Musculoskeletal conditions?
Common Questions About Fibromyalgia (fibrositis, primary fibromyalgia syndrome) VA Ratings
What is the VA disability rating for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
The VA rates Fibromyalgia (fibrositis, primary fibromyalgia syndrome) under Diagnostic Code 5025 at the following tiers: 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.
What is Diagnostic Code 5025?
Diagnostic Code 5025 is the VA rating identifier for Fibromyalgia (fibrositis, primary fibromyalgia syndrome) within 38 CFR 38 CFR § 4.71a. It defines the specific symptom criteria and percentage thresholds a VA adjudicator uses to assign a disability rating. The diagnostic code is listed on a veteran's rating decision letter.
What is the highest rating for Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
The highest schedular rating for Fibromyalgia (fibrositis, primary fibromyalgia syndrome) under DC 5025 is 40%. This tier requires: That are constant, or nearly so, and refractory to therapy. Veterans who cannot secure substantially gainful employment due to Fibromyalgia (fibrositis, primary fibromyalgia syndrome) alone or in combination with other service-connected conditions may also qualify for TDIU at the 100% compensation rate under 38 CFR § 4.16.
What 38 CFR section governs Fibromyalgia (fibrositis, primary fibromyalgia syndrome) ratings?
Fibromyalgia (fibrositis, primary fibromyalgia syndrome) is rated under 38 CFR 38 CFR § 4.71a, Diagnostic Code 5025. This section is part of the Schedule for Rating Disabilities (38 CFR Part 4) and can be read in full at the eCFR website.
Which conditions are commonly secondary to Fibromyalgia (fibrositis, primary fibromyalgia syndrome)?
Conditions commonly secondary to Fibromyalgia (fibrositis, primary fibromyalgia syndrome) include: Chronic Fatigue Syndrome, Irritable Bowel Syndrome (Fibromyalgia-Associated), Major Depression (Fibromyalgia-Associated), Temporomandibular Joint Disorder (TMJ), Testosterone Deficiency / Hypogonadism. Secondary conditions caused or aggravated by a service-connected disability are ratable under 38 CFR § 3.310. Medical nexus evidence linking the primary and secondary condition is required.
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 that may have caused or aggravated it, and (3) a medical nexus connecting the current diagnosis to that in-service event. A nexus letter from a treating physician or independent medical examiner is the most reliable nexus evidence. C&P exam findings can also establish nexus if adequately documented.
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