Fibromyalgia
Fibromyalgia is rated under Diagnostic Code 5025 based on the persistence of symptoms and response to treatment. The condition involves 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. Widespread pain means pain in both the left and right sides of the body, both above and below the waist, and affecting both the axial skeleton and extremities. A licensed rheumatologist is generally needed for proper diagnosis. If the veteran has other conditions that could explain some associated symptoms, those conditions can receive their own individual ratings alongside fibromyalgia. However, if there is no other basis established, separate ratings are not allowed.
VA Rating Levels
Requires continuous medication for control.
Symptoms persist at least one-third of the time.
Symptoms are continuous and treatments are not effective. Maximum rating.
Exam Tips & Key Evidence
- →A proper fibromyalgia diagnosis generally needs to come from a licensed rheumatologist.
- →If you have other established conditions that share some of the same symptoms, like depression or IBS, those can be rated on their own alongside your fibromyalgia rating.
- →Fibromyalgia is recognized as a presumptive condition for veterans exposed to Gulf War environmental hazards.
- →Just be aware that 40% is the highest rating available under this code.
Commonly Related Conditions
38 CFR Reference
38 CFR 4.71a, Diagnostic Code 5025