Fibromyalgia is a silent yet devastating condition that many veterans battle long after their military service ends. Characterized by chronic pain, extreme fatigue, and cognitive issues, it’s frequently misdiagnosed or overlooked due to its invisible nature. Thankfully, the Department of Veterans Affairs (VA) does recognize fibromyalgia as a compensable condition, particularly for Gulf War veterans.
In this guide, learn what fibromyalgia is, its VA disability ratings, how to establish a service connection, and practical steps to build a strong, successful disability claim. Moreover, explore the unique challenges women veterans face with fibromyalgia.
Table of Contents
Veterans Living with Fibromyalgia
Fibromyalgia is a chronic neurological disorder that affects how the brain processes pain signals, leading to widespread musculoskeletal pain accompanied by fatigue, memory issues (often called “fibro fog”), and sleep disturbances. In veterans, these symptoms can be particularly debilitating and are often compounded by PTSD, depression, or other service-connected injuries.
The key symptoms of fibromyalgia include:
- Persistent, widespread pain across both sides of the body and above and below the waist.
- Chronic fatigue, regardless of sleep quality.
- Sensitivity to light, sound, and temperature.
- Gastrointestinal issues such as Irritable Bowel Syndrome (IBS).
- Difficulty concentrating or remembering things (cognitive dysfunction).
Despite the lack of a known cure, treatments such as medication, physical therapy, cognitive behavioral therapy, and lifestyle changes can help manage symptoms.
The Invisible Illness
While fibromyalgia affects about 4 million Americans, it’s especially prevalent among veterans, particularly those exposed to trauma, stress, or chemical hazards during their service. According to the researchers, 10.8% of service members with PTSD had fibromyalgia in a pre-deployment cohort compared to 0.8% without PTSD. The prevalence of fibromyalgia was 39.7% in those seeking PTSD treatment.
A fibromyalgia diagnosis is made largely through clinical evaluation since there is no definitive blood test or imaging that can identify the condition. This “invisible illness” often causes veterans to feel misunderstood, especially when their outward appearance doesn’t reflect the internal pain they experience daily.
Oftentimes, the fluctuating nature of the condition makes it difficult for veterans to demonstrate their VA claim for compensation.
Understanding VA Disability Ratings for Fibromyalgia
The VA uses Diagnostic Code 5025 under 38 CFR § 4.71a to assign disability ratings for fibromyalgia at 10%, 20%, or 40%, depending on the frequency and severity of symptoms.
Breakdown of VA Disability Ratings Criteria:
- 10% Rating: 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 controlled by continuous medication.
- 20% Rating: Episodic symptoms occur more than one-third of the time and are triggered by environmental or emotional stress or overexertion.
- 40% Rating: Symptoms are constant or nearly constant and resistant to therapy, impairing daily functioning.
Each rating determines your monthly tax-free compensation. For example, in 2025, a 40% rating grants approximately $755 per month for a single veteran, excluding dependents.
How VA Evaluates the Severity
To meet the VA’s definition of “widespread pain,” the discomfort must occur on both sides of the body, both above and below the waist. This also includes axial pain in areas like the spine, neck, chest, hips, limbs, or lower back. The VA also considers additional symptoms like sleep disturbances, chronic fatigue, and irritable bowel syndrome when assigning a disability rating.
Getting the highest rating possible is critical for maximizing compensation. A 40% rating can be the key to qualifying for Total Disability based on Individual Unemployability (TDIU).
Establishing a Service Connection for Fibromyalgia
To receive disability compensation, veterans must prove that their fibromyalgia is service-connected. There are multiple pathways to establishing a service connection, including:
1. Direct Service Connection
If you developed fibromyalgia during your military service, you may be eligible for a direct service connection. To establish this type of VA benefits claim, you must provide evidence for the following:
Current Diagnosis
A formal diagnosis of fibromyalgia from a licensed healthcare provider is required.
In-Service Event, Injury, or Illness
You need documented evidence that your symptoms or related events began or were aggravated during your time in service. This may include:
- Service Treatment Records (STRs) showing complaints of chronic pain, fatigue, or related symptoms
- Deployment records indicating exposure to high-stress or hazardous environments
- Incident or accident reports documenting physical or psychological stress during active duty
Medical Nexus Opinion
A Nexus (medical opinion) linking the condition to your military service. This letter or statement must be written by a qualified medical professional, such as:
- Your treating physician (MD or DO)
- A specialist (e.g., rheumatologist or neurologist familiar with fibromyalgia)
- A VA healthcare provider
- An independent medical examiner (IME) experienced in VA disability claims
The nexus letter provider must review your service and medical records and explain why it is “at least as likely as not” that your fibromyalgia is connected to your service. A well-reasoned, evidence-based opinion significantly strengthens your VA claim. It is important to note that veterans are not required to obtain these statements on their own, and if VA orders a compensation and pension (C&P) exam, a medical opinion will be provided either favorably or unfavorably.
2. Secondary Service Connection
In some cases, fibromyalgia develops due to another service-connected condition, such as:
- PTSD
- Migraine headaches
- Insomnia
- Irritable bowel syndrome
- Rheumatoid arthritis or lupus
- Depression and others
For instance, if your primary service-connected PTSD is already rated by the VA, you may qualify for additional compensation under a secondary claim. Medical evidence, including an official diagnosis and a nexus letter, must show that the secondary fibromyalgia is “at least as likely as not” caused by the primary disability.
3. Aggravation of Pre-Existing Condition
If fibromyalgia existed before your service and was worsened by the physical or emotional stress of military duties, you could still receive VA disability benefits based on aggravation. You’ll need strong medical evidence that your condition was aggravated during or after your service.
Besides, an independent medical opinion should clearly state that the pre-existing fibromyalgia was permanently worsened beyond its natural progression due to your active service.
Fibromyalgia and Gulf War Veterans: Presumptive Claims Explained
A VA-conducted survey indicated that 3.7% of deployed Gulf War veterans and 2.9% of non-deployed veterans reported suffering from fibromyalgia.
Considering this prevalence, the VA has simplified the disability claims process for Gulf War veterans by recognizing presumptive service connection for fibromyalgia. Under 38 CFR § 3.317, fibromyalgia is classified as a medically unexplained chronic multisymptom illness (MUCMI). This presumption was created in recognition of the exposures like burn pits, chemical agents, and pesticides that Gulf War veterans faced.
This means, in most cases, Gulf War veterans don’t need to prove the condition was directly caused by service. If they served in the Southwest Asia theater and later developed and experienced fibromyalgia for six months or more, the VA automatically presumes it was service-connected.
Eligible service locations include:
As a Gulf War Veteran, you must have served in the following locations on or after August 2, 1990:
- Iraq
- Kuwait
- Saudi Arabia
- The neutral zone between Iraq and Saudi Arabia
- Bahrain
- Qatar
- The United Arab Emirates (UAE)
- Oman
- Gulf of Aden
- Gulf of Oman
- Waters of the Persian Gulf, Arabian Sea, and Red Sea
- Afghanistan
- Egypt
- Israel
- Jordan
- Syria
- Turkey
To qualify for presumptive fibromyalgia VA claims, symptoms must:
- Serve in the Gulf War theatre after August 2, 1990
- Be at least 10% disabling.
- Emerge during active duty or by December 31, 2026 (Thanks to the PACT Act, this deadline may be extended or even lifted, allowing more Gulf War veterans to apply).
This presumptive status eliminates the need to prove a link between their illness and service to receive compensation, speeding up the claims process for many veterans.
Conditions Secondary to Fibromyalgia in Veterans
Fibromyalgia often causes or co-exists with other debilitating conditions. Identifying and linking these conditions in your VA claim may raise your overall combined disability rating.
Irritable Bowel Syndrome (IBS):
More than 70% of fibromyalgia patients experience IBS, causing chronic abdominal pain, diarrhea, constipation, and bloating. VA rates IBS secondary to fibromyalgia at 0%, 10%, or 30% depending on severity.
Chronic Fatigue Syndrome (CFS):
CFS often overlaps with fibromyalgia, both involving unrelenting fatigue, cognitive issues, and flu-like symptoms. When nearly constant, Chronic fatigue syndrome can significantly impair daily functioning and is rated up to 100%.
Anxiety and Depression:
Fibromyalgia-related chronic pain, isolation, and sleep disruption frequently lead to anxiety and depression. VA rates all mental health symptoms together on a scale from 0% to 100%, based on functional impairment.
Post-Traumatic Stress Disorder (PTSD):
Chronic pain from fibromyalgia may intensify PTSD symptoms. Likewise, psychological trauma can trigger fibromyalgia. This connection can strengthen your claim if both conditions contribute to mental and physical disability.
Migraines:
Fibromyalgia causes muscle tension and nervous system hypersensitivity, which often trigger frequent, debilitating migraines. These secondary headaches can be rated up to 50% if they severely disrupt work and daily life.
Sleep Apnea:
Fatigue and poor sleep are hallmarks of both fibromyalgia and sleep apnea. Fibromyalgia may affect airway muscles or nerves, worsening sleep apnea symptoms. VA rates sleep apnea secondary to fibromyalgia from 0% to 100%, with higher ratings assigned to veterans requiring CPAP machine use.
TMJ (Temporomandibular Joint Dysfunction):
Jaw pain and limited motion caused by fibromyalgia may exacerbate TMJ symptoms. VA rates TMJ secondary to fibromyalgia at 10% to 50% based on how much the jaw’s range of motion is restricted.
Each of these conditions has its own VA diagnostic code and rating criteria. In some instances, many veterans use a Nexus Letter from a medical provider to link their secondary conditions directly to fibromyalgia. By connecting them to your primary fibromyalgia diagnosis, you may successfully boost your total VA benefits and compensation.
Fibromyalgia and Total Disability Based on Individual Unemployability (TDIU)
Veterans with fibromyalgia often find that chronic pain, fatigue, and cognitive dysfunction make it impossible to maintain substantially gainful employment. That’s where Total Disability based on Individual Unemployability (TDIU) comes in.
TDIU allows veterans to receive compensation at the 100% disability rate even if their combined rating is lower.
To qualify for schedular TDIU:
- You must have one condition rated at 60% or
- Two or more conditions with one rated at least 40%, and a combined rating of 70% or higher.
A 40% VA disability rating for fibromyalgia paired with secondary conditions like IBS or PTSD can easily qualify a veteran for TDIU. For example, a Gulf War veteran with a 40% rating for fibromyalgia, 30% for PTSD, and 10% for migraines has a combined rating of 70%, making them eligible to apply for TDIU.
Even if you don’t meet the above requirements, extra-schedular TDIU may still apply if your service-connected fibromyalgia prevents you from holding gainful employment.
TDIU can be a financial lifeline, offering full compensation, access to VA healthcare, and eligibility for dependent benefits.
Steps to Consider When You File a VA Disability Claim for Fibromyalgia
Filing a VA claim for fibromyalgia requires a strategic approach and detailed documentation. Here’s a step-by-step overview that many veterans and their accredited legal professionals consider:
Step 1: Get Diagnosed
Ensure you have a formal diagnosis from a VA or private doctor, preferably from a rheumatologist, confirming fibromyalgia. This documented diagnosis is essential as the foundation of your VA disability claim.
Step 2: Collect Evidence
Gather comprehensive evidence to support your VA disability claim, which may include:
- Medical records of diagnosis or treatment
- Service treatment records (STRs)
- Independent medical opinions from doctors or “nexus letters” if desired
- Lay statements from family or colleagues when applicable
Step 3: File Your VA Claim
VA.gov has instructions for those who wish to complete and submit VA Form 21-526EZ online, by mail, or at your nearest VA regional office. The website details that a Veteran can submit an “Intent to File” form if they’re not ready with their full claim. This preserves your effective date.
Step 4: Attend a C&P Exam
Attend the VA Compensation and Pension (C&P) exam when scheduled. If you fail to attend, it can even lead to a denied claim. The examiner will discuss symptoms like pain levels, fatigue, sleep disturbances, and tender points to assess severity.
Ensure your symptoms are well-documented. Be honest and specific when describing the impact of the service-connected condition on your daily life.
Step 5: Track and Respond
Monitor your claim status through the VA.gov website or by contacting the VA. Respond to any requests for additional evidence or clarification quickly to avoid delays. Submitting timely updates and providing supplemental claims can strengthen your case.
Step 6: Appeal if Denied
Unfortunately, many fibromyalgia claims are denied due to insufficient medical evidence, weak nexus letters, or incomplete documentation. If your initial claim is denied or underrated, there is still hope. Under the Appeals Modernization Act, you can file a Supplemental Claim with stronger evidence, request a Higher-Level Review, or submit a Board Appeal.
If you’re appealing, consider seeking legal help from a VA-accredited representative or attorney.
What to Expect at a C&P Exam for Fibromyalgia
During a VA Compensation & Pension (C&P) exam for fibromyalgia, the examiner uses the Fibromyalgia Disability Benefits Questionnaire (DBQ) to evaluate how the condition affects a veteran’s life. The DBQ form focuses on the following:
- Diagnosis history and date of onset
- Frequency of symptoms like widespread musculoskeletal pain, stiffness, chronic fatigue, sleep disturbances, anxiety, depression, or other mental health conditions
- Related symptoms: chronic headaches, irritable bowel syndrome (IBS), depression, and anxiety
- Physical Examination: At least 11 of 18 specific anatomical sites must be painful, covering both sides of the body, above and below the waist
- Symptom frequency: Noted as constant, episodic, or worsened by overexertion or stress
- Treatment history: Medications (e.g., Lyrica), therapy, and effectiveness
- Functional impact: Limitations in work, mobility, and need for canes, braces, or other assistive devices
Veterans should review the appointment packet, which includes the C&P examiner’s details. Be prepared to describe symptom frequency, severity, and how the condition affects daily life.
Considerations for a Successful VA Claim for Fibromyalgia
Here are some practical considerations for supporting your VA disability claim for fibromyalgia.
1. Maintain a Symptom Diary
Keep a journal or log detailing how often you experience pain, fatigue, and flare-ups. Documentation of constant or refractory symptoms can help you qualify for a higher disability rating (up to 40%).
2. Be Consistent with Treatment Records
Attend regular medical appointments and follow prescribed treatment plans. Gaps in treatment can weaken your claim. A consistent medical record demonstrates the ongoing impact of fibromyalgia on your daily life and employment capacity.
3. Include Secondary Conditions When Applicable
Identify and claim for any conditions related to your fibromyalgia, such as IBS, chronic fatigue syndrome, migraines, depression, or PTSD. These may qualify for additional ratings and increase your overall VA rating for fibromyalgia through combined or secondary claims.
4. Get a Nexus Letter for Non-Presumptive Claims
For veterans without presumptive eligibility, a Nexus Letter may be helpful in some cases. This letter from a medical professional must clearly state that your fibromyalgia is related to your military service or another service-connected condition.
5. Prepare Thoroughly for Your C&P Exam
Downplaying pain, fatigue, or flare-ups during your Compensation & Pension (C&P) exam can lower your VA rating in some circumstances. Be honest and detailed about your physical and mental impacts. Remember, what you say here directly affects your fibromyalgia VA rating.
6. Submit a Disability Benefits Questionnaire
Have your treating doctor fill out a Disability Benefits Questionnaire (DBQ), which helps the VA understand the severity and symptoms of your fibromyalgia. It can streamline the evaluation process and improve your chances for a favorable rating in some cases. It is important to remember that this is not a requirement, but if your treating doctor is willing to assist with these documents, it may be helpful.
7. Use Lay Statements for Support
Gather personal statements from family, friends, or former colleagues who have observed your symptoms firsthand. These “buddy letters” can support your claim by illustrating how fibromyalgia affects your daily functioning and work abilities beyond what medical records show.
8. Highlight Impact on Employment
If fibromyalgia prevents you from maintaining substantially gainful employment, provide evidence showing work limitations, absenteeism, or inability to perform basic job duties. This can support a TDIU claim and result in 100% rating compensation.
Women Veterans and Fibromyalgia
Nearly 90% of fibromyalgia cases are female. Hormonal differences, particularly estrogen’s role in pain sensitivity, may lead to this imbalance. Many women face greater challenges when fibromyalgia overlaps with other conditions like lupus, osteoarthritis, or rheumatoid arthritis.
Among veterans diagnosed with fibromyalgia, approximately 25.5% are female, a notably higher percentage compared to their male counterparts. Notably, female Gulf War veterans were found to be over three times more likely to develop fibromyalgia than male veterans.
Research shows strong links between fibromyalgia (FM) and psychological conditions like post-traumatic stress disorder (PTSD) and depression. Additionally, experiences of military sexual trauma (MST) are also connected to higher rates of fibromyalgia, highlighting how psychological stressors and physical health are closely connected in women veterans.
Yet, many women in the military go undiagnosed or misdiagnosed due to gender stereotypes. Their symptoms may appear differently than in men and may sometimes be dismissed as emotional stress.
If you’re a woman dealing with chronic pain, fatigue, and cognitive fog, step up yourself to advocate for VA disability compensation. Join a women’s veterans advocacy group or VA Women’s Health Center for tailored resources and providers more familiar with symptoms in women.
Conclusion
Fibromyalgia may be invisible, but its impact is all too real, especially for veterans who gave their all in service to their country. Whether your symptoms emerged during service or developed after, the VA offers multiple routes to compensation. From direct and presumptive claims to secondary connections and TDIU, you have multiple options.
But don’t go it alone. The Veterans Benefits system can be confusing, slow, and frustrating. With the right documentation, medical support, and professional guidance, you can navigate the process and get the VA benefits you deserve.
FAQs
What is the highest VA rating for fibromyalgia?
The highest schedular VA rating for fibromyalgia is 40%.
How do I prove my VA disability for fibromyalgia?
You need a formal diagnosis, evidence of an in-service event or condition, and a medical nexus linking your fibromyalgia to your service or a service-connected condition.
How much compensation for fibromyalgia?
In 2025, a 40% fibromyalgia VA rating pays approximately $755 per month for a single veteran, with higher amounts for additional dependents.
Is fibromyalgia secondary to PTSD VA disability?
Yes, fibromyalgia can be secondary to PTSD because psychological trauma from PTSD can trigger or worsen fibromyalgia symptoms, creating a direct medical link between the two conditions.
Is fibromyalgia a presumptive disability?
Yes, fibromyalgia is a presumptive disability for Gulf War veterans who served in specified Southwest Asia regions after August 2, 1990, and develop symptoms rated at least 10% disabling.
Also read: Hip Pain Secondary to Back Pain in VA Disability
At Prestige Veteran Medical Consulting, a veteran-owned company, we specialize in Independent Medical Opinions (IMOs) known as Nexus letters.
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