How does the VA rate fibromyalgia?

Under 38 CFR 4.71a Diagnostic Code 5025. Three brackets: 10% requires continuous medication for control; 20% requires symptoms episodic with exacerbations often precipitated by environmental or emotional stress or by overexertion, but symptoms present more than one-third of the time; 40% requires symptoms constant or nearly so and refractory to therapy. There is no 60%, 70%, 80%, or 100% schedular rating for fibromyalgia under DC 5025 itself, though TDIU and secondary conditions can lift total compensation above 40%.

What symptoms does DC 5025 cover?

The diagnostic code lists widespread musculoskeletal pain plus tender points, and may include any of the following: stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud-like symptoms. The rater evaluates the syndrome as a whole at one of the three percentage levels rather than rating each symptom separately. Pyramiding rules under 38 CFR 4.14 prevent rating fibromyalgia AND a separate condition that is part of the fibromyalgia symptom complex.

Is fibromyalgia presumptive for Gulf War veterans?

Yes. Under 38 CFR 3.317, fibromyalgia is one of three Medically Unexplained Chronic Multisymptom Illnesses (MUCMI) presumptively service-connected for Persian Gulf War veterans who served in the Southwest Asia theater. The other two MUCMI presumptives are Chronic Fatigue Syndrome and functional gastrointestinal disorders (IBS and similar). The condition must have manifested to a degree of 10% or more, either during qualifying service or to December 31, 2026 (currently the active sunset under 38 CFR 3.317(a)(1)(i)).

Which diagnostic criteria does the VA accept?

Both the 1990 American College of Rheumatology (ACR) tender-point criteria (widespread pain plus 11 of 18 tender points on digital palpation) and the 2010/2016 ACR criteria (widespread pain index plus symptom severity scale, without tender-point requirement). A diagnosis from a rheumatologist using either set is sufficient. Primary care diagnoses are accepted if the documentation supports either criteria set.

Can fibromyalgia be secondary to PTSD?

Yes. The central-sensitization mechanism connecting trauma-related autonomic dysregulation to chronic pain syndromes including fibromyalgia is documented in the peer-reviewed literature and accepted by VA raters when supported by a nexus opinion. The secondary pathway under 38 CFR 3.310 is most relevant for non-Gulf War veterans whose fibromyalgia developed after a service-connected PTSD diagnosis. A rheumatologist or pain physician nexus letter citing central sensitization is the typical evidence package.

What evidence produces the 40% rating rather than 10%?

Documentation showing symptoms are constant or nearly so AND refractory to therapy. Practical elements: medication history showing multiple failed trials (gabapentin, pregabalin, duloxetine, amitriptyline, milnacipran, tramadol — at least three failed); pain diary or treatment notes documenting daily pain rather than episodic flares; functional assessment from a physical therapist or occupational therapist describing inability to perform sustained activity; statement from treating rheumatologist that symptoms persist despite optimized therapy. Without the refractory-to-therapy element, the rating typically caps at 20%.

Does fibromyalgia qualify for TDIU?

Yes, when fibromyalgia alone or in combination with other service-connected conditions prevents substantially gainful employment. A 40% fibromyalgia rating alone does not meet the schedular TDIU threshold under 38 CFR 4.16(a) (which requires one 60%+ condition or combined 70%+ with one 40%+). However, fibromyalgia combined with PTSD, chronic pain syndromes, or other rated conditions frequently meets the threshold, and extraschedular TDIU under 38 CFR 4.16(b) remains available when the schedular formula does not capture the functional limitation.

How does Gulf War fibromyalgia interact with the December 31, 2026 sunset?

The MUCMI presumptive period currently sunsets December 31, 2026 unless extended by regulation or statute. Veterans whose fibromyalgia manifested before the sunset retain the presumption permanently — the sunset affects the manifestation window, not previously granted ratings. Veterans with Gulf War service whose fibromyalgia is undiagnosed or partially diagnosed should establish a manifestation date on the record before the sunset, even if the formal claim is filed later.

Fibromyalgia VA Rating

By Shirley Chia. Published 2026-05-31. Source: 38 CFR 4.71a (DC 5025), 38 CFR 3.317 (Gulf War MUCMI).

TL;DR. Fibromyalgia is rated under 38 CFR 4.71a Diagnostic Code 5025 at 10% (controlled by continuous medication), 20% (episodic, symptoms present more than one-third of the time), or 40% (constant or nearly so, refractory to therapy). There is no schedular rating above 40% for fibromyalgia itself. For Gulf War veterans who served in the Southwest Asia theater, fibromyalgia is one of three Medically Unexplained Chronic Multisymptom Illnesses (MUCMI) presumptively service-connected under 38 CFR 3.317, alongside Chronic Fatigue Syndrome and functional GI disorders. For non-Gulf War veterans, the most common direct path is secondary to PTSD via central-sensitization, or direct service connection with a nexus opinion. The difference between a 10% and 40% rating is documented refractoriness to multiple therapy trials.

The rating brackets under DC 5025

38 CFR 4.71a Diagnostic Code 5025 (Fibromyalgia) contains three brackets and a syndrome description. The relevant percentages with 2026 monthly compensation (single veteran with spouse, no dependents otherwise) are:

Rating	Criteria	2026 monthly comp
10%	Symptoms that require continuous medication for control	$211
20%	Episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but symptoms present more than one-third of the time	(falls between 10% and 30% brackets; combined per 38 CFR 4.25)
40%	Symptoms constant, or nearly so, and refractory to therapy	(falls in 30-50% combined range)

The note to DC 5025 specifies the symptom complex: widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud-like symptoms. The rater evaluates the syndrome as one entity rather than separately rating each symptom.

The pyramiding interaction

Under 38 CFR 4.14, the VA cannot rate the same disability twice. If fibromyalgia is rated under DC 5025 and the symptom complex includes irritable bowel symptoms, the VA generally will not also assign a separate rating under DC 7319 (IBS) for the same gastrointestinal symptoms. However, when symptoms are clearly distinct (separate etiology, separate functional impact), separate ratings can attach. The rater documents the analysis in the decision narrative.

The Gulf War MUCMI presumption

Under 38 CFR 3.317, veterans who served in the Southwest Asia theater of operations during the Persian Gulf War (defined as Iraq, Kuwait, Saudi Arabia, the neutral zone, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the waters of the Persian Gulf, the Arabian Sea, and the Red Sea, plus the airspace above) are entitled to a presumption of service connection for:

Medically Unexplained Chronic Multisymptom Illnesses (MUCMI), defined to include fibromyalgia, chronic fatigue syndrome, and functional gastrointestinal disorders (including IBS and functional dyspepsia).
Undiagnosed illnesses (symptoms without a confirmed diagnosis).
Certain infectious diseases listed in 3.317(c).

The condition must have manifested to a degree of 10% or more either during qualifying service or by December 31, 2026 (current sunset under the regulation, subject to extension). Veterans whose fibromyalgia manifests at any time during this window receive the presumption and need not prove a service nexus.

Operation Iraqi Freedom and Operation Enduring Freedom

The MUCMI presumption applies to qualifying service during the period beginning August 2, 1990 with no current end date for active duty, meaning OIF and OEF veterans who served in the Southwest Asia theater are also covered. Afghanistan service alone (outside the geographic Southwest Asia theater) does not trigger the 3.317 presumption — but PACT Act presumptions under 38 CFR 3.320 may apply for specific conditions (not fibromyalgia).

Diagnostic criteria the VA accepts

1990 ACR criteria

The original 1990 American College of Rheumatology criteria require: (1) widespread pain present for at least three months, defined as pain in all four body quadrants plus axial pain; AND (2) pain on digital palpation in at least 11 of 18 designated tender point sites. The 1990 criteria remain accepted by the VA even though current rheumatology practice has moved toward the 2010/2016 criteria.

2010 / 2016 ACR criteria

The revised criteria eliminated the tender-point exam in favor of a Widespread Pain Index (WPI, 0-19 points scoring pain in 19 body regions) plus a Symptom Severity Scale (SSS, 0-12 points scoring fatigue, sleep, cognitive symptoms, and somatic symptoms). Fibromyalgia is diagnosed when WPI is at least 7 AND SSS is at least 5, OR WPI is 4-6 AND SSS is at least 9, with symptoms present for at least three months and no other condition that would otherwise explain the pain.

The 2016 revision tightened the criteria slightly by requiring generalized pain in at least four of five body regions. VA raters accept diagnoses under either the 2010 or 2016 version.

The secondary-to-PTSD pathway

Under 38 CFR 3.310, a non-service-connected condition can be secondarily service-connected when it is proximately caused or aggravated by a service-connected condition. The central-sensitization mechanism linking PTSD to fibromyalgia is well documented in the peer-reviewed literature: chronic autonomic dysregulation and HPA-axis disruption associated with PTSD produces central pain amplification, lowered pain threshold, and the cluster of symptoms meeting fibromyalgia criteria.

The evidence package for a successful secondary claim:

Service-connected PTSD already established (or claimed and pending).
Current fibromyalgia diagnosis from a rheumatologist or pain physician using either ACR criteria set.
Nexus letter from a treating physician (preferably rheumatologist or pain specialist) stating that the fibromyalgia is at least as likely as not (50% or more) caused or aggravated by the service-connected PTSD via central sensitization, citing the relevant literature.
Timeline showing fibromyalgia onset after PTSD diagnosis or symptom onset.

The nexus letter is the load-bearing element. Generic "could be related" language is insufficient. The phrase "at least as likely as not" (mirroring the 38 CFR 3.102 benefit-of-the-doubt standard) is the standard.

The 40% evidence package

The difference between a 20% rating and a 40% rating is the "constant or nearly so, refractory to therapy" language. Raters look for objective indicators that the syndrome has not responded to treatment. The strongest 40% packages include:

Failed medication history. Documented trials of at least three of the standard fibromyalgia medications — pregabalin (Lyrica), duloxetine (Cymbalta), milnacipran (Savella), gabapentin, amitriptyline, cyclobenzaprine, tramadol, or low-dose naltrexone — each tried for an adequate duration with documented inadequate response or intolerable side effects.
Daily symptom documentation. Pain diary, app log, or treatment notes spanning six months or more showing daily pain rather than episodic flares. "Constant or nearly so" is operationalized as symptoms most days of the week.
Functional assessment. Physical therapy or occupational therapy notes describing limitation in sustained activity, sitting tolerance, standing tolerance, or reaching/lifting capacity. Often paired with a fibromyalgia impact questionnaire (FIQR) showing severe scores.
Specialty care continuity. Documentation that the veteran is under the care of a rheumatologist or interdisciplinary pain clinic, not just primary care. Continued specialty involvement signals refractoriness.
Treating physician statement. A short letter from the treating rheumatologist stating the syndrome is constant and has not responded to optimized therapy. Two sentences are often enough if the medical record backs them.

Worked example

Army veteran, Operation Desert Storm, served in Saudi Arabia and Kuwait from December 1990 to May 1991. Files fibromyalgia claim in 2026.

Service eligibility. Qualifying Southwest Asia service confirmed via DD-214. The MUCMI presumption under 38 CFR 3.317 applies as long as fibromyalgia manifested to 10% or more by December 31, 2026.

Diagnosis. Diagnosed by VA rheumatology in 2022 using the 2016 ACR criteria: WPI = 12, SSS = 8, symptoms present for over five years prior to diagnosis. The five-year prior-symptom history establishes manifestation well before the sunset date.

Treatment history. Pregabalin 2022-2023, discontinued for sedation. Duloxetine 2023-2024, partial response only. Amitriptyline 2024-2025, intolerable dry mouth. Currently on milnacipran 100 mg twice daily plus low-dose tramadol PRN, still with daily pain rated 6-8/10 on most days.

Functional documentation. Physical therapy evaluation 2025 documents limited sitting tolerance (under 30 minutes), limited standing tolerance (under 20 minutes), grip strength reduction, and fatigue cycle. FIQR score 72 (severe). Treating rheumatologist letter states "Mr. Smith's fibromyalgia is constant and has not responded to optimized therapy across multiple medication classes."

Rating analysis. Symptoms constant or nearly so (daily pain documented); refractory to therapy (three failed agents plus partial response on current). The 40% bracket fits.

2026 compensation. 40% rating with a spouse = $882.84/month (between the 30% $617.47 and 50% $1,241.90 brackets in the 2026 schedule, computed under 38 CFR 4.25 combined ratings tables for veterans with one dependent). Annual = $10,594.

Secondary claims to consider. Sleep apnea (often comorbid with fibromyalgia and a separate DC 6847 rating). Depression (often comorbid, separate rating if functionally distinct from fibromyalgia symptom complex). IBS as a separate MUCMI presumptive condition — possible if symptoms predate or are clearly distinct from the fibromyalgia complex.

TDIU consideration. 40% alone does not meet schedular TDIU threshold under 38 CFR 4.16(a). With added secondaries lifting the combined rating to 70%+ with one condition at 40%+, schedular TDIU becomes available. Extraschedular TDIU under 4.16(b) remains an option if functional impact prevents work despite a lower combined rating.

Sources cited in this article

38 CFR 4.71a Diagnostic Code 5025 (Fibromyalgia)
38 CFR 3.317 (Compensation for certain disabilities occurring in Persian Gulf veterans)
38 CFR 3.310 (Disabilities that are proximately due to, or aggravated by, service-connected disease or injury)
38 CFR 4.16 (Total disability ratings for compensation based on unemployability)
38 USC 1117 (Compensation for disabilities occurring in Persian Gulf War veterans)
Wolfe et al., 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria, Seminars in Arthritis and Rheumatism 46(3):319-329.

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