Fibromyalgia VA Rating and Diagnostic Code 5025 Criteria

Mandatory requirements: widespread pain, tender points, and associated symptoms

Every compensable tier under Diagnostic Code 5025 requires “widespread musculoskeletal pain and tender points,” which may occur “with or without” nine listed associated symptoms.

The binding regulatory definition of widespread pain

Diagnostic Code 5025 in 38 CFR 4.71a includes a binding Note defining widespread pain:

• Note to DC 5025: “Widespread pain means pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities.”

To satisfy this definition, medical evidence must document pain across (1) both the left and right sides of the body, (2) both above and below the waist, and (3) both the axial skeleton (cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

Tender points and associated symptoms

Alongside widespread pain, Diagnostic Code 5025 requires tender points (also called trigger points for pain on the VA examination form)—symmetrical anatomical sites where focal pressure elicits pain. Even though outside rheumatologists increasingly use widespread pain and symptom severity scales without manual tender-point counts, 38 CFR 4.71a, Diagnostic Code 5025 explicitly requires “widespread musculoskeletal pain and tender points,” and the VA examination worksheet records which bilateral tender points are present.

The preamble to Diagnostic Code 5025 evaluates widespread musculoskeletal pain and tender points with or without nine associated symptoms:

• Fatigue and sleep disturbance (unrefreshing or fragmented sleep).
• Stiffness (generalized morning or post-inactivity stiffness) and paresthesias (numbness or tingling in the extremities).
• Headache (including tension or migraine headaches) and irritable bowel symptoms (similar to IBS).
• Depression, anxiety, and Raynaud’s-like symptoms (cold sensitivity or color changes in fingers and toes).

Because the regulation specifies “with or without,” a veteran does not need any of these nine associated symptoms to qualify for 10%, 20%, or 40% if widespread pain and tender points meet the tier criteria.

Detailed breakdown of the 10%, 20%, and 40% rating tiers

0 percent noncompensable rating (38 CFR 4.31)

Although Diagnostic Code 5025 omits a 0% row, 38 CFR 4.31 directs adjudicators to assign 0% when a service-connected disability does not meet the minimum 10% criteria—such as mild symptoms managed without continuous medication. (Presumptive Gulf War claims under 38 CFR 3.317 require manifestation to 10% or more.)

10 percent disability rating

A 10% evaluation applies when widespread musculoskeletal pain and tender points (with or without associated symptoms) require continuous medication for control, such as daily duloxetine, pregabalin, milnacipran, gabapentin, cyclobenzaprine, amitriptyline, or continuous analgesics keeping flare-ups present one-third of the time or less. Effective 2025-12-01, a standalone 10% rating pays $180.42 per month for a veteran alone.

20 percent disability rating

A 20% evaluation applies when widespread musculoskeletal pain and tender points (with or without associated symptoms) 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 (roughly 11 or more days per 30-day month). Effective 2025-12-01, a standalone 20% rating pays $356.66 per month for a veteran alone.

40 percent disability rating (schedular maximum)

The highest schedular evaluation under Diagnostic Code 5025 is 40%, assigned when widespread musculoskeletal pain and tender points (with or without associated symptoms) are constant, or nearly so, and refractory to therapy:

1. Constant, or nearly so: Widespread pain and associated symptoms occur daily or nearly every day rather than only in intermittent flare-ups.
2. Refractory to therapy: Ongoing medical therapy (continuous medications and physical modalities) fails to control the constant or nearly constant symptoms.

Effective 2025-12-01, a standalone 40% rating pays $795.84 per month for a veteran alone, with additional allowances for eligible dependents at 30% or higher.

Gulf War presumptive service connection under 38 CFR 3.317

Under 38 CFR 3.317, qualifying Persian Gulf War veterans do not need to prove an in-service injury or submit a medical nexus opinion. Specifically, 38 CFR 3.317(a)(2)(i)(B) defines a qualifying chronic disability to include a medically unexplained chronic multisymptom illness (MUCMI) defined by a cluster of signs or symptoms, explicitly listing:

1. Chronic fatigue syndrome;
2. Fibromyalgia (38 CFR 3.317(a)(2)(i)(B)(2)); and
3. Functional gastrointestinal disorders, such as IBS.

Because the regulation designates fibromyalgia as a MUCMI by name, a confirmed fibromyalgia diagnosis satisfies 38 CFR 3.317(a)(2)(ii). Establishing presumptive service connection under 38 CFR 3.317 and the VA Gulf War Illness rules requires:

1. Qualifying service location: Service under 38 CFR 3.317(e)(2) in the Southwest Asia theater of operations (Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and airspace above them) on or after August 2, 1990, or locations added under 38 U.S.C. 1117 by the PACT Act (Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan) on or after September 11, 2001 (with no filing deadline).
2. Six-month chronicity (38 CFR 3.317(a)(4)): Persistence of symptoms for 6 months or more, including intermittent episodes over a 6-month period.
3. Manifestation to 10% or more (38 CFR 3.317(a)(1)(i)): Manifestation during qualifying active service or to 10 percent or more after separation.

Direct and secondary service connection pathways

Direct service connection (38 CFR 3.303)

For veterans without qualifying Gulf War service, direct service connection under 38 CFR 3.303 requires a current diagnosis of fibromyalgia, evidence of in-service symptom onset or an in-service event, and a medical nexus opinion. Continuity of symptomatology under 38 CFR 3.303(b) can connect in-service treatment notes for widespread pain and fatigue to a post-service diagnosis.

Secondary service connection (38 CFR 3.310)

Under 38 CFR 3.310(a), secondary service connection applies when a condition is proximately due to or aggravated by a service-connected disability:

• Fibromyalgia secondary to another service-connected condition: Fibromyalgia may be claimed secondary to chronic orthopedic trauma (back pain or neck conditions) or psychiatric conditions (PTSD, depression, or anxiety) when supported by a specialist’s nexus opinion explaining how the primary disability caused or aggravated central sensitization and widespread pain.
• Conditions secondary to service-connected fibromyalgia: Chronic widespread pain, sleep disruption, or daily medications for service-connected fibromyalgia may cause or aggravate secondary conditions such as depressive or anxiety disorders, migraine headaches, IBS, or GERD, subject to anti-pyramiding rules.

Anti-pyramiding rules (38 CFR 4.14) and separate ratings

Under 38 CFR 4.14, the VA cannot evaluate the same manifestation under multiple diagnostic codes. Because Diagnostic Code 5025 includes “with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms,” separate ratings depend on whether symptoms can be differentiated:

• When separate ratings are barred: If headaches, bowel symptoms, or mood symptoms are needed to establish that fibromyalgia symptoms occur more than one-third of the time (20%) or are constant and refractory (40%), those exact same manifestations cannot be rated a second time under another code.
• When separate ratings may be assigned: If a veteran has a separately diagnosed condition—such as major depressive disorder or PTSD (38 CFR 4.130), IBS (DC 7319), migraines (DC 8100), or a spine/joint condition with objective range-of-motion loss—and the DC 5025 rating is supported by widespread musculoskeletal pain and tender points alone, separate ratings may be assigned without violating 38 CFR 4.14. Section III of the VA Fibromyalgia DBQ specifically instructs examiners: “Note: If Mental Health conditions, such as depression due to fibromyalgia are identified, a Mental Disorders Questionnaire must also be completed.”

How the C&P exam and Fibromyalgia DBQ measure your condition

At a Compensation and Pension (C&P) exam, the clinician completes the Fibromyalgia Disability Benefits Questionnaire (DBQ) (verified on the VA Public DBQs page):

1. Diagnosis and treatment history (Sections I–II): Confirms fibromyalgia (fibrositis or primary fibromyalgia syndrome), asks whether continuous medication is required for symptom control (10% criterion, Item 2B), and asks whether symptoms are refractory to therapy (40% criterion, Item 2D).
2. Symptoms and frequency (Section III, Items 3A–3B): Documents widespread musculoskeletal pain across both sides of the body, above and below the waist, and the axial skeleton and extremities, plus associated symptoms, and checks whether symptoms are episodic with exacerbations, present more than one-third of the time (20%), or constant or nearly constant (40%).
3. Nine paired bilateral tender points (Section III, Item 3C): Records Right, Left, or Both across 18 sites: (1) low cervical region (C5–C7 interspaces), (2) second rib (second costochondral junction), (3) occiput (suboccipital muscle insertion), (4) trapezius muscle (midpoint of upper border), (5) supraspinatus muscle (above medial border of scapular spine), (6) lateral epicondyle (2 cm distal to lateral epicondyle), (7) gluteal (upper outer quadrant of buttocks), (8) greater trochanter (posterior to greater trochanteric prominence), and (9) knee (medial joint line).
4. Testing and functional impact (Sections V–VI): Notes that “Imaging studies are not required to document fibromyalgia,” and describes occupational impact on standing, walking, lifting, or sitting.

TDIU (38 CFR 4.16), combined ratings, and accredited help

Because Diagnostic Code 5025 caps schedular ratings at 40%, veterans unable to maintain substantially gainful employment due to service-connected disabilities may apply for Total Disability based on Individual Unemployability (TDIU) under 38 CFR 4.16, which pays at the 100% rate ($3,938.58 per month for a veteran alone). A 40% fibromyalgia rating satisfies the single 40% anchor requirement under 38 CFR 4.16(a) when combined ratings reach 70% or more, and under 38 CFR 4.16(a)(4), multiple disabilities incurred by a Persian Gulf veteran under 38 CFR 3.317 count as one single disability toward the 60% single-disability TDIU threshold.

Fibromyalgia ratings combine with other evaluations using the whole-person table in 38 CFR 4.25 (the bilateral factor in 38 CFR 4.26 does not apply to DC 5025). Model your combined evaluation with our VA combined rating calculator and estimate retroactive pay with our VA back pay calculator.

For free claims help, contact an accredited Veterans Service Organization (VSO) such as the DAV, VFW, or American Legion, or consult an accredited claims agent or attorney for appeals. No representative can promise an outcome; verify credentials via the VA Office of General Counsel Accreditation Search.