How VA Rates Fibromyalgia: DC 5025 Pain Frequency and Trigger Point Guide

Diagnostic Code 5025 evaluates fibromyalgia (fibrositis or primary fibromyalgia syndrome) across three distinct levels: 10% is awarded when symptoms require continuous medication for control; 20% is assigned when symptoms are episodic, with exacerbations often triggered by stress or overexertion, present more than one-third of the time; and 40% is granted when widespread musculoskeletal pain and tender points are constant, or nearly constant, and refractory (resistant) to medical therapy.

Under the Note to DC 5025, widespread pain is defined specifically by anatomical boundaries. The pain must affect both the left and right sides of the body, exist both above and below the waist, and involve the axial skeleton (cervical spine, anterior chest, thoracic spine, or low back) as well as the extremities. Pain localized to a single limb or quadrant does not satisfy the regulatory definition.

Fibromyalgia is explicitly recognized under 38 CFR 3.317 as a presumptive medically unexplained chronic multisymptom illness for Persian Gulf War veterans who served in the Southwest Asia theater of operations. Eligible veterans who develop chronic fibromyalgia symptoms to a degree of 10% or more do not need to prove an in-service injury or separate medical nexus.

Fibromyalgia frequently coexists with associated symptoms such as chronic fatigue, irritable bowel syndrome (IBS), tension headaches or migraines, and depression. Under 38 CFR 4.14 and established federal precedent, if these conditions are formally diagnosed as separate clinical disorders, they can be rated independently alongside fibromyalgia, provided the same exact symptoms are not counted twice.

Claims require a completed Fibromyalgia DBQ and documentation from a rheumatologist or treating physician. Key evidence includes clinical tender point examination findings, documentation of attempted medication therapies (such as pregabalin, duloxetine, or milnacipran), and treatment records showing symptom frequency and resistance to treatment.