Obtaining fibromyalgia veterans benefits has been challenging for years. The VA had relied on two precedents to deny the vast majority of disability claims for fibromyalgia. However, the tide is beginning to turn for veterans, particularly Gulf War veterans, whether you are submitting a new claim or challenging a previously denied claim for fibromyalgia veterans benefits.
In This Article About Fibromyalgia VA Disability:
- Two Policy Changes that Can Help Veterans Succeed in Claiming Fibromyalgia Veterans Benefits
- How to Establish a Service Connection to Obtain Fibromyalgia Veterans Benefits for Non-Gulf War Veterans
- How the Highest VA Rating Is Determined for Claiming Fibromyalgia Veterans Benefits
- How to List Fibromyalgia as a Secondary Service-Connected Disability to Obtain Fibromyalgia Veterans Benefits
- What Happens If Your Claim for Fibromyalgia Veterans Benefits Is Denied?
Two Policy Changes that Can Help Veterans Succeed in Claiming Fibromyalgia Veterans Benefits
The VA has a long and checkered history with fibromyalgia claims. Fibromyalgia symptoms, such as a body-wide ache, sensitivity to pain, muscle and joint stiffness, and numbness and tingling in the extremities, were sometimes viewed by the VA and physicians with skepticism. Fibromyalgia cannot be diagnosed using laboratory tests, so physicians rely on your description of your symptoms and their own subjective observations to diagnose fibromyalgia.
However, veterans, particularly Gulf War veterans, have experienced a consistent pattern of fibromyalgia symptoms that the VA had to eventually recognize. As a result, the VA has adopted a fibromyalgia rating scale with 10% being the lowest VA rating for fibromyalgia and 40% being the highest. As discussed in greater detail below, the disability percentage assigned by the VA depends on the extent of the symptoms and whether they respond to medication or other treatments.
Moreover, two policies have been changed, giving veterans a much greater chance of succeeding in a fibromyalgia veterans benefits claim, including those who were previously rejected for benefits.
1. VA Presumptive Fibromyalgia
All claims for VA disability benefits require a service connection between the disability and the veteran’s service. However, for veterans who served in specific theaters of operations, the VA has classified certain conditions and diseases as presumptively connected to the veteran’s service.
For these disabling conditions and diseases, the veteran does not need to prove a service connection. Rather, the service connection is presumed, unless there is evidence to show that the disability was incurred after the veteran’s service had ended.
For Gulf War veterans, a claim for fibromyalgia veterans benefits does not need to include proof of a service connection because the VA has established a fibromyalgia presumptive Gulf War service connection.
This means that a Gulf War veteran with a diagnosis of fibromyalgia from either a VA doctor or a private doctor can apply for fibromyalgia veterans benefits by submitting service records showing that the veteran served in the Southwest Asia Theater of Operations during the Gulf War and a diagnosis letter showing that the fibromyalgia is at least 10% disabling. However, you will need to act quickly if you meet these criteria since any application must be filed with the VA by December 31, 2021.
2. Undiagnosed Pain
Under a case decided in 1999, the VA was allowed to reject VA disability benefits claims for “pain alone, without a diagnosed or identifiable underlying malady or condition.” However, in 2018, a court of appeals reversed this precedent stating that pain is a functional impairment of a veteran’s earning capacity regardless of the underlying cause. As a result, pain alone can serve as a basis for a disability claim.
With this decision, the VA will no longer be allowed to reject claims that assert a disability arising from pain without a medical explanation for the cause of the pain. This can be particularly helpful for claims for fibromyalgia veterans benefits since fibromyalgia is characterized by body-wide pain or pain sensitivity. Even without a diagnosis of fibromyalgia, a veteran should be able to obtain a disability rating based on the body regions and systems that are so affected by pain that it impairs the function of the body region or system.
How to Establish a Service Connection to Obtain Fibromyalgia Veterans Benefits for Non-Gulf War Veterans
Applying for fibromyalgia veterans benefits will require a service connection when the veteran served anywhere besides the Southwest Asia Theater of Operations during the Gulf War. A service connection can arise under three circumstances:
1. Compensation for Fibromyalgia Caused by Service
Fibromyalgia has no established cause. Doctors suspect that it is neurological in origin, even though the symptoms seem (and are classified by the VA as) musculoskeletal. According to the most recent research, fibromyalgia is caused by a misinterpretation or amplification by the brain of pain signals received through the nerves. For example, the brain of someone who has fibromyalgia may experience an ordinary poke or pressure on the arm as extremely painful.
This neurological link may be borne out by the other conditions that accompany fibromyalgia. For example, depression, chronic fatigue and sleep disturbances caused by chronic pain and anxiety have all been linked to fibromyalgia. Although there is no definitive causal link among them, they are often observed to manifest in veterans at the same time.
To establish a service connection, you will likely need a letter from a doctor. There are several theories for how your doctor can establish a connection between your service and fibromyalgia.
1a. Environmental exposure:
The VA’s fibromyalgia presumptive Gulf War service connection arises from research suggesting that Gulf War veterans may have been exposed to chemical weapon agents or pollutants in the air that led to fibromyalgia. While speculative, it would seem logical that exposure to, for example, nerve agents or nerve agent residues might cause a neurological condition like fibromyalgia. Thus, it may be possible for non-Gulf War veterans exposed to pollutants or chemical weapon agents while on active duty or active training to establish a service connection with fibromyalgia.
1b. Physical trauma:
One theory for how fibromyalgia develops is that the brain changes the way it perceives pain in response to a traumatic event. If you suffered trauma during your service, such as a combat injury, vehicle accident, training injury, or surgery, one result might have been a rewiring of your brain to become oversensitive to pain that is characteristic of fibromyalgia.
1c. Psychological stress:
While there is no medically proven mechanism for how psychological stress causes fibromyalgia, a connection between the two has been observed. In fact, the link between post-traumatic stress disorder (PTSD) is so established that many VA disability claims for PTSD as the primary disability also include fibromyalgia secondary to PTSD.
Doctors believe that some bacterial and viral infections may trigger fibromyalgia. If you suffered from infection by influenza or Epstein-Barr virus during your service, it may be possible to establish a service connection. Gastrointestinal infections, such as Salmonella or Shigella bacterial infections, painful bladder syndrome (or interstitial cystitis), and irritable bowel syndrome (IBS) have also been observed to coincide with fibromyalgia. Any of these GI conditions experienced during your military service could have signified or brought on a case of fibromyalgia.
2. Compensation for Fibromyalgia Made Worse by Service
If you were diagnosed with fibromyalgia prior to your service and the disorder advanced in a way that was worse than a natural progression, there is a service connection. However, as you may expect, the two issues that you or your VA disability benefits lawyer will need to be prepared to address are (a) the mechanism by which your fibromyalgia was exacerbated (made worse) by your service and (b) how the advancement was worse than a natural progression of the condition.
For the first issue, a doctor’s letter that asserts a link between environmental exposure, physical trauma, psychological stress, and infection that you experienced during your service can help show that your condition was worsened by your time in the military.
On the second issue, each case will vary, but one path to showing an unnatural progression of your condition would be to show that your condition was stable prior to your service, and your service caused your condition to worsen. Another path may be to show that your condition rapidly declined after your exposure to environmental, physical, psychological, or infectious stresses. In either case, the event causing the trajectory of your condition to change would connect your fibromyalgia to your service.
3. Compensation for Fibromyalgia Diagnosed After Service
While the fibromyalgia-Gulf War presumption allows disability claims for cases diagnosed long after discharge for Gulf War veterans, all other veterans would need to show that diagnosis after discharge is linked to your service in some manner. One example of linking a post-service diagnosis to a service disability is to use your service medical records to show that your fibromyalgia manifested during your service but was misdiagnosed.
Because of the diversity of symptoms and difficulty of diagnosis associated with fibromyalgia, this would not be an unusual scenario. Often military doctors and corpsmen are inexperienced in complicated diagnoses and may look to the simplest explanation for your physical symptoms.
For example, body-wide aches could be misdiagnosed as an infectious disease or even a physical injury when they are, in fact, an early sign of fibromyalgia. To establish a service connection and obtain fibromyalgia veterans benefits, you may need to comb your military medical records for any sign that your fibromyalgia started during your service and either went undiagnosed or was misdiagnosed.
We can also help you go through your medical records. Call us today and we’ll review your case for free to see if you have a chance with the VA.
How the Highest VA Rating Is Determined for Claiming Fibromyalgia Veterans Benefits
The VA assigns a VA disability rating for fibromyalgia using an established schedule of symptoms in the VA’s regulations under Fibromyalgia 38 CFR 4.71(a). This schedule ranges from 10% for symptoms that can be controlled but require continuous medication, to 20% for outbreaks of exacerbated symptoms that occur more than 1/3rd of the time. 40% is the highest VA rating for fibromyalgia. To award a disability rating of 40% fibromyalgia in VA claim applications, the VA must be convinced that you have constant symptoms that cannot be managed with therapy.
It may be possible to obtain a comparable or higher VA rating for disabilities caused by fibromyalgia using “residuals” rather than the VA’s fibromyalgia rating schedule. For example, if your case of fibromyalgia causes depression, widespread pain, sleep disturbances, numbness in the hands and feet, and fatigue, it may be possible to aggregate the individual ratings for each of these disabilities using VA math. Just keep in mind that VA math is not a simple addition of the individual disability percentages. For example, four disabilities rated at 10% would result in an overall rating of 30%.
In the event that you believe your VA disability rating is too low, you are allowed to request an extra schedular rating. This is only granted in exceptional cases where the schedules fail to account for special circumstances such as a case of fibromyalgia that requires extensive hospitalization or substantially interferes with your ability to work.
If you believe your case justifies an extra schedular rating, you may want to consult with a VA benefits attorney who can explain what is needed to obtain such a rating.
How to List Fibromyalgia as a Secondary Service-Connected Disability to Obtain Fibromyalgia Veterans Benefits
To maximize the compensation for fibromyalgia awarded by the VA, you may want to list fibromyalgia as a secondary service-connected disability to any related disabilities. For example, as noted above, many disability claims include fibromyalgia secondary to PTSD, fibromyalgia secondary to chronic fatigue syndrome, or fibromyalgia secondary to IBS. The benefit of this approach is that it may be easier to establish a service connection for a different primary service-connected disability, such as PTSD, than for fibromyalgia.
Nexus Letter for Fibromyalgia Veterans Benefits as a Secondary Service-Connected Disability
Once the service connection is established for the primary disability, a nexus letter for fibromyalgia is usually the only further evidence needed to obtain fibromyalgia veterans benefits. This nexus letter establishes a scientific link between primary and secondary service-connected disabilities.
Fibromyalgia Secondary to PTSD
For example, there is scientific evidence that PTSD is linked to fibromyalgia. This would make fibromyalgia a secondary service-connected disability to PTSD and allow you to claim VA disability benefits for both PTSD and fibromyalgia.
VA Disability Rating for Chronic Fatigue Syndrome
Thus, if you file a disability claim with chronic fatigue syndrome as the primary disability and fibromyalgia as the secondary disability, you would submit evidence of a service connection for chronic fatigue syndrome and a nexus letter linking chronic fatigue syndrome to fibromyalgia. If the disability claim is approved, the VA would aggregate the VA disability rating for chronic fatigue syndrome with the disability rating for fibromyalgia using VA math.
What Happens If Your Claim for Fibromyalgia Veterans Benefits Is Denied?
VA disability claims based on chronic pain, whether they have been diagnosed as fibromyalgia or not, suffer from a very high denial rate. For example, claims for undiagnosed Gulf War illnesses, such as chronic pain, had a historical approval rate of less than 5%. Although those rates should increase with the Gulf War presumption for fibromyalgia, veterans who served at other times or in other regions could still see very high denial rates.
This means that you should probably be prepared to fight for any fibromyalgia veterans benefits you may be entitled to. You will need a strategy for establishing a service connection, whether it arises from a specific incident that occurred during your service, a misdiagnosis in your military medical records, or a service-connected primary disability that caused fibromyalgia.
If your claim is denied even after submitting this evidence, the VA allows you to obtain a review of the decision, either on the same record or after submitting additional evidence. If you previously submitted a claim and it was denied, you may be able to submit a new claim under the new standards for pain-related disabilities established by the court of appeals in 2018. In either situation, you may want to consult a VA disability benefits attorney to put your request into the best possible form for approval by the VA.
The VA can be difficult to persuade when it comes to fibromyalgia veteran’s benefits. Regardless of where you are currently located or whether you were deployed during your military service, contact a VA attorney to discuss what is needed to receive disability benefits for your fibromyalgia. Your call and questions are all free.
The ratings range from 10% to 40% based on the effects of your fibromyalgia. Other related disabilities can also be combined with fibromyalgia to get a higher rating.
Maybe not. Let’s look over your file to see if the VA made a mistake. If we can find a mistake, we can build on your past claims. If the window for appeals has run out, we will try to help you start over and make sure we give the VA a complete case with all possible evidence.
Like any civilian doctor, fibromyalgia is diagnosed when a series of tests rule out many other conditions. Fibromyalgia symptoms mimic several other conditions and you are supposed to get whatever rating is the highest. If a diagnosis for arthritis would give you a higher rating than a diagnosis for fibromyalgia, they are required to use the rating from your arthritis.