Pain is a natural response of the nervous system. Pain is the way your body tells you that something is wrong. However, chronic pain takes a toll on you both physically and mentally and, as a result, can have a severe effect on your ability to work. The VA has made strides toward compensating veterans for lost earning potential due to chronic pain. Under a recent court of appeals decision, the VA must provide VA disability benefits for chronic pain and chronic pain syndrome even if the pain has no diagnosed cause.
In This Article About VA Disability Ratings for Pain:
- Can VA Disability Benefits for Chronic Pain Include Undiagnosed Pain?
- Chronic Pain VA Benefits Summary
- How to Assign a Rating for VA Disability Benefits for Chronic Pain
- Does Chronic Back Pain Qualify for Disability?
- Is Chronic Pelvic Pain a Disability?
- What Is the VA Disability Rating for Chronic Pain Disorder?
- Is Chronic Myofascial Pain Syndrome a Disability?
- How to Establish a Service Connection to Support VA Disability Benefits for Chronic Pain
- How to Increase the VA Rating for Chronic Pain
- Evolving Position on VA Disability Benefits for Chronic Pain
Can VA Disability Benefits for Chronic Pain Include Undiagnosed Pain?
Pain can be a tricky concept when it comes to VA disability claims. While many painful conditions can be verified with examination and laboratory tests, the VA has been reluctant to treat pain itself as a disability because there was often no way to confirm the existence or severity of the pain.
Chronic Pain VA Benefits Summary
- The VA has opened a way to give VA Disability Ratings based on pain without a clear cause of the pain.
- The VA will give some veterans disability benefits based on the area and impact of the pain on their daily life if they can prove it is service-connected.
- Since the Gulf War, more Veterans are applying for benefits for chronic pain, and other medically unexplained conditions… and the VA is listening!
Undiagnosed pain, including undiagnosed chronic pain, was treated as an unratable disability until 2018. Even if doctors and VA claims adjudicators believed that the veteran suffered from pain, the VA’s policy was to reject all claims for VA disability benefits for “pain alone, without a diagnosed or identifiable underlying malady or condition.”
This all changed in 2018 when a court of appeals held that pain, by itself, is a functional impairment of a veteran’s earning capacity regardless of the condition or the disease-causing the pain. Under this court case, the VA must allow claims for VA disability benefits for chronic pain even when the veteran is unable to specify the cause of the pain.
This shift in policy is significant. The VA cannot reject claims for VA disability benefits for chronic pain merely because the pain cannot be explained. This opens the VA’s disability benefits system to claims for VA disability benefits for chronic pain syndrome, fibromyalgia, and other medical conditions that center around pain as a primary symptom of the condition.
There are still advantages to identifying the source of pain if it has been diagnosed. Identifying a source of your pain may help you to establish a service connection for your disability. For example, if you have chronic back pain that arose from a training accident during your service, you would identify the back injury suffered during the training accident as the source of the pain to establish a service connection.
How to Assign a Rating for VA Disability Benefits for Chronic Pain
To assign a rating for a claim for VA disability benefits for chronic pain, you must look to the body part or system affected by the pain.
Fibromyalgia, for example, is often described as body-wide pain. Although current medical thinking is that fibromyalgia is a neurological condition, the VA has a disability rating schedule specifically for fibromyalgia in the musculoskeletal section. Under the fibromyalgia rating schedule, widespread pain is rated at 40% if it is nearly continuous, 20% if it is episodic and appears more than 1/3rd of the time, and 10% if it requires continuous medication to control.
One of our Certified VA Disability Benefits Lawyers talks about VA Disability for Fibromyalgia in this video.
Does Chronic Back Pain Qualify for Disability?
Yes. As mentioned above, chronic back pain would qualify for VA disability benefits for chronic pain even if the cause of the pain is undiagnosed. Thus, it does not matter whether the back pain is caused by a degenerative intervertebral disc, improperly heal spine fracture, or pinched nerve in the neck. Under any of these circumstances, a chronic pain VA disability rating can be assigned.
When a condition is not specifically rated, the rating table for the most analogous condition is used. Thus, the general back condition ratings tables would be used to assign a VA disability rating for chronic back pain.
One rating table is based on the range of motion of the back. By taking six different range of motion measurements, a rating can be arrived at under this first rating table. The rating percentages range from 10% to 100% depending on the range of motion of the cervical spine and lumbar spine.
The second rating table is based on the number of incapacitating episodes over the span of a year. A greater number of incapacitating episodes are associated with a higher VA disability chronic back pain rating. The rating percentages fall between 10% and 60%.
Here is a video of one of our Veterans Disability Lawyers teaching you how to use our VA Disability Combined Ratings Calculator.
Is Chronic Pelvic Pain a Disability?
Yes. Chronic pelvic pain, like other forms of chronic musculoskeletal pain, qualifies for VA disability benefits. A claim for chronic pelvic pain would be rated based on how the pain affects the hip and thigh. By measuring the range of hip and thigh motion and ankylosis (angle where the hip joint is frozen), a rating for the chronic pelvic pain can be calculated.
Additionally, pelvic pain can be rated using residuals for each effect flowing from the chronic pelvic pain. For example, the VA’s regulations on fractured pelvis bones advise evaluating residuals, pain in the lumbar spine, muscle spasm, sciatic neuritis, peripheral nerve injury, and range of hip motion to arrive at a disability rating.
What Is the VA Disability Rating for Chronic Pain Disorder?
Chronic pain disorder is broader than chronic pain. Chronic pain disorder includes the disabling conditions that are caused by chronic pain. For example, chronic pain may lead to insomnia due to the inability to sleep while suffering pain. Similarly, chronic pain may lead to depression about the pain.
While there is no VA disability rating schedule for chronic pain disorder, you can approximate the effects of all your service-connected disabilities through the secondary service-connected disability doctrine. Under this procedure, you can include claims for secondary disabling conditions that have a “nexus” to a primary disability. By aggregating the VA disability rating for the source of the pain with the VA disability rating for the effects of the pain, the overall VA disability rating covers the entire chronic pain disorder.
Thus, in the examples above, chronic pain would be your primary service-connected disability, and depression or insomnia would be your secondary service-connected disability. When you use secondary service-connected disabilities, the individual rating percentages for each disability are aggregated using VA math.
Applying this to the example above, the VA would first rate the source of chronic pain using the ratings schedule for the body part or system affected by the pain. The VA would then rate the mental disability (depression or insomnia) using the mental disorder ratings schedule. The VA uses these two ratings to arrive at an overall VA disability rating for chronic pain syndrome.
Here is our video explaining how the VA Combined Rating table works and why VA Math can be so confusing.
Is Chronic Myofascial Pain Syndrome a Disability?
Yes. Chronic myofascial pain is a form of chronic pain disorder where trigger points on muscles cause the sensation of pain in a distant point on the same muscle. For example, pressure on your elbow may cause severe and deep pain in your shoulder. Chronic myofascial pain is often caused by repetitive motions or muscle injury.
Again, the reason for the pain does not need to be identified to obtain a rating for VA disability benefits for chronic pain. While chronic myofascial pain is not clearly understood, you can obtain VA disability benefits for chronic pain merely because the pain interferes with your ability to work.
A disability rating for myofascial pain syndrome would be determined based on the body part that is affected by the pain. Since myofascial pain occurs in the muscles, the disability rating for chronic myofascial pain syndrome is determined using the VA’s rating schedule for muscle injuries.
As with chronic pain disorder, chronic myofascial pain syndrome can lead to secondary disabilities such as insomnia and depression. VA disability ratings for secondary disabilities connected to chronic myofascial pain syndrome can be aggregated with the VA disability rating for chronic pain.
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How to Establish a Service Connection to Support VA Disability Benefits for Chronic Pain
A service connection must be established for all VA disability claims. Thus, a claim for VA disability benefits for chronic pain must include evidence that the pain either manifested during your service or was worsened by your service.
1. Pain Manifesting In-service
Unlike many other types of VA disability claims, establishing the manifestation of pain may be straightforward for many veterans due to a couple of reasons. First, most pain is related to a physical injury. Your service records would likely include some documentation about physical injuries, whether they were combat-related or arose from a training or vehicle accident.
Second, most service members visit a military doctor or corpsman when they experience pain. This visit would generate a record of the service member’s painful condition.
Third, pain can often be documented in other records and reports. For example, if you required accommodation in your duties due to repetitive stress injuries or had to take a few days to recover from a training injury, there would be documentation for those events even if you were not examined by a doctor.
When filing a claim for VA disability benefits for chronic pain, these records would support a service connection for chronic pain arising from the documented incidents.
2. Pain Exacerbated by Service
If you had a pre-existing condition when you joined the military, and your military service exacerbated that injury to an extent worse than a natural progression of that condition, you can establish a service connection to your chronic pain flowing from that condition.
For example, if you had a “trick knee” that was only painful on a few occasions when you joined the military but, by the time you were discharged, your knee experienced continuous and chronic pain, you might be entitled to VA disability benefits for chronic pain.
The key, however, is to show that the worsening of the pain was not a natural progression, but rather was caused by your military service. There are many ways to establish that a worsening is not natural. For example, you can use medical records to show a marked increase in medical visits for treatment. Similarly, you can use documentary evidence, such as x-rays or test results, to show that your condition showed a severe decline that would not be expected in a natural progression. You can use expert opinions from doctors that the progression was worse than a natural progression of the condition.
Finally, you can point to a specific event during your service that caused your condition to immediately worsen. For example, if you were involved in a training accident during your service and that caused your “trick knee” to immediately swell and develop a chronic ache thereafter, you may be able to establish that the worsening was due to the accident and not a natural progression of your knee condition.
3. Chronic Pain Diagnosed After Service
If your chronic pain was diagnosed after service, it may still be service-related if it manifested during your service. For example, if your chronic back pain is caused by degenerative disc disorder but was misdiagnosed during your service as muscle strain, you should be able to establish a service connection through a doctor’s opinion letter identifying the misdiagnosis and stating that the degenerative disc disorder started during your service.
How to Increase the VA Rating for Chronic Pain
When you file your claim for VA disability benefits for chronic pain, remember to include all disabilities flowing from your chronic pain. As mentioned previously, insomnia, depression, and other mental disorders may arise from chronic pain. However, keep in mind that the VA usually groups together symptoms of mental disorders and issues a single disability rating for the overall mental disorder rather than, for example, issuing one rating for depression and a separate rating for insomnia.
If your medications that are used to treat your chronic pain cause side effects, those side effects are considered secondary service-connected disabilities as well. For example, pain medications can cause gastroesophageal reflux disease (also called GERD, acid reflux, or heartburn) and sleep apnea. When filing a claim for VA disability benefits for chronic pain, you are entitled to request a rating for these effects.
Finally, if your condition worsens, you can request an increase in your disability rating. Thus, if you have chronic back pain, a loss in range of motion or increase in incapacitating events may entitle you to a higher VA disability rating than the one initially awarded. The process for requesting an increase in rating is similar to that for applying for the initial rating, although you will not need to establish a service connection for a disability that is already deemed service-connected.
Evolving Position on VA Disability Benefits for Chronic Pain
If you have a claim for VA disability benefits for chronic pain that was previously denied, you may find greater success with VA’s new process. If you are filing a new claim, you may avoid some of the resistance previously exhibited by the VA to approving chronic pain claims.
We keep all of our customers’ files so that we can follow up with you if your denied case is worth reopening, but it’s worth calling us back to check. With the instability in Washington, opportunities for veterans can come and go very quickly.
To learn how the VA’s new policy for pain-based claims may affect you, contact a VA benefits attorney who can discuss your disability claim regardless of where you are currently located or whether you were deployed.