38 CFR Part 4 — 38 CFR § 4.71a
Fibromyalgia
dc-5025-fibromyalgia
Musculoskeletal
Diagnostic code
5025
Why your DC matters: DC 5025 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 5025 — Fibromyalgia — is listed under 38 CFR § 4.71a in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): 10%, 20%, or 40% under the fibromyalgia criteria in § 4.71a. Gulf War presumptive under § 3.317. See the dedicated guide on this site.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (5025) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “5025”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 5025 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 5025 in the subpart for your body system (use Find in Page if needed).
Fibromyalgia under DC 5025 is one of the cleanest rating schedules in the CFR — three flat tiers (10/20/40%). The whole game is documenting symptom frequency and refractory treatment. Gulf War veterans get presumptive service connection under 38 CFR § 3.317; for everyone else, the cleanest secondary lane is mental health (chronic pain → depression).
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 40% | Symptoms constant or nearly so, and refractory to therapy. | Multi-year treatment record showing failed trials of duloxetine, milnacipran, pregabalin/gabapentin. Pain/fatigue noted on >50% of clinic visits. |
| 20% | Symptoms episodic, exacerbations occurring more than 1/3 of the time. | Pain diary or chart notes showing flares totaling >120 days/year. Tender-point exam findings (≥ 11 of 18) documented. |
| 10% | Symptoms requiring continuous medication for control. | Ongoing prescription for pregabalin, gabapentin, duloxetine, or milnacipran with continued symptoms. |
What Qualifies as Fibromyalgia Under DC 5025?
Widespread musculoskeletal pain
Pain on both sides of the body, above and below the waist, including axial skeleton (neck, mid-back, low-back, chest). Lasting ≥ 3 months.
Diagnostic findings
Tender-point exam (≥ 11 of 18 classic points) OR 2010/2016 ACR criteria (WPI + Symptom Severity).
Refractoriness drives the tier
DC 5025 has three flat tiers:
- • 10% — symptoms require continuous medication
- • 20% — episodic, occurring more than 1/3 of the time
- • 40% — constant or nearly constant, refractory to therapy
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Constant, or nearly constant, refractory to therapy”
Verbatim from DC 5025. 'Refractory' means failed trials of multiple FDA-approved fibro therapies. 'Partial response to duloxetine' is NOT refractory. Push the provider to chart 'failed multiple lines of therapy.'
“Episodic, with exacerbations occurring more than one-third of the time”
More than 120 flare days per year. A pain diary is the cleanest proof. Without one, examiners default to 10%.
“Widespread musculoskeletal pain and tender points on examination”
DC 5025 requires BOTH widespread pain AND tender-point findings. Without tender-point documentation, examiners may rate under a different DC at a lower percentage.
Evidence Checklist — Specific to This Condition
Rheumatology evaluation
CRITICALTender-point exam (≥ 11 of 18 classic points) OR 2010/2016 ACR criteria (Widespread Pain Index + Symptom Severity). Diagnosis must come from a qualified provider.
Treatment-failure documentation
CRITICALChart notes showing trials of at least 2 of: duloxetine, milnacipran, pregabalin, gabapentin, amitriptyline — with dates and outcomes for each.
Pain/fatigue diary
CRITICAL30–90 day diary noting flare days, severity (0–10), sleep disruption, and impact on daily activities. Drives the 20% vs 40% distinction.
Gulf War service records
IMPORTANTDD-214 showing service in SW Asia theater (Aug 2, 1990–present). Fibromyalgia is presumptive under § 3.317 — no nexus letter needed.
Sleep study
SUPPORTINGNon-restorative sleep is a fibro hallmark. A sleep study (even one that rules out OSA) reinforces severity narrative.
C&P Exam Tips
Bring a pain diary covering ≥ 30 days
Day-by-day flare log with severity scores. Hand it to the examiner — they'll paste it into the DBQ verbatim.
Describe your WORST day in concrete terms
'There are 4–5 days a month I can't get out of bed. My wife brings me food. I can't shower.' Concrete impairment beats vague descriptions.
Bring a list of failed treatments with dates
'Tried Lyrica 2019–2020, stopped due to side effects. Tried Cymbalta 2020–2022, partial response only. Currently on gabapentin with continued daily pain.' Builds the refractory case.
Don't say 'I manage with stretching and a heating pad'
Tanks the rating. Describe the medication regimen, the side effects, and what STILL doesn't work despite treatment.
Common Mistakes That Cost Veterans Points
Filing under generic 'chronic pain' instead of DC 5025
Chronic pain is not a ratable VA condition. Insist the claim be coded as fibromyalgia with a rheumatology diagnosis.
Accepting 10% because 'meds help a little'
If you're still flaring >1/3 of the year despite medication, that's 20%. File supplemental with a pain diary.
Skipping the Gulf War presumptive path
Veterans who served in SW Asia from Aug 2, 1990 onward qualify under § 3.317. No nexus letter required.
Letting mental-health conditions get absorbed
Fibro + MDD is NOT pyramiding. They rate side by side — fibro for pain/fatigue/sleep, MDD for mood.
Tactical Plays
⚡ Gulf War presumptive — file even with no STR pain notes
Per § 3.317, fibromyalgia in a Persian Gulf veteran is presumed service-connected. No in-service onset proof needed. DD-214 + current rheumatology diagnosis = grant. Highest-leverage move available.
⚡ Pair with MDD as the cleanest secondary stack
40% fibro + 50% MDD-secondary combines to ~70% before bilateral factor. Two well-evidenced claims that don't pyramid. Many veterans never file the MDD that the chronic pain caused.
⚡ Build the refractory case BEFORE refiling for increase
Want 20→40%? Document at least 2 medication failures and a 90-day pain diary BEFORE the new exam. Examiners can't credit refractoriness they can't see in the chart.
Secondary Conditions to File With This One
Major depressive disorder
STRONGDC 9434
Chronic pain → depression is well-established medical chain. Often more impactful than the fibro rating itself.
IBS
MODERATEDC 7319
Functional GI overlap with fibro is well-documented in rheumatology literature.
Insomnia / sleep disturbance
MODERATENon-restorative sleep is a fibro hallmark; formal sleep disorder can rate separately.
Migraines
SITUATIONALDC 8100
Tension/migraine headaches develop secondary to chronic widespread pain in many veterans.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Continuous medication (pregabalin, duloxetine, gabapentin) required for control.
20% — single, no dependents
Base rating
$356.66
TOTAL
$356.66/mo
Flares >1/3 of the year despite medication.
40% — single, no dependents
Base rating
$795.84
TOTAL
$795.84/mo
Constant or near-constant, refractory to multiple lines of therapy.
40% fibro + 50% MDD-secondary (combined ~70%)
Base rating
$1,808.45
TOTAL
$1,808.45/mo
Chronic-pain-to-depression nexus is the single highest-leverage secondary stack for fibro.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
💊What does 'Refractory to Therapy' mean?
Failed trials of multiple FDA-approved fibromyalgia treatments at therapeutic doses. Not 'partial response' — actual failure or intolerable side effects. The 40% gate.
🪖What is the Gulf War presumptive?
Per 38 CFR § 3.317, fibromyalgia (along with CFS and IBS) is a 'medically unexplained chronic multisymptom illness' presumed service-connected for veterans who served in SW Asia from Aug 2, 1990 onward.
📍What are 'Tender Points'?
18 specific anatomical points palpated by the rheumatologist. Pre-2010 ACR criteria required ≥ 11. Post-2010 criteria use WPI/SS scoring instead, but VA still references tender points in DC 5025.
How to File Your Claim
Get a rheumatology diagnosis on paper
VA examiners often defer to rheumatology for fibro diagnosis. Get a note that uses DC-5025 phrasing ('fibromyalgia,' 'widespread musculoskeletal pain,' tender-point or ACR criteria).
File 21-526EZ specifying 'fibromyalgia (DC 5025)'
If Gulf War service applies, ALSO write 'presumptive service connection under 38 CFR § 3.317.' This shifts the burden of proof to VA.
Submit a 30–90 day pain diary + medication-failure log
Drives the tier. A diary showing 6+ flare days/month moves 10 → 20%. A documented refractory case moves 20 → 40%.
File MDD as secondary at the same time
Don't wait. The chronic-pain-to-depression nexus is well-trodden. Filing both at once locks the same effective date for the secondary.
If denied service connection, appeal via HLR with VSO
Gulf War presumptive denials are routinely overturned. A VSO cites § 3.317 verbatim.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Gulf War service = presumptive — don't let VA require a nexus
If you served in SW Asia between Aug 2, 1990 and now, § 3.317 presumes fibromyalgia is service-connected. VA cannot lawfully require a nexus letter. Cite the regulation.
Don't accept 'chronic pain syndrome' as a substitute
Chronic pain is not a ratable condition. The diagnosis must be 'fibromyalgia' and the rating must reference DC 5025.
Pair with MDD or PTSD secondary
Chronic pain → mental health secondary is recognized law. Don't leave this on the table.
Re-file when treatment escalates
Every new medication trial that fails is fresh evidence of refractoriness. Each failure rebuilds the case for 40%.
Related Tools & Resources
Frequently Asked Questions
Is fibromyalgia always presumptive for Gulf War veterans?
Yes — per 38 CFR § 3.317, fibromyalgia is one of three 'medically unexplained chronic multisymptom illnesses' presumed service-connected for veterans who served in SW Asia from Aug 2, 1990 to the present. No nexus letter needed.
Can I be rated for fibromyalgia AND another musculoskeletal condition?
Yes — fibro is a systemic pain syndrome. You can also be rated for specific joint conditions (knee, back, shoulder) with their own ratings as long as the joint-specific limitation is documented separately.
Does fibromyalgia qualify for TDIU?
Yes when severe. A 40% fibro alone usually won't reach schedular 60%/70% on its own, but combined with secondaries (MDD, IBS, migraines) it often does — and the chronic-fatigue impact is exactly what TDIU was designed for.
What if my rheumatologist says 'chronic widespread pain' not 'fibromyalgia'?
Push for the specific diagnosis. 'Chronic widespread pain' is not a ratable VA condition. If criteria are met (tender points OR ACR WPI/SS scores), the diagnosis should be 'fibromyalgia.'
What secondary conditions should I claim?
MDD (chronic pain → depression), insomnia, IBS, and migraines. Each rates separately under its own DC.
Official Regulatory Source
Fibromyalgia is rated under 38 CFR § 4.71a, DC 5025. Gulf War presumptive at § 3.317.
38 CFR § 4.71a — Musculoskeletal System (eCFR) →Scroll to DC 5025; presumptive rule is at § 3.317.
Next Steps
If your rating decision lists DC 5025, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 5025 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.