Fibromyalgia is a disability that can qualify you for veterans benefits through the U.S. Department of Veterans Affairs (VA). If you served in Southwest Asia, you may be presumptively eligible for VA disability compensation benefits.
Stone Rose Law can help you apply for fibromyalgia disability benefits or appeal a denied claim for benefits. Call us at (480) 498-8998 to speak with one of our VA benefits lawyers about your fibromyalgia disability benefits claim and to schedule a free consultation.
The VA rates fibromyalgia under medical diagnostic code 5025. If the VA approves your disability claim for fibromyalgia, then, depending on the frequency and severity of your symptoms, you can receive a disability rating of 10%, 20%, or 40%.
At this level, your fibromyalgia condition involves symptoms that require continuous medication to treat, but it does not significantly impact your daily life or work activities.
What distinguishes this rating level is that your fibromyalgia symptoms are getting worse, with widespread musculoskeletal pain episodes being worsened by triggers more than one-third of the time. These triggers can be environmental or emotional stress or overexertion.
At this level, your widespread pain symptoms are constant or nearly constant and are also resistant to treatment.
Widespread musculoskeletal pain means more than chronic pain in one part of your body. Instead, widespread pain exists on the left and right sides of your body, above and below the waist, and it affects your cervical spine, anterior chest, lower back, and extremities.
As you may imagine from the descriptions of its symptoms, fibromyalgia can make it hard or even impossible to work. This can be even more so if your fibromyalgia is combined with one or more other disabilities.
If fibromyalgia makes it impossible to get or to keep substantially gainful employment, then even if your combined rating for fibromyalgia and other service-connected disabilities does not equal 100%, you can still receive the equivalent in benefits compensation through what the VA calls total disability based on individual unemployability, or TDIU.
Fibromyalgia by itself ordinarily cannot qualify you for TDIU. But in combination with other disabilities with a combined disability rating of at least 70 percent, a 40 percent fibromyalgia VA rating can meet the requirements for schedular TDIU benefits.
Or, your fibromyalgia VA disability rating can contribute to the overall 70 percent disability rating as long as another disability in your combined rating is at least 40 percent.
To learn more about how combined VA ratings work, see our VA disability calculator.
In some cases, even if you do not qualify for TDIU under the VA schedular rating requirements, the VA may still consider you for TDIU on an extraschedular basis if your fibromyalgia disability and your other disability ratings still make it too difficult to keep substantially gainful employment.
You can apply for VA benefits for fibromyalgia in one of the following ways:
If you are a Gulf War veteran, then you may be able to apply for disability benefits for fibromyalgia based on a presumptive service connection. This means if you meet the eligibility requirements, the VA will presume that your condition is service-connected. You will not need to establish a nexus between an in-service event or condition and your fibromyalgia diagnosis.
To be eligible for a presumptive fibromyalgia VA rating, you must meet all of the following requirements:
If you served in the Southwest Asia Theater on or after August 2, 1990, including the airspace over them unless otherwise noted, then the VA presumes your fibromyalgia condition is associated with your service if you were at any of the following locations:
If you develop fibromyalgia during your service but do not qualify for presumptive eligibility, or if your non-presumptive condition was pre-existing but your time in service made it worse (an aggravated condition), you may still be able to receive disability benefits.
In these situations, you will need to qualify for benefits using the regular procedure:
Proving a direct service connection requires you to submit evidence in the form of documentation. This includes your doctor’s medical diagnosis and medical records of treatment, the written results of any VA medical examination you may have, and other supporting documentation like “buddy letters” from people who can attest to your fibromyalgia and its effects on your life and your work.
A secondary service connection is one in which another disability the VA has already assigned you a disability rating for is the source of another claimed disability. Several situations exist where fibromyalgia can be a secondary condition to one or more other service-connected conditions.
Secondary conditions include the following VA disabilities:
You will need to convince a VA examiner that your secondary service-connected claim is at least as likely as not to have been caused by the primary, pre-existing disability.
To prove that your pre-existing disability caused your fibromyalgia condition, you need to provide detailed medical evidence linking the two conditions. This evidence can include a medical diagnosis and medical treatment records for both conditions.
When evaluating your claim, sometimes the VA may request you to undergo a compensation and pension (C&P) exam. The purpose of this exam is to gather more information to establish whether you have a disability, and if you do then how severe it is for VA disability rating purposes.
During the C&P exam, a VA examiner will review your supporting claim documentation, ask you some questions about your symptoms and how they affect your ability to work and your daily life activities, and possibly have you undergo a physical examination and testing.
A C&P exam is not optional. It is important to make your scheduled exam day and time. Failure to show up for a C&P exam could jeopardize your claim.
VA claim denials are not uncommon. Overall, the VA initially rejects about one of every three first-time claim applications it receives, and these include claims for fibromyalgia benefits.
Common reasons why the VA rejects claims include mistakes made by the applicant when completing the necessary forms, missing filing deadlines, and not providing enough supporting documentary evidence.
Sometimes, the VA itself can make a mistake that can lead to a claim denial.
Fortunately, these claim denials are not always final. In fact, many initial denials are reversed on appeal, especially when you have help from a VA claims attorney.
The VA has established the ways that you can appeal a denial of your fibromyalgia disability claim. These include less formal methods like requesting a higher level review from a senior VA examiner or filing a supplemental claim with new and relevant evidence to more formal procedures like filing an appeal with the VA Board of Veterans Appeals and having a hearing before a VA Law Judge.
Your VA disability benefits appeals attorney can help you decide which appeal method is most practical for you, help you prepare the necessary documentary evidence you will need to support your appeal, file your appeal, and, if necessary, appear on your behalf in the hearing before the board.
Fibromyalgia can be hard to live with, even at a 10% disability rating. And while the claims process for VA disability benefits for this condition may sound simple in concept, putting together the most persuasive claim application can be a painstaking effort requiring considerable attention to detail and much supporting evidence.
The VA disability lawyers at Stone Rose Law are experts in handling service-connected and secondary service-connected disabilities for fibromyalgia. Contact one of our attorneys today to get help with your VA disability claim. Our expert VA Disability Attorneys can help you calculate your disability percentage and determine if you are being paid appropriately for your injuries.
Contact Stone Rose Law online or call (480) 498-8998 today for your free consultation.
