Gulf War Veterans who develop fibromyalgia do not have to prove a connection between their illness and service to be eligible to receive VA disability compensation. In order to be eligible for this presumptive service connection, fibromyalgia must have emerged during active duty in the Southwest Asia Theater of military operations or by December 31, 2016. It must also be at least 10% disabling.
Fibromyalgia is characterized by unexplained, widespread pain throughout the body, lasting longer than 3 months. Fibromyalgia has been linked to repetitive injuries, physical and emotional trauma, stress, and infections. The main symptoms associated with fibromyalgia are chronic pain in muscles, tendons, and other soft tissues accompanied by “tender points” that hurt when pressure is applied. These “tender point” locations include:
- Back of the head
- Between the shoulder blades
- Top of shoulders
- Front sides of neck
- Upper chest
- Outer elbows
- Upper hips
- Sides of hips
- Inner knees
Other symptoms may be present in people with fibromyalgia. These symptoms include:
- Moderate or severe fatigue and decreased energy
- Feeling anxious or depressed
- Sleep disturbances (such as insomnia)
- Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
- Jaw and facial tenderness
- Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
- Post-Traumatic Stress Disorder (PTSD)
- Tension or migraine headaches
- Impaired memory and concentration
- Numbness or tingling in the face, arms, hands, legs, or feet
- Increase in urinary urgency or frequency (irritable bladder)
- Reduced tolerance for exercise and muscle pain after exercise
- A feeling of swelling, without actual swelling, in the hands and feet
A diagnosis of fibromyalgia is confirmed with a brief physical exam that involves the testing of the trigger points. In order to give a diagnosis of fibromyalgia, there must be widespread pain lasting at least three months, and at least 11 out of the 18 possible tender points.
The onset of fibromyalgia may be gradual or sudden. Sudden onset of fibromyalgia is usually associated with physical injury or trauma such as a car accident. Fibromyalgia may also be initiated by infections or chemical and drug exposure. There is no known cure for fibromyalgia, but there are effective treatment options to manage symptoms. Treatment usually focuses on relieving pain, avoiding stress, improving sleep, and correcting hormonal imbalances.
Tips for Meeting with Doctors
Because many of the signs and symptoms of fibromyalgia are similar to various other disorders, you may have to see multiple doctors before receiving a diagnosis. Before meeting with a doctor you may want to write a list covering the following topics:
- Detailed description of your symptoms
- Information about medical problems you’ve had in the past
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Any questions you want to ask the doctor.
As previously discussed above, fibromyalgia symptoms mimic many of the symptoms of other conditions. Because of this, fibromyalgia is sometimes referred to as the “great imitator.” Knowing the differences between common disorders that fibromyalgia is often mistaken for can help ensure that your doctor properly diagnoses you. The common disorders that fibromyalgia is often mistaken for include:
- Lyme disease
- Rheumatoid arthritis
- Cushing’s syndrome
- Polymyalgia Rheumatica
- Reflex sympathetic dystrophy syndrome
- Cervical spinal stenosis
A rheumatologist will run the tests which are needed to rule out the above conditions. After you test negative for each condition, the rheumatologist would diagnose you with fibromyalgia.
How Fibromyalgia is Rated by the VA
Fibromyalgia is rated under diagnostic code 5025. A rheumatologist must evaluate and diagnose the condition for it to be rated under this code. Additionally, the pain must be present on both sides of the body and both above and below the waist to be rated under this code. A veteran with a diagnosis of fibromyalgia will receive either a 10%, 20%, or 40% rating when they are suffering from widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel syndrome symptoms, depression, anxiety, or Raynaud’s like symptoms that:
- Require continuous medication for control – 10%
- Are episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than 1/3 of the time – 20%
- Are constant, or nearly so, and refractory (resistant) to therapy – 40%
Widespread pain is defined by the VA to mean pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e. cervical spine, anterior chest, thoracic spine, or low back) and the extremities.
Keep in mind that it is possible to have a different condition (such as hypothyroidism) and fibromyalgia at the time. In that situation, you cannot win a claim for fibromyalgia until the other condition has been treated and stabilized for six months and the fibromyalgia symptoms persist.