Fibromyalgia Secondary to PTSD Claim Guide
Fibromyalgia (VA diagnostic code 5025) is sometimes claimed as secondary to service-connected PTSD (code 9411) under 38 CFR 3.310. We analyzed published Board of Veterans' Appeals decisions on that pairing; here is what they show. It is an encyclopedic reference, not a forecast.
The Numbers, from 1.9M Appeals
We analyzed the Board's published decisions and found fibromyalgia (DC 5025) claimed as secondary to PTSD (DC 9411) is a small but documented claim pool that comes down close to a coin flip once it reaches a merits decision.
How those 174 issues came out
Symptoms Recorded in Granted Fibromyalgia Decisions
We analyzed 451 granted Board decisions involving fibromyalgia for symptoms named in sentences about the condition (rating-criteria recitations excluded). Descriptive of the published record, what the Board wrote down, not a checklist of what to report.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
ICD-10 Diagnosis Codes for Fibromyalgia
The ICD-10 diagnosis codes most commonly used for DC 5025, Fibromyalgia (the kind on your medical records, decision letter, or C&P exam report). VA rates the disability and its residuals, not the diagnosis itself, so coding can vary.
What a secondary claim on this pairing needs
Under 38 CFR 3.310 a secondary claim turns on three elements:
- A current diagnosis: a medical diagnosis of fibromyalgia (the secondary).
- A service-connected primary: PTSD, already service-connected (the primary). A 0% primary still counts.
- A medical nexus: a medical opinion linking the fibromyalgia to the PTSD, showing the primary caused or aggravated it.
See the Secondary Claim guide for the caused-versus-aggravated split, and the Nexus Letter guide for what makes the medical opinion strong.
Why fibromyalgia is claimed secondary to PTSD
Whether that medical link exists in any one case is a medical question decided on that case's own evidence (the nexus).
Caused By vs Aggravated By: What the Board Found
The outcome split above counts whole issues. This section goes one layer deeper. Under 38 CFR § 3.310 a secondary claim can be won two ways: the PTSD caused the fibromyalgia (§ 3.310(a)), or it aggravated an existing fibromyalgia (§ 3.310(b)). Every grant rests on one or the other, so the numbers below divide up the granted claims only.
Direct causation is the route that carries most grants here: 84% of them found the PTSD caused the fibromyalgia, the rest found aggravation. A practical consequence for the nexus opinion: it should address both routes, because a medical opinion that only argues causation leaves the aggravation theory, a separate legal basis, on the table. See the caused-vs-aggravated guide for how the two theories differ.
On the other side: in 11 denied claims the Board looked at this pairing and found no link, meaning it decided the PTSD neither caused nor worsened the fibromyalgia. That is a separate group from the grants above, counted here so the picture is not one-sided.
We analyzed published Board decisions on this pairing to build this split. The grant split covers granted claims only; denied, remanded, and dismissed claims are not in it. Descriptive of the published record, not a prediction.
What VA Looks For: Tests, Records, and Diagnostic Codes
The record VA actually reviews centers on a small set of documents. We analyzed published Board decisions on these claims and ranked the records that appeared most often:
- A medical nexus opinion: the one record VA weighs most on a secondary claim, a doctor's statement linking your fibromyalgia to your service-connected ptsd and naming the mechanism.
- Southwest Asia (Gulf War) service addressed
- Tender or trigger points documented
- Widespread musculoskeletal pain finding
- Symptoms refractory to therapy discussed
- Continuous medication for control documented
The diagnostic code involved: DC 5025 (Fibromyalgia). The rating levels for this code are in the rating section below.
Records ranked by how often published Board decisions cited them. The exam that captures most of this is covered in the C&P Exam section below. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
The Evidence That Wins Fibromyalgia Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- A fibromyalgia diagnosis from a rheumatologist, not just your regular doctor: the VA wants to see the ACR 2010 criteria used (widespread pain index and symptom severity scores). A "chronic pain" note in your chart is not the same as a documented fibromyalgia diagnosis, and examiners look for the formal criteria to be there.
- Treatment records covering at least 6 months: the VA needs to see your symptoms are ongoing and current, not a one-time complaint. Records that spell out "fibromyalgia" by name, and describe how it limits your daily activities, carry more weight than vague notes about aches and fatigue.
- A clear timeline showing PTSD came first: gather the date your PTSD was service-connected and compare it to when your fibromyalgia symptoms started or got worse. This order matters. It is how you prove PTSD caused or aggravated the fibromyalgia, not the other way around.
- A full medication history, with dates and why each one stopped: list every pain medication you tried and failed. Multiple failed treatments show this is a real, hard-to-manage condition and can push your rating higher, not just prove you have some pain.
- A completed Disability Benefits Questionnaire (DBQ) for Fibromyalgia: ask your doctor to fill this out. It is the form built specifically for this condition, and a doctor's direct answers on it carry more weight than a general letter.
- A nexus letter that explains the connection in plain medical terms: the letter needs to say your fibromyalgia is "at least as likely as not" caused or made worse by your PTSD, and it needs to explain how. PTSD keeps your body in a constant state of alert, which turns up your pain signals and wrecks the deep sleep your muscles need to repair. Also make sure the letter addresses both causation and aggravation separately. The VA does not assume one means the other.
- If a VA exam denies your claim, get a second opinion (an IMO): if the VA's examiner says there is no connection, a private doctor's opinion that directly disagrees with that finding, and explains why, can put your case in a tie. When the evidence is evenly balanced, the tie goes to you.
- Medical research backing up the PTSD-fibromyalgia link: ask your doctor to reference published medical literature connecting PTSD to fibromyalgia in the nexus letter. This shows the VA the connection is an accepted medical fact, not just your doctor's personal opinion.
Evidence Cited in Published Fibromyalgia Decisions
We analyzed 8,073 published Board decisions involving fibromyalgia for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 60.7%. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Board Grants on This Pairing, Dissected
The Board has granted service connection for fibromyalgia as secondary to PTSD in several published decisions. In each case, the veteran already had a service-connected PTSD diagnosis, and the fight came down to whose medical opinion the Board found more convincing. Remember that these decisions are not binding precedent on any other veteran's claim. They simply show how the Board has weighed similar evidence in the past.
Private opinion beats VA exam that ignored the aggravation question Citation A26022394 (March 12, 2026), Direct Review docket
The record: A private clinician gave an opinion that the veteran's service-connected PTSD contributed to her fibromyalgia, reasoning that stress is a trigger for fibromyalgia and PTSD increases stress. The VA examiner agreed the veteran had fibromyalgia but said it was less likely than not related to PTSD, based mainly on a 15 year gap between service and diagnosis. The VA examiner also criticized the private opinion for not giving an "exact timeline" of onset.
Why it won: The Board found the VA opinion inadequate. It said the 15 year gap did not answer the real question, whether PTSD caused or aggravated the fibromyalgia, and the VA examiner never addressed aggravation at all, which was the private clinician's actual theory. The Board wrote that the VA opinion was given "no probative value" and called the private opinion persuasive even though its rationale was "somewhat limited."
Two positive opinions outweigh a general causation dispute Citation A25087462 (October 9, 2025), Direct Review docket
The record: A private clinician stated that psychological stress worsens fibromyalgia and that the veteran's stress was "very possible and even likely" a primary reason for her worsening condition. A VA examiner, addressing a different question, still wrote that fibromyalgia's environmental triggers may include "mental health problems, such as anxiety or depression."
Why it won: The Board found the evidence was "in at least approximate balance" on whether fibromyalgia was proximately due to PTSD, and used the benefit of the doubt rule to grant the claim. The Board noted that VA's burden of proof only requires an approximate balance of evidence, not a tie.
VA examiner's own literature review supported the veteran's claim Citation A25038806 (April 28, 2025), Evidence Submission docket
The record: A VA doctor reviewed the file and, while rejecting a toxic exposure theory, concluded fibromyalgia was "most likely caused and aggravated by emotional stressors" and specifically named PTSD as the most likely contributing factor. He cited medical literature on emotional stressors triggering fibromyalgia. A private physician's March 2022 opinion and a January 2020 VA psychiatric exam supported the same relationship.
Why it won: The Board called the VA examiner's positive nexus opinion "very well-explained" even though he was only asked about direct service connection. It found the opinion consistent with the rest of the record and persuasive under Prejean v. West, which looks at whether the examiner reviewed the records and gave adequate rationale.
Primary care provider's diagnosis outweighs a VA examiner who reversed himself Citation A24066547 (October 17, 2024), Direct Review docket
The record: A VA examiner first diagnosed fibromyalgia, then filed two later opinions saying the veteran did not actually meet the diagnostic criteria. The veteran's primary care provider wrote that the veteran had "all the characteristic symptoms of" fibromyalgia after extensive work up ruled out other causes. The same VA examiner had also stated, in the original report, that fibromyalgia is "one of the associated conditions of PTSD."
Why it won: The Board found the diagnosis question in equipoise and resolved it for the veteran, citing Lynch v. McDonough for the rule that evidence only needs to be in approximate balance, not exact equipoise. Once a diagnosis was established, the Board held the VA examiner's earlier statement linking fibromyalgia to PTSD "remains valid" and was highly probative.
Cited medical literature applied to the veteran's own facts wins out Citation A24047517 (August 19, 2024), Direct Review docket
The record: Three VA opinions conflicted. One VA examiner said fibromyalgia and PTSD were "not medically related" but cited no literature. A second VA examiner found a positive link, citing a study showing PTSD symptoms often precede chronic widespread pain and applying that study directly to the veteran's history. A third VA addendum opinion tried to walk the finding back but relied on speculative language.
Why it won: The Board rejected the first and third opinions as inadequate, noting that speculative wording like "may play a role" is insufficient under Polovick v. Shinseki. The Board found the second opinion adequate because the examiner did not rely on speculation and applied the cited study "specifically to the Veteran's circumstances."
What the Board Said in Recent Grants
These are the Board's own words, quoted from the findings in 5 recent granted decisions on this pairing. Each sentence is the finding the grant rested on, not a summary of it. Click a citation to read the full decision.
“Resolving all reasonable doubt in the Veteran's favor, it is at least as likely as not that her fibromyalgia was aggravated by her service-connected PTSD.”
“The evidence is in at least approximate balance as to whether the Veteran's diagnosed fibromyalgia is proximately due to her service connected PTSD”
“The Veteran has a current diagnosis of fibromyalgia that is at least as likely as not caused by her service-connected posttraumatic stress disorder (PTSD)”
“The Veteran's fibromyalgia was caused or aggravated by the Veteran's service-connected PTSD.”
“The competent evidence of record persuasively establishes that the Veteran's current diagnosis of fibromyalgia is likely due to her service-connected PTSD.”
Quoted from published Board decisions on this pairing, most recent first. Descriptive of the published record, not a prediction about any individual claim. Search the full decisions in BVA Decision Search.
Why VA Denies, and How the Board Answered
The rationales below are the ones VA examiners actually used against this pairing in the published record, each paired with the Board's response.
- Read the left column first: if a VA opinion in your file uses one of these arguments, that is the reasoning your own evidence has to meet.
- The right column is the counter: it shows how the Board actually answered that argument, with the decision cited.
- A rationale appearing here is not a verdict: the same argument won some cases and lost others, on different records.
| VA examiner's rationale | How the Board answered it |
|---|---|
| Fibromyalgia and PTSD are "not medically related," described as entirely separate conditions | The Board found this conclusion undermined by the medical literature in the same file and gave the opinion no probative weight because the examiner cited no literature despite claiming to have reviewed some (23026954, 2023) |
| No statistically significant evidence links PTSD and fibromyalgia, even though the two are "comorbid conditions" with common antecedent traumatic experiences | The Board found this opinion persuasive where it was based on accurate facts and supported by adequate rationale, and it outweighed the veteran's lay belief about onset (23026954, 2023) |
| Fibromyalgia affects PTSD, but the relationship does not run the other way, so PTSD is not a causative factor for fibromyalgia | The Board gave this opinion high probative weight because it was based on review of records and medical literature and contained adequate rationale (20079404, 2020) |
| Medical literature shows only an "association" between PTSD and fibromyalgia, not proof of a causative effect, and literature still lacks strong clinical evidence for a causal link | The Board found this opinion persuasive and gave it great probative value, noting it adequately addressed the favorable evidence, including comorbidity literature the veteran raised (1617548, 2016) |
| No current diagnosis of fibromyalgia exists in the file, so there is no disability to service connect | The Board agreed there was no valid diagnosis of record and denied the claim on that basis, without reaching the nexus question (9905957, 1999); (1240959, 2012) |
If Granted: How Fibromyalgia Is Rated
The VA assigns one of these percentages based on what your medical record documents. Plain-language summary of the rating criteria at 38 CFR; the controlling text is the regulation itself.
| Rating | What the record has to show for DC 5025, Fibromyalgia |
|---|---|
| 40% | Your fibromyalgia symptoms must be present almost all the time and don't get better even with medical treatment. The pain, fatigue, and other symptoms are essentially constant (refractory means they don't respond to or improve with therapy, medications, or other treatments your doctor has tried). |
| 20% | Your fibromyalgia symptoms come and go in episodes (flare-ups), and these flare-ups are often triggered by things like stress, weather changes, or doing too much physical activity. However, you experience these painful episodes more than one-third of the time - meaning if you track your symptoms over several months, you're having fibromyalgia pain and other symptoms for more days than you're symptom-free. |
| 10% | You need to take medication every day without breaks to manage your fibromyalgia symptoms. This includes prescription pain relievers, muscle relaxants, anti-inflammatory drugs, or other medications that your doctor has prescribed specifically to control the widespread pain, stiffness, and other effects of fibromyalgia. The key requirement is that you cannot go without this medication - you must take it continuously to keep your condition under control. |
Do's and Don'ts
Every item below comes from a pattern in the decisions on this pairing, not from general claim advice.
- Get a clear current diagnosis first: Several denials failed simply because the record never contained a definite fibromyalgia diagnosis. Make sure your file has one before anything else.
- Ask your doctor to address aggravation, not just direct cause: Grants often turned on aggravation of fibromyalgia by PTSD, a question VA examiners sometimes skipped entirely.
- Look for an opinion that cites actual medical literature and applies it to your case: The Board favored opinions that named specific studies and explained how they fit the veteran's own history.
- Keep records from a treating provider with a long history with you: The Board gave extra weight to providers who had treated the veteran over time, compared to one-time examiners.
- Point out when a VA opinion contradicts the file's own literature: In more than one case, the Board rejected VA opinions that were undercut by studies already in the claims file.
- Don't rely only on a gap in time between service and diagnosis: The Board rejected VA reasoning based mainly on a 15 year gap when the real question was aggravation by an already service-connected condition.
- Don't submit general medical articles without a doctor connecting them to your specific case: The Board gave low weight to treatises and buddy statements that only described a general correlation between PTSD and fibromyalgia.
- Don't expect your own lay statements to establish a diagnosis or medical cause: The Board repeatedly found veterans not competent to diagnose fibromyalgia or explain its cause themselves.
- Don't assume speculative words like "may play a role" will support a denial or a grant: The Board treated this kind of hedging language as inadequate.
- Don't ignore a request from VA for more information: In one case a veteran's claim was denied in part because he failed to respond to a request to clarify which joints were affected.
Quick Checklist Before You File
- Service connection already in place for PTSD, and a current medical diagnosis of fibromyalgia.
- Diagnostic testing, imaging, or clinical records documenting the fibromyalgia, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with fibromyalgia, stating it is at least as likely as not caused or aggravated by the PTSD, and naming the mechanism rather than just the conclusion.
- Lay statements: spouse, family, friends, or battle buddies describing what they've witnessed or noticed.
- Your STRs and any VA opinions already in the file on either condition. If a VA opinion already went against you, your submitted opinion or statement should address its specific reasoning.
For the mechanics of filing itself, see the Standard Claim Guide and the Fully Developed Claim Guide.
The Claims Process, Step by Step
A secondary claim moves through the same pipeline as any other. Understanding who does what helps you know who to contact and what to expect.
- You file the claim, naming PTSD as the service-connected primary and fibromyalgia as secondary. Directly with VA, through VA.gov, or with an accredited representative's help.
- VA assigns a Veteran Service Representative (VSR) to develop the claim: gather your service treatment records, VA and private medical records, and order a C&P exam if needed.
- The C&P exam is conducted, usually with the examiner asked to address the specific secondary theory (causation and aggravation both).
- The file goes to a Rating Veteran Service Representative (RVSR), the "rater," who weighs the medical evidence and decides service connection and, if granted, the rating percentage.
- VA issues the decision letter stating the outcome and the reasoning.
- If denied or under-rated, you choose an appeal lane, Supplemental Claim, Higher-Level Review, or a Board appeal, covered below.
Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner
Your VSO
An accredited representative, agent, or attorney. Not a VA employee. Helps prepare and file, and can represent you on appeal. Has no authority to decide your claim.
VSR
VA staff who develops the claim: gathers records and schedules the exam. Does not decide the rating.
Rater (RVSR)
VA staff who reviews the complete file and makes the actual decision on service connection and percentage.
C&P Examiner
Conducts the exam and, where asked, gives a nexus opinion. Does not decide the claim, but the opinion's reasoning and legal framing carry real weight.
For the full walkthrough, see Inside Your Claim and Claim Stages.
DBQs and Your C&P Exam
A Disability Benefits Questionnaire (DBQ) is the standardized form the examiner completes for your condition. See the DBQ Guide for how these forms work and whether a private DBQ from your own doctor can be submitted instead of relying solely on a VA exam. For what to expect and how to prepare, see the C&P Exam Prep Guide, and be specific about how your fibromyalgia symptoms relate to your PTSD timeline, treatment, and any aggravation, that is the detail a nexus opinion relies on.
Reading Your Decision Letter, and What to Do If Denied
Your decision letter has a narrative "reasons and bases" section and a codesheet with the rating and effective date. See the Reading Your Decision Letter Guide or use the Letter Interpreter tool to decode your own letter. If denied, you have three main lanes:
- Supplemental Claim: refile with new and relevant evidence, such as a nexus opinion that addresses the mechanism and the specific VA rationale you're rebutting. See Supplemental Claim Guide.
- Higher-Level Review (HLR): a senior reviewer looks at the same evidence again, useful if the denial rested on a legal error. See HLR Guide.
- Board Appeal: your case goes to a Veterans Law Judge, with a direct review, evidence, or hearing docket. See Board Appeal Guide.
Not sure which lane fits? See the Appeals decision guide for a side-by-side comparison.
After You Win: Maintaining Your Rating
Keep documentation of ongoing treatment, follow-up evaluations, and any updated diagnostic testing for your fibromyalgia on file, this protects you if VA schedules a future reexamination. See Protect Your Rating for when a rating becomes protected and Future Reexaminations for what triggers one. If your fibromyalgia worsens, see the Rating Increase Guide.
Frequently Asked Questions
Does PTSD have to be highly rated to support a fibromyalgia secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected PTSD caused or aggravated the fibromyalgia, not at how severe the PTSD rating is. Even a 0% service-connected primary can anchor a secondary claim.
What do the percentages on this page mean?
They are the historical outcomes of 174 published Board decisions on this exact pairing: 32% granted, 28% denied, 39% remanded. They describe decided appeals already on record. They do not predict what would happen in any individual case.
RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.