How the Board ruled on fibromyalgia claims, 2021–2025

Fibromyalgia (direct service connection)

Direct (began in or was caused by service), or theory not stated in the Board order

41.1% granted of 375 decided cases (margin of error 36.2–46.1%). 154 granted, 221 denied, 509 sent back to VA (remanded, not decided), 83 dismissed.

What convinced the Board in granted cases

• The Board gave a VA examiner's negative opinion little weight when it rested on silent service records, an incorrect fact, or was internally inconsistent, and in two cases favored a private opinion with a clear rationale. (4 of 12 decisions read; e.g. 21016106, 23006120, A25004296)
• For Gulf War veterans, fibromyalgia counts as a medically unexplained multi-symptom illness, so a current diagnosis plus Southwest Asia service was enough without a separate nexus opinion. (5 of 12 decisions read; e.g. 24009651, A25004296, 23055910)
• The veteran's own credible account of widespread pain starting in service and continuing since was given high weight, especially when it matched the medical records. (5 of 12 decisions read; e.g. A24005142, 21072150, A24047148)

Common reasons in denied cases

• Most denials turned on no current diagnosis of fibromyalgia. VA examiners found the criteria were not met, and no medical evidence showed otherwise. (9 of 13 decisions read; e.g. 21076405, A21015927, A25018063)
• The veteran's own belief that he or she had fibromyalgia, or that it came from service, was not competent medical evidence, and no medical opinion supported a link. (6 of 13 decisions read; e.g. 21006197, 21045834, A25009269)
• The pain was explained by something else, such as chemotherapy neuropathy or other service-connected conditions, or records placed its onset years after service. (4 of 13 decisions read; e.g. 21034231, A25008498, 21024260)

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Fibromyalgia (exposure claims)

Exposure (e.g. Agent Orange, Camp Lejeune, burn pits)

23.8% granted of 42 decided cases (margin of error 13.5–38.5%). 10 granted, 32 denied, 57 sent back to VA (remanded, not decided), 1 dismissed.

What convinced the Board in granted cases

• Most grants came through the Gulf War presumption: once fibromyalgia was diagnosed in a veteran who served in Southwest Asia, it counted as a chronic multi-symptom illness and no medical link to service was required. (4 of 6 decisions read; e.g. 22035455, 21074697, A21000207)
• Medical opinions mattered when the diagnosis or link was disputed. A private opinion with a rationale matched a contrary VA opinion, and a VA opinion that ignored a private fibromyalgia diagnosis got no weight. (3 of 6 decisions read; e.g. 24002859, A22010055, 21074697)
• The Board credited the veteran's own reports of widespread pain, stiffness, fatigue, and sleep problems as competent evidence of symptoms. (2 of 6 decisions read, few decisions; e.g. A21000207, 21022625)

Common reasons in denied cases

• The Board most often denied because there was no current fibromyalgia diagnosis. VA examiners found the criteria were not met, or that the pain came from other conditions such as arthritis or myofascial pain. (8 of 13 decisions read; e.g. 22010377, 23016463, 24008941)
• A private opinion lost out when the doctor reviewed only his own files and not the service records or claims file. A VA opinion that cited literature and went unrebutted carried significant weight. (2 of 13 decisions read, few decisions; e.g. A21009245, 21013288)
• The Board denied when only the veteran's own belief linked fibromyalgia to herbicide or other exposure, with no competent medical evidence of a connection. (2 of 13 decisions read, few decisions; e.g. 21051263, 21013288)

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Fibromyalgia secondary to any service-connected condition

Secondary (caused or worsened by a service-connected condition)

44.4% granted of 36 decided cases (margin of error 29.5–60.4%). 16 granted, 20 denied, 78 sent back to VA (remanded, not decided), 4 dismissed.

What convinced the Board in granted cases

• The Board granted when a medical opinion, often private, cited medical literature and applied it to this veteran, such as studies tying fibromyalgia to PTSD, endometriosis, or hepatitis C. (5 of 9 decisions read; e.g. A21001900, A24018516, 21028101)
• Negative VA opinions lost weight when they gave no adequate rationale, wrongly said there was no diagnosis, or contradicted the medical literature. (3 of 9 decisions read; e.g. A21017494, 24009991, A24018516)
• Most grants linked fibromyalgia to service-connected PTSD. (6 of 9 decisions read; e.g. 24009991, A24047517, 23010572)

Common reasons in denied cases

• The most common reason for denial was no valid current diagnosis: VA examiners found the symptoms did not meet fibromyalgia criteria or were explained by other conditions. (7 of 15 decisions read; e.g. 21000104, 21008933, 21073901)
• A thorough VA opinion that addressed both causation and worsening, and reviewed the record and literature, went unrebutted. (5 of 15 decisions read; e.g. 24005347, 21013133, 21025123)
• Other denials turned on the claimed primary condition not being service connected, or on a long gap after service that made the veteran's account of ongoing symptoms not credible. (2 of 15 decisions read, few decisions; e.g. A21004667, 21077384)

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Fibromyalgia secondary to PTSD

Secondary (caused or worsened by a service-connected condition)

Small sample: 10 decided cases, too few for a reliable percentage. 7 granted, 3 denied, 15 sent back to VA (remanded, not decided), 0 dismissed.

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