Evidence Checklist: Fibromyalgia

Rheumatology evaluation documenting fibromyalgia diagnosisCritical

Evaluation by a rheumatologist applying ACR criteria: widespread pain index (WPI) >=7 and symptom severity scale (SSS) >=5, or WPI 4-6 and SSS >=9, persisting at a similar level for at least 3 months.

Nexus opinion linking fibromyalgia to service ("at least as likely as not")Critical

A medical opinion connecting your fibromyalgia to military service, including physical trauma, PTSD, TBI, or other service stressors. Fibromyalgia is frequently secondary to PTSD or TBI.

Tender point examination findings or widespread pain assessmentCritical

Documented findings from tender point survey or widespread pain assessment. Under the 2010 ACR diagnostic criteria, 18 tender points are no longer required, but documentation of widespread pain and symptom severity scale is essential.

Documentation of associated symptoms (fatigue, sleep disturbance, cognitive symptoms)

Medical records documenting fatigue, non-restorative sleep, cognitive difficulties ("fibro fog"), headaches, IBS, and other associated symptoms that affect the symptom severity scale score.

Treatment records (medications, physical therapy, pain management)

Records documenting treatment trials including duloxetine, milnacipran, pregabalin, physical therapy, cognitive behavioral therapy, and other interventions with response or lack thereof.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Personal statement describing symptoms and functional impact

Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.

Completed DBQ FibromyalgiaCritical

Standardized form capturing widespread musculoskeletal pain, tender point findings, and functional limitations. VA rates fibromyalgia under 38 CFR § 4.71a, DC 5025.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.