Fibromyalgia

There are 953 fibromyalgia cases in my BVA dataset. The denial rate is 53.5%. Meaningfully above the 42.0% BVA overall denial rate, and high enough that fibromyalgia ranks among the harder conditions to get service-connected at the Board. The single biggest reason is the diagnosis problem. Of the 510 denied cases, 180, about 35%, were denied because the Board concluded a clinical diagnosis of fibromyalgia wasn't adequately established. That's a structural feature of how fibromyalgia is diagnosed, not a quirk of the dataset.

But the more interesting finding sits next to that one. Of the 953 cases, 290, almost a third, invoke the Gulf War presumption under 38 CFR § 3.317. And the presumptive lane in this dataset grants at 43.6%, compared to direct connection at 27.6%. The 16-point gap is the structural advantage Congress wrote into the Gulf War statute, and most veterans with qualifying service under 38 USC § 1117 who file fibromyalgia under direct connection are giving up that advantage.

I want to walk through what 953 cases say about why the diagnosis is the wall, how the Gulf War presumption changes the math, why DC 5025 creates a structural 40% ceiling that affects almost every granted case, and where the TDIU bridge lives for veterans whose fibromyalgia is more disabling than the schedule allows the rating to recognize.

TL;DR

• Fibromyalgia grants at 23.2% across 953 BVA cases, well below the 30.6% overall BVA average. Denial rate at 53.5% is unusually high. Remand rate at 23.3%.
• Diagnosis missing is the wall. 180 of 510 denials (35%) are coded "diagnosis missing." Fibromyalgia diagnostic criteria are specific, and many C&P exams don't apply them.
• The Gulf War presumption under 38 CFR § 3.317 is the headline. 290 cases invoke it. Presumptive grant rate runs 43.6% versus direct at 27.6%.
• DC 5025 has only three tiers: 10%/20%/40%. The 40% rating is the schedular ceiling. There is no 50%, 60%, 80%, or 100% under this diagnostic code. 104 of the granted cases land at 40%.
• The strong-nexus grant rate is 92.0%. The weak-nexus and missing-nexus grant rates are both 0.0%. Same absolute cliff I see in most conditions.
• TDIU under 38 CFR § 4.16 is the bridge from 40% schedular to 100% paid for veterans whose fibromyalgia prevents substantially gainful employment.

953 Cases. and a 53.5% Denial Rate

The first thing the data tells me about fibromyalgia is that it's one of the harder conditions to get service-connected at the BVA. The outcome split:

• Granted: 221 cases (23.2%)
• Denied: 510 cases (53.5%)
• Remanded: 222 cases (23.3%)

The denial rate is 11.5 points above the 42.0% BVA overall average. The grant rate is 7.4 points below the 30.6% average. The remand rate is roughly average. So fibromyalgia is producing more denials and fewer grants than the typical condition, with the gap concentrated on the denial side rather than the remand side.

That distribution tells you something about why these claims fail. Remands happen when the Board thinks the case can be saved with more development: better C&P exam, more records, a fresh opinion. When the Board denies instead of remanding, it's usually because the structural defect in the file isn't fixable with more development. The most common structural defect, in this dataset, is that the diagnosis of fibromyalgia itself isn't adequately established.

Looking at the denial reasons:

• Diagnosis missing: 180 cases (35% of denials, by far the largest single bucket)
• Severity insufficient: 56 cases
• Other: 54 cases
• Nexus gap: 44 cases
• Service connection missing: smaller numbers

For most conditions, "nexus gap" is the dominant denial reason. For fibromyalgia, it's tied for third. The dominant reason is "diagnosis missing," which is unusual and worth unpacking.

The Diagnosis Wall: Why 180 Cases Failed Before the Nexus Analysis

Fibromyalgia is diagnosed clinically, not by lab tests or imaging. The 2010 American College of Rheumatology criteria (and the 2016 revisions) require a combination of:

• Widespread pain across specific body regions
• Symptom severity in fatigue, cognitive symptoms, and unrefreshing sleep
• Duration of at least three months
• Exclusion of other disorders that could otherwise explain the pain

Earlier criteria from 1990 required tender point examination (11 of 18 specified tender points painful on palpation). The newer criteria moved away from the tender point exam toward a widespread pain index and symptom severity score. Either set of criteria can support a clinical diagnosis, but both require specific evaluation steps.

In my dataset, the 180 diagnosis-missing denials are mostly cases where the Board found the C&P examiner or other evaluating clinician didn't apply formal fibromyalgia criteria. The chart entries that read "diffuse musculoskeletal pain, etiology unclear" or "fibromyalgia by history, criteria not documented" don't establish the diagnosis to the standard the rating schedule requires. The Board's position in these cases is consistent: without a clinically supported diagnosis of fibromyalgia, the rating schedule for fibromyalgia doesn't apply.

The pattern I see in granted cases is the opposite. The strongest fibromyalgia files include a rheumatology consultation where the diagnosis was made by a specialist using the formal criteria, with documentation of the widespread pain distribution, the tender point exam findings (if pre-2010 criteria are being applied) or the widespread pain index score (if post-2010 criteria are being applied), the duration of symptoms, and the exclusion of competing diagnoses like rheumatoid arthritis, lupus, polymyalgia rheumatica, or hypothyroidism.

The takeaway is that the rheumatology workup matters more for fibromyalgia than for most conditions. A C&P examiner, usually a generalist, who doesn't apply the diagnostic criteria isn't going to produce a file that survives at the Board. A rheumatologist consultation that documents the criteria-based diagnosis is what unlocks the rating analysis.

For veterans who have a working fibromyalgia diagnosis from primary care but no rheumatology workup, the diagnostic foundation is fragile. The 180 denied cases in my dataset are the visible artifact of that fragility.

The Gulf War Presumption Under 38 CFR § 3.317

Here's where the framework gets interesting, and where most of the path-of-least-resistance grant cases are coming from.

In 1994, Congress recognized the connection between Gulf War service and a cluster of unexplained chronic symptoms in veterans returning from Southwest Asia. The statute (38 USC § 1117) and the implementing regulation (38 CFR § 3.317) created a presumptive framework commonly called "Gulf War illness." It covers undiagnosed illnesses and medically unexplained chronic multisymptom illnesses for veterans with qualifying service in the Southwest Asia theater or one of the additional locations now named in § 1117.

VA's June 10, 2003 final rule at 68 FR 34539 implemented Public Law 107-103 by adding fibromyalgia to the list of qualifying medically unexplained chronic multisymptom illnesses under § 3.317(a)(2)(i)(B). The other listed conditions are chronic fatigue syndrome and irritable bowel syndrome. All three are presumptive for veterans with qualifying service.

For fibromyalgia under the Gulf War presumption, the requirements are:

• Qualifying service during the Gulf War under 38 USC § 1117, including the Southwest Asia theater and the additional statutory locations
• A clinical diagnosis of fibromyalgia (this is where the diagnosis problem reappears)
• Objective indications of the disability and the required six-month chronicity
• Manifestation to any degree at any time under the current text of 38 USC § 1117. The eCFR text for § 3.317 still carries the older 10-percent/December 2026 language, but the later statute controls that conflict.

The qualifying service area covers Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the UAE, Oman, the Gulf of Aden, the Gulf of Oman, the waters of the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above those locations. The PACT Act amended § 1117 to add Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan. Do not substitute the different location lists used for other PACT Act toxic-exposure presumptions.

In my dataset, 290 fibromyalgia cases invoke the Gulf War presumption. That's almost a third of the entire subset. Smaller categories:

• Burn pit: 63 cases (often overlapping with Gulf War service)
• Camp Lejeune: 8 cases (rare for this condition)

The grant rates by connection type:

• Direct service connection: 392 cases, 27.6% grant rate
• Presumptive service connection: 188 cases, 43.6% grant rate
• Secondary service connection: 100 cases, 31.0% grant rate
• Aggravation: small sample

The presumptive lane runs 16 points higher than direct. That's a meaningful structural advantage, and it's the lane most fibromyalgia veterans should be filing under if their service makes them eligible. The catch, and there's always a catch, is that the diagnosis problem doesn't go away under the presumption. The Gulf War presumption removes the nexus requirement, but the veteran still has to establish a clinically supported diagnosis of fibromyalgia. The same 180 diagnosis-missing denials apply across both direct and presumptive cases.

For veterans with qualifying service under § 1117 who haven't filed under the presumption, the lane switch is the single highest-yield decision in the entire claim. Filing direct when you qualify for presumptive is leaving the structural advantage on the table.

DC 5025: Three Tiers, 40% Ceiling

The three tiers and what they require

Once fibromyalgia is service-connected, the rating mechanics are unusually constrained. The rating code is 38 CFR § 4.71a Diagnostic Code 5025, and the entire ladder runs:

• 10%: That which requires continuous medication for control
• 20%: That which is episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time
• 40%: That which is constant, or nearly so, and refractory to therapy

That's it. There is no 30%, no 50%, no 60%, no 80%, no 100% under DC 5025. The schedule tops out at 40%.

Rating-tier distribution among grants

In my dataset, the granted rating tier distribution looks like:

• 10%: 25 cases
• 20%: 23 cases
• 40%: 104 cases (the modal tier by a wide margin)

The 40% rating is the most common landing spot for granted fibromyalgia cases. That makes sense once you understand the schedular structure. The 10% tier requires continuous medication. The 20% tier requires episodic exacerbations more than one-third of the time. The 40% tier requires constant or near-constant symptoms refractory to therapy. Many veterans with chronic fibromyalgia satisfy the highest tier's criteria, and there's no schedular landing above it.

For a single veteran in 2026:

• 10%: $175.51 per month, $2,106 per year
• 20%: $346.95 per month, $4,163 per year
• 40%: $774.16 per month, $9,290 per year

The jump from 10% to 40% is roughly $7,200 per year, tax-free. The jump from 40% to 100% schedular doesn't exist for fibromyalgia alone. There is no path under DC 5025 to 60%, 80%, or 100%.

Read that again. A veteran with severe, debilitating fibromyalgia that prevents employment maxes out at 40% under the schedule. The same veteran with severe, debilitating PTSD maxes out at 100% under § 4.130. The schedular treatment of these two conditions is structurally different, and it reflects choices Congress and VA made about how to compensate fibromyalgia specifically.

The implication is that the rating ceiling for fibromyalgia isn't actually 40%. It's whatever the combined rating from fibromyalgia plus other service-connected conditions adds up to, and whatever TDIU the veteran can establish if employment is precluded. The 40% under DC 5025 is the structural cap on the fibromyalgia rating itself, not the cap on what the veteran can be compensated for if the picture is more disabling than the schedule allows.

Why 40% Is the Modal Rating

The 40% tier under DC 5025 is the most common granted rating, and the dataset shows why with unusual clarity.

The 10% tier requires continuous medication for control. The 20% tier requires episodic exacerbations more than one-third of the time. The 40% tier requires constant or near-constant symptoms that are refractory to therapy. The dividing line between 20% and 40% is whether the symptoms are present "more than one-third of the time" or "constant or nearly so."

In practice, fibromyalgia rarely has a one-third-of-the-time presentation. The condition is, by definition, chronic and widespread. Patients with diagnosed fibromyalgia who are sick enough to file a VA claim are usually experiencing daily or near-daily pain, fatigue, and cognitive symptoms. The clinical reality matches the 40% criterion more often than it matches the 20% criterion.

The "refractory to therapy" element is what makes the 40% tier sometimes contested. The Board's reading of "refractory" has been generally consistent: it doesn't mean the patient has tried every conceivable treatment without effect. It means the symptoms persist despite reasonable treatment attempts. Patients who have tried multiple modalities (medications, physical therapy, exercise programs, sleep hygiene, cognitive-behavioral therapy) and continue to have constant or near-constant symptoms usually clear the refractory bar.

The cases that land at 20% rather than 40% are usually cases where:

• The medical records show good control of symptoms on a stable medication regimen
• The episodic nature of the symptoms is documented in the chart
• The veteran's own statements describe periods of relative wellness alternating with flares
• The clinician characterizes the condition as "stable" or "controlled"

The cases that land at 40% are usually cases where:

• The medical records show daily or near-daily symptom burden
• Multiple treatment modalities have been tried with limited effect
• The veteran's statements describe chronic baseline pain and fatigue with flares on top
• The clinician characterizes the condition as "refractory" or "treatment-resistant"

The documentation language matters. The Board is reading the same chart phrases the clinician wrote, and "constant pain refractory to therapy" produces a different rating than "stable on current regimen with episodic flares."

The Strong-Nexus Cliff: 92% vs 0%

When the case isn't presumptive and the veteran is on the direct path, the entire claim depends on the nexus opinion. The nexus quality breakdown for fibromyalgia cases:

• Strong nexus: 75 cases, 92.0% grant rate
• Adequate nexus: 179 cases, 64.2% grant rate
• Weak nexus: 178 cases, 0.0% grant rate
• Missing nexus: 192 cases, 0.0% grant rate
• Not applicable: 329 cases, 11.2% grant rate (this captures most of the presumptive cases and others where nexus analysis didn't drive the outcome)

The strong-versus-weak gap is 92 percentage points. The strong-versus-missing gap is 92 percentage points. The weak-nexus and missing-nexus categories grant at zero.

What separates strong from weak in fibromyalgia cases:

• Strong nexus opinions are written by a rheumatologist or other specialist with relevant expertise, walk through the application of formal diagnostic criteria, identify the specific in-service exposure or event that triggered the condition (often a documented Gulf War exposure or a specific in-service injury), address competing diagnoses and exclude them, cite the medical literature on environmental triggers for fibromyalgia, and arrive at an "at least as likely as not" or stronger conclusion with clear reasoning.
• Weak nexus opinions are written by a generalist provider without rheumatology expertise, state conclusions without showing diagnostic reasoning, fail to address whether formal criteria were applied, ignore competing diagnoses, or rely on generic statements about service.

The pattern parallels what I've seen in kidney disease and other conditions where the medical opinion is structurally load-bearing. When the opinion is strong, the case grants almost always. When the opinion is weak, the case essentially never grants.

For veterans on the direct path, meaning veterans without qualifying service under § 1117, the rheumatology opinion is the case. There's no fallback presumptive lane to absorb the weakness in the nexus.

The TDIU Bridge from 40% to 100%

Because DC 5025 caps schedular fibromyalgia at 40%, the path to 100% compensation for severely disabled fibromyalgia veterans runs through Total Disability Individual Unemployability (TDIU) under 38 CFR § 4.16.

TDIU pays at the 100% schedular rate even when the schedular rating itself is lower, provided two things are true:

• The veteran has a single disability rated at 60% or more, OR multiple disabilities with at least one rated at 40% or more and a combined rating of at least 70%
• The veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities

For a veteran with 40% fibromyalgia and nothing else, the single-disability TDIU eligibility threshold (60%) isn't met. But fibromyalgia rarely shows up alone in a veteran's claim file. The combined rating analysis often includes other service-connected conditions, mental health (anxiety, depression, PTSD), other musculoskeletal conditions, sleep disorders, headaches, and the combined rating frequently clears the 70% threshold for two-or-more-disability TDIU.

The substantially-gainful-employment analysis is the second prong, and it's where fibromyalgia-driven TDIU claims either succeed or fail. The Board has been consistent that "substantially gainful" means employment that earns more than the federal poverty threshold. Marginal employment, sheltered employment, and employment that pays below poverty don't count against TDIU eligibility.

For fibromyalgia specifically, the TDIU argument tends to focus on:

• Inability to maintain consistent work attendance due to flares
• Cognitive symptoms ("fibro fog") that prevent jobs requiring concentration
• Pain that prevents physical work
• Fatigue that prevents extended shifts
• The combined effect of fibromyalgia plus other service-connected conditions

A vocational rehabilitation specialist opinion is often the strongest evidence for the substantial-gainful-employment prong. A vocational expert who reviews the veteran's medical records, work history, education, and current functional limitations can produce an opinion stating that no substantially gainful occupation is available to a veteran with these specific limitations.

The 2026 financial gap between 40% and 100% paid (which is what TDIU produces) is meaningful:

• 40% schedular: $774.16 per month
• 100% schedular or TDIU: $4,044.91 per month

The difference is $3,270 per month, or roughly $39,250 per year, tax-free. For a fibromyalgia veteran whose symptoms genuinely prevent work, the TDIU pathway is where the compensation actually matches the disability.

What I Can't Tell You From This Data

There are real limits on what 953 BVA cases can teach you about your specific claim.

I can't tell you whether you qualify for the Gulf War presumption under 38 USC § 1117 and 38 CFR § 3.317. The list of qualifying locations and the Persian Gulf War period are specific, and the PACT Act amended the statute. Service in Iraq during Operation Desert Storm clearly qualifies. Afghanistan is now named in the statute, but the exact service dates and character of service still need to be verified. Service in adjacent regions sometimes does and sometimes doesn't qualify under this framework. Check the full statutory text rather than borrowing a location list from a different PACT Act presumption.

I can't tell you whether your fibromyalgia diagnosis will survive scrutiny at the Board. The diagnostic criteria are clinical and require specific evaluation steps that many C&P examiners and primary care providers don't apply. Whether your current documentation will hold up depends on the specific chart language, the specialist consultation history, and the C&P examiner who evaluates the case.

I can't tell you which of the three rating tiers under DC 5025 your symptoms will match. The dividing line between 20% and 40% turns on whether your symptoms are "constant or nearly so" and "refractory to therapy" versus "episodic with exacerbations more than one-third of the time." The same patient can clear either threshold depending on how the medical records characterize the chronicity and treatment response.

I can't tell you whether you'll qualify for TDIU based on fibromyalgia alone. TDIU eligibility depends on your combined service-connected ratings, your employment history, your education, your vocational background, and the substantial-gainful-employment analysis. Aggregate fibromyalgia data can't resolve those questions.

I can't tell you why the diagnosis-missing denial rate is so high. The structural feature is clear in the data, 180 of 510 denials, 35% of denials. The proximate cause is that C&P examiners often don't apply formal diagnostic criteria. But the deeper question of why VA's exam infrastructure produces this pattern isn't something the aggregate data can answer.

What the data can tell you is the structural shape of these claims at the Board. Diagnosis is the wall. The Gulf War presumption is the headline lever. The 40% ceiling is the structural cap. The TDIU bridge is where severe cases find the 100% pay.

What it can't tell you is which side of those distributions your case will land on.

What Wins a Fibromyalgia Claim

Pulling the patterns together, the fibromyalgia claims that succeed at the Board usually have a few things in common.

A criteria-based diagnosis from a rheumatologist. This is the single most important variable. A diagnosis made by a specialist using formal criteria (1990 ACR tender point criteria or 2010/2016 ACR widespread pain index and symptom severity criteria), with documentation of the diagnostic process in the chart, is what gets past the diagnosis-missing wall. A "fibromyalgia by history" note in a primary care record isn't enough. A consultation note from a rheumatologist applying the criteria is.

Gulf War presumption invoked when applicable. If your service qualifies under 38 USC § 1117 and 38 CFR § 3.317, the presumptive lane in this dataset raises the grant rate from about 28% to about 44%. The presumption removes the traditional nexus requirement. The diagnosis and remaining framework requirements still apply, so the rheumatology consultation matters regardless of the lane.

Documented symptom chronicity and treatment refractoriness. The 40% tier under DC 5025 requires constant or near-constant symptoms refractory to therapy. The chart language matters. Records that show daily pain ratings, multiple medication trials, multiple non-pharmacologic interventions, and persistent symptom burden establish the refractory profile. Records that show stable symptoms on a single medication regimen establish a lower tier.

A strong nexus opinion for direct-connection cases. When the presumptive lane isn't available, the rheumatology opinion is the case. A 92% grant rate on strong-nexus cases versus 0% on weak-nexus cases is the cliff that defines this claim. The opinion needs to walk through the diagnostic process, identify the in-service trigger, exclude competing diagnoses, and arrive at an "at least as likely as not" conclusion with reasoning.

The TDIU file when applicable. For veterans whose fibromyalgia is genuinely disabling, the schedular 40% under DC 5025 doesn't capture the full picture. The TDIU file, vocational evidence, employment history, functional limitations from all service-connected conditions combined, is what bridges from 40% schedular to 100% paid. The fibromyalgia rating alone won't get you there, but fibromyalgia plus other service-connected conditions plus a substantial-gainful-employment analysis often will.

Secondary chains where applicable. Fibromyalgia often co-occurs with depression, anxiety, sleep disorders, and irritable bowel syndrome. Some of these may be separately compensable under their own diagnostic codes. The combined rating math from fibromyalgia plus secondary mental health conditions plus IBS (if Gulf War-presumptive) plus sleep apnea can build a combined rating that approaches the TDIU threshold without needing the substantial-gainful-employment finding.

None of this is a guarantee. The 23.2% overall grant rate is the same 23.2% regardless of how clean the file is. But the structural levers that move fibromyalgia outcomes, criteria-based diagnosis, presumptive lane, refractory documentation, strong nexus, TDIU bridge, are knowable, and the cases that grant tend to have them.

Bottom Line

Fibromyalgia is rated under 38 CFR § 4.71a, Diagnostic Code 5025, with only three tiers: 10%, 20%, and 40%. The 40% schedular ceiling means severe cases require TDIU under 38 CFR § 4.16 to reach 100% paid. The Board grants fibromyalgia at 23.2% across 953 cases, well below the 30.6% BVA overall average, and the dominant denial reason is "diagnosis missing," which accounts for 35% of denials (180 of 510). The diagnostic problem is structural: fibromyalgia requires criteria-based clinical diagnosis that many C&P examiners and primary care providers don't apply, and a rheumatology consultation is often the difference between a file that survives at the Board and one that doesn't. The Gulf War presumption under 38 USC § 1117 and 38 CFR § 3.317 is the most consequential lever in the entire framework. 290 cases invoke it, the presumptive grant rate is 43.6% versus 27.6% for direct connection, and fibromyalgia is specifically listed as a medically unexplained chronic multisymptom illness for veterans with qualifying § 1117 service. Strong nexus opinions grant at 92.0% and weak or missing nexus opinions grant at 0.0%. The cliff is absolute. The 40% tier is the modal granted rating (104 of 152 cases with a clear rating tier), and it reflects how often fibromyalgia presents as constant or near-constant symptoms refractory to therapy. For veterans whose fibromyalgia genuinely prevents substantially gainful employment, the TDIU pathway is the bridge from the schedular 40% ceiling to the 100% pay rate of $4,044.91 per month in 2026, about $3,270 per month more than the schedular 40% rate. The single most useful thing a veteran can do for a fibromyalgia claim is secure a rheumatology consultation with formal criteria-based documentation, because every other lever in the framework depends on that diagnostic foundation being solid.

Methodology and Limitations

• Data source: Statistics in this post are drawn from Claim Raven's analysis of 101,518 condition records drawn from 49,876 Board decisions, including 953 fibromyalgia cases. Outcomes within the fibromyalgia subset ran 23.2% granted, 53.5% denied, and 23.3% remanded. Rating criteria are paraphrased from 38 CFR § 4.71a Diagnostic Code 5025. Gulf War presumption rules are drawn from 38 USC § 1117 and 38 CFR § 3.317. TDIU framework is from 38 CFR § 4.16. 2026 VA disability compensation figures are for a single veteran with no dependents.
• Sample size: 953 fibromyalgia cases overall. Within that subset, connection-type identification was possible in 691 cases: direct (392), presumptive (188), secondary (100), and aggravation (small sample). The presumptive subset includes Gulf War (290 cases, the dominant pathway), burn pit (63), and Camp Lejeune (8), with some overlap. Diagnostic code distribution: DC 5025 (168 cases as primary code), 8850-5025 hyphenated combination (12), and smaller remainders.
• Classification approach: Cases coded as fibromyalgia based on condition extraction from BVA decisions. Nexus quality (strong, adequate, weak, missing, not applicable) is assigned by Claim Raven's analysis pipeline based on the language and substance of medical opinions in each case. Connection type reflects the theory of service connection the Board addressed, which may not always match the original claim theory at the regional office.
• Limitations:
• The "diagnosis missing" denial reason captures cases where the Board concluded the file lacked adequate evidence of a clinical fibromyalgia diagnosis. The dataset doesn't always distinguish between cases where no diagnosis was documented at all and cases where a diagnosis was documented but the Board found it insufficiently rigorous.
• The Gulf War presumption applies to veterans with qualifying service under 38 USC § 1117. The 290 cases invoking it are cases where the Board explicitly addressed the presumption, not every veteran who served during the Persian Gulf War period and has fibromyalgia.
• The 92.0% strong-nexus grant rate reflects 75 cases, which is a meaningful but not enormous sample. The 0.0% weak-nexus and 0.0% missing-nexus grant rates reflect 178 and 192 cases respectively, which are more substantial samples.
• Rating tier distribution (10%, 20%, 40%) reflects the cases where the tier was specifically discussed in the BVA decision. Many BVA cases focus on service connection rather than rating tier, so the tier-distribution sample is smaller than the overall case count.
• The TDIU pathway from 40% schedular to 100% paid depends on combined service-connected ratings and the substantial-gainful-employment analysis. The aggregate fibromyalgia data doesn't track TDIU outcomes separately, so the TDIU framing in this post is structural rather than empirical.
• The 1990 ACR tender point criteria and the 2010/2016 ACR widespread pain index criteria represent different clinical approaches to fibromyalgia diagnosis. Both can support a clinical diagnosis for VA purposes, but they produce different evaluation documentation. The dataset doesn't reliably code which criteria were applied in each case.
• Cases that made it to the BVA are not representative of all fibromyalgia claims. Many fibromyalgia claims are granted at the regional office or never appealed, and they don't appear in this dataset.
• These observations reflect patterns from BVA decisions. They are not predictions of individual outcomes.