Fibromyalgia and PTSD: Nexus Letters for Fibromyalgia

Author: Jessica R. Allen, M.D. | Physician and Former C&P Examiner

For many veterans, chronic pain is just one part of the daily struggle after service. If you’ve been diagnosed with Fibromyalgia and also live with Posttraumatic Stress Disorder (PTSD), you may be wondering: Is there a connection between the two?

The answer is yes, and understanding that connection is critical for filing a strong VA disability claim. In this post, we’ll explain the link in simple terms, go over VA ratings, and explain how a fibromyalgia nexus letter can help prove your case.

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What Is Fibromyalgia and How Does It Relate to PTSD?

Fibromyalgia is a condition that causes widespread pain, along with fatigue, sleep problems, and memory issues. It is what doctors call a central sensitivity syndrome, meaning the brain and spinal cord become more sensitive to pain signals.

Think of it like this

Your body has a volume knob for pain. In fibromyalgia, that knob is turned way up. Even small touches, stress, or poor sleep can feel overwhelming.

Now imagine adding PTSD into the mix. PTSD affects your brain’s stress system—your alarm bell. In PTSD, that bell is stuck in the on position. The stress from PTSD can turn up the pain knob even more, making your symptoms worse.

What Does the Research Say?

Studies have shown a clear link between trauma, PTSD, and fibromyalgia:

• A 2017 article in Current Rheumatology Reports found that PTSD is strongly associated with fibromyalgia and may contribute to its development through abnormal pain processing and increased stress sensitivity.
• A 2022 review in Frontiers in Psychiatry noted that veterans with PTSD are at higher risk of developing fibromyalgia than the general population.

How Is Fibromyalgia Diagnosed?

Doctors use criteria from the American College of Rheumatology to diagnose fibromyalgia. Key features include:

• Widespread pain on both sides of the body and above and below the waist for at least 3 months
• Tender points or generalized pain in multiple areas
• Other symptoms like fatigue, nonrestorative sleep, and cognitive difficulty (sometimes called "fibro fog")
• No other underlying medical condition that better explains the symptoms

VA Ratings for Fibromyalgia

The VA rates fibromyalgia under 38 C.F.R. § 4.71a, Diagnostic Code 5025. Fibromyalgia is rated on widespread musculoskeletal pain with tender points, and the rating depends on how constant and treatment-resistant your symptoms are:

Rating	Criteria
10%	Symptoms that require continuous medication for control.
20%	Symptoms that are 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%	Symptoms that are constant, or nearly so, and refractory to therapy.

Note: Associated mental health conditions such as depression or anxiety may be separately rated when they are separately diagnosed, in addition to any schedular rating for fibromyalgia itself.

Fibromyalgia may be directly service-connected or claimed as secondary to PTSD if properly supported by the medical evidence.

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What Is a Nexus Letter—and Why Do You Need One?

A nexus letter is a medical opinion written by a qualified provider—often a psychiatrist, rheumatologist, or pain specialist—that explains how your fibromyalgia is "at least as likely as not" caused or aggravated by your service-connected PTSD.

What Makes a Nexus Letter Exceptional?

A strong nexus letter should:

• Clearly state the medical opinion using the VA’s required legal language ("at least as likely as not")
• Include a review of your medical records and symptom history
• Explain the pathophysiological link between PTSD and fibromyalgia (for example, how trauma dysregulates the stress response and increases pain sensitivity)
• Reference peer-reviewed medical literature
• Be authored by a qualified medical professional with expertise in both PTSD and chronic pain disorders

A weak or inadequate nexus letter often:

• Contains only a one-line statement with no explanation
• Doesn’t show review of your medical history
• Lacks citations or medical reasoning
• Comes from a provider with little relevant experience

Why a Psychiatrist Is the Right Person to Help

As a psychiatrist and former C&P examiner, I understand both the mental health aspects of PTSD and how chronic pain conditions like fibromyalgia emerge and interact with trauma. Learn more about our team on the about us page. I specialize in writing thorough, evidence-based nexus letters that help veterans present the strongest possible case for the benefits they may be entitled to.

Ready to Move Forward?

If you believe your fibromyalgia is related to your PTSD, you may be eligible for a secondary service connection—but you’ll need the right evidence. Learn more about the full range of nexus letters we write for veterans.

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