Chronic Widespread Pain
Gulf War service and PTSD/central-sensitization mechanisms associated with fibromyalgia and chronic widespread pain in veterans.
38 CFR diagnostic code 5025
Peer-reviewed evidence · 7 studies
Every one links to its record
Institute of Medicine (US) Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. The National Academies Press, Washington, DC; 2006. doi:10.17226/11729. Available at: https://doi.org/10.17226/11729.
Mohanty AF, Helmer DA, Muthukutty A, McAndrew LM, Carter ME, Judd J, Garvin JH, Samore MH, Gundlapalli AV. Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration. J Rehabil Res Dev. 2016;53(1):45-58. PMID:26934034. doi:10.1682/JRRD.2014.10.0265.
PMID 26934034Check the record (opens in a new tab)Blanchard M, Molina-Vicenty HD, Stein PK, Li X, Karlinsky J, Alpern R, Reda DJ, Toomey R. Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans. Am J Med. 2019;132(4):510-518. PMID:30576630. doi:10.1016/j.amjmed.2018.11.045.
PMID 30576630Check the record (opens in a new tab)
Key facts
- Diagnostic code
- 5025
- Verified studies
- 7
- Legal theories
- Direct (§ 3.303)
Peer-reviewed evidence (7)
The verified studies behind a Chronic Widespread Pain claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Institute of Medicine (US) Committee on Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Gulf War and Health: Volume 4: Health Effects of Serving in the Gulf War. The National Academies Press, Washington, DC; 2006. doi:10.17226/11729. Available at: https://doi.org/10.17226/11729.
- Mohanty AF, Helmer DA, Muthukutty A, McAndrew LM, Carter ME, Judd J, Garvin JH, Samore MH, Gundlapalli AV. Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration. J Rehabil Res Dev. 2016;53(1):45-58. PMID:26934034. doi:10.1682/JRRD.2014.10.0265.
- Blanchard M, Molina-Vicenty HD, Stein PK, Li X, Karlinsky J, Alpern R, Reda DJ, Toomey R. Medical Correlates of Chronic Multisymptom Illness in Gulf War Veterans. Am J Med. 2019;132(4):510-518. PMID:30576630. doi:10.1016/j.amjmed.2018.11.045.
- Eisen SA, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R, Jackson LW. Gulf War veterans' health: medical evaluation of a U.S. cohort. Ann Intern Med. 2005;142(11):881-90. PMID:15941694. doi:10.7326/0003-4819-142-11-200506070-00005.
- Grady EP, Carpenter MT, Koenig CD, Older SA, Battafarano DF. Rheumatic findings in Gulf War veterans. Arch Intern Med. 1998;158(4):367-71. PMID:9487234. doi:10.1001/archinte.158.4.367.
- Lacefield K, Samph SP, Orbon S, Otis J. Integrated intervention for comorbid posttraumatic stress disorder and fibromyalgia: A pilot study of women veterans. Psychol Trauma. 2020;12(7):725-729. PMID:32757579. doi:10.1037/tra0000635.
- Lewis JD, Wassermann EM, Chao W, Ramage AE, Robin DA, Clauw DJ. Central sensitization as a component of post-deployment syndrome. NeuroRehabilitation. 2012;31(4):367-72. PMID:23232159. doi:10.3233/NRE-2012-00805.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
Related guides & tools
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Educational information about the evidentiary standard — not legal or medical advice, and never a prediction about any claim.