[Federal Register Volume 61, Number 89 (Tuesday, May 7, 1996)]
[Rules and Regulations]
[Pages 20438-20440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-11275]



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DEPARTMENT OF THE TREASURY
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 4

RIN 2900-AH05


Schedule for Rating Disabilities; Fibromyalgia

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule with request for comments.

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SUMMARY: This document amends the Department of Veterans Affairs (VA) 
Schedule for Rating Disabilities by adding a diagnostic code and 
evaluation criteria for fibromyalgia. The intended effect of this rule 
is to ensure that veterans receive consistent evaluations for this 
condition.

DATES: This interim final rule is effective May 7, 1996. Comments must 
be received on or before July 8, 1996.


[[Page 20439]]


ADDRESSES: Mail written comments to: Director, Office of Regulations 
Management (02D), Department of Veterans Affairs, 810 Vermont Ave., 
NW., Washington, DC 20420 or hand deliver written comments to: Office 
of Regulations Management, Room 1176, 801 Eye St., NW., Washington, DC 
20001. Comments should indicate that they are submitted in response to 
``RIN 2900-AH05.'' All written comments received will be available for 
public inspection in the Office of Regulations Management, Room 1176, 
801 Eye St., NW., Washington, DC 20001 between the hours of 8:00 a.m. 
and 4:30 p.m., Monday through Friday (except holidays).

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff, Compensation and Pension Service, Veterans Benefits 
Administration, Department of Veterans Affairs, 810 Vermont Ave., NW., 
Washington, DC 20420, (202) 273-7210.

SUPPLEMENTARY INFORMATION: The VA Schedule for Rating Disabilities, 
which constitutes 38 CFR Part 4, is a guide for the evaluation of 
disability resulting from diseases or injuries. This document adds to 
the musculoskeletal section of the Schedule, Sec. 4.71a, a new 
diagnostic code, 5025, for fibromyalgia, also called fibrositis or 
primary fibromyalgia syndrome, and establishes criteria for its 
evaluation.
    Fibromyalgia is a syndrome of chronic, widespread musculoskeletal 
pain associated with multiple tender or ``trigger'' points, and often 
with multiple somatic complaints. Sleep disorders are present in more 
than half of the patients. Anxiety, fatigue, headache, and irritable 
bowel symptoms are also common. Some patients complain of neurologic 
symptoms such as numbness and weakness, but objective neurologic 
abnormalities are not found. Other associated findings include 
depression, Raynaud's-like symptoms, and stiffness. The etiology is 
unknown.
    Classification criteria for fibromyalgia for research and 
epidemiological purposes were established by the American College of 
Rheumatology in 1990. The first requirement is a history of widespread 
pain, which means pain in both the left and right sides of the body, 
pain both above and below the waist, and pain in both the axial 
(cervical spine, anterior chest, thoracic spine, or low back) and 
peripheral (extremity) skeleton. The second requirement is the presence 
of pain on digital palpation at a minimum of 11 of the following 18 
tender point sites: occiput, low cervical, trapezius, supraspinatus, 
second rib, lateral epicondyle, gluteal, greater trochanter, knee 
(there is a left site and a right site at each location). In clinical 
practice, the diagnosis is often made on less stringent criteria, with 
fewer tender points required.
    We are providing three levels of evaluation: 10, 20, and 40 
percent, consistent, in our judgment, with the clinical range of 
impairment of this condition. While patients may have numerous symptoms 
that may be chronic, it is a benign disease that does not result in 
loss of musculoskeletal function. For the 40 percent level, the 
requirements are that the widespread pain and multiple tender points, 
with or without certain associated complaints, be constant, or nearly 
so, and refractory to therapy. For the 20 percent level, the 
requirements are that the pain and tender points, etc., be episodic, 
with exacerbations often precipitated by environmental or emotional 
stress or by overexertion, but present more than one-third of the time. 
For the 10 percent level, the requirement is that the pain and tender 
points, etc., require continuous medication for control.
    It is necessary to make this rule effective upon publication. 
Conditions not listed in the Schedule may be evaluated under a closely 
related condition in which anatomical localization, functions affected, 
and symptomatology are closely analogous. (See 38 CFR 4.20.) However, 
because of the variety of analogous conditions under which fibromyalgia 
may be evaluated, it is necessary to establish a final rule immediately 
in order to avoid inconsistency in evaluations. Comments are being 
solicited for 60 days after publication of this document. VA may modify 
the rule in response to comments, if appropriate.
    Because no notice of proposed rulemaking was required in connection 
with the adoption of this interim final rule, no regulatory flexibility 
analysis is required under the Regulatory Flexibility Act (5 U.S.C. 601 
et seq.). Further, this amendment would not directly affect any small 
entities since it would affect only individuals.
    This rule has been reviewed as a ``significant regulatory action'' 
under E.O. 12866 by the Office of Management and Budget.
    The Catalog of Federal Domestic Assistance program numbers are 
64.104 and 64.109.

List of Subjects in 38 CFR Part 4

    Disability benefits, Individuals with disabilities, Pensions, 
Veterans.

    Approved: December 7, 1995.
Jesse Brown,
Secretary of Veterans Affairs.

    For the reasons set forth in the preamble, 38 CFR part 4, subpart B 
is amended as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

    1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155.

Subpart B--Disability Ratings

    2. In Sec. 4.71a, diagnostic code 5025 is added immediately after 
the sentence that follows diagnostic code 5024, to read as follows:


Sec. 4.71a  Schedule of ratings--musculoskeletal system.

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                                                                Rating  
------------------------------------------------------------------------
                                                                        
*                  *                  *                    *            
                   *                  *                  *              
5025  Fibromyalgia (fibrositis, primary fibromyalgia                    
 syndrome)                                                              
    With widespread musculoskeletal pain and tender points,             
     with or without associated fatigue, sleep disturbance,             
     stiffness, paresthesias, headache, irritable bowel                 
     symptoms, depression, anxiety, or Raynaud's-like                   
     symptoms:                                                          
        That are constant, or nearly so, and refractory to              
         therapy...........................................           40
        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.............................           20
        That require continuous medication for control.....           10
                                                                        
*                  *                    *                    *          
                    *                  *                    *           
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Note: Widespread pain means pain in both the left and right sides of the
  body, that is both above and below the waist, and that affects both   
  the axial skeleton (i.e., cervical spine, anterior chest, thoracic    
  spine, or low back) and the extremities.                              


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[FR Doc. 96-11275 Filed 5-6-96; 8:45 am]
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