Myofascial Pain Syndrome in Veterans: VA Ratings and Service Connection

Myofascial pain syndrome (MPS) is a chronic and often debilitating condition that arises from pressure on sensitive muscle points, leading to localized and referred pain patterns. This pain can be spontaneous or triggered by movement and can affect multiple areas of the body. 

MPS frequently develops from repeated muscle injuries, overuse, or prolonged stress on musculoskeletal structures, making it particularly relevant to veterans who have endured physically demanding service-related activities. Many veterans seeking VA compensation must navigate the complexities of myofascial pain syndrome and the VA rating system to secure the benefits they deserve. 

Veterans suffering from myofascial pain syndrome experience persistent pain, muscle stiffness, and the presence of trigger points—tight, hyperirritable muscle knots that not only cause localized discomfort but also refer pain to other body parts. These trigger points can develop due to inadequate muscle recovery, trauma, or chronic strain, and they may lead to secondary complications such as sleep disturbances, reduced mobility, and even emotional distress due to prolonged pain. 

Myofascial Pain Syndrome and VA Ratings 

The VA does not have a specific diagnostic code for myofascial pain syndrome. Instead, it typically rates it under the criteria for fibromyalgia (diagnostic code 5025), with a disability rating from 0% to 40%, depending on severity. This rating is based on widespread musculoskeletal pain, fatigue, and other symptoms. 

Myofascial pain syndrome can also be rated as: 

• Myositis (diagnostic code 5021), evaluated based on the limitation of motion in affected areas, with ratings depending on the severity of functional impairment in the impacted muscles. 
• Chronic Pain Syndrome (diagnostic code 8850), if pain leads to significant functional impairment, affecting daily activities and employment capabilities. 

Because myofascial pain syndrome is challenging to diagnose and evaluate, many initial claims are denied or underrated. Veterans should ensure they provide comprehensive medical documentation, including evidence of trigger points and functional limitations. Consulting with a specialist experienced in MPS can significantly strengthen a claim. Be prepared to appeal VA decisions if necessary and present additional medical opinions or lay evidence. 

What Can Cause Myofascial Pain Syndrome?  

• Muscle injuries: Trauma or micro-tears in muscle fibers can lead to chronic pain and trigger point formation. 
• Repetitive strain or overuse: Activities that require continuous muscle engagement, such as carrying heavy gear or prolonged physical exertion, can lead to muscle fatigue and dysfunction. 
• Pinched nerves: Compressed nerves can cause referred pain, exacerbating muscle tension and leading to the development of trigger points. 
• Exposure to cold environments: Cold temperatures reduce blood flow to muscles, increasing stiffness and the likelihood of developing MPS. 
• Emotional stress: Chronic stress contributes to muscle tension and altered pain perception, intensifying MPS symptoms over time. 

Establishing Service Connection 

The VA can recognize myofascial pain syndrome as a primary or secondary disability. For a direct service connection, you must prove that MPS developed as a direct result of an incident or injury sustained in the military. 

Direct Service Connection 

To establish a direct service connection, a veteran must provide compelling evidence of the condition’s link to their military service. This requires: 

• A current diagnosis of myofascial pain syndrome, confirmed by a qualified medical professional. 
• Documented evidence of an in-service injury, event, or illness that could have led to myofascial pain syndrome. 
• A medical nexus opinion from a physician explicitly connecting the diagnosed MPS to the in-service event.  

For example, a veteran who suffered a significant muscle strain during active duty may develop myofascial pain syndrome years later due to unresolved inflammation, scar tissue accumulation, and chronic muscle dysfunction. Additionally, repetitive physical tasks such as carrying heavy gear, prolonged marching, or engaging in combat-related activities may create the conditions necessary for MPS to manifest. Service medical records, post-service treatment notes, and expert medical opinions are crucial in proving a direct service connection. 

Secondary Service Connection

Secondary service connection is granted when myofascial pain syndrome is caused or worsened by an already service-connected condition. Common contributing factors include: 

• Musculoskeletal injuries: Herniated discs, degenerative disc disease, joint injuries, arthritis. 
• Neurological conditions: Peripheral neuropathy, radiculopathy, diabetes-related nerve damage. 
• Mental health disorders: PTSD, anxiety, and depression, which can exacerbate muscle tension and pain sensitivity. 

MPS from Injuries and Musculoskeletal Conditions

• Spinal injuries: Conditions such as herniated discs, compression fractures, and degenerative disc disease can significantly impact muscle function. Spinal pathology often results in altered biomechanics, leading to muscle imbalances, postural changes, and increased stress on muscles. These factors contribute to the formation of myofascial trigger points, resulting in chronic pain. 
• Head and neck disorders: Temporomandibular disorders (TMD), cervical degenerative disc disease, cervical facet arthropathy, and whiplash-related neck pain can lead to chronic tension and trigger point activation in the surrounding muscles. Veterans with a history of head and neck injuries may experience persistent MPS symptoms in these areas. 
• Thoracolumbar back disorders: Conditions such as kyphosis, scoliosis, and lumbar facet arthropathy can contribute to chronic muscular strain and postural dysfunction. These conditions can lead to compensatory muscle tightening, increasing the risk of myofascial pain development. 
• Joint injuries: Trauma to the shoulders, knees, hips, or ankles sustained during service may result in improper healing, reduced mobility, and chronic muscle tension, all of which contribute to myofascial pain syndrome. 
• Pelvic pain syndromes: Chronic pelvic pain conditions may involve deep muscle structures, contributing to persistent myofascial pain. Veterans with a history of pelvic fractures or prolonged strain on the lower body are at an increased risk. 
• Traumatic injuries: Fractures, sprains, or ligament tears that healed improperly can lead to compensatory movement patterns, creating overuse of surrounding muscle groups and triggering myofascial pain. 
• Arthritis: Inflammation and stiffness in the joints place added stress on adjacent muscles, increasing the likelihood of trigger point formation and chronic myofascial pain. 
• Cold weather injuries: Prolonged exposure to extreme cold, common in military environments, can damage muscle tissue and lead to chronic musculoskeletal pain, including MPS.  

MPS Secondary to Neurological Conditions

Myofascial pain syndrome is often linked to neurological conditions that affect nerve function and muscle control. Some key neurological conditions that may contribute to or exacerbate MPS include: 

• Peripheral neuropathy: Nerve damage resulting from injuries, toxic exposures, or underlying conditions can lead to muscle dysfunction and chronic pain. 
• Diabetes-related neuropathy: High blood sugar levels can damage nerves, leading to numbness, tingling, and muscle pain. 
• Radiculopathy: Nerve impingement caused by service-connected spinal conditions can lead to muscle weakness and chronic pain, increasing the risk of MPS development.  

MPS Secondary to Mental Health Conditions

Psychological factors play a significant role in the development and progression of myofascial pain syndrome. Stress and mental health disorders can lead to muscle tension, pain sensitivity, and altered pain perception. Common mental health conditions linked to myofascial pain include: 

• Post-Traumatic Stress Disorder (PTSD): Veterans with PTSD often experience heightened muscle tension, which can contribute to chronic pain and trigger point formation. 
• Anxiety disorders: Chronic anxiety can lead to muscle guarding and increased tension, which exacerbates pain and stiffness. 
• Depression: Studies suggest that depression can lower the pain threshold, making individuals more susceptible to chronic pain conditions like MPS. 

How to Get VA Disability for Myofascial Pain Syndrome

• Gather evidence – Collect all relevant medical records, including service treatment records, private physician evaluations, and VA medical documentation. These records should demonstrate the presence of MPS symptoms, treatments received, and any history of injuries that may have contributed to the condition. 
• Obtain a diagnosis – Consult a specialist who understands myofascial pain syndrome and its connection to military service. A thorough evaluation should include physical examinations, diagnostic imaging (if applicable), and documentation of trigger points and muscle dysfunction. 
• File a well-documented claim – Submit a fully developed claim (FDC) with comprehensive documentation, including medical reports, a detailed medical nexus letter linking MPS to military service, and evidence of functional impairment affecting daily activities or employment. 
• Seek representation – A veterans service organization (VSO) or experienced VA disability attorney can assist in navigating the complex claims process, ensuring that all necessary evidence is submitted and advocating on your behalf during appeals if needed.  

What Evidence Can Help Prove Your Case? 

Medical Evidence 

• Treatment records: These should include documentation from VA or private healthcare providers, detailing treatments such as physical therapy, trigger point injections, chiropractic adjustments, massage therapy, and prescribed medications. Consistent medical records can strengthen a claim by proving ongoing treatment and management efforts. 
• Pain journal: Keeping a detailed journal of daily pain levels, flare-ups, and functional limitations provides direct insight into how myofascial pain affects daily activities. This should include information on specific triggers, responses to treatment, and the impact on mobility and work-related tasks. 
• Diagnostic imaging and clinical assessments: Although myofascial pain syndrome does not always appear in standard imaging, muscle assessments, electromyography (EMG), and nerve conduction studies may support claims by ruling out other conditions.  

Medical Evidence 

• Personal statements: Veterans should provide a detailed narrative describing how and when symptoms began, the progression of pain, and the impact on their quality of life. Statements should include specific examples of physical limitations, such as difficulty lifting, walking long distances, or engaging in daily tasks. 
• Buddy statements: Fellow service members who witnessed the veteran’s symptoms or in-service injuries can submit sworn affidavits to confirm the onset and severity of the condition during or after service. 
• Family testimonials: Statements from spouses, children, or close family members describing behavioral changes, pain episodes, and physical limitations at home can provide further context to how MPS affects daily life outside of medical settings. 

What If the VA Denies or Underrates You? 

Denied or underrated claims are not the end of the road. Veterans have the right to appeal through: 

• Higher-Level Review – Request a fresh evaluation by a senior VA rater. 
• Supplemental Claim – Submit new and relevant evidence. 
• Board of Veterans Appeals (BVA) Appeal – three different appeal options are available at the BVA, where experienced judges make the decisions: 

1. Request a direct review based on the evidence already in your file
2. Request to submit new and relevant evidence to support your claim (must be submitted with your appeal or within 90 days of submitting the appeal)
3. Request a formal hearing for reconsideration of the claim (a Veteran may also submit new evidence at this hearing)

Veterans seeking to appeal MPS claims can get a free case evaluation from Hill & Ponton. Our VA-accredited lawyers specialize in disability law and provide expert assistance to veterans who need help securing the benefits they deserve. 

Content Reviewed by

Attorney Rachel Cheek

Rachel Cheek is an attorney at Hill & Ponton dedicated to helping veterans secure the benefits they deserve. A University of Florida graduate, she combines her passion for social justice with legal expertise to serve those most in need.