Inflammation of a muscle and its fascia.

Myofascial disorders are often secondary to other conditions caused by

• Bacteria,

• viruses,

• parasites,

• fungi,

• spirochetes, or

• autoimmune diseases.

Other conditions that may contribute to the development of myofasciitis and its associated contractile unit pain are

• muscle injury or infection;

• secondary infections in associated areas;

• ligament and joint disorders;

• neurological dysfunctions;

• malignancy;

• osteomalacia (see Diagnostic Code: 5014); and

• connective tissue diseases.

1. Pain and symptoms over the past week, based on the total of number of painful areas out of 19 parts of the body plus level of severity of these symptoms:

   • Fatigue

   • Waking unrefreshed

   • Cognitive (memory or thought) problems

   • Plus number of other general physical symptoms

2. Symptoms lasting at least three months at a similar level

3. No other health problem that would explain the pain and other symptoms

Diagnosis requires a thorough history and physical examination, and may also include:

• laboratory studies to rule out other causes;

• muscle-strength testing;

• x-ray;

• computed tomography (CT) scan;

• magnetic resonance imaging (MRI);

• electromyography (EMG); and

• muscle biopsy.

Treatment may include:

• stretching of the affected muscle;

• massage;

• acupuncture;

• electrical stimulation; and

• medications to decrease inflammation, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Pain medications (opiods) should be used sparingly or avoided if possible due to the chronic nature of the problem.

Continued spasms of the affected muscle may lead to loss of the elastic fibers in the muscle, which do not regenerate. This can lead to permanent contractures. Complications of the inflammatory response may include:

• the formation of an abscess, if the area of inflammation is walled off and destruction of the tissue byproducts takes place;

• the formation of scar tissue, if the tissue is irreversibly injured; or

• persistent inflammation, if the inflammatory cells do not eliminate the pathological insult.

This may also lead to fibrosis and scar formation.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Pain alone or any condition resulting in functional impairment of earning capacity, even in the absence of a specific diagnosis or otherwise identified disease or injury, may constitute a disability under 38 U.S.C. 1110 or 38 U.S.C. 1131 for which service connection may be granted. The Veteran’s pain or condition must result in functional impairment of earning capacity to constitute a disability.

• The provisions for 10 and 20 percent evaluations for arthritis with multiple joint involvement without limitation of motion do not apply to these conditions as is reflected in Note (2) under DC 5003.

• Since myofasciitis is not always chronic, chronic residuals are required to establish service connection.

• May be entitled to special monthly compensation under 38 CFR 3.352 for advanced myofasciitis. Also, consider entitlement to SMC under 38 CFR 3.350 as an issue in every case where there is a severe degree of disability involving the loss or loss of use of an extremity or sensory organ or any other functional loss providing entitlement to SMC.

• Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.