VA Hearing Loss & Tinnitus Guide
This guide explains how the VA evaluates hearing loss and tinnitus and turns the results into a rating. You will learn how the VA tests hearing under 38 CFR § 4.85 with puretone audiometry and the Maryland CNC speech test, and how those scores map to a percentage through the VA tables. It covers tinnitus under Diagnostic Code 6260, including why it gets a single 10 percent rating whether it affects one ear or both. You will also find what you need for service connection, the evidence that supports a claim, how examiners read the results, and why many veterans rate lower than they expect despite real hearing difficulty. Whether you are filing or appealing, this guide shows you exactly how the VA rates hearing conditions.
Section 1: Overview
Hearing loss is the second most commonly claimed VA disability, exceeded only by tinnitus. It is rated under DC 6100, which falls within 38 CFR § 4.85 and 38 CFR § 4.86 (Impairment of Auditory Acuity). Unlike most VA conditions, hearing loss ratings are not based primarily on subjective symptoms or functional limitations. They are derived from a mechanical three-step process using specific audiometric test results.
The average VA rating for hearing loss is 10%, and many veterans receive 0%. High ratings require substantial audiometric evidence of severe impairment in both ears. Understanding how the formula works prevents veterans and representatives from misjudging claim value based on subjective difficulty rather than tested acuity.
Section 2: The Two Required Tests
A VA C&P examination for hearing impairment must be conducted by a state-licensed audiologist and must include both of the following tests (see 38 CFR § 4.85(a)). Examinations are conducted without the use of hearing aids.
Test 1: Puretone Audiometry
Puretone audiometry measures the softest sounds a veteran can detect at specific frequencies. VA tests at four frequencies: 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz. Results are recorded in decibels (dB), representing the lowest volume at which the veteran detected a tone at each frequency.
The Puretone Threshold Average (PTA) is calculated for each ear by adding the threshold values at 1000, 2000, 3000, and 4000 Hz and dividing by four. This single average number represents each ear's overall sensitivity loss and is one of the two inputs into Table VI.
Higher decibel values mean worse hearing. A PTA of 20 dB represents near-normal hearing. A PTA of 70 dB represents severe hearing loss.
Test 2: Maryland CNC Speech Discrimination Test
The Maryland CNC (Consonant-Nucleus-Consonant) test measures speech recognition ability. The audiologist presents a recorded list of 50 phonetically balanced, monosyllabic words at a calibrated volume. The veteran repeats each word as heard. The percentage of correctly identified words is the speech discrimination score.
Important: CID W-22 and NU-6 word lists are not Maryland CNC tests. A private audiology report using those tests is not an acceptable C&P substitution for determining the rating under 38 CFR § 4.85, although the decibel data from such exams may be usable under the exceptional pattern provisions of 38 CFR § 4.86 when the speech recognition component is not available. (BVA Decision 25000413, January 2025)
Section 3: The Three-Step Rating Process
1Assign a Roman Numeral to Each Ear Using Table VI
Table VI is titled "Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination." The horizontal rows represent speech discrimination percentages and the vertical columns represent the PTA. The Roman numeral designation (I through XI) is found at the intersection. Roman numeral I represents the least severe hearing loss and Roman numeral XI represents the most severe (essentially total deafness). This step is done separately for each ear, producing two Roman numeral designations.
2Combine Both Ears Using Table VII
Table VII is titled "Percentage Evaluations for Hearing Impairment." The horizontal rows represent the ear with better hearing (lower Roman numeral) and the vertical columns represent the ear with worse hearing (higher Roman numeral). The percentage rating is found at the intersection. Both ears combine into a single rating. Hearing loss in one ear and hearing loss in the other ear do not produce two separate percentages.
Special rule for one-ear service connection: When hearing impairment is service-connected in only one ear, the non-service-connected ear is assigned Roman Numeral I (the most favorable designation) before entering Table VII. (38 CFR § 4.85(f))
3Read the Final Percentage from Table VII
The percentage found in Table VII is the disability rating. Ratings range from 0% to 100% and may include values at every 10% interval. The average result for bilateral hearing loss claims is 10%, reflecting that most audiometric results across the VA population fall within mild-to-moderate impairment ranges.
- What the VA measures at your C&P exam
- Evidence that has won at the Board
- Inside the rater's playbook: grant, denial, and remand rates
- Secondary condition map
Section 4: Exceptional Patterns of Hearing Loss
When certain extreme audiometric patterns exist, the standard Table VI formula may underrepresent the severity of hearing loss. Two exceptional patterns trigger modified evaluation procedures (see 38 CFR § 4.86).
Exceptional Pattern 1: High-Frequency Severe Loss
When the puretone threshold at each of the four tested frequencies (1000, 2000, 3000, and 4000 Hz) is 55 decibels or more in one ear, the rating specialist determines the Roman numeral from both Table VI and Table VIa and uses whichever produces the higher (more favorable to the veteran) numeral for that ear. (38 CFR § 4.86(a))
Exceptional Pattern 2: Sharp High-Frequency Drop
When the puretone threshold at 1000 Hz is 30 dB or less AND the threshold at 2000 Hz is 70 dB or more, the rating specialist determines the Roman numeral from both Table VI and Table VIa and then elevates the resulting numeral to the next higher Roman numeral. (38 CFR § 4.86(b))
When Table VIa applies instead of Table VI: Table VIa uses only the PTA (not the speech discrimination score) to assign a Roman numeral. The examiner certifies that the speech discrimination test is not appropriate, typically due to language difficulties or inconsistent speech discrimination scores. Table VIa is also used in the exceptional pattern analysis described above when it produces a more favorable result than Table VI.
Section 5: Why Hearing Aid Use Does Not Affect the Rating
All hearing examinations for VA purposes are conducted without the use of hearing aids (see 38 CFR § 4.85(a)). This prevents the corrected hearing level from masking the underlying disability. A veteran who functions normally with hearing aids may still have severe hearing loss that produces a significant rating under the unaided audiometric results.
A related consequence: a veteran whose hearing is adequately corrected with aids and who therefore shows minimal symptoms in daily life may still hold a 10% or higher rating based on unaided test results. The VA rating reflects the organic impairment, not the corrected functional level.
Section 6: Tinnitus Rated Separately as DC 6260
Tinnitus (ringing or other persistent sounds in the ears without an external source) is the most commonly rated VA disability. It is rated separately from hearing loss under DC 6260, 38 CFR § 4.87. There is no higher schedular rating for tinnitus under DC 6260.
Tinnitus and hearing loss can both be service-connected and rated simultaneously. They are separate conditions under separate diagnostic codes and do not pyramid. See our Pyramiding Guide for more.
- What the VA measures at your C&P exam
- Evidence that has won at the Board
- Inside the rater's playbook: grant, denial, and remand rates
- Secondary condition map
Section 7: Service Connection for Hearing Loss
Direct service connection. The veteran demonstrates that hearing loss began during military service or was caused by in-service noise exposure. Noise-induced hearing loss is the most common pathway. Supporting evidence includes military occupational records, DoD Duty MOS Noise Exposure Listings (which document occupational noise hazard levels by MOS and branch), service treatment records documenting hearing complaints or in-service audiograms, and current audiometric results showing a pattern consistent with noise-induced loss (typically most pronounced at 4000 Hz, the "notch" frequency).
Nexus for noise-induced hearing loss. A medical nexus opinion from a licensed audiologist or physician attributing the current hearing loss pattern to in-service noise exposure strengthens claims where the service treatment record lacks direct documentation.
Aggravation. Pre-existing hearing loss that was demonstrably worsened beyond natural progression by in-service noise exposure is ratable under 38 CFR § 3.306.
Presumptive service connection. Hearing loss is not a VA presumptive condition. Direct or aggravation pathways are required.
Threshold note. VA will not assign a compensable rating based on hearing difficulty that does not meet the audiometric thresholds in Table VII, even when the veteran credibly reports significant difficulty hearing in daily life. The rating criteria contemplate speech reception thresholds and Maryland CNC test performance only. (Lendenmann v. Principi, 3 Vet. App. 345 (1992); affirmed in BVA Decision 25000413)
Hearing-loss SC threshold. Under 38 CFR § 3.385, hearing loss qualifies as a disability for VA purposes only when audiometric thresholds at certain frequencies meet specified decibel or speech-recognition floors. Below those floors, even a documented hearing loss is not service-connectable as a "disability" under VA standards.
When a Denial Relies on "Normal Hearing at Separation"
A large share of hearing-loss and tinnitus denials rest on a single line: the entrance and separation audiograms were both within normal limits, so the examiner concludes the condition is not related to service. Standing alone, that rationale runs against settled VA law.
"Normal" at separation does not bar service connection
The Court held in Hensley v. Brown that normal hearing at separation does not preclude service connection for a current hearing disability. The threshold for normal hearing is 0 to 20 decibels, and readings above 20 dB reflect some degree of loss. A veteran can establish service connection by showing the current hearing condition is linked to service, even when the separation audiogram read within normal limits. (Hensley v. Brown, 5 Vet. App. 155 (1993))
Why a "normal audiograms" opinion is an inadequate rationale
A negative nexus opinion that rests only on normal results at enlistment and separation, without analyzing the etiology of the current loss across the whole record, is an insufficient rationale. The correct step is to return the examination to the examiner for a complete opinion, not to deny on it. The same rule reaches tinnitus, which follows the hearing-loss examination provisions. (VA Adjudication Procedures Manual M21-1, Part III, Subpart iv, Chapter 4, Section B)
The threshold-shift analysis
Because nearly every veteran had some noise exposure, examiners weigh whether a measurable threshold shift occurred between the entrance and separation audiograms rather than relying on exposure alone. A documented worsening across the tested frequencies between entry and exit is strong objective evidence of an in-service injury. A veteran whose audiograms show that shift has the more direct case. A veteran missing one of those exams, or whose audiograms look similar, relies more on the Hensley principle and a well-reasoned nexus opinion.
Who can examine for tinnitus, and what a private opinion must show
A tinnitus-only examination may be done by an audiologist or a non-audiologist clinician, but only when a hearing-loss examination is of record and available for review. A private tinnitus opinion or DBQ that does not show the clinician reviewed the hearing-loss audiogram can be rejected on that basis. Hearing-loss DBQs themselves may be completed only by a state-licensed audiologist. A private tinnitus opinion should state the date and source of the hearing examination it reviewed.
Common Secondary Conditions
These are the conditions most often linked with tinnitus in the Board's published decisions. Each bar is the BVA grant rate for DC 6260, with the number of decisions below it. They describe what the Board's record shows across many veterans, not a prediction about any one claim.
Conditions that can cause tinnitus (tinnitus as the secondary)
Claims where tinnitus was argued as secondary to an already service-connected condition:
Conditions tinnitus can cause (tinnitus as the primary)
Conditions veterans have claimed as caused or aggravated by a service-connected tinnitus:
Evidence That Wins These Claims
The Board's published DC 6260 (tinnitus) decisions show a private medical opinion is the highest-yield evidence for these claims. The bars below compare the grant rate when the file has a private opinion against when it does not, refreshed weekly.
Common Mistakes
- No nexus opinion in the file. A missing medical nexus is the leading reason tinnitus service-connection claims are denied. A useful opinion names the in-service noise exposure or the service-connected primary and explains the link.
- Expecting a rating above 10 percent. Tinnitus carries a single 10% rating under DC 6260 whether it affects one ear or both. There is no higher schedular rating regardless of severity.
- Treating tinnitus and hearing loss as one claim. They are separate conditions under separate diagnostic codes and do not pyramid. Both can be service-connected and rated at the same time.
- Leaving the in-service noise exposure undocumented. Military occupational records and the DoD MOS noise exposure listings support the in-service event. Without that record, the claim leans on a nexus opinion alone.
Section 8: Conditions Commonly Associated with Hearing Loss
Tinnitus (DC 6260). Frequently co-occurs with noise-induced sensorineural hearing loss. Rated separately at 10%.
Depression and anxiety (DC 9434, DC 9400). Chronic hearing loss is associated with social isolation, communication frustration, and reduced quality of life. Secondary mental health conditions are ratable when a documented causal link exists. See our Mental Health Rating Formula Guide for how those ratings are scored.
Balance disorders / vestibular dysfunction. The inner ear structures responsible for hearing and balance are anatomically adjacent. Noise or trauma affecting cochlear function may also affect vestibular function. Rated under DC 6204 (peripheral vestibular disorders) or analogously.
Social isolation and occupational limitations. Not separately ratable on their own, but contribute to the evidence record for mental health secondary claims.
Section 9: Bilateral vs. Unilateral Service Connection
When hearing loss is service-connected in both ears, both ears enter Table VII and combine into a single bilateral rating. When only one ear is service-connected, the non-service-connected ear is assigned Roman Numeral I (most favorable baseline) before Table VII is applied. This protects against veterans being penalized for having one serviceable ear.
A separate rule addresses the evaluation of disabilities in paired organs and extremities and may apply when one ear is entirely unaffected (see 38 CFR § 3.383).
Section 10: Quick Reference Tables
DC 6100 Rating Pathway
| Step | What Happens | Regulatory Reference |
|---|---|---|
| 1 | Audiologist performs puretone test and Maryland CNC test (without hearing aids) | 38 CFR § 4.85(a) |
| 2 | PTA calculated per ear (avg of 1000, 2000, 3000, 4000 Hz) | 38 CFR § 4.85(d) |
| 3 | Roman numeral assigned per ear from Table VI (or VIa) | 38 CFR § 4.85(b), (c) |
| 4 | Check for exceptional pattern: all 4 freqs ≥55 dB or 1000 Hz ≤30 / 2000 Hz ≥70 | 38 CFR § 4.86 |
| 5 | Combine both ear numerals using Table VII for final percentage | 38 CFR § 4.85(e) |
| 6 | If only one ear is SC, non-SC ear assigned Roman Numeral I before Table VII | 38 CFR § 4.85(f) |
Key Audiometric Concepts
| Term | Definition |
|---|---|
| PTA (Puretone Threshold Average) | Average of thresholds at 1000, 2000, 3000, and 4000 Hz per ear |
| Maryland CNC | 50-word speech recognition test; VA-required specific test |
| Roman Numeral I | Least severe designation (near-normal hearing) |
| Roman Numeral XI | Most severe designation (profound deafness) |
| Table VI | Assigns Roman numeral using PTA plus speech discrimination score |
| Table VIa | Assigns Roman numeral using PTA only (no speech discrimination) |
| Table VII | Converts both-ear Roman numerals into a final percentage rating |
Related Tools and Guides
Sources
- 38 CFR § 4.85, Evaluation of Hearing Impairment (Tables VI, VIa, VII)
- 38 CFR § 4.86, Exceptional Patterns of Hearing Impairment
- 38 CFR § 3.306, Aggravation of Pre-Service Disability
- 38 CFR § 3.383, Benefits for Disabilities of Paired Organs / Extremities
- 38 CFR § 3.385, Service connection for impaired hearing (audiometric thresholds)
- Lendenmann v. Principi, 3 Vet. App. 345 (1992), Hearing disability ratings derived mechanically from audiometric testing; lay reports of difficulty alone insufficient
- Hensley v. Brown, 5 Vet. App. 155 (1993), Normal hearing at separation does not bar service connection; the threshold for normal hearing is 0 to 20 dB
- VA Adjudication Procedures Manual (M21-1), Part III, Subpart iv, Chapter 4, Section B, Rating hearing impairment and tinnitus; examination-adequacy and opinion-rationale requirements
- BVA Decision 25000413, January 14, 2025, Maryland CNC requirement; CID W-22 and NU-6 tests not equivalent
- DoD Duty MOS Noise Exposure Listing, Occupational noise hazard data by MOS and branch