VA Hearing Loss & Tinnitus Guide

Hearing loss and tinnitus are, together, the most commonly claimed VA disabilities: tinnitus is the single most common, and hearing loss runs a close second. Hearing loss 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. Tinnitus, by contrast, is rated separately under DC 6260, 38 CFR § 4.87, at a single 10 percent rating. Tinnitus is also proved differently: because it can be observed only by the person experiencing it, a veteran's own credible report of the ringing is competent evidence that the condition exists, and no audiometric test can confirm or rule it out. That affects how the condition is established, not how likely any particular claim is to be granted.

VA's Annual Benefits Report for FY2025 counts about 5.5 million ear-category disabilities in payment status, and 69.1% of them are rated 10% while 25.3% are rated 0%. That figure is worth reading carefully before applying it to a hearing-loss claim: tinnitus alone makes up 64.7% of the category and carries a fixed 10% rating, so the pile-up at 10% mostly reflects tinnitus, not hearing acuity. The report does not publish a separate distribution for DC 6100. What the rating rules do tell you is that the percentage tracks tested acuity rather than reported difficulty: a high percentage requires audiometric evidence of severe impairment, and a service-connected hearing loss can be rated 0% when the measured thresholds and speech scores fall in the lower ranges of Table VII. Tinnitus and hearing loss are separate conditions under separate diagnostic codes; both can be service-connected and rated at the same time, and they do not pyramid.

Before getting into the specific tests and pathways below, it helps to understand the three things every hearing loss or tinnitus claim ultimately has to show. This is the same basic test that applies to any VA disability claim, just applied to these two conditions.

1. A current diagnosis. For hearing loss, this means audiometric results meeting the thresholds in 38 CFR § 3.385. For tinnitus, this element is unusually easy: because ringing in the ears is something only the veteran can perceive, a veteran's own credible report that they currently experience it is generally enough, no clinical test can confirm or disprove tinnitus the way an audiogram confirms hearing loss.
2. An in-service event, or a service-connected condition behind it. Usually in-service noise exposure (combat, weapons qualification, aircraft, machinery, or a documented MOS with a noise hazard), or a disability VA has already service-connected that caused or worsened the hearing loss or tinnitus.
3. A medical nexus. A doctor's opinion, or in tinnitus's case sometimes the veteran's own competent, consistent account of continuous symptoms since service, connecting the condition to service or to the service-connected condition, and explaining the reasoning, not just stating a conclusion.

One-page guide: Direct Service Connection Roadmap Four-step roadmap for direct hearing-loss or tinnitus service connection. Opens the full-size chart, free to save or print.

Direct Service Connection for Hearing Loss

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). See our Service Connection Guide.

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))

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.

Direct Service Connection for Tinnitus

Because a veteran's own credible report can establish the current diagnosis, and VA frequently concedes the in-service noise event based on a documented MOS, combat service, or weapon qualification, the pathway that most often decides a tinnitus claim is the nexus element: whether the ringing is tied to that in-service noise, either through a doctor's opinion or through the veteran's own account of symptoms that began in service and have continued ever since. Tinnitus is treated as a chronic disease of the nervous system for this purpose, so continuity of symptoms since service is itself an accepted way to prove the link.

One-page guide: Secondary and Aggravation Pathways Comparison of secondary causation, secondary aggravation, and pre-service aggravation. Opens the full-size chart, free to save or print.

Secondary Service Connection (38 CFR § 3.310)

A veteran demonstrates that hearing loss or tinnitus was caused or chronically aggravated by an already service-connected condition. See our Secondary Service Connection Guide.

Documented secondary pathways for tinnitus include:

For hearing loss, the reverse direction is more commonly documented: a service-connected hearing loss aggravating a secondary mental health condition (covered in Conditions Commonly Associated below), rather than another condition causing the hearing loss itself. See the cond-bars data below for the specific conditions and grant rates the Board's published decisions actually show for each code.

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.

One-page guide: Puretone Average Calculation Four-frequency calculation for the puretone threshold average in each ear. Opens the full-size chart, free to save or print.

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.

The diagnostic codes involved: DC 6100 for hearing loss and DC 6260 for tinnitus, plus whatever code applies to a condition you're connecting either of them to secondarily, for example DC 9434 (depression), DC 9400 (anxiety), or DC 6204 (peripheral vestibular disorders).

We analyzed the Board's published decisions and found a private medical opinion is high-yield evidence for both conditions. The bars below compare the grant rate when the file has a private opinion against when it does not, refreshed weekly.

DC 6100 (Hearing Loss)

DC 6260 (Tinnitus)

Audiogram and Maryland CNC results: For hearing loss, the puretone thresholds and speech discrimination score are the foundational evidence; without them VA cannot assign any rating under DC 6100.

Documented noise exposure: Military occupational records, the DoD MOS noise exposure listings, combat service, and weapon qualification badges all support the in-service event for both conditions.

A threshold shift in service. A measurable change between an entrance hearing test and a later in-service test is strong objective evidence of an in-service injury. Even a single in-service note of ringing or hearing complaints can help establish onset.

Consistency of your account. A tinnitus claim in particular can be won largely on the veteran's own competent, believable testimony that the ringing began in service and never stopped. Because tinnitus can be observed only by the person experiencing it, that consistency across every statement and exam carries real weight, and a VA examiner may not reject the account solely because service records are silent on the issue.

Nexus opinion: For secondary claims and for hearing loss claims lacking an in-service audiogram, a medical opinion from a treating provider or qualified clinician explaining the causal or aggravating relationship is the clearest path to a grant when it spells out how the connection works and applies the reasoning to your own facts, rather than a bare conclusion with no rationale. See our Nexus Letters Guide.

Lay statements: First-person descriptions of when symptoms began and how they've progressed, along with statements from people who served alongside you who observed you complaining of ringing or hearing difficulty, contribute to the record. Tinnitus symptoms are the kind of thing lay evidence is competent to establish because they come through the senses and require no specialized medical knowledge. See our Buddy & Lay Statements Guide.

Beyond the normal-audiogram rationale covered above, a few specific denial patterns show up often enough in the Board's published hearing loss and tinnitus decisions to call out on their own.

A condensed version of everything above, in the order it actually matters when you sit down to build your file.

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.

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.

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.

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. A medical opinion based solely on the absence of documentation in the file is inadequate, and the correct step is to return the examination to the examiner for a complete opinion, not to deny on it (Dalton v. Peake, 21 Vet. App. 23 (2007)). 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.

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.

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).

Bring these together before you submit anything.

For the mechanics of actually submitting the claim, see the Standard Claim Guide and the Fully Developed Claim Guide (filing with all your evidence up front can speed up the decision).

Once you file, your claim moves through a series of hand-offs. Understanding who does what helps you know who to contact, and what to expect, at each stage.

1. You file the claim. Directly with VA, through VA.gov, or with the help of an accredited representative.
2. VA acknowledges the claim and assigns it for development. A Veteran Service Representative (VSR) is assigned to gather your service treatment records, VA and private medical records, and any other evidence needed.
3. The VSR orders a Compensation & Pension (C&P) exam if one is needed. Most hearing loss and tinnitus claims require an audiology exam, especially secondary claims where a nexus opinion is required.
4. The C&P exam is conducted. By a state-licensed audiologist (for hearing loss) or an audiologist or non-audiologist clinician with a hearing-loss exam of record (for tinnitus), who completes a Disability Benefits Questionnaire (DBQ) documenting the diagnosis, severity, and, where relevant, a nexus opinion.
5. The file goes to a Rating Veteran Service Representative (RVSR), the "rater." The rater reviews the complete file, including the audiogram and exam results, and decides whether service connection is warranted and at what percentage.
6. A senior reviewer may review the decision before it's finalized, depending on the complexity of the claim.
7. VA issues the decision letter. This states whether the claim is granted or denied, the rating percentage if granted, and the reasons behind the decision.
8. If you disagree, you choose an appeal lane. Higher-Level Review, Supplemental Claim, or a Board appeal, covered later in this guide.

Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner

For the full walkthrough of every stage with more detail, see Inside Your Claim and Claim Stages.

A Disability Benefits Questionnaire (DBQ) is the standardized form an examiner completes for your condition, it structures the exam findings into the specific data points VA's rating schedule requires (for hearing loss, that includes the puretone thresholds at each frequency and the Maryland CNC speech discrimination score for each ear; for tinnitus, the presence and onset). See the DBQ Guide for how these forms work, including whether a private DBQ completed by your own audiologist can be submitted instead of relying solely on a VA exam, subject to the Maryland CNC requirement described above.

Before your C&P exam, do not wear hearing aids to the appointment, since testing is conducted unaided. Bring a clear, specific account of when your symptoms started and how they've progressed, and be consistent with what's already in your medical records and prior statements. For a full walkthrough of what to expect and how to prepare, see the C&P Exam Prep Guide.

Your decision letter has two parts: a narrative section explaining the reasoning (often called "reasons and bases"), and a codesheet showing the actual rating percentage, the effective date, and the diagnostic code used. See the Reading Your Decision Letter Guide for how to find and interpret each part, or use the Letter Interpreter tool to upload your own letter and get a plain-English breakdown.

If your claim is denied, or the rating is lower than you expected, you have three main lanes:

• Supplemental Claim: refile with new and relevant evidence, such as a new nexus opinion or updated audiogram. See Supplemental Claim Guide.
• Higher-Level Review (HLR): a senior reviewer looks at the same evidence again for a difference of opinion, no new evidence is added. See HLR Guide.
• Board Appeal: your case goes to a Veterans Law Judge at the Board of Veterans' Appeals, with options for a direct review, an evidence docket, or a hearing. See Board Appeal Guide.

Not sure which lane fits your situation? See the Appeals decision guide for a side-by-side comparison of all three.

What to do if the effective date is wrong. Your effective date, when back pay starts, is usually the date VA received your claim. An intent to file only preserves an earlier date if the completed claim is submitted within one year, and a representative's filing mistake does not extend that window. If you believe VA used the wrong date, that is a separate, and often harder, fight from the service-connection question itself; see Reading Your Decision Letter for how effective dates are explained in your letter.

A grant is not always the end of the story. Keep your treatment consistent, continued follow-up with an audiologist for hearing loss, and documentation of any change in your tinnitus, protects you if VA schedules a future reexamination. Not every rating gets reexamined; understand when a rating becomes protected from future review (including Permanent and Total status) and what to do if VA proposes to reduce it. See Protect Your Rating and Future Reexaminations for the specifics.

If your hearing loss worsens after the initial grant, you can file for an increased rating with updated audiometric testing. Tinnitus, by contrast, is capped at 10 percent regardless of severity, so there is no increased-rating path for tinnitus alone. See the Rating Increase Guide.

We found these are the conditions most often linked with hearing loss and tinnitus in the Board's published decisions. Each bar is the BVA grant rate for the code, 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:

One-page guide: Tinnitus Secondary-Claim Snapshot Two-direction secondary-claim snapshot for TINNITUS, showing BVA grant rates and appeal counts for conditions claimed toward and away from TINNITUS. Opens the full-size chart, free to save or print.

Conditions that can cause hearing loss (hearing loss as the secondary)

Claims where hearing loss was argued as secondary to an already service-connected condition:

Conditions hearing loss can cause (hearing loss as the primary)

Conditions veterans have claimed as caused or aggravated by a service-connected hearing loss, most often the mental health and vestibular conditions discussed below:

One-page guide: Hearing-Loss Secondary-Claim Snapshot Two-direction secondary-claim snapshot for HEARING LOSS, showing BVA grant rates and appeal counts for conditions claimed toward and away from HEARING LOSS. Opens the full-size chart, free to save or print.

DC 6100 Rating Pathway

Key Audiometric Concepts

Secondary Connection Pathways for Tinnitus

From Filing to Decision: Who Does What