Hearing Loss Secondary to Tinnitus Claim Guide
Hearing Loss (VA diagnostic code 6100) is sometimes claimed as secondary to service-connected Tinnitus (code 6260) under 38 CFR 3.310. We analyzed published Board of Veterans' Appeals decisions on that pairing; here is what they show. It is an encyclopedic reference, not a forecast.
The Numbers, from 1.9M Appeals
We analyzed the Board's published decisions and found hearing loss (DC 6100) claimed as secondary to tinnitus (DC 6260) is a real, mid-sized claim pool that loses more often than it wins once it reaches a merits decision.
How those 484 issues came out
ICD-10 Diagnosis Codes for Hearing Loss
The ICD-10 diagnosis codes most commonly used for DC 6100, Hearing Loss (the kind on your medical records, decision letter, or C&P exam report). VA rates the disability and its residuals, not the diagnosis itself, so coding can vary.
What a secondary claim on this pairing needs
Under 38 CFR 3.310 a secondary claim turns on three elements:
- A current diagnosis: a medical diagnosis of hearing loss (the secondary).
- A service-connected primary: Tinnitus, already service-connected (the primary). A 0% primary still counts.
- A medical nexus: a medical opinion linking the hearing loss to the tinnitus, showing the primary caused or aggravated it.
See the Secondary Claim guide for the caused-versus-aggravated split, and the Nexus Letter guide for what makes the medical opinion strong.
Why hearing loss is claimed secondary to tinnitus
Whether that medical link exists in any one case is a medical question decided on that case's own evidence (the nexus).
Caused By vs Aggravated By: What the Board Found
The outcome split above counts whole issues. This section goes one layer deeper. Under 38 CFR § 3.310 a secondary claim can be won two ways: the tinnitus caused the hearing loss (§ 3.310(a)), or it aggravated an existing hearing loss (§ 3.310(b)). Every grant rests on one or the other, so the numbers below divide up the granted claims only.
Direct causation is the route that carries most grants here: 77% of them found the tinnitus caused the hearing loss, the rest found aggravation. A practical consequence for the nexus opinion: it should address both routes, because a medical opinion that only argues causation leaves the aggravation theory, a separate legal basis, on the table. See the caused-vs-aggravated guide for how the two theories differ.
On the other side: in 67 denied claims the Board looked at this pairing and found no link, meaning it decided the tinnitus neither caused nor worsened the hearing loss. That is a separate group from the grants above, counted here so the picture is not one-sided.
We analyzed published Board decisions on this pairing to build this split. The grant split covers granted claims only; denied, remanded, and dismissed claims are not in it. Descriptive of the published record, not a prediction.
What VA Looks For: Tests, Records, and Diagnostic Codes
The record VA actually reviews centers on a small set of documents. We analyzed published Board decisions on these claims and ranked the records that appeared most often:
- A medical nexus opinion: the one record VA weighs most on a secondary claim, a doctor's statement linking your hearing loss to your service-connected tinnitus and naming the mechanism.
- Audiometric testing in the record
- Separation examination hearing findings discussed
- Threshold shift or hearing-acuity decrease in service
- Duty-MOS noise exposure conceded or highly probable
- Post-service occupational or recreational noise weighed
The diagnostic code involved: DC 6100 (Hearing Loss). The rating levels for this code are in the rating section below.
Records ranked by how often published Board decisions cited them. The exam that captures most of this is covered in the C&P Exam section below. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
The Evidence That Wins Hearing Loss Secondary Claims
What veterans who win this pairing actually put in the file, and why each piece moves the claim.
- Current audiogram (Maryland CNC and puretone tests): You need VA-approved hearing tests showing your current hearing loss, especially high-frequency loss, the pattern noise exposure typically leaves behind. This sets your baseline and rating.
- Nexus letter that names the shared cause, not just both conditions: A letter that says "veteran has hearing loss and tinnitus" does nothing. It has to say hearing loss caused or made your tinnitus worse, and explain why. Audiograms alone, without this letter, get denied far more often.
- An audiologist or ENT for that letter, not a general doctor: A family doctor can sign a nexus letter, but VA raters weigh an audiologist or ear specialist much more heavily on inner-ear damage. Get the specialist if you can.
- The letter states the mechanism in plain terms: Ask the provider to explain that hearing loss and tinnitus come from the same inner-ear (cochlear) damage. When your ear stops sending the brain normal sound signals, the brain fills the gap by overworking damaged nerve pathways, and that overwork is what you hear as ringing or buzzing. One injury, two conditions.
- The letter uses "at least as likely as not," never "could" or "may": VA decides on a 50/50-or-better standard. Weak words like "possible" or "may contribute" read as too soft and can sink an otherwise solid claim.
- Proof of in-service noise exposure: Gather your MOS, unit records, deployment history, or anything showing you were around gunfire, aircraft, engines, or other loud equipment. "It was loud" is not enough; name the source. Buddy statements from people who served alongside you help fill in gaps here.
- A clear timeline connecting your service to when tinnitus started: If your ringing showed up years after discharge, don't leave that gap unexplained. Have your provider address why that delay still fits with noise-caused inner-ear damage, since VA raters often try to use time gaps as a reason to deny.
- Get your causation direction straight: This claim is hearing loss caused by tinnitus's damage, the reverse of the more common tinnitus-secondary-to-hearing-loss claim. Make sure every form, letter, and statement says hearing loss is the condition you're claiming, and tinnitus is the cause, not the other way around.
Evidence Cited in Published Hearing loss Decisions
We analyzed 162,474 published Board decisions involving hearing loss for condition-specific evidence, counting only case-specific mentions (boilerplate recitations excluded). "Favorable" is the share of decisions citing that evidence where every issue was granted or the outcome was mixed; the baseline across all these decisions is 57%. Evidence appearing in a decision does not mean it decided the case. Descriptive of the published record, not a prediction.
Detected by phrase-reading the decision text with condition-specific vocabularies. Source: Board of Veterans' Appeals decisions, RateMyVSO analysis.
Board Grants on This Pairing, Dissected
These decisions show veterans who won service connection for hearing loss by tying it to an already service-connected tinnitus disability. The Board looked at whether tinnitus caused the hearing loss, or made it worse (aggravation), not just whether hearing loss started in the military. Published Board decisions like these are not binding on other cases, but they show the kind of evidence that has persuaded the Board in this specific pairing.
Tinnitus onset first, hearing loss followed Citation A26019640 (March 2026), Hearing docket
The record: The veteran testified that ringing in his ears started in service and worsened over time until he could not hear the television or conversations. A private primary care physician submitted a letter after the hearing linking tinnitus to noise exposure in service. A private audiologist's letter, written to the veteran's own doctor, stated the veteran had "associated hearing loss (both ears)" tied to his worsening tinnitus. The VA examiner had opined the opposite relationship, that tinnitus was secondary to hearing loss, and separately denied a nexus for hearing loss based on the lack of a threshold shift in service.
Why it won: The Board found the VA opinion inadequate because it ignored the veteran's lay statements about when his symptoms began. The Board also held that relying only on the absence of an in-service threshold shift is not a proper basis to deny hearing loss claims, citing Ledford v. Derwinski. It found the veteran's competent, credible reports of hearing decline alongside worsening tinnitus, combined with the audiologist's letter, persuasive enough to grant the claim.
One ear granted, the other denied on the same facts Citation A25065509 (August 2025), Evidence Submission docket
The record: The veteran was granted service connection for tinnitus, an acquired psychiatric disorder, hepatitis C, erectile dysfunction, and migraines in the same decision. For hearing loss, the Board found the evidence for the left ear was at least in approximate balance as being related to the now-service-connected tinnitus. The right ear did not meet the regulatory definition of a hearing loss disability at all.
Why it won: Because so many disabilities were already granted as related to service or to each other, the Board found the overall record supported a similar link between tinnitus and left ear hearing loss. The right ear claim was denied for a separate, threshold reason, there was no diagnosed disability there under 38 C.F.R. § 3.385, showing the Board still requires a qualifying diagnosis before secondary connection can even be considered.
Improvement with hearing aids used as evidence of aggravation Citation A24013176 (March 2024), Hearing docket, RAMP appeal
The record: The veteran reported constant tinnitus and told his VA treatment provider that his hearing aids helped with both his hearing and his "ear noises." A November 2014 VA examiner found the tinnitus itself not related to service, reasoning largely on the lack of treatment records for years after service. The Board found that opinion inadequate.
Why it won: The Board reasoned that if hearing aids improved both the tinnitus and the hearing, then logically the reverse was also true, that the tinnitus was aggravating the hearing loss. It cited Ward v. Wilkie for the point that aggravation does not need to be permanent to count. With the evidence in approximate balance, the Board resolved doubt in the veteran's favor.
Functional impact statement from a tinnitus exam used to prove aggravation of hearing loss Citation A22009983 (May 2022), Evidence Submission docket
The record: The veteran was already service connected for tinnitus. A December 2021 VA audiological examiner, while discussing the functional impact of the tinnitus, wrote that it "makes it difficult to sleep, listen to TV, speech, and hear the telephone ring."
Why it won: The Board treated that functional-impact language as evidence that the tinnitus was affecting the veteran's ability to understand speech and hear everyday sounds, the same functions affected by hearing loss. Citing Ward v. Wilkie again on the point that aggravation need not be permanent, the Board found the evidence in approximate balance and granted the claim.
Same functional-impact language, different veteran, same result Citation A22006900 (April 2022), Hearing docket
The record: A VA examiner who evaluated the veteran's tinnitus stated that "tinnitus makes hearing even more difficult than just having hearing loss alone." A separate April 2019 VA addendum opinion had denied direct service connection for hearing loss, reasoning that entrance and separation exams were negative and the veteran's hearing loss developed after separation.
Why it won: The Board denied the direct theory but granted the secondary one. It read the examiner's own functional-impact statement as proof that the tinnitus was aggravating the hearing loss, even though no formal secondary opinion had been requested. The Board again relied on Ward v. Wilkie to hold that aggravation does not need to be permanent, and resolved reasonable doubt for the veteran.
What the Board Said in Recent Grants
These are the Board's own words, quoted from the findings in 5 recent granted decisions on this pairing. Each sentence is the finding the grant rested on, not a summary of it. Click a citation to read the full decision.
“The Veteran's bilateral hearing loss was caused by his service-connected tinnitus.”
“The evidence is at least in approximate equipoise in support of a finding that the Veteran's left ear hearing loss is proximately related to his service-connected tinnitus”
“The evidence is at least in approximate balance as to whether the Veteran's hearing loss was aggravated by his service-connected tinnitus disability.”
“The evidence is at least in approximate balance as to whether the Veteran's hearing loss is aggravated by his service-connected tinnitus disability.”
“Resolving all reasonable doubt in the Veteran's favor, the Veteran's bilateral hearing loss disability is aggravated by the Veteran's service-connected tinnitus.”
Quoted from published Board decisions on this pairing, most recent first. Descriptive of the published record, not a prediction about any individual claim. Search the full decisions in BVA Decision Search.
Why VA Denies, and How the Board Answered
The rationales below are the ones VA examiners actually used against this pairing in the published record, each paired with the Board's response.
- Read the left column first: if a VA opinion in your file uses one of these arguments, that is the reasoning your own evidence has to meet.
- The right column is the counter: it shows how the Board actually answered that argument, with the decision cited.
- A rationale appearing here is not a verdict: the same argument won some cases and lost others, on different records.
| VA examiner's rationale | How the Board answered it |
|---|---|
| Hearing loss and tinnitus may share a common cause, but there is no medical literature showing tinnitus itself causes or worsens hearing loss. | The Board found this reasoning adequately addressed both causation and aggravation, and with no competent evidence to the contrary, upheld the denial (A26028564). |
| The veteran's own belief that hearing loss is tied to tinnitus is not competent evidence, and a private audiologist's opinion recited facts without explaining how those facts caused the disability. | The Board found the private opinion conclusory and based on an inaccurate factual premise (the veteran's not-credible report of in-service onset), so it carried no weight, and the claim was denied (A25092678). |
| The left ear hearing loss preexisted service, was not aggravated during service, and no audiologist or physician linked it to the already service-connected right ear hearing loss or tinnitus. | The Board held that the veteran's lay statements alone cannot establish a medical relationship between the pre-existing left ear loss and the service-connected conditions, since that question requires audiological training. Denied (A25058130). |
| A private physician's letter stated that the veteran's hearing loss was "definitely responsible for the ringing in his ears," supporting the opposite direction of causation. | The Board found this letter did not establish that tinnitus caused hearing loss, only the reverse, and found the veteran's own theory not credible without medical support. Denied (9712778). |
If Granted: How Hearing Loss Is Rated
The VA assigns one of these percentages based on what your medical record documents. Plain-language summary of the rating criteria at 38 CFR; the controlling text is the regulation itself.
| Rating | What the record has to show for DC 6100, Hearing Loss |
|---|---|
| -1% | Hearing loss is rated on a scale from 0% to 100% in 10% steps. The rating is not based on prose descriptions, it comes from a strict numeric lookup. Step 1: an audiologist measures your puretone hearing thresholds at 1, 2, 3, and 4 kHz in each ear and tests your speech discrimination. Step 2: each ear's puretone average + speech discrimination are looked up in Table VI to produce a Roman numeral (I = best hearing, XI = worst). Step 3: the two numerals (one per ear) are cross-referenced in Table VII to give the final percentage. Tables VI and VII are published in 38 CFR § 4.85. |
| -1% | A special rule under § 4.86 applies when hearing loss matches certain patterns common in noise-exposed veterans. Pattern A: hearing thresholds of 55 dB or worse at all four frequencies (1, 2, 3, 4 kHz). Pattern B: relatively normal at 1 kHz (30 dB or better) but 70 dB or worse at 2 kHz, a steep drop typical of noise damage. If either pattern matches, an alternate Table VIa is used (puretone-only, no speech-discrimination input), and the better-for-the-veteran numeral is the one that counts. Many veterans with combat or flightline noise exposure qualify for higher ratings under this rule than they would under the standard Table VI calculation. |
| -1% | Ringing in the ears (tinnitus) is rated under a different code (DC 6260) at a flat 10%, that is the highest rating tinnitus can ever receive, no matter how loud or constant. Hearing loss and tinnitus are usually claimed together because the same noise exposure causes both, but each gets its own rating; the two are then combined using the VA combined-ratings table in § 4.25. |
Do's and Don'ts
Every item below comes from a pattern in the decisions on this pairing, not from general claim advice.
- Ask your doctor to explain how tinnitus is affecting your ability to hear speech, the phone, or the television, in plain functional terms.
- Get service connection for tinnitus established first if it is not already, since these hearing loss grants depended on tinnitus already being service-connected.
- Report consistently whether your hearing got worse around the same time your tinnitus got worse. The Board has treated this timing as important evidence.
- Ask a private doctor or audiologist to give a full rationale, not just a conclusion, when writing a letter connecting tinnitus and hearing loss.
- Point out if a VA examiner relied only on the lack of a threshold shift during service. The Board has called that reasoning improper on its own.
- Don't expect a private letter that lists facts without explaining the connection to carry much weight. The Board has called these opinions conclusory.
- Don't rely only on your own belief that tinnitus caused your hearing loss. The Board has repeatedly found veterans not competent to give that medical opinion.
- Don't assume a claim will succeed just because you have both tinnitus and hearing loss. The Board looked for an actual medical link, not mere coexistence.
- Don't ignore contradictory statements you made closer in time to service, such as denying hearing trouble at separation. The Board gave those statements strong weight against later claims.
- Don't forget that hearing loss in one ear can be denied even when the other ear is granted, if that ear does not meet the regulation's decibel or speech-recognition thresholds.
Quick Checklist Before You File
- Service connection already in place for Tinnitus, and a current medical diagnosis of hearing loss.
- Diagnostic testing, imaging, or clinical records documenting the hearing loss, whatever your provider used to diagnose and track it.
- A nexus opinion, whenever possible from a doctor familiar with hearing loss, stating it is at least as likely as not caused or aggravated by the tinnitus, and naming the mechanism rather than just the conclusion.
- Lay statements: spouse, family, friends, or battle buddies describing what they've witnessed or noticed.
- Your STRs and any VA opinions already in the file on either condition. If a VA opinion already went against you, your submitted opinion or statement should address its specific reasoning.
For the mechanics of filing itself, see the Standard Claim Guide and the Fully Developed Claim Guide.
The Claims Process, Step by Step
A secondary claim moves through the same pipeline as any other. Understanding who does what helps you know who to contact and what to expect.
- You file the claim, naming Tinnitus as the service-connected primary and hearing loss as secondary. Directly with VA, through VA.gov, or with an accredited representative's help.
- VA assigns a Veteran Service Representative (VSR) to develop the claim: gather your service treatment records, VA and private medical records, and order a C&P exam if needed.
- The C&P exam is conducted, usually with the examiner asked to address the specific secondary theory (causation and aggravation both).
- The file goes to a Rating Veteran Service Representative (RVSR), the "rater," who weighs the medical evidence and decides service connection and, if granted, the rating percentage.
- VA issues the decision letter stating the outcome and the reasoning.
- If denied or under-rated, you choose an appeal lane, Supplemental Claim, Higher-Level Review, or a Board appeal, covered below.
Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner
Your VSO
An accredited representative, agent, or attorney. Not a VA employee. Helps prepare and file, and can represent you on appeal. Has no authority to decide your claim.
VSR
VA staff who develops the claim: gathers records and schedules the exam. Does not decide the rating.
Rater (RVSR)
VA staff who reviews the complete file and makes the actual decision on service connection and percentage.
C&P Examiner
Conducts the exam and, where asked, gives a nexus opinion. Does not decide the claim, but the opinion's reasoning and legal framing carry real weight.
For the full walkthrough, see Inside Your Claim and Claim Stages.
DBQs and Your C&P Exam
A Disability Benefits Questionnaire (DBQ) is the standardized form the examiner completes for your condition. See the DBQ Guide for how these forms work and whether a private DBQ from your own doctor can be submitted instead of relying solely on a VA exam. For what to expect and how to prepare, see the C&P Exam Prep Guide, and be specific about how your hearing loss symptoms relate to your tinnitus timeline, treatment, and any aggravation, that is the detail a nexus opinion relies on.
Reading Your Decision Letter, and What to Do If Denied
Your decision letter has a narrative "reasons and bases" section and a codesheet with the rating and effective date. See the Reading Your Decision Letter Guide or use the Letter Interpreter tool to decode your own letter. If denied, you have three main lanes:
- Supplemental Claim: refile with new and relevant evidence, such as a nexus opinion that addresses the mechanism and the specific VA rationale you're rebutting. See Supplemental Claim Guide.
- Higher-Level Review (HLR): a senior reviewer looks at the same evidence again, useful if the denial rested on a legal error. See HLR Guide.
- Board Appeal: your case goes to a Veterans Law Judge, with a direct review, evidence, or hearing docket. See Board Appeal Guide.
Not sure which lane fits? See the Appeals decision guide for a side-by-side comparison.
After You Win: Maintaining Your Rating
Keep documentation of ongoing treatment, follow-up evaluations, and any updated diagnostic testing for your hearing loss on file, this protects you if VA schedules a future reexamination. See Protect Your Rating for when a rating becomes protected and Future Reexaminations for what triggers one. If your hearing loss worsens, see the Rating Increase Guide.
Frequently Asked Questions
Does Tinnitus have to be highly rated to support a hearing loss secondary claim?
No. 38 CFR 3.310 looks at whether the service-connected Tinnitus caused or aggravated the hearing loss, not at how severe the Tinnitus rating is. Even a 0% service-connected primary can anchor a secondary claim.
What do the percentages on this page mean?
They are the historical outcomes of 484 published Board decisions on this exact pairing: 20% granted, 34% denied, 43% remanded. They describe decided appeals already on record. They do not predict what would happen in any individual case.
RateMyVSO. Educational resource. Not affiliated with the U.S. Department of Veterans Affairs. Not legal advice. All RateMyVSO tools are free. Find a VSO representative for personalized guidance.