VA Disability for Hearing Loss and Tinnitus: How They're Rated (2026)

Two Conditions, Two Different Rating Frameworks

Hearing loss and tinnitus often appear together in VA claims, but the VA evaluates them through two completely different lenses. Tinnitus is a subjective condition - perceived sound without an external source - and the VA awards a single fixed rating that does not change based on severity. Hearing loss is an objective condition measured through standardized audiometry, and the rating depends entirely on the numbers produced by the audiogram.

This separation matters in claims strategy. A veteran with severe tinnitus and mild hearing loss may end up with a 10 percent tinnitus rating and a 0 percent hearing loss rating - even though the symptoms substantially affect daily life. Understanding the framework helps veterans manage expectations and identify when secondary claims or other strategies are appropriate.

How Tinnitus Is Rated

Under 38 CFR 4.87, Diagnostic Code 6260, recurrent tinnitus is assigned a single 10 percent rating. Notes within the diagnostic code make clear:

• The 10 percent rating applies whether the tinnitus is unilateral or bilateral
• A separate evaluation for tinnitus may not be assigned with conditions like Meniere's syndrome that already account for tinnitus in the rating criteria
• Objective tinnitus (a rare clinical entity) and subjective tinnitus are both rated under DC 6260

The Federal Circuit confirmed the single-rating ceiling in Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006). Veterans who experience disabling tinnitus that goes beyond what 10 percent captures sometimes pursue extraschedular consideration under 38 CFR 3.321(b)(1), or pursue secondary claims for conditions that arise from tinnitus (sleep disturbance, anxiety, depression) under 38 CFR 3.310.

How Hearing Loss Is Rated

Hearing loss is rated under 38 CFR 4.85 and 4.86. The framework relies on three measured values for each ear:

• Pure tone thresholds at 1000, 2000, 3000, and 4000 Hz, expressed in decibels
• The pure tone threshold average - the average of those four thresholds
• Speech discrimination percentage from a Maryland CNC word recognition test

For each ear, the pure tone average and the speech discrimination percentage are used to find a Roman numeral hearing level (I through XI) on Table VI. The two ear levels are then plugged into Table VII to produce a percentage rating from 0 to 100. The result is mathematical and leaves little room for clinical judgment - which is why audiometric accuracy is so important.

Section 4.86 provides for an alternative scoring method (Table VIA, using pure tone thresholds only) in two specific scenarios:

• When pure tone thresholds at 1000, 2000, 3000, and 4000 Hz are all 55 dB or greater
• When the threshold at 1000 Hz is 30 dB or less and the threshold at 2000 Hz is 70 dB or greater (a "ski slope" pattern)

In these cases, the higher of the Table VI or Table VIA hearing level is used for that ear.

Tables VI and VII Explained

Table VI is a matrix of speech discrimination percentages (0 to 100 percent) on one axis and pure tone averages (0 to 105+ dB) on the other axis. The intersection produces a Roman numeral level for that ear. Better hearing yields lower numerals (I or II); profound loss yields higher numerals (X or XI).

Table VII is a 11-by-11 matrix that combines the better-ear and worse-ear hearing levels into a percentage rating. The scale tilts heavily toward bilateral severity. A veteran with Level I in both ears receives a 0 percent rating. A veteran with Level XI in both ears receives 100 percent. Mixed levels - say Level IV in one ear and Level VI in the other - typically yield a 10 to 30 percent rating depending on the combination.

This is why many veterans with subjectively significant hearing loss end up with 0 percent ratings: the audiometric thresholds simply have not crossed the regulatory boundary that produces a higher Roman numeral level. Hearing loss can be real, debilitating, and well-documented, yet still rate at 0 percent under the schedule. Veterans in this situation may pursue increased ratings if hearing thresholds worsen, or may seek extraschedular consideration in unusual circumstances.

MOS Noise Exposure Probability

The VA's Duty MOS Noise Exposure Listing classifies military occupational specialties as having a "highly probable," "probable," or "low probability" of noise exposure. The list is not in the regulations, but is in the VA's M21-1 adjudication manual and is used by raters and C&P examiners to evaluate the in-service event element of hearing loss and tinnitus claims.

"Highly probable" noise exposure typically includes:

• Combat arms specialties - infantry, special forces, combat engineers
• Artillery and field artillery
• Armor and cavalry
• Aviation - pilots, aircrew, aviation maintenance, flight deck
• Boatswain's mates and certain shipboard ratings
• Vehicle mechanics and operators of heavy equipment
• Military police in tactical environments

For veterans in these MOSs, the in-service noise exposure element is generally accepted without specific documentation. The medical link to a current diagnosis still must be established, but the foundation for service connection is much easier.

Evidence for Tinnitus Claims

A well-developed tinnitus claim typically includes:

• The veteran's own description of onset, character, and frequency of tinnitus
• MOS or duty assignment evidence showing in-service noise exposure
• Service treatment records documenting any noise complaints, hearing test changes, or related encounters
• Post-service primary care or audiology notes documenting tinnitus
• Any audiogram results, even if hearing loss does not meet the rating threshold
• Lay statements from spouses, partners, or coworkers describing observed effects (sleep disturbance, irritation, withdrawal)

Evidence for Hearing Loss Claims

Hearing loss claims center on the audiogram. The strongest claims include:

• A current VA-style audiogram with pure tone thresholds at 500, 1000, 2000, 3000, 4000 Hz, plus a Maryland CNC speech discrimination score
• Service entrance and separation audiograms for comparison
• Any in-service audiograms showing threshold shifts
• MOS noise exposure documentation
• Records of hearing protection use, hearing protection failures, or specific incidents (blast events, acoustic trauma)
• Post-service audiology records showing progression

The Maryland CNC speech discrimination test is the only test result the VA uses for the speech component. An audiogram that uses a different speech recognition test will not satisfy the rating criteria, even if the audiogram is otherwise excellent. Always request that any private audiologist providing testing for VA purposes use the Maryland CNC.

Secondary Conditions and Quality-of-Life Impact

Because tinnitus is capped at 10 percent, many veterans with severe tinnitus pursue secondary claims for conditions that flow from chronic tinnitus, including:

• Sleep disturbance - documented insomnia, sleep fragmentation, or non-apneic sleep disorder secondary to tinnitus
• Anxiety or depression - mood disorders that develop or worsen because of chronic tinnitus
• Headache disorders - in some veterans, tinnitus is associated with worsening headache patterns

Each of these requires its own diagnosis and a nexus letter that articulates the pathway from tinnitus to the secondary condition.

When a Nexus Letter Helps

Many tinnitus claims with a clear MOS noise-exposure history and a credible veteran statement do not need a nexus letter. Many hearing loss claims with a current audiogram and documented in-service noise exposure also do not. A nexus letter becomes important when:

• A C&P examiner has rendered a negative opinion that needs to be addressed
• The veteran's MOS is "low probability" but specific noise events occurred
• Service treatment audiograms do not show in-service threshold shift, but post-service audiograms show clear hearing loss with delayed onset
• The claim is for a secondary condition arising from tinnitus or hearing loss
• The claim involves an unusual fact pattern (acoustic trauma incident, unique unit, less common audiometric pattern)

A nexus letter for hearing or tinnitus claims should reference the specific noise exposures, comment on any threshold shifts in service audiograms, address competing causes (occupational, recreational), and cite the relevant audiology and otolaryngology literature on noise-induced hearing loss and tinnitus.