DC 6100 · 38 CFR 4.85
Ear (Hearing / Tinnitus) C&P Exam Prep
To evaluate the current severity of your hearing loss and/or tinnitus, establish or confirm diagnosis, document functional impact, and provide data used to assign a rating under 38 CFR 4.85 (Tables VI/VIa and VII) for hearing loss and 38 CFR 4.87 DC 6260 for tinnitus.
- Format:
- Interview + Physical
- Typical duration:
- 30 minutes
- DBQ form:
- Ear_Including_Vestibular_and_Infectious (Ear_Including_Vestibular_and_Infectious)
- Examiner:
- Audiologist
What the examiner evaluates
- Pure-tone audiometric thresholds at 1000, 2000, 3000, and 4000 Hz in each ear
- Speech discrimination (word recognition) scores in each ear using controlled word lists
- History of onset, course, and in-service noise exposure
- Presence, laterality, and frequency of tinnitus
- Presence of vestibular symptoms: vertigo, staggering, nystagmus
- Physical examination of the external ear canal, tympanic membrane, and auricle
- Romberg test and gait assessment if vestibular symptoms are present
- Dix-Hallpike test if BPPV is suspected
- Functional impact on occupational and daily activities
- Current medications used for ear-related diagnoses
- Any prior surgeries, procedures, or imaging related to the ear
- Nexus between current condition and reported in-service noise exposure or injury
The audiometric portion will be conducted in a soundproof booth or controlled acoustic environment. Arrive without hearing aids if possible, or bring them to show the examiner. Do not expose yourself to loud noise for at least 14 hours before the exam, as temporary threshold shifts can temporarily improve your measured hearing. The examiner will conduct a clinical interview before and/or after audiometric testing. Be prepared to discuss your worst hearing days, not just your average experience.
Measurements and tests
Pure-Tone Audiometry (Air Conduction)
What it measures: Your threshold of hearing at specific frequencies (500, 1000, 2000, 3000, and 4000 Hz) in each ear. VA rating uses the average of 1000, 2000, 3000, and 4000 Hz thresholds to determine a Roman numeral (I-XI) under Table VI or VIa per 38 CFR 4.85.
What to expect: You will sit in a soundproof booth wearing headphones and press a button each time you hear a tone. Tones will vary in pitch and volume. The test takes approximately 10-15 minutes per ear.
Critical thresholds
- Average threshold 0-40 dB HL Likely Roman numeral I-II; minimal to no compensable rating unless combined with poor speech discrimination
- Average threshold 41-55 dB HL Roman numeral III-V range; moderate hearing loss; rating depends on speech discrimination and other-ear score via Table VII
- Average threshold 56-70 dB HL Roman numeral V-VIII range; moderately severe to severe loss; higher combined Table VII ratings possible
- Average threshold 71+ dB HL Roman numeral VIII-XI range; severe to profound loss; significant Table VII ratings, potentially 30-100%
- 4000 Hz threshold -55 dB HL (38 CFR 4.86) Exceptional pattern: examiner must use whichever of Table VI or Table VIa yields the HIGHER Roman numeral-this is favorable to the veteran
- Pure-tone threshold -30 dB at all frequencies tested (38 CFR 4.86(b)) May allow for a 30% rating based on speech discrimination alone under special provisions
Tips
- Respond as soon as you hear the faintest possible tone-do not wait until you are certain. Waiting too long underestimates your hearing ability.
- If you have hearing aids, remove them before testing unless the examiner specifically requests otherwise.
- Avoid loud noise exposure (concerts, power tools, firearms) for at least 14 hours before the exam to avoid artificially better scores from masking a temporary threshold shift.
- Tell the examiner if one ear is significantly better than the other so each is evaluated separately.
- Report if you experience tinnitus during the test, as it can affect threshold perception.
Pain considerations: Not applicable for this test-there is no pain involved. However, if insertion of earphones causes discomfort due to canal abnormalities, inform the examiner immediately.
Speech Discrimination (Word Recognition Score)
What it measures: Your ability to understand spoken words at a comfortable listening level. Scored as a percentage (0-100%). Used in conjunction with pure-tone averages to assign the Roman numeral under Table VI or VIa per 38 CFR 4.85.
What to expect: The audiologist will present a list of single-syllable words through headphones at a set volume. You repeat each word aloud. Typically 25-50 words are presented per ear.
Critical thresholds
- 90-100% speech discrimination Minimal impact on Roman numeral designation; rating primarily driven by pure-tone averages
- 76-89% speech discrimination Mild reduction; Roman numeral may increase by one level depending on pure-tone average
- 60-75% speech discrimination Moderate reduction; can significantly increase Roman numeral designation, increasing combined Table VII rating
- Below 60% speech discrimination Severe reduction; may result in Roman numeral IX-XI; substantially increases Table VII rating percentage
Tips
- Repeat exactly what you hear, even if you think you heard wrong. Guessing correctly inflates your score.
- If you did not understand a word, say so honestly rather than guessing-this accurately reflects your real-world difficulty.
- Communicate if you have difficulty distinguishing the words from background noise even in the controlled setting.
- This test reflects your worst-case communication ability-do not try to perform better than you normally do in real-world settings.
Pain considerations: No pain involved. If cognitive fatigue affects your performance, let the examiner know.
Tympanometry
What it measures: Middle ear function and tympanic membrane mobility. Detects fluid behind the eardrum, perforations, Eustachian tube dysfunction, or ossicular chain abnormalities.
What to expect: A soft probe is placed in your ear canal. You will feel a slight pressure change lasting a few seconds per ear. You do not need to respond-it is passive.
Critical thresholds
- Type A (normal) Normal middle ear pressure; hearing loss is likely sensorineural rather than conductive
- Type B (flat) Suggests fluid, perforation, or significant pathology; supports diagnoses like chronic suppurative otitis media
- Type C (negative pressure) Suggests Eustachian tube dysfunction; relevant to chronic otitis media diagnoses
Tips
- Do not swallow or move during the measurement.
- If you have a known perforation, tell the examiner before the probe is inserted.
Pain considerations: Mild pressure sensation only. Report any pain as this may indicate an active perforation or infection that the examiner should document.
Dix-Hallpike Test
What it measures: Presence of benign paroxysmal positional vertigo (BPPV) by provoking positional nystagmus. Relevant if you have claimed vestibular conditions or Meniere's disease.
What to expect: You will be quickly moved from a sitting to a head-hanging position with your head turned. The examiner watches your eyes for abnormal movement (nystagmus). This may briefly provoke dizziness-this is expected and not dangerous.
Critical thresholds
- Positive Dix-Hallpike (nystagmus provoked) Supports BPPV diagnosis; relevant to vestibular disorder ratings under DC 6204 or 6205
- Negative Dix-Hallpike Does not rule out vestibular pathology; other testing may be needed
Tips
- Inform the examiner of the frequency and severity of your vertigo episodes before testing.
- If you experience severe nausea or spinning during the test, describe the experience fully-this is clinically meaningful.
- Do not take anti-vertigo medications (meclizine, dimenhydrinate) within 24 hours of the exam unless medically necessary, as these may suppress a positive test result.
Pain considerations: No pain involved but dizziness and nausea may be provoked. Inform the examiner if you feel unsafe during positional changes.
Romberg Test and Gait Assessment
What it measures: Balance and proprioceptive function. Evaluates whether vestibular dysfunction causes unsteadiness or staggering-symptoms rated under DC 6204 and 6205.
What to expect: You will stand with feet together, first with eyes open, then eyes closed, for approximately 30 seconds. The examiner will also observe your walking pattern.
Critical thresholds
- Positive Romberg (swaying or falling with eyes closed) Supports vestibular pathology; documented as unsteady gait, relevant to higher ratings for vestibular disorders
- Abnormal gait / staggering observed Directly relevant to rating criteria for Meniere's disease and peripheral vestibular disorders
Tips
- Perform this test as you actually are on a typical day, not on your best day.
- If you normally use a cane or assistive device for balance, bring it and inform the examiner.
- Describe episodes where you have stumbled, fallen, or had to hold onto walls at home.
Pain considerations: Not a painful test. Stand near a wall or have someone nearby for safety during eyes-closed testing.
Rating criteria by percentage
0%
Hearing impairment that does not meet the threshold for a compensable evaluation under Table VII. Under 38 CFR 3.385, 'impaired hearing' exists when the pure-tone threshold in the better ear is 40 dB or more at any frequency from 500 to 4000 Hz, or when speech recognition scores are 94% or less. A 0% (noncompensable) rating is still service-connected and medically significant.
Key symptoms
- Mild difficulty hearing in quiet environments
- Slight difficulty understanding speech in background noise
- Occasional need to ask for repetition
- Audiometric thresholds within near-normal range
From 38 CFR: Table VII intersection of Roman numeral I (better ear) and Roman numeral I (worse ear) yields 0%. A 0% rating is still service-connected and opens the door to future increases and secondary conditions.
10%
Hearing impairment resulting in a Table VII intersection yielding 10%. Tinnitus is separately rated at 10% (the maximum single rating under DC 6260, regardless of bilateral vs. unilateral). A veteran may receive 10% for tinnitus and a separate rating for hearing loss.
Key symptoms
- Tinnitus that is at least intermittent
- Mild hearing loss in one or both ears
- Difficulty understanding speech at normal conversational volume
- Need for louder television or phone volume
- Tinnitus causing sleep disruption or concentration difficulty
From 38 CFR: DC 6260: Tinnitus is rated at 10% whether unilateral or bilateral. Per M21-1, if hearing loss is service-connected and tinnitus is a symptom of the hearing loss, tinnitus is established on a direct (not secondary) basis and rated separately under DC 6260.
30%
Under 38 CFR 4.86, when the pure-tone threshold at each frequency tested (500, 1000, 2000, 3000, and 4000 Hz) is 30 dB or less in one ear and the speech discrimination score in that ear is 94% or less, a 30% evaluation is assigned for that ear. Additionally, when the 4000 Hz threshold is 55 dB or greater, the rating specialist uses the higher of Table VI or Table VIa-this exceptional pattern can push the rating to 30% or higher.
Key symptoms
- Significant difficulty understanding speech in noise
- Frequent requests for repetition even in quiet environments
- Difficulty using telephone without amplification
- Noticeable impact on work performance requiring verbal communication
- 4000 Hz threshold -55 dB HL (noise-induced pattern)
From 38 CFR: 38 CFR 4.86(b): 30% rating when pure-tone thresholds are 30 dB or less at all tested frequencies and speech discrimination is 94% or less. 38 CFR 4.86(a): exceptional pattern at 4000 Hz allows use of higher Table VI or VIa designation.
50%
Hearing impairment with Meniere's disease (DC 6205) rated at 50% when there are attacks of hearing impairment with vertigo occurring one to four times per month, with or without cerebellar gait. Hearing loss and vestibular dysfunction together at this level represent a substantial disability.
Key symptoms
- Episodic attacks of vertigo occurring 1-4 times per month
- Associated hearing fluctuation during attacks
- Nausea and/or vomiting with vertigo episodes
- Tinnitus that worsens during attacks
- Unsteady gait between attacks
- Significant impact on daily functioning and employment
From 38 CFR: DC 6205 (Meniere's disease/endolymphatic hydrops): 50% when hearing impairment with attacks of vertigo and cerebellar gait occurs 1-4 times per month. Evaluated separately from pure audiometric data under 38 CFR 4.87 because hearing may be transient.
100%
Hearing impairment with Meniere's disease rated at 100% when hearing impairment with very frequent attacks of vertigo (more than once weekly) with cerebellar gait is documented. Profound sensorineural hearing loss bilaterally (Roman numeral XI in both ears) via Table VII can also yield very high ratings. Malignant neoplasm of the ear rates at 100% during active treatment.
Key symptoms
- Vertigo attacks occurring more than once per week
- Cerebellar gait (profound balance dysfunction)
- Near-total or total hearing loss bilaterally
- Complete inability to work or function independently due to auditory/vestibular disability
- Active malignancy of the ear
From 38 CFR: DC 6205: 100% for hearing impairment with very frequent attacks of vertigo and cerebellar gait. DC 6209 (malignant neoplasm of ear): 100% during active treatment per 38 CFR 4.87.
Describing your symptoms accurately
Tinnitus Description
How to describe it: Describe the sound accurately: ringing, buzzing, hissing, roaring, pulsing, cricket-like, or high-pitched tone. Specify whether it is in one ear, both ears, or appears to come from inside your head. State how often it occurs (constant vs. intermittent), how long episodes last, and what makes it worse (noise, stress, silence, fatigue). Describe the impact on sleep, concentration, and mood.
Example: On my worst days, the ringing is constant and so loud that I cannot hold a conversation without losing track of what was said. I wake up multiple times per night because of it. I've had to leave meetings at work because I couldn't concentrate. The sound is a high-pitched screech in both ears that I'd rate as a 7 out of 10 in loudness.
Examiner listens for: Laterality (bilateral vs. unilateral), frequency of occurrence, duration of episodes, impact on daily function, sleep disruption, and any correlation with noise exposure or exacerbating factors.
Avoid: Saying 'it only bothers me sometimes' without quantifying how often 'sometimes' is. Failing to mention sleep disruption caused by tinnitus. Not mentioning that tinnitus has been present since service even if it was not documented.
Hearing Loss in Daily Life
How to describe it: Describe specific real-world scenarios where your hearing loss causes functional difficulty: understanding speech in restaurants or crowded rooms, missing parts of conversations on the phone, needing the TV volume at levels that bother others, difficulty understanding coworkers in open-plan offices, missing alarms or doorbells, and the social withdrawal caused by communication difficulty.
Example: On my worst days, I can barely understand my spouse when they speak from another room even at a raised voice. I've missed phone calls from doctors because I couldn't hear the ring, and I've had to ask my supervisor to repeat instructions three or four times in one conversation. I stopped going to group dinners with friends because I can't follow conversations and it's embarrassing.
Examiner listens for: Functional impact beyond what the audiogram shows. The examiner fills out Section 10 (functional impact) of the DBQ based on your reported daily difficulties-this narrative is as important as the audiometric data.
Avoid: Saying 'I get by okay' when you use compensatory strategies constantly. Not mentioning that you rely on lip-reading or closed captions. Failing to describe how hearing loss affects your occupational performance or has caused you to change jobs or reduce responsibilities.
Vertigo and Vestibular Symptoms
How to describe it: Describe the frequency (how many times per week or month), duration (seconds, minutes, hours), and severity of each episode. Specify triggers (head movement, standing up, loud sounds). Describe associated symptoms: nausea, vomiting, sweating, fullness in the ear, or tinnitus changes during attacks. Explain how episodes affect your ability to drive, work, or function safely.
Example: Last month I had six episodes of severe spinning vertigo, each lasting 20 to 45 minutes. During the worst one, I vomited twice and had to lie on the floor for over an hour before I could stand safely. I've stopped driving because I'm afraid of losing control during an attack. I called out of work three times last month due to vertigo.
Examiner listens for: Frequency per month (this directly determines the rating level for Meniere's disease under DC 6205), duration, whether cerebellar signs (gait disturbance, staggering) are present between attacks, and functional impairment.
Avoid: Describing vertigo as 'dizziness' without specifying it involves the sensation of the room spinning. Not tracking and reporting the actual number of episodes per month. Minimizing nausea or falls that accompany vertigo episodes.
Functional and Occupational Impact
How to describe it: Be specific about which work tasks are affected: phone calls, verbal instructions, group meetings, safety warnings. Describe social withdrawal, depression or anxiety caused by communication difficulty, and any accommodations you've requested at work. This populates the DBQ's functional impact section which directly influences the overall disability picture.
Example: I had to request a workplace accommodation to receive all instructions in writing because I miss verbal communications in our open office. I've been passed over for a supervisory role because the position requires phone-based customer service that I can no longer perform reliably. I've stopped attending my veteran group meetings because I can't follow conversations.
Examiner listens for: Concrete examples of lost function, changes to employment, social withdrawal, and any secondary mental health impact from hearing loss and tinnitus.
Avoid: Saying the condition 'doesn't affect work much' if you have made any accommodations or changes. Not mentioning secondary mental health effects like depression, irritability, or anxiety caused by the condition.
Common mistakes to avoid
Performing at your best during audiometric testing
Why: Veterans sometimes try to prove they can hear or understand words when they are uncertain. This inflates speech discrimination scores and elevates pure-tone thresholds, producing a result that understates actual disability.
Do this instead: Respond only when you genuinely hear a tone, no matter how faint. For speech discrimination, repeat only what you clearly understood. Accurately reflect your real hearing ability-the test should represent a typical day, not your best effort.
Impact: All levels-directly determines Roman numeral designation and Table VII percentage
Exposing yourself to loud noise before the exam
Why: Noise exposure within 14 hours of testing can cause temporary threshold shifts (TTS)-temporary hearing improvements that mask your true chronic hearing loss levels.
Do this instead: Avoid all significant noise exposure (firearms, power tools, concerts, loud machinery) for at least 14-16 hours before the exam. Sleep with ear protection if you work nights in a noisy environment.
Impact: All levels-pure-tone thresholds at 2000 and 4000 Hz are most vulnerable to TTS
Describing tinnitus as only intermittent when it is actually frequent or constant
Why: Veterans often minimize tinnitus habitually. DC 6260 is a flat 10% rating and does not increase with severity, but accurate documentation of constant tinnitus supports secondary conditions (insomnia, depression, anxiety) and prevents future denials.
Do this instead: Accurately report whether tinnitus is constant, near-constant, or truly intermittent. If it is present most waking hours, say so. Document its impact on sleep, concentration, and emotional well-being.
Impact: 10% tinnitus rating and secondary mental health/sleep disorder claims
Failing to report vestibular symptoms separately from hearing loss
Why: Many veterans with Meniere's disease or peripheral vestibular disorders focus only on hearing loss during the exam and do not volunteer vertigo, staggering, or balance problems. These symptoms rate separately and at significantly higher percentages.
Do this instead: Proactively report every episode of vertigo, dizziness, staggering, or balance problems. Bring a log of episodes with dates, durations, and triggers if possible. Request that the examiner assess for Meniere's or vestibular disorder if not already on the claim.
Impact: 50-100% under DC 6205 (Meniere's) vs. 0-30% for hearing loss alone
Not disclosing that tinnitus began in service even without contemporaneous records
Why: M21-1 recognizes that a veteran's lay statement that tinnitus began in service is competent and credible evidence. Many veterans assume no documented in-service record means the claim will be denied.
Do this instead: Clearly state that you noticed tinnitus while in service, identify the noise sources (weapons, aircraft, machinery, explosives), and describe when the sound first appeared. Your lay statement alone can support nexus.
Impact: Service connection determination-affects all rating levels
Saying 'I manage okay' or 'I've learned to cope' in response to functional impact questions
Why: The DBQ's functional impact section directly influences the examiner's narrative and the rater's overall disability picture. Minimizing your condition understates its true burden.
Do this instead: Describe the actual strategies you use to cope (turning up volume, asking for repetition, lip-reading, avoiding social situations) as evidence of the problem, not evidence that there is no problem. Coping strategies demonstrate disability, not absence of it.
Impact: All levels-particularly relevant for functional impact narrative in the DBQ
Taking vestibular suppressants or anti-vertigo medications before the exam
Why: Medications like meclizine, dimenhydrinate, or benzodiazepines suppress vestibular symptoms and can produce a falsely negative Dix-Hallpike test or artificially stable gait on exam day.
Do this instead: Unless medically unsafe to do so, avoid vestibular suppressant medications for 24-48 hours before the exam. Discuss this with your treating physician before making any medication changes.
Impact: Vestibular disorder ratings under DC 6204, 6205; Dix-Hallpike and Romberg findings
Prep checklist
- critical
Gather all relevant medical records
Collect service treatment records showing any noise exposure, hearing complaints, or ear conditions. Gather post-service audiologist records, ENT specialist notes, and any prior VA audiometric exams. Print or bring copies to the exam.
before exam
- critical
Log your tinnitus and vestibular symptoms for the past 30 days
Write down: how often tinnitus occurs, how loud it is, whether it disrupts sleep. For vertigo: log each episode with date, duration, severity (1-10), and what you were doing. This log can be referenced during the interview and given to the examiner.
before exam
- critical
Avoid loud noise for at least 14-16 hours before the exam
Do not use firearms, power tools, attend concerts, or operate loud machinery. Wear hearing protection if you work in a noisy environment the day before. This prevents temporary threshold shift from artificially improving your audiometric results.
before exam
- recommended
Avoid vestibular suppressant medications before the exam
If you take meclizine, dimenhydrinate, or similar medications for vertigo, discuss with your doctor whether it is safe to hold them for 24-48 hours before the exam so vestibular tests are not suppressed. Do not stop any medication without physician approval.
before exam
- critical
Write down your in-service noise exposure history
Document your MOS, duty stations, specific equipment operated (weapons, aircraft, vehicles, generators), and any events involving explosions or blast exposure. Include dates and frequency. This is your nexus evidence.
before exam
- recommended
Research your right to record the exam in your state
Many states allow veterans to record their C&P exam. Check whether your state requires one-party or two-party consent. If recording is permitted, notify the examiner before the exam begins and use a dedicated recording device or phone.
before exam
- recommended
Prepare a written summary of your worst-day symptoms
Write a 1-2 page summary describing your worst hearing days, worst tinnitus days, and worst vertigo days. Include specific functional limitations: conversations you missed, work tasks affected, social events avoided, and falls or near-falls due to balance issues.
before exam
- recommended
List all current medications for ear/hearing conditions
Include medication name, dose, prescribing provider, and what condition it treats. The DBQ asks the examiner to list medications used for the diagnosed ear condition.
before exam
- critical
Arrive without hearing aids (or bring them to show the examiner)
Audiometric testing should be conducted without hearing aids. However, bring your hearing aids so the examiner can document their use and note that you require them for daily function. Do not wear them during pure-tone and speech discrimination testing unless specifically instructed.
day of
- optional
Bring a support person if needed for communication
If your hearing loss is severe enough that you have difficulty understanding speech, bring a family member or VSO representative. Let the examiner know your communication needs at the start of the appointment.
day of
- recommended
Arrive 15 minutes early and request the examiner review your records
Ask the examiner at the start of the exam whether they have reviewed your records. Per M21-1, the DBQ requires the examiner to identify the evidence reviewed. If they have not reviewed key records, note this for your own tracking.
day of
- critical
Describe your worst days, not your average or best days
Per M21-1 guidance, VA disability ratings should reflect the full range of your condition including its worst manifestation. When asked how your condition affects you, describe your worst-day experience and note how frequently those worst days occur.
during exam
- critical
Report all associated symptoms proactively
Do not wait to be asked about vertigo, staggering, tinnitus, ear fullness, or facial nerve symptoms. Volunteer this information if the examiner does not ask. Each symptom category may support additional diagnostic codes and ratings.
during exam
- critical
Request that the examiner document functional impact in detail
Explicitly tell the examiner how your hearing loss and/or tinnitus affects your work, social life, and daily activities. Ask them to include this in the DBQ's functional impact section (Section 10 of the DBQ).
during exam
- critical
Do not minimize or apologize for your symptoms
It is common for veterans to say 'it's not that bad' or 'I'm sure others have it worse.' This language is recorded and can be used to support a lower rating. Describe your symptoms honestly and completely without comparison to others.
during exam
- optional
Ask what diagnoses the examiner is documenting
At the end of the exam, you may ask the examiner what diagnoses they are recording on the DBQ. This helps you track whether all claimed conditions are being addressed.
during exam
- critical
Write detailed notes immediately after the exam
Within 30 minutes of leaving, write down everything you remember: what tests were performed, what questions were asked, your answers, and anything the examiner said. Note if the examiner seemed rushed, did not review your records, or skipped any portion of the evaluation.
after exam
- recommended
Request a copy of the completed DBQ
You have the right to obtain a copy of your C&P exam report. Submit a records request through MyHealtheVet or your VA Regional Office. Review the DBQ for accuracy and completeness-errors or omissions can be challenged.
after exam
- recommended
Follow up with your VSO or accredited claims agent
Share your post-exam notes with your Veterans Service Organization representative or accredited attorney/agent. If the DBQ is inadequate, your representative can request a supplemental examination or submit a rebuttal.
after exam
Your rights during a C&P exam
- You have the right to record your C&P examination in most states. Check your state's recording consent laws. Notify the examiner before recording begins.
- You have the right to receive a copy of your completed DBQ and C&P exam report by submitting a records request through MyHealtheVet, the VA FOIA office, or your Regional Office.
- You have the right to a thorough and contemporaneous examination. If the examiner does not conduct audiometric testing, review your records, or assess all claimed symptoms, the examination may be inadequate and can be challenged.
- You have the right to submit a lay statement (buddy statement or personal statement) describing your symptoms and in-service noise exposure. Per M21-1, a claim for hearing loss is itself acceptable lay evidence that you experience difficulty hearing.
- You have the right to request a new C&P examination if the original exam is found to be inadequate, does not address all claimed conditions, or contradicts objective evidence in your records.
- Under 38 CFR 4.3 (benefit of the doubt), when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, the benefit of the doubt will be given to the claimant.
- If your hearing loss is service-connected and tinnitus is a symptom of that hearing loss, per M21-1, tinnitus should be established on a direct basis (not secondary) and rated separately under DC 6260. You are entitled to both ratings.
- You have the right to bring a VSO representative, accredited claims agent, or accredited attorney to your C&P examination.
- You have the right to submit a supplemental claim or request a Higher-Level Review if you believe the C&P examination was flawed, inadequate, or inconsistent with your medical evidence.
- Per 38 CFR 4.86, if your 4000 Hz threshold is 55 dB or greater, the VA must use whichever of Table VI or Table VIa results in the higher Roman numeral for your ear-this provision is applied automatically by the rating specialist and is favorable to you.
- Under 38 CFR 3.383, if hearing loss is service-connected in only one ear, the non-service-connected ear is assigned Roman Numeral I for Table VII purposes-you should not be penalized for having one healthy ear.
Related conditions
- Tinnitus Tinnitus is rated separately under DC 6260 at a flat 10% (maximum for a single rating). If hearing loss is service-connected and tinnitus is a symptom of the hearing loss, per M21-1, tinnitus is established on a direct basis and rated concurrently. Do not accept a denial of tinnitus on secondary grounds if your hearing loss is already service-connected.
- Meniere's Disease / Endolymphatic Hydrops Meniere's disease combines hearing loss, tinnitus, and episodic vertigo under DC 6205. Rated independently of pure audiometric data because hearing may be transient during attacks. Rated 30-100% based on frequency and severity of vertigo attacks. Veterans with recurring vertigo should explore this diagnosis even if initially diagnosed with hearing loss alone.
- Benign Paroxysmal Positional Vertigo (BPPV) BPPV is a vestibular disorder causing brief, intense vertigo triggered by head position changes. Rated under DC 6204. Can be secondary to head trauma or noise-induced inner ear damage. Diagnosed via Dix-Hallpike test during the C&P exam. May be claimed in addition to hearing loss.
- Peripheral Vestibular Disorder Rated under DC 6204. Includes chronic balance dysfunction, dizziness, and unsteadiness not meeting Meniere's criteria. Commonly associated with sensorineural hearing loss and noise-induced damage. Veterans with persistent balance problems and hearing loss should claim this separately.
- Sleep Disorder (Insomnia) Tinnitus is a well-documented cause of chronic insomnia. A secondary service connection claim for insomnia secondary to tinnitus or hearing loss may be warranted if sleep disruption is documented. Supports a separate rating under DC 6354 or sleep disorder diagnostic codes.
- Major Depressive Disorder / Anxiety (Secondary) Chronic hearing loss and tinnitus are associated with depression, anxiety, and social isolation. A secondary service connection claim for a mental health condition secondary to hearing loss or tinnitus may be warranted and rated separately under mental health diagnostic codes (9434, 9400, etc.).
- Otosclerosis Rated under DC 6202 per 38 CFR 4.87: 'Rate hearing impairment.' Conductive hearing loss due to stapes fixation. If service-connected, audiometric rating follows the same Table VI/VIa and Table VII process as DC 4000.
- Chronic Suppurative Otitis Media Active or chronic ear infections with perforation or discharge. Rated under DC 6200. Can cause conductive hearing loss and supports a concurrent hearing loss rating. Veterans with history of ear infections during or after service should ensure this is claimed.
- Traumatic Brain Injury (TBI) Blast-related TBI is a common cause of both sensorineural hearing loss and tinnitus in combat veterans. If TBI is service-connected, hearing loss and tinnitus may be rated as secondary conditions or as manifestations of TBI. Ensure claims are cross-referenced.
Get a personalized prep packet
This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.
This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.