1. What This Condition Is
Sensorineural hearing loss is permanent damage to the hair cells of the inner ear or the auditory nerve, reducing your ability to detect sound and understand speech. Military service is one of the leading causes: weapons fire, jet and rotary aircraft, explosions, tracked vehicles, shipboard machinery, and sustained industrial noise all cause cumulative cochlear damage that cannot be reversed. The VA rates sensorineural hearing loss based on how well you can hear tones and how well you can discriminate speech, using a standardized audiometric testing process. Even a 0% rating matters because it locks in service connection before your hearing deteriorates further.
2. VA Rating Criteria
Hearing loss is rated under 38 CFR Part 4, § 4.85, Diagnostic Code 6100, using a three-table audiometric system.
Table VI assigns a Roman numeral designation (I through XI) based on a combination of your puretone threshold average (average of 1000, 2000, 3000, and 4000 Hz) and your speech discrimination score (Maryland CNC word list). Where those two values intersect on Table VI, you get your Roman numeral for that ear.
Table VIa is used instead of Table VI when speech discrimination testing is not reliable or consistent. It assigns the Roman numeral based on puretone threshold average alone.
Table VII is the final step. It cross-references the Roman numeral for your better ear (horizontal row) against the Roman numeral for your worse ear (vertical column). The intersection gives your overall percentage rating.
| Possible Rating Range | Note |
|---|---|
| 0% to 100% (in 10% increments) | Based on Table VII intersection of both ears |
A 0% rating confirms service connection. A veteran with mild bilateral hearing loss often receives 0% initially but retains the service-connected designation, which matters when deterioration eventually supports a higher rating. Do not decline to file because you expect a 0%.
3. What to Expect at Your C&P Exam
The hearing loss C&P exam must be conducted by a state-licensed audiologist, not a general practitioner. The audiologist will administer two specific tests.
Pure tone audiometry measures the quietest tones you can detect at 1000, 2000, 3000, and 4000 Hz. The results are averaged to produce your puretone threshold average for each ear.
Maryland CNC speech discrimination test measures how accurately you can repeat monosyllabic words played at a controlled volume. This is a standardized word list. The score is expressed as a percentage.
Both tests must be conducted without hearing aids. Do not wear hearing aids to the exam.
The audiologist will not ask you much about your military history. That is established by your service records. Your job is to be present, test without aids, and accurately report any symptoms like tinnitus or sound sensitivity if asked.
One important protection: if the C&P exam does not include both the puretone test and the Maryland CNC test, the exam is inadequate under 38 CFR § 3.159(c)(4). You can challenge an inadequate exam and request a new one.
4. Evidence You Need to Win
Service Records. Documentation of noise hazard occupational exposure: MOS/AFSC descriptions, duty stations, aircraft assignments, weapons qualifications, deployment records. The VA has a duty to assist in obtaining these (38 CFR § 3.159), but pull them yourself via the National Personnel Records Center and submit them with your claim.
Separation Audiogram. Your military exit audiogram from your separation physical is often the strongest single piece of evidence. It documents your hearing at the end of service and can be compared to current testing to show deterioration. Request your STRs before filing.
Current Audiology Evaluation. A formal audiogram from a civilian audiologist confirming your current diagnosis and severity. This is separate from the C&P exam. Get this before you file so you know where you stand.
Nexus Letter. A letter from a licensed audiologist or ENT physician stating "at least as likely as not" that your sensorineural hearing loss was caused or aggravated by military noise exposure. The letter must review your records, describe your current diagnosis, and provide a clear rationale (Barr v. Nicholson, 21 Vet. App. 303 (2007)). It must cite your noise exposure history, your audiometric results, and the medical basis for connecting the two.
DBQ Form. The relevant VA examination form is the "Hearing Loss and Tinnitus" DBQ (VA Form 21-0960N-1). If you obtain a private nexus opinion or audiological evaluation, ask your provider to complete this DBQ to ensure all rating-relevant data is captured.
Personal Statement. Describe how your hearing loss affects your daily life: difficulty following conversations, requiring television at high volume, struggling in noisy environments, missing alarms or important sounds. Submit as a written statement with your 21-526EZ or on VA Form 21-10210.
Buddy Statements. Fellow service members (VA Form 21-10210) who served alongside you can confirm shared exposure to noise hazards. Particularly useful if your STRs lack audiometric history.
5. Secondary Conditions to Consider
Tinnitus (DC 6260). Tinnitus and sensorineural hearing loss share the same cause and often the same cochlear damage pathway. File both simultaneously. The tinnitus claim is rated separately at 10% and is not subsumed by the hearing loss rating.
Depression and Anxiety (DC 9434/9400). The isolation, communication difficulty, and social withdrawal that accompany significant hearing loss are directly linked to depression and anxiety. Secondary service connection under 38 CFR § 3.310 is medically well-supported. A nexus letter from a treating mental health provider connecting mood disorder to hearing loss is the key piece of evidence.
Balance Disorders and Vestibular Dysfunction (DC 6204). The inner ear handles both hearing and balance. Sensorineural damage frequently co-occurs with vestibular damage, causing dizziness, vertigo, and fall risk. If you have balance problems alongside hearing loss, file these together. An ENT or neurologist can provide the nexus.
Cognitive and Concentration Difficulties. Emerging medical literature links untreated hearing loss to accelerated cognitive decline. If you have documented cognitive symptoms alongside significant hearing loss, discuss this with your treating physician as a potential secondary claim.
Social Isolation and Relationship Strain. While not a standalone VA diagnostic code, these downstream effects support the occupational and social impairment picture for any secondary mental health claim.
6. Common Mistakes That Kill Claims
1. Wearing hearing aids to the C&P exam. The audiometric testing must be conducted without amplification devices. If you wear aids to the exam and the audiologist allows testing with them in, the results will understate your actual impairment. Arrive without aids and inform the examiner at the start.
2. Not filing tinnitus simultaneously. These two conditions almost always co-exist and share the same nexus. Filing them together costs nothing extra and captures a separate 10% rating for tinnitus under DC 6260. Many veterans leave this on the table.
3. Accepting inadequate C&P exam results without challenge. If the examiner did not administer the Maryland CNC speech discrimination test, or if the exam was conducted without a state-licensed audiologist, the exam is legally inadequate. Request a new exam under 38 CFR § 3.159(c)(4) and submit a private audiology opinion as rebuttal evidence.
4. Relying only on separation audiogram as evidence of current severity. The separation audiogram establishes the in-service link, but the VA needs current audiometric data to rate your present level of impairment. Without a current evaluation, you may receive a lower rating than your actual hearing loss warrants.
5. Failing to update your rating as hearing deteriorates. Sensorineural hearing loss typically worsens over time. Once service-connected (even at 0%), file a claim for increase when your audiogram results show worsening. The duty to assist continues, and the VA should order a new C&P exam to reassess.
7. FWD Assist Resources
The FWD Assist HQ Hearing Loss and Tinnitus guide walks through the audiogram process, what the VA's rating tables actually measure, how to read your own audiogram results, and how to build the evidence package for both conditions simultaneously.
The C&P Exam guide at FWD Assist HQ covers how to prepare for audiological exams and what to do if the exam is inadequate.
8. Get Help Without a Claim Shark
Free, accredited help is available through Veterans Service Organizations (VSOs) like the DAV, VFW, and American Legion, county veterans service officers, and VA-accredited agents and attorneys. Anyone charging upfront fees to help you file a VA claim violates 38 USC § 5905 and is committing a federal crime. VA-accredited attorneys and agents may only charge fees after an initial VA decision, and those fees are capped at 20% of past-due benefits. Find free accredited help at va.gov/ogc/accreditation.asp.