Inside the exam room
1. A licensed audiologist will ask about your hearing and noise exposure. Identify the affected ears, hearing aids, and noise during and after service.
2. You will listen for tones and repeat spoken words without hearing aids. VA uses the Maryland CNC word test unless a documented exception applies. Follow the instructions and respond to the sounds and words you hear.
3. You will be asked about hearing outside the test room. Explain trouble with conversations, phone calls, work, and background noise.
How VA rates hearing loss
The percentage comes from hearing and word-recognition test results. Describe everyday hearing difficulties, but use the audiologist's results for the rating calculation. Under sections 4.85 and 4.86, hearing impairment generally uses a controlled Maryland CNC speech-discrimination test and puretone audiometry by a state-licensed audiologist, without hearing aids. Each ear receives a Roman-numeral designation; Table VII combines the ear designations. Exceptional patterns and specified exceptions require additional review.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| Table-based | Use the puretone average at 1000, 2000, 3000, and 4000 Hz with the qualifying speech-discrimination score in Table VI, then combine the ear designations in Table VII. |
| Exceptions | Table VIa and exceptional-pattern rules apply only in the circumstances specified in sections 4.85 and 4.86. Hearing-loss symptoms alone are not a substitute for these findings. |
Which exam or test results are needed?
A hearing specialist must test your hearing and word recognition before VA can work out a percentage. The tests must meet VA’s requirements. This tool cannot turn conversation difficulty, noise exposure, or use of hearing aids into a rating.
What may happen in the exam room
- A hearing specialist tests the quietest sounds you can hear and how well you recognize spoken words.
- The specialist checks whether the results can be used and whether there is a reason the word test is unsuitable.
What the measurements tell you
- The quietest tones you can hear (puretone thresholds) at 1000, 2000, 3000, and 4000 Hz in each ear. Hz describes the pitch of the sound.
- Your score for recognizing spoken words on the Maryland CNC test, for each ear when appropriate.
- VA uses special rules for these test patterns: all four tones need at least 55 dB, or the 1000 Hz tone needs 30 dB or less and the 2000 Hz tone needs 70 dB or more. dB describes how loud the sound must be for you to hear it.
Questions the examiner may cover
- What hearing difficulties do you experience in daily life?
- What relevant hearing and noise-exposure records are available?
- What hearing-assistance devices have been prescribed?
Questions to expect
Which hearing tests are available?
Explain: Identify the audiologist, dates, puretone results and Maryland CNC speech scores. During testing, respond to the sounds and words you hear.
Rating connection: The rating is calculated from qualifying audiology results, not a description of difficulty or hearing-aid use. Symptoms cannot supply missing test scores.
Where do communication difficulties occur?
Explain: Describe conversation, background noise, telephone use and work, plus remaining abilities and prescribed devices.
Rating connection: The examiner records functional impact alongside the test results; the hearing tables still determine the schedular percentage.
Your answer outline
I hear [situation] [how well]. In [different situation], I have difficulty with [specific detail]. This affects [activity or interaction] by [consequence]. I use [prescribed device or actual adjustment], which [effect].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Describe difficulty in quiet, groups, work, or other settings accurately.
- Follow the audiologist’s test instructions without intentionally changing responses.
Common mistakes to avoid
- Assuming both ears at level II establish 10%; the result must come from Table VII.
- Treating any hearing difficulty as a minimum 10% rating.
- Inferring service connection or a percentage from noise exposure alone.
Records to get ready before the exam
- Audiology reports with thresholds, speech-test method, and results.
- Relevant service hearing records.
- Records describing effects on daily life and treatment.
Preparation notes
- Not every commercial hearing test satisfies the VA rating requirements.
- If only one ear is service-connected, special rules apply; do not assume both ears can be combined as service-connected.
Official rating rule and code numbers
Use this source to check the full rule and its medical terms: 38 CFR 4.85 and 4.86, DC 6100. Source review recorded 2026-09-04.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
The same noise event may cause hearing loss and tinnitus. One does not usually cause the other. Check whether both are recorded.
A separate mental-health disability needs a diagnosis, a medical explanation of the connection, and effects that are not already counted in another rating.
If an inner-ear balance problem is diagnosed, ask your provider to explain the connection in your case.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.