How VA rates hearing loss
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.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 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. |
Clinical findings needed
Not estimated: hearing-loss percentages require qualifying audiometry and the applicable VA tables. Conversation difficulty, noise exposure, or needing hearing aids cannot be converted to a percentage here.
What may happen in the exam room
- Puretone audiometry and controlled speech-discrimination testing as required by the applicable rules.
- Review of test validity and any reason speech-discrimination scores are inappropriate.
Measurements and findings to understand
- Puretone thresholds at 1000, 2000, 3000, and 4000 Hz for each ear.
- Maryland CNC percentage for each ear when appropriate.
- Exceptional patterns: all four thresholds at least 55 dB, or 1000 Hz at 30 dB or less with 2000 Hz at 70 dB or more.
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?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- 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.
Evidence to organize before the exam
- Audiology reports with thresholds, speech-test method, and results.
- Relevant service hearing records.
- Records describing functional effects 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 source
38 CFR 4.85 and 4.86, DC 6100. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Hearing loss and tinnitus are often two direct conditions from the same noise event, not secondaries of each other. Review whether both are documented.
A separate mental-health disability requires diagnosis, nexus, and non-duplicative impairment.
Review only with a diagnosed vestibular condition and individualized medical support.