Hearing Loss VA Claim

By Shirley Chia. Published 2026-05-28. Source: 38 CFR 4.85, 38 CFR 4.86.

Why the formula matters more than your symptoms

Here is the hard truth most veterans learn the disappointing way. Hearing loss is one of the only VA conditions where how you feel and how you function barely enter into the rating. There is no "considerable impairment" judgment call, no prostrating-attack language, no room for a sympathetic rater to round up. DC 6100 is arithmetic. Your audiogram numbers go into two tables, and a percentage comes out the other end. That is the rating. It means the path to a higher number runs entirely through the test results — so understanding the math, and the exceptional-pattern escape hatches in 4.86, is the whole strategy.

The four-step formula

Step 1: Pure-tone average (PTA)

The VA averages your pure-tone air-conduction thresholds at four frequencies per ear: 1000, 2000, 3000, and 4000 Hz. A threshold is the quietest level, in decibels, at which the ear detects that tone. Add the four and divide by four. So a right ear at 25, 35, 60, and 75 dB averages to 48.75, which the rater rounds to 49.

Two traps live in this step. First, 500 Hz is tested on almost every audiogram but is not in the rating average — it is there for diagnostic reasons only. If a rater quietly folds 500 Hz into your PTA, the number is wrong. Second, only air conduction counts. Bone-conduction thresholds tell the audiologist whether the loss is conductive or sensorineural, but they never feed the rating.

Step 2: Maryland CNC speech discrimination

A separate test that measures how many of a list of monosyllabic words the veteran can correctly repeat when played at 65 dB in a quiet booth. The CNC score is a percentage 0-100. The test must use the W-22 word list or equivalent VA-approved list. State-licensed audiologists routinely administer Maryland CNC because the VA requires it.

If an audiogram lacks Maryland CNC and only has another speech discrimination test (such as NU-6), the VA may request a new audiogram or use Table VIa (PTA-only) instead.

Step 3: Table VI converts PTA + CNC to a Roman numeral per ear

Table VI is a grid: PTA on one axis, CNC on the other. Each cell contains a Roman numeral I through XI. Worst hearing = XI.

Example: PTA 50 dB, CNC 84%. Looking up in Table VI yields Roman numeral III. Another example: PTA 80 dB, CNC 60%. Table VI yields Roman numeral VII.

Step 4: Table VII converts bilateral Roman numerals to a percentage

Table VII is another grid: better-ear Roman numeral on one axis, worse-ear on the other. Each cell contains a percentage from 0 to 100. Result is the schedular hearing-loss rating.

Example: better ear = II, worse ear = IV. Table VII yields 0% (still rated 0%). Better ear = V, worse ear = VII. Table VII yields 30%. Better ear = X, worse ear = XI. Table VII yields 90%.

Exceptional patterns under 38 CFR 4.86

Pattern 1: severe across-the-board loss

When the puretone threshold is 55 dB or more at EACH of the four tested frequencies (1000, 2000, 3000, 4000 Hz), the rater uses Table VIa (PTA-only, ignores CNC) instead of Table VI, and takes whichever Roman numeral is HIGHER (better for the veteran). Affects veterans with profound across-the-board hearing loss.

Pattern 2: sloping high-frequency loss

When the puretone threshold is 30 dB or LESS at 1000 Hz AND 70 dB or MORE at 2000 Hz (a steep slope from normal low-frequency hearing to severe high-frequency hearing), the rater uses Table VIa AND increases the Roman numeral by one bracket (better for the veteran). This pattern is highly characteristic of noise-induced hearing loss and combat-noise exposure.

The sloping high-frequency pattern is the most common reason an audiogram looks worse to an audiologist than the plain Table VI math suggests. Always check whether 4.86 applies — and check both ears separately, because the exception can rescue one ear's Roman numeral even if the other ear does not qualify. Raters miss this constantly. If your decision letter does not mention 4.86 and your thresholds even arguably fit one of the two patterns, that omission alone can justify a supplemental claim.

What actually changes your rating

Because the rating is arithmetic, only three things move it, and it helps to know which lever you are pulling.

The first is a worse PTA — higher dB thresholds at the four rated frequencies. This usually comes with time and continued exposure; hearing loss tends to progress, which is why a 0% today can become a compensable rating at re-test years later. The second is a worse Maryland CNC score. Word-recognition often degrades faster than pure tones in noise-damaged ears, and a CNC drop can push your Table VI Roman numeral up even when the PTA looks stable. That is why the speech test is not a formality — push for a properly administered Maryland CNC every time. The third is qualifying for a 4.86 exceptional pattern, which can bump a Roman numeral without any change in the underlying numbers. Notice that none of the three is "explain to the rater how much you struggle." That argument has its place in a TDIU or extraschedular claim, but it does not move the schedular DC 6100 percentage.

Service connection for hearing loss

Direct service connection

In-service noise exposure documented through MOS (combat arms, aviation, artillery, armor) or specific exposures (range duty, NCO training). Hearsay or self-reported in-service noise is insufficient if MOS does not support it.

Presumptive — chronic disease one-year

Hearing loss qualifying as "organic disease of the nervous system" can be presumptively service-connected if diagnosed within one year of separation under 38 CFR 3.307(a)(3). The Federal Circuit confirmed this in Fountain v. McDonald, 27 Vet. App. 258 (2015).

Combat presumption

Veterans with documented combat service receive the 38 USC 1154(b) combat presumption — consistent lay testimony of in-service hearing loss is accepted as sufficient evidence of in-service occurrence, even without service treatment records documenting it.

Common rating errors

1. Ignoring 4.86 exceptional patterns. The most common underrating. Always check both Pattern 1 and Pattern 2.
2. Using bone conduction. Only air conduction counts for the rating. Bone conduction is diagnostic, not rating-determinative.
3. Including 500 Hz in the PTA. The formula uses 1000/2000/3000/4000 only. 500 Hz is reported but not averaged.
4. Using a CNC score from a non-Maryland test. Maryland CNC is specifically required.
5. Failing to claim tinnitus separately. Tinnitus (DC 6260) is rated separately and stacks.

Secondary pathways and aggravation

Most hearing-loss claims are direct, but two secondary angles under 38 CFR 3.310 are worth knowing. Ototoxic medication is one: certain drugs taken for a service-connected condition — some chemotherapy agents, high-dose loop diuretics, a handful of antibiotics — can damage hearing, which opens a secondary claim tied to the underlying disability. Ménière's disease or other inner-ear conditions can also produce sensorineural loss that is rated through a different code. And do not overlook aggravation: if you had mild hearing loss that a service-connected condition or its treatment made measurably worse, the worsening is compensable even though the loss is not new.

The C&P exam and re-testing strategy

The hearing C&P exam is a real audiogram in a sound booth plus a Maryland CNC, done by a state-licensed audiologist. There is not much to "argue" — the booth produces the numbers — but two things still matter. Make sure the examiner runs Maryland CNC, not a substitute like NU-6, because a non-Maryland word list can get your speech score thrown out or replaced by a PTA-only Table VIa calculation that may not help you. And take the test seriously: do not guess loudly at tones you cannot really hear, and do not power through the word list pretending you caught words you missed. Honest responses produce thresholds and CNC scores that reflect your actual loss, which is exactly what the formula needs.

Because the rating is locked to your audiogram, the smartest long game is re-testing. Noise-damaged hearing usually keeps declining, and age stacks on top of it. A veteran rated 0% in their forties is frequently compensable by their late fifties. File a claim for increase when a new audiogram shows the thresholds or CNC have slipped enough to push the Roman numerals up. The 0% you have now is what makes that future increase easy — service connection is already established, so you are only litigating severity.

Hearing loss, TDIU, and combined ratings

Hearing loss rarely drives TDIU on its own, but severe bilateral loss with poor word recognition can contribute to an unemployability picture, and the functional-impact statements that do nothing for your schedular percentage become directly relevant under 38 CFR 4.16. More commonly, hearing loss is one tile in a combined rating: a 10 or 20% hearing loss combined with tinnitus and other conditions under 38 CFR 4.25 can be the increment that crosses a payment threshold. Remember that combined ratings are not additive — 10% hearing loss plus 10% tinnitus is 19% rounded to 20%, not 20% flat — so a small hearing-loss rating is worth claiming even when it looks minor in isolation.

Worked example

Sources cited in this article

• 38 CFR 4.85 — Evaluation of hearing impairment (DC 6100)
• 38 CFR 4.86 — Exceptional patterns of hearing impairment
• 38 CFR 3.310 — Secondary service connection (including ototoxic medication and aggravation)
• 38 CFR 4.16 — Total disability ratings based on unemployability (TDIU)
• Fountain v. McDonald, 27 Vet. App. 258 (2015) (hearing loss as chronic disease for 3.307 presumption).
• 38 USC 1154(b) (combat veteran presumption of in-service occurrence).

VetDisabilityCalc is an independent reference site. We are not VA-accredited and we do not prepare or present VA claims. This guide is reference material and is not legal advice.