Tinnitus is the single most frequently claimed VA disability condition, and hearing loss is right behind it. Nearly every veteran who served in a combat arms, aviation, armor, or heavy equipment role has meaningful noise exposure — yet many of these veterans are denied or rated at 0% simply because they did not understand how the exams work. The hearing loss and tinnitus C&P process is unique: it relies on objective audiological testing that cannot be gamed, but requires specific preparation and accurate symptom description to get right. This guide covers both exams start to finish.
If you have filed claims for both hearing loss and tinnitus — which most veterans should if they have both — you may receive one combined appointment or two separate appointments scheduled close together. The structure is different for each:
Both exams are required for their respective claims. Do not assume one will cover the other. If you were only scheduled for one exam and you have filed both claims, contact your VA Regional Office or VSO to confirm scheduling.
The audiology exam takes place in a sound-attenuating booth — essentially a small room lined with acoustic foam, insulated from outside noise, with a window between you and the audiologist. You will wear headphones connected to an audiometer. The audiologist controls the test from outside the booth.
The exam has two main components: Pure Tone Audiometry (PTA) and Speech Discrimination Score (SDS). Together, these two scores produce a Roman numeral category (I through XI) for each ear using the VA's audiogram grid, and those Roman numerals determine your rating.
Pure Tone Audiometry measures the softest sound you can hear at specific frequencies. The audiologist will play a series of tones through your headphones — starting at a comfortable volume and then dropping progressively quieter until you can no longer hear them. You indicate when you hear a tone by pressing a button or raising your hand.
The VA requires testing at these specific frequencies:
These four frequencies are averaged to produce a Pure Tone Average (PTA) for each ear. Higher PTA values (measured in decibels, dB) indicate greater hearing loss. The PTA feeds into the audiogram grid along with the Speech Discrimination Score.
Unlike ROM testing where your effort affects the outcome, the PTA measures your actual auditory threshold — the physical limit of what your cochlea and auditory nerve can perceive. You can report hearing a tone you did not actually hear, but you cannot hear a tone that your ears physically cannot detect. The audiologist is also trained to identify inconsistencies in threshold responses that indicate unreliable effort, which would trigger a retest.
Do not attempt to respond later than you actually hear tones, or to skip responses. This is considered malingering and is detectable. It could result in the exam being flagged as unreliable, delaying or harming your claim. Simply respond honestly each time you hear a tone — let the test reflect your actual hearing.
After the pure tone test, the audiologist will present a list of single-syllable words (a standardized word recognition list) through your headphones. You repeat each word aloud. The percentage of words you correctly identify is your Speech Discrimination Score (SDS).
The SDS is tested in a quiet environment and sometimes in a background noise condition as well. For veterans with noise-induced hearing loss, performance in noise is often significantly worse than in quiet — this distinction matters and is relevant to your daily functional impairment.
A 100% SDS means you understood every word correctly. As the score drops, it reflects increasing difficulty understanding speech. Veterans with scores below 80% typically notice significant difficulty following conversations, especially in groups, restaurants, or noisy environments. Scores below 60% indicate severe speech discrimination impairment.
The VA rates hearing loss using Tables VI and VIa in 38 CFR Part 4. These tables combine your PTA and SDS into a Roman numeral category (I through XI) for each ear, where:
Here is a simplified version of how the grid works:
| Speech Discrimination Score | PTA (dB): 0–41 | PTA (dB): 42–62 | PTA (dB): 63–74 | PTA (dB): 75–93 |
|---|---|---|---|---|
| 92–100% | I | II | III | IV |
| 76–91% | II | III | IV | V |
| 60–75% | III | IV | V | VI |
| 44–59% | IV | V | VI | VII |
| 28–43% | V | VI | VII | VIII |
| 0–27% | VI | VII | VIII | IX |
Once the audiologist has a Roman numeral for each ear, a second table (Table VIa) converts the combination of both ears' Roman numerals into a final disability percentage. For example, a veteran with Category III in both ears might receive a 10% rating, while a veteran with Category VI in the worse ear and Category IV in the better ear might be at 30%. A veteran with both ears at Category VIII or higher may qualify for 100% in that condition.
The audiogram grid is entirely objective — your PTA and SDS are measured, not estimated. This means the single most important thing you can do before your audiology exam is NOT to try to change your test results, but to ensure the examiner has the proper context about your noise exposure history and functional hearing difficulties. That context affects the nexus opinion and can support secondary conditions.
Before the audiometric testing begins, the audiologist will take a case history. This is your opportunity to establish the nexus between your service and your hearing condition. Be specific, thorough, and detailed.
The audiologist's nexus opinion — whether your hearing loss is "at least as likely as not" connected to your military service — is as important as the test results themselves. A finding of moderate hearing loss with a strong nexus opinion is a winning claim. The same findings without a nexus opinion is a denied claim. Give the audiologist everything they need to write a supportive opinion.
Tinnitus — rated under Diagnostic Code 6260 — is one of the simplest conditions to establish in the VA system: if you have tinnitus that began or worsened during military service, and you can describe it credibly, you qualify for a 10% rating. There is no objective test for tinnitus. The examiner documents what you report.
The tinnitus exam is typically brief — 15 to 30 minutes. A general medical examiner (physician, physician assistant, or nurse practitioner) will ask you about:
Under DC 6260, tinnitus is rated at a single flat rate of 10% — regardless of severity, frequency, or which ear is affected. There is no 20% or 30% for tinnitus. The rating is binary: documented tinnitus with service connection = 10%. The goal of your tinnitus exam is simply to ensure that documentation is thorough, credible, and clearly connected to your service. That 10% is also combinable with your hearing loss rating, your PTSD rating, and any other service-connected condition.
If you have hearing loss in both ears — which is the norm for veterans with noise-induced hearing loss, since military noise typically affects both ears — both ears are rated separately and then combined using Table VIa. This means the VA tests and documents each ear independently.
The practical implication: you will have two hearing thresholds recorded and two speech discrimination scores. When the VA claims examiner applies Table VIa, they look up the Roman numeral for your better ear and your worse ear in the combined table. Having significant loss in both ears produces a higher combined rating than if only one ear is affected.
Do not assume that because you hear "okay" out of one ear, bilateral hearing loss does not apply to you. Most noise-induced loss is sensorineural and affects both ears, often asymmetrically — with slightly more loss in one ear than the other. Both ears should be tested and both should be included in your claim.
A separate VA benefit — independent from your disability rating — is the provision of Assistive Listening Devices (ALDs) and hearing aids for service-connected veterans with hearing loss. You do not need to reach a specific rating threshold to qualify; eligibility is based on service-connection and clinical need.
At the end of your audiology C&P exam — or at your next VA audiology appointment — ask explicitly: "Do I qualify for VA hearing aids based on my service-connected hearing loss?" If you do qualify, the VA will fit you with hearing aids at no cost and provide batteries and follow-up services.
This benefit is separate from your compensation. Receiving hearing aids does not reduce your disability rating. Do not avoid pursuing hearing aids out of concern that it will affect your claim — it will not.
Use our disability calculator to see how your audiogram results translate into a VA rating — and how bilateral hearing loss combines with tinnitus and other service-connected conditions.
Try the Combined Rating Calculator →Want to estimate your total compensation before the exam? The Rating Estimator walks through your hearing loss severity and associated conditions to project your potential monthly benefit. When you are ready to file, our claim builder guides you through documenting noise exposure, audiogram history, and tinnitus the way VA raters need to see it.