Hearing loss and tinnitus are the two most commonly claimed VA disabilities, yet many veterans receive lower ratings than they deserve because they don't understand how the rating formula works. This guide walks through 38 CFR 4.85, the Maryland CNC speech test, Table VI/VIa/VII rating grids, puretone average calculations, and the exceptional patterns under 38 CFR 4.86 that many veterans miss.
VA hearing loss is rated under Diagnostic Code (DC) 6100 using the evaluation framework established in 38 CFR 4.85. Unlike most VA disabilities, which are rated based on a physician's clinical assessment of impairment, hearing loss is rated using a highly specific, formula-driven system based entirely on two audiometric measurements:
Each measurement is converted to a Roman numeral designation using separate tables (Table VI for speech discrimination, Table VIa for puretone threshold), and those two Roman numerals are cross-referenced in Table VII to produce the final disability percentage rating for each ear. The individual ear ratings are then combined under the bilateral rating formula to produce the overall combined hearing loss rating.
This system is precise but unforgiving. A veteran whose audiogram places them at the boundary of two rating categories may fall either above or below a compensable threshold based on a few decibels. Understanding how the tables work — and how to identify whether a higher rating is appropriate — is essential for veterans who believe their hearing loss is more disabling than their rating reflects.
The Maryland CNC (Consonant-Nucleus-Consonant) word recognition test is a standardized audiological assessment specifically required by 38 CFR 4.85(b) for VA hearing loss rating purposes. It was developed at the University of Maryland and is designed to assess speech intelligibility — not just the ability to detect sound, but the ability to understand spoken words clearly.
The test presents 50 monosyllabic words — words with a consonant-vowel-consonant structure (like "cat," "ship," "bell") — through headphones at a comfortable loudness level, typically 40 dB above the pure tone threshold. The patient identifies each word and the examiner records the percentage correct. The CNC word list is standardized to minimize familiarity bias, and the 50-word list size provides a reliable percentage score from 0% (no words recognized correctly) to 100% (all words correct).
The VA regulation specifies the Maryland CNC test — and no other — because different word recognition tests produce different scores for the same patient, making cross-facility consistency impossible if any test were acceptable. This matters enormously for veterans: a private audiologist who uses a different word recognition test (Northwestern University Auditory Test No. 6 (NU-6), for example) has produced results that the VA cannot directly plug into its rating tables. For VA claim purposes, ensure that any audiology evaluation specifically uses the Maryland CNC word list.
The Maryland CNC percentage score is converted to a Roman numeral level using Table VI in 38 CFR 4.85:
| Maryland CNC Score (%) | Table VI Roman Numeral |
|---|---|
| 92–100% | I |
| 84–90% | II |
| 76–82% | III |
| 68–74% | IV |
| 60–66% | V |
| 52–58% | VI |
| 44–50% | VII |
| 36–42% | VIII |
| 28–34% | IX |
| 20–26% | X |
| 0–18% | XI |
The puretone average (PTA) is calculated from a standard audiogram. Under 38 CFR 4.85(c), the VA uses thresholds at four specific frequencies: 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz. These frequencies represent the speech range and are where noise-induced hearing loss is most prominent (particularly the classic 4000 Hz "noise notch" on audiograms).
Consider a veteran with the following right ear audiogram thresholds:
VA PTA = (35 + 50 + 65 + 75) / 4 = 225 / 4 = 56.25 dB, rounded to 56 dB
Note that the VA calculation only uses four frequencies. Audiologists often calculate a 4-frequency average or a 3-frequency average (1000, 2000, 3000 Hz) for clinical purposes — neither of which matches the VA formula exactly. Always use the VA's specific four-frequency formula when evaluating your rating potential.
The calculated puretone average is then converted to a Roman numeral using Table VIa in 38 CFR 4.85:
| Puretone Average (dB) | Table VIa Roman Numeral |
|---|---|
| 0–41 dB | I |
| 42–48 dB | II |
| 49–55 dB | III |
| 56–62 dB | IV |
| 63–69 dB | V |
| 70–76 dB | VI |
| 77–83 dB | VII |
| 84–90 dB | VIII |
| 91–97 dB | IX |
| 98–104 dB | X |
| 105+ dB | XI |
From the example above: a 56 dB PTA falls in the 56–62 dB range = Table VIa Roman Numeral IV.
Once you have the two Roman numerals — one from the speech discrimination score (Table VI) and one from the puretone average (Table VIa) — you cross-reference them in Table VII to find the disability evaluation percentage for that ear.
Table VII is a grid with Table VIa Roman numerals (PTA) along the left and Table VI Roman numerals (speech discrimination) across the top. The intersection gives the percentage rating. Key illustrative intersections:
| PTA Level (VIa) | Speech Discrim I (92-100%) | Speech Discrim III (76-82%) | Speech Discrim V (60-66%) | Speech Discrim VIII (36-42%) |
|---|---|---|---|---|
| Level I (0–41 dB) | 0% | 0% | 0% | 10% |
| Level II (42–48 dB) | 0% | 0% | 10% | 20% |
| Level III (49–55 dB) | 0% | 10% | 10% | 30% |
| Level IV (56–62 dB) | 10% | 10% | 20% | 40% |
| Level V (63–69 dB) | 10% | 20% | 30% | 50% |
| Level VI (70–76 dB) | 20% | 30% | 40% | 60% |
| Level XI (105+ dB) | 80% | 90% | 90% | 100% |
Using our example veteran from above (right ear, 56 dB PTA = Table VIa Level IV) with a Maryland CNC speech discrimination score of 72%:
This calculation is performed separately for each ear. The left ear will have its own PTA and CNC score, producing its own percentage. The two ear percentages are then combined using the VA bilateral factor hearing loss formula under 38 CFR 4.85(h): the larger ear percentage is the "whole person" value and the smaller ear percentage is applied to the remaining "whole person" to generate the combined hearing loss rating. This produces a final combined percentage that may differ from a simple average of the two ears.
Some veterans have hearing loss patterns that don't fit neatly into the standard Table VII rating grid — specifically, extreme high-frequency loss with steep audiometric configuration or total speech discrimination failure. 38 CFR 4.86 provides for higher evaluations in these exceptional cases.
Exception 1: When the pure tone threshold at 1000 Hz or below is 30 dB or less, AND the pure tone threshold is 70 dB or more at 2000 Hz — a very steep high-frequency loss with near-normal low-frequency hearing — the rater uses a modified Table VI that gives the veteran the more favorable (higher) Roman numeral designation, potentially increasing the rating above what the standard puretone average calculation would produce. This pattern is common in noise-induced hearing loss, which characteristically spares low frequencies and devastates high frequencies.
Exception 2: When the speech discrimination score is 0% (total speech recognition failure) and the puretone average is 82 dB or more, the evaluation is 100% for that ear regardless of what Table VII would otherwise produce. This reflects the practical reality that a veteran who can detect sound but understands no speech has a profoundly disabling communication loss.
If your audiogram shows a steep high-frequency notch (4000 Hz notch typical of noise-induced hearing loss) or near-total speech discrimination failure, raise 38 CFR 4.86 specifically with your VA audiologist or in your claim. Many VA examiners do not apply 38 CFR 4.86 unless the veteran specifically invokes it. A private Au.D. evaluation that explicitly analyzes whether your audiogram qualifies for exceptional pattern consideration under 38 CFR 4.86 can be a significant asset in a rating claim or appeal.
Tinnitus — the perception of ringing, buzzing, hissing, roaring, or other phantom sounds in the ears or head — is the single most common VA disability in the United States, with over 3 million veterans currently service-connected for it. Tinnitus is rated under Diagnostic Code (DC) 6260 at a flat 10% disability rating, regardless of severity, frequency, or the degree to which it impairs daily function.
While tinnitus itself is limited to 10%, its impact on combined ratings is meaningful. A veteran with 30% hearing loss and 10% tinnitus has a combined disability rating of approximately 37%, which rounds to 40% under VA rounding rules — an additional $264/month over the 30% rate in 2026. If the same veteran had other service-connected conditions, the tinnitus 10% continues to combine and incrementally increase the overall combined rating. Never fail to claim service connection for tinnitus if you have it — it costs nothing to add and consistently adds value to the combined rating calculation. See our combined ratings calculator and bilateral factor guide for the math.
🩺 Hearing Loss Claim — Get a Proper Medical Opinion
Many veterans with significant noise-induced hearing loss receive lower ratings than the actual severity warrants because the C&P exam audiogram doesn't fully capture functional impairment. REE Medical provides audiological evaluations specifically designed for VA claims, including 38 CFR 4.86 exceptional pattern analysis and nexus opinions connecting hearing loss to noise-exposed MOS service.
Get a Hearing Loss Evaluation from REE Medical →claim.vet may receive a referral fee. Veterans never pay more.
When hearing loss is present in both ears — as it commonly is in noise-induced hearing loss from military service — the VA rates each ear separately using the Table VII formula and then combines them using the bilateral hearing loss formula. This is not the same as the standard VA combined ratings formula used for other body systems.
Under 38 CFR 4.85(h), bilateral hearing loss is evaluated as a single disability with the combined effect of both ears — specifically:
This produces a slightly higher combined rating than simply averaging the two ears, and the combined percentage is then compared against Table VII to produce the final bilateral hearing loss disability evaluation. The bilateral factor also applies — hearing loss in both ears qualifies for the 10% bilateral factor adjustment added to the combined rating before final rounding. This nuance means veterans with bilateral hearing loss should pay careful attention to how their VA adjudicator calculates the bilateral rating.
Establishing service connection for hearing loss requires showing: (1) a current hearing loss diagnosis, (2) an in-service inciting event (noise exposure), and (3) a nexus linking the two. For veterans with recognized high-noise occupational specialties, the nexus is often straightforward — the occupational noise exposure is well-documented and consistent with noise-induced hearing loss patterns on audiogram.
If your MOS or rating is on a recognized high-noise list, your claim of noise exposure is given greater weight and a nexus letter from a private audiologist may be unnecessary for establishing service connection — though it remains valuable for establishing the degree of severity and the rating level.
Military personnel in noise-hazardous MOSs are supposed to be enrolled in Hearing Conservation Programs (HCPs) and receive annual occupational audiometric surveillance testing. These records, when they exist, can be among the most powerful evidence in a hearing loss claim because they show a documented progression of hearing loss during service — from baseline to separation.
Request your complete service treatment records through the National Personnel Records Center (NPRC) at archives.gov. The records request form is SF-180. Turnaround times vary from weeks to months. Your VSO can help expedite records requests and interpret audiological findings in the context of your claim. See our VA claims process guide for the complete evidence-gathering workflow.
Hearing loss does not exist in isolation, and veterans who have hearing loss secondary to service-connected conditions — or who have developed additional conditions due to hearing loss — may have additional ratable disabilities beyond DC 6100 and DC 6260.
Veterans with service-connected traumatic brain injury (TBI) — from blast exposure, vehicle accidents, or direct head trauma — commonly develop auditory complications including:
CAPD secondary to service-connected TBI requires a nexus letter from an audiologist (Au.D.) or neurologist specifically linking the CAPD to the TBI. A specialized CAPD evaluation — including dichotic listening tests and other central processing assessments — provides the diagnostic foundation for this secondary claim. Many veterans with TBI have significant functional communication impairment from CAPD that is never claimed because it doesn't show up on a standard audiogram.
Some medications are ototoxic — meaning they can damage hearing and vestibular (balance) function as a side effect. Common ototoxic medications include certain aminoglycoside antibiotics (gentamicin, tobramycin), loop diuretics (furosemide, ethacrynic acid), some chemotherapy agents (cisplatin, carboplatin), and high-dose aspirin. Veterans who received ototoxic medications during service or as treatment for service-connected conditions may have hearing loss secondary to those medications. This requires documentation of the ototoxic medication use and a medical nexus opinion from an audiologist or otolaryngologist connecting the medication exposure to the hearing loss pattern on audiogram.
Two types of specialists handle hearing conditions: Doctors of Audiology (Au.D.) and Ear, Nose, and Throat physicians (ENT/Otolaryngologist). For VA hearing loss claims, each has a distinct role:
Specializes in audiometric testing, Maryland CNC speech testing, 38 CFR 4.86 exceptional pattern analysis, CAPD evaluation, hearing aid prescription, and auditory rehabilitation. Best choice for a private evaluation specifically for VA rating purposes.
Physician who specializes in ear diseases, can diagnose the underlying etiology of hearing loss (noise-induced, otosclerosis, Meniere's disease), provide surgical consultation, and write medical nexus letters for service connection based on medical history and occupational noise exposure.
For most hearing loss claims, you want both: an Au.D. for the audiometric evaluation (including Maryland CNC testing under conditions that maximize accuracy) and potentially an ENT or Au.D. with IMO experience for the nexus letter if VA C&P examiners are questioning service connection. REE Medical can provide the physician-authored nexus opinions that connect hearing loss and tinnitus to service-specific noise exposure, which can make the difference between a grant and a denial at the RO level.
| Rating | Monthly Pay (2026, Single) | Annual Pay | Common Scenario |
|---|---|---|---|
| 0% (SC, non-comp) | $0 / service connection established | $0 | Mild hearing loss, speech disc normal |
| 10% | $171.23 | $2,054.76 | Tinnitus alone (DC 6260) |
| 20% | $338.49 | $4,061.88 | Moderate bilateral hearing loss |
| 30% | $599.46 | $7,193.52 | Significant bilateral loss |
| 40% | $863.43 | $10,361.16 | 30% HL + 10% tinnitus combined = ~40% |
| 50% | $1,179.99 | $14,159.88 | Severe bilateral hearing loss |
| 10% + 10% combined = ~19% → 20% | $338.49 | $4,061.88 | Tinnitus + mild hearing loss |
The value of a properly documented hearing loss claim compounds over time. A 20% hearing loss rating for a 35-year-old veteran pays $338.49/month. Over 30 years to age 65, at no COLA increase, that's over $121,000. If the rating is elevated to 30% through a proper appeal, the additional $260/month over the same period is another $94,000. Getting the rating right from the beginning — or correcting an underrated claim through appeal — has very long-term financial significance. See our Supplemental Claim guide and free eligibility check if you believe your hearing loss rating is lower than it should be.
🎖️ Is Your Hearing Loss Rating Accurate?
Many veterans with significant hearing loss and tinnitus are rated too low because the C&P exam didn't apply the 38 CFR 4.86 exceptional pattern rules, or because secondary conditions like CAPD from TBI weren't claimed. A free 2-minute check can tell you if your rating may be underscored.
Check My Hearing Loss Rating — Free →Free screening. No obligation. Takes 2 minutes.
Yes. VA healthcare provides hearing aids based on audiological need through the VA audiology department — this is separate from the VA disability rating system. Veterans enrolled in VA healthcare can receive hearing aids, batteries, and follow-up audiology care regardless of their hearing loss disability rating. Even a 0% non-compensable hearing loss rating establishes service connection, which may help with priority access to VA audiology services. Contact your local VA medical center's audiology department to schedule an evaluation for VA-provided hearing aids.
Yes. If your service-connected hearing loss has worsened since your last rating decision, you can request a rating increase by filing a Supplemental Claim with new audiological evidence — specifically, a new audiogram and Maryland CNC speech test showing higher thresholds or lower speech discrimination. The new rating will be based on the current audiometric results at the time of the new C&P exam. Hearing loss from noise exposure typically progresses with age, so veterans rated years ago often qualify for rating increases as the condition worsens. See our rating increase guide for the step-by-step process.
Balance disorders (vestibular dysfunction) associated with inner ear damage may be separately ratable under VA diagnostic codes for vestibular conditions — including Meniere's disease (DC 6205), labyrinthitis (DC 6210), and peripheral vestibular disorders. These conditions can produce ratings of 10–100% depending on vertigo frequency and functional impairment, separate from the hearing loss DC 6100 rating. If you have dizziness, vertigo, or balance problems along with your hearing loss, consult an ENT or neurologist and file for any vestibular conditions as secondary to your service-connected hearing loss. See our comprehensive disability ratings guide for vestibular diagnostic code specifics.
🩺 Need an Audiology Evaluation for Your VA Claim?
REE Medical provides physician-authored audiology IMOs that specifically apply 38 CFR 4.85 and 38 CFR 4.86 criteria, document the nexus between military noise exposure and current hearing loss, and analyze whether exceptional patterns under 38 CFR 4.86 apply to your audiogram.
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