VA Audiology & Hearing Services

Hearing loss and tinnitus are the most common service-connected disabilities among veterans. According to VA Research:

• More than 2.3 million veterans receive disability compensation for tinnitus — the #1 disability among veterans
• More than 1.3 million veterans receive compensation for hearing loss
• Among Iraq/Afghanistan veterans: 7.8% diagnosed with hearing loss, 6.5% with tinnitus, 6.2% with both
• Active duty tinnitus rates tripled from 2001 to 2015 (1.8 to 6.3 per 1,000)

Military noise exposure comes from gunfire, explosives, rockets, heavy weapons, jets and aircraft, and machinery — during combat operations, training exercises, and general duties.

VA is the largest employer of audiology professionals in the U.S., with more than 1,370 audiologists, 410 audiology health technicians, and 450 speech-language pathologists providing services at 490+ VA sites.

If you file a claim for hearing loss or tinnitus, VA will schedule a Compensation & Pension (C&P) hearing examination. Per 38 CFR 4.85(a), this exam must be conducted by a state-licensed audiologist and includes:

1. Controlled speech discrimination test using the Maryland CNC word list
2. Puretone audiometry test at 1000, 2000, 3000, and 4000 Hz

Important Exam Facts

• The exam is conducted without hearing aids
• Both ears are tested even if you are claiming only one ear
• The C&P examiner does not decide service connection — VBA claims processors make that determination

Ear Conditions DBQ

The Disability Benefits Questionnaire for ear conditions also evaluates Meniere's syndrome, peripheral vestibular disorders, BPPV, chronic otitis externa/media, mastoiditis, cholesteatoma, otosclerosis, and ear neoplasms. Physical exam components include external ear assessment, ear canal examination, tympanic membrane evaluation, gait/balance testing (Dix-Hallpike), and finger-nose coordination.

VA provides hearing aids, repairs, batteries, and accessories at no cost to eligible veterans. In practice, VA states that any veteran enrolled and eligible for VA care can receive hearing aids through audiology services.

Eligibility Under 38 CFR 17.149

VA furnishes hearing aids to veterans who are:

• Service-connected with compensable disabilities
• Former prisoners of war
• Purple Heart recipients
• Receiving 38 U.S.C. § 1151 benefits
• Receiving increased pension for aid/attendance or permanent housebound status
• Have hearing impairment caused by another VA-treated medical condition
• Have significant functional/cognitive impairment affecting daily living
• Severely hearing impaired, requiring aids for medical treatment participation

Veterans with service-connected hearing disabilities rated 0% also qualify if organic conductive, mixed, or sensory impairment exists with loss of pure tone hearing sensitivity affecting communication. Authority: 38 U.S.C. § 501, § 1707(b).

What VA Provides

• Premium-level hearing aids (not basic or entry-level models)
• Bluetooth connectivity, rechargeable batteries, and smartphone app integration
• Wireless microphones for distance hearing
• TV streaming devices
• Remote controls and smartphone apps
• Alerting devices (doorbell, alarm clock, smoke detector)
• Batteries and wax guards

Ordering Batteries & Supplies

Use VA Form 2346a to reorder batteries and supplies:

• Online at VA.gov (must have ordered within the past 2 years)
• Mail using the blue VA Form 2346 card/envelope
• Phone at (303) 273-6200 (Denver Acquisition & Logistics Center / DALC)
• Email to dalc.css@va.gov

Batteries arrive within 7–10 days. Reorder when your remaining supply covers about 30 days — each order provides approximately 6 months of batteries. For wax guards and accessories, call DALC and press 2.

VA replaces hearing aids based on clinical need as determined by your VA audiologist. There is no publicly documented fixed replacement interval. If your hearing aids are no longer working properly, your hearing has changed, or the devices cannot be repaired, contact your VA audiology clinic to discuss replacement.

Repairs to existing hearing aids are covered at no cost as long as you maintain VA eligibility for care.

VA contracts with what it describes as "the top five hearing aid manufacturers, offering the latest, premium models in various styles." The Denver Acquisition & Logistics Center (DALC) manages national hearing aid contracts.

Current VA hearing aid technology includes Bluetooth connectivity, rechargeable batteries, and smartphone app integration. Technology is updated through ongoing procurement contracts — veterans receive premium-level devices, not basic or entry-level models.

VA provides cochlear implant services at over 125 sites of care. Cochlear implants are for veterans with severe to profound hearing loss who are not benefiting from hearing aids. Candidacy is reviewed by VA's Cochlear Implant Advisory Board (CIAB).

VA also provides auditory osseointegrated devices (bone-anchored hearing aids) as an additional implantable option.

Geographic access challenge: A 2019 VA study found significant disparities — half of eligible veterans lived at least 80 miles from a VA facility providing cochlear implant care, and nearly 4 million veterans lived over 160 miles from such facilities.

Cochlear implants are provided at no cost to eligible veterans. Talk with your VA audiologist about whether you may be a candidate.

Under 38 CFR 4.87, Diagnostic Code 6260, recurrent tinnitus receives a flat 10% disability rating. This is the maximum schedular rating and applies regardless of whether tinnitus is unilateral or bilateral. This rating was established by the September 19, 2002 Federal Register final rule (67 FR 59033).

At the 10% rating level, the 2026 VA compensation rate for a single veteran with no dependents is $175.51 per month.

In 2022 (87 FR 8474), VA proposed evaluating tinnitus as a symptom of the underlying disease rather than a stand-alone disability. Specifically, a note to § 4.85 would add a 10% evaluation for noncompensable hearing loss with tinnitus present, where tinnitus is related to the hearing loss diagnosis.

The proposed rule includes a protection clause: "No change to a Veteran's current rating would occur due to these proposed changes." Until a final rule is published in the Federal Register, the current DC 6260 rating applies.

Progressive Tinnitus Management (PTM)

Developed in 2006 by the National Center for Rehabilitative Auditory Research (NCRAR) at VA Portland, PTM is VA's standard approach to tinnitus management. It uses five levels, with most patients needing only basic education:

1. Triage: Initial screening
2. Evaluation: Audiological assessment
3. Group Education: How to manage tinnitus
4. Interdisciplinary Evaluation: Complex cases
5. Individualized Support: Intensive, long-term treatment

Cognitive Behavioral Therapy (CBT)

CBT can be used alone or to augment masking or Tinnitus Retraining Therapy (TRT). While typically performed by psychologists, audiologists with appropriate training can also administer it.

Sound Therapy

Includes sound generators, tinnitus masking devices, and environmental sound enrichment. A 2017 VA study of 60 patients found that after 3 months, all three types of sound-therapy devices helped patients feel less bothered by tinnitus.

2024 VA/DoD Clinical Practice Guideline

Published June 2024, the updated guideline contains 25 evidence-based recommendations organized into two clinical algorithms: Module A (Initial Evaluation) and Module B (Managing and Improving Quality of Life).

Additional Approaches

• Guided imagery
• Deep breathing exercises
• Relaxation techniques
• Engagement in pleasant activities

What Counts as a Hearing Disability (38 CFR 3.385)

Hearing impairment is considered a disability when:

• Auditory threshold at any frequency (500, 1000, 2000, 3000, 4000 Hz) is 40 dB or greater
• Thresholds at least three of those frequencies are 26 dB or greater
• Speech recognition (Maryland CNC Test) is less than 94%

The Three-Table Rating System

VA determines your hearing loss rating using three tables:

1. Table VI: Combines your speech discrimination percentage and puretone threshold average to assign a Roman numeral (I through XI) for each ear. The puretone threshold average is the sum of thresholds at 1000, 2000, 3000, and 4000 Hz, divided by four.
2. Table VIA: Used instead of Table VI when speech discrimination testing is not appropriate (e.g., language difficulties or inconsistent scores). Uses puretone threshold average only.
3. Table VII: Combines the Roman numerals from both ears. The better ear is on the horizontal axis, the poorer ear on the vertical axis. The intersection gives your disability percentage.

Single ear claims: If only one ear is service-connected, the non-service-connected ear is assigned Roman numeral I (normal hearing) for rating purposes, unless bilateral conditions apply under 38 CFR 3.383.

Possible hearing loss ratings: 0%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100%.

Exceptional Patterns (38 CFR 4.86)

• Section (a): When puretone threshold at each of the four frequencies is 55 dB or more, VA uses whichever table (VI or VIA) produces the higher Roman numeral. Each ear evaluated separately.
• Section (b): When puretone threshold is 30 dB or less at 1000 Hz and 70 dB or more at 2000 Hz, VA uses the higher numeral and then elevates it to the next higher Roman numeral. Each ear evaluated separately.

Note: Hearing impairment and complications like labyrinthitis or tinnitus from DC 6200 conditions are evaluated separately.

High-frequency sensorineural hearing loss (SNHL) is considered an organic disease of the nervous system and therefore a presumptive disability under 38 CFR 3.309. This means veterans who develop SNHL within one year of discharge may be eligible for service connection without proving a direct nexus to a specific in-service event.

Connection to Other Conditions

• Both PTSD and TBI are linked to worsening tinnitus, particularly among veterans who suffered TBI from blast exposure
• A 2021 VA study found veterans with moderate to severe tinnitus had increased likelihood of screening positive for PTSD, depression, or anxiety
• Higher prevalence of hearing conditions with greater age, longer service, more noise exposure, and blast/TBI exposure

Secondary claims: You can claim hearing loss or tinnitus as secondary to other service-connected conditions, such as TBI.

VA audiology services are available at over 650 sites of care including VA medical centers, outpatient clinics, and CBOCs. Audiology is one of the few VA services that can be scheduled directly without a referral from a primary care provider.

Community Care Under the MISSION Act

You may be eligible for audiology through a community provider if:

• VA specialty care access standard is not met (60-minute average drive time or 28-day wait)
• The service is not available at any VA facility
• Your VA provider agrees community care is in your best medical interest
• You reside in a state or territory without a full-service VA facility

Important: You must get approval from your VA health care team before receiving care from a community provider.

Teleaudiology

VA provides three modes of teleaudiology:

• Clinic-to-clinic: Connects you at a local CBOC with audiologists at larger VA facilities
• Clinic-to-home: Receive audiology care from the comfort of your home
• Remote hearing aid programming: Audiologists adjust and fine-tune your hearing aids without an in-person visit

Beyond hearing aids, VA provides assistive listening devices at no cost:

• Wireless microphones for improved hearing at distance
• TV streaming devices to route audio directly to hearing aids
• Alerting devices for doorbell, alarm clock, and smoke detector alerts
• Captioned telephones that display real-time transcriptions of the other person's words during calls — available free from participating providers
• Remote controls and smartphone apps for hearing aid management

Ask your VA audiologist about which assistive devices may help with your specific hearing needs.

File using VA Form 21-526EZ (Application for Disability Compensation and Related Compensation Benefits). You can file online at VA.gov, in person at a VA regional office, by mail, or with help from a VSO or accredited representative.

Evidence Needed

1. Medical evidence of current disability: Audiogram showing hearing loss per 38 CFR 3.385 criteria, or diagnosis of tinnitus
2. Evidence of in-service incurrence: Service treatment records, military noise exposure history, MOS with known noise exposure
3. Nexus: Medical opinion linking your current condition to military service

Supporting Evidence

• VA medical records and hospital records
• Private medical records
• Buddy/lay statements (VA Form 21-10210) from family, friends, fellow service members
• Statement in Support of Claim (VA Form 21-4138)

You have up to one year from the date VA receives the claim to submit additional evidence.

Key Contact Numbers

• Health Care: 877-222-8387
• Benefits: 800-827-1000
• TDD (hearing impaired): 800-829-4833