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Nexus Letters for Hearing Loss
Licensed Physician, MD | Patriot Path Medical Team
Specializing in VA auditory evaluations and independent medical opinions • Last updated: June 2026
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Hearing loss is the second most claimed VA disability, right behind tinnitus, and for the same reason: years around weapons, aircraft, and heavy machinery take a toll. It usually comes on slowly, so a lot of veterans do not connect it to service until the conversations at the dinner table start slipping by.
A nexus letter can fix that. Our physicians connect your hearing loss to your service in the language the VA expects, and pair it with your tinnitus claim. One flat fee of $1,500, and the first consultation is free.
How VA Rates Hearing Loss
VA rates hearing loss under 38 C.F.R. § 4.85, Diagnostic Code 6100. Unlike most conditions, it is not judged by how bad it feels. It is calculated from your audiogram, using two hearing tests and two tables. Ratings run from 0% to 100%, but 0% is the most common result, even for real, documented loss. The bands below are a plain-language guide; the exact number comes from the math explained underneath.
| Rating | What it generally takes | Monthly pay (approx) |
|---|---|---|
| 0% | Mild to moderate loss, especially when your word recognition is still good. This is the most common outcome, even with real loss that you notice every day.Most Common | $0 |
| 10% | Moderate loss in both ears, or moderate loss in one ear with worse loss in the other. | ~$180/mo |
| 20% | Moderate-to-severe loss in both ears, with reduced word recognition. | ~$357/mo |
| 30% to 40% | Severe loss in both ears. | ~$552 to $796/mo |
| 50% and up | Profound loss or near-total deafness in both ears. | ~$1,133/mo+ |
Pay figures are approximate 2026 rates (effective December 1, 2025) for a single veteran with no dependents. Check VA.gov for current amounts.
How the VA actually calculates a hearing loss rating
The rating is not a judgment call. It is a calculation from your audiogram. Here is the path your numbers take.
- 1
Two tests, no hearing aids
A state-licensed audiologist runs a puretone audiometry test and a Maryland CNC word-recognition test. Both are done with your hearing aids out, so the result reflects your unaided hearing.
- 2
Average your hearing thresholds
For each ear, the VA averages your puretone thresholds at 1000, 2000, 3000, and 4000 Hertz. That single number is your puretone threshold average.
- 3
Turn each ear into a Roman numeral (Table VI)
That average and your word-recognition score meet on a grid called Table VI, which gives each ear a Roman numeral from I (near normal) to XI (profound loss).
- 4
Combine both ears (Table VII)
Your better ear and your poorer ear meet on a second grid, Table VII. Where they cross is your rating, from 0% to 100%.
Two things to know. First, unusual patterns of loss get special handling under 38 C.F.R. § 4.86, which can bump your numeral up. Second, hearing loss only counts as a disability for VA purposes once it crosses the thresholds in 38 C.F.R. § 3.385. Because the formula leans heavily on word recognition, many veterans with real, documented loss still rate 0%. A 0% rating is not a loss: it makes your hearing loss service-connected, so any future worsening is already on record, and it sits alongside a 10% tinnitus rating.
Want your own number? Run your audiogram through the tables.
Open the hearing loss rating calculator→Making a VA Disability Claim for Hearing Loss
When you file a VA disability claim for hearing loss, three things need to line up:
A current diagnosis
An audiogram from a state-licensed audiologist, using the Maryland CNC word test and puretone audiometry, that shows loss meeting 38 C.F.R. § 3.385.
A service connection
Noise exposure in service, such as flight lines, engine rooms, armor, firing ranges, or blasts, usually without consistent hearing protection.
A medical nexus
A qualified opinion that your hearing loss is 'at least as likely as not' connected to that noise exposure.
Hearing loss is not presumptive, and it often comes on slowly, so the VA frequently denies it as 'age-related' when the service link is not spelled out. The nexus is where these claims are won. A nexus letter supplies it: a written medical opinion tying your hearing loss to your service. The 'at least as likely as not' standard (a 50% or better chance) comes from the benefit-of-the-doubt rule in 38 U.S.C. § 5107(b), carried out in 38 C.F.R. § 3.102.
How to Connect Your Hearing Loss to Service
There are a few ways to tie hearing loss to your service. The direct noise-exposure path is the common one, even when the loss did not show up until years later.
Direct connection
Loud noise in service damaged your hearing.
- Sustained high noise. Flight lines, engine and boiler rooms, generators, armor, and firing ranges wear hearing down over months and years.
- Your job. The VA keeps a noise-exposure list by military job. Aviation, armor, motor pool, artillery, and infantry roles carry a high probability of hazardous noise.
- Delayed onset. Noise damage often shows up as measurable loss years after service. That gap does not disqualify you, but it makes a nexus letter more important.
Secondary connection
Another service-connected condition, or its treatment, caused the hearing loss (38 C.F.R. § 3.310).
- Head injury or TBI. A blast or head injury in service can damage hearing.
- Ear disease. Meniere's disease and chronic ear infections can cause lasting loss.
- Ototoxic medication. Some drugs taken for a service-connected condition can damage the inner ear.
Aggravation
You had some hearing loss before service, and service made it permanently worse.
- Worsened by service. Mild loss at entry that loud duty pushed measurably worse, beyond normal aging.
Secondary Conditions
Hearing loss rarely travels alone. These links can add to your combined rating, so they are worth documenting.
Hearing loss may be secondary to
- Head injury or TBI. A blast or head injury can damage hearing.
- Meniere's disease or ear conditions. Chronic ear disease can cause lasting loss.
- Ototoxic medication. Drugs taken for a service-connected condition can harm the inner ear.
Conditions that may go with hearing loss
- Tinnitus. The same noise usually causes both, so they are claimed together and rated separately.
- Depression and anxiety. Struggling to follow conversation can lead to isolation, low mood, and stress, which can be claimed as secondary.
- Balance problems. Some inner-ear conditions that cause hearing loss also cause dizziness, which is rated on its own.
What to Gather - Evidence Checklist
Gather these before you file or ask for a letter. Tick each off as you go.
Frequently Asked Questions
How does the VA rate hearing loss?
From your audiogram, not from how bad it feels. A state-licensed audiologist runs a Maryland CNC word test and a puretone test. The VA averages your thresholds at 1000, 2000, 3000, and 4000 Hertz, turns each ear into a Roman numeral on Table VI, then combines both ears on Table VII for a rating from 0% to 100%.
Why did I get 0% when my hearing is clearly bad?
The formula leans heavily on word recognition, so it is common to rate 0% even with real loss, especially if you still score well on the word test. A 0% rating still makes your hearing loss service-connected, which protects you if it worsens and lets it pair with a 10% tinnitus rating.
What is the Maryland CNC test?
It is a standardized word-recognition test the VA requires for hearing claims. You repeat back a list of words, and your score, along with your puretone average, sets your Roman numeral on Table VI. It must be done by a state-licensed audiologist, without hearing aids.
Is hearing loss presumptive?
No. You have to show it is 'at least as likely as not' connected to your service, usually to noise exposure. Because loss often shows up years later, a clear record of your military job and a nexus letter matter a great deal.
Can I claim hearing loss and tinnitus together?
Yes, and most veterans should. The same noise usually causes both. They are rated separately, hearing loss under DC 6100 and tinnitus at a flat 10% under DC 6260, and then combined.
What does it cost, and how do we start?
Patriot Path charges $1,500 flat for a nexus letter, and the first consultation is free. Book a consultation and a clinician will tell you straight whether a letter can help.
The noise took your hearing. Let your claim show it.
Let our physicians prepare a hearing loss nexus letter that meets the VA's evidence standards, and pair it with your tinnitus claim.
Sources & Regulatory References
- VA disability compensation (VA.gov) https://www.va.gov/disability/
- 38 CFR 4.85, Evaluation of hearing impairment, Tables VI, VIa, VII (eCFR) https://www.ecfr.gov/current/title-38/section-4.85
- 38 CFR 4.86, Exceptional patterns of hearing impairment (eCFR) https://www.ecfr.gov/current/title-38/section-4.86
- 38 CFR 3.385, Disability due to impaired hearing (eCFR) https://www.ecfr.gov/current/title-38/section-3.385
- 38 CFR 3.303, Principles relating to service connection (eCFR) https://www.ecfr.gov/current/title-38/section-3.303
- 38 U.S.C. 5107, Benefit of the doubt (Cornell LII) https://www.law.cornell.edu/uscode/text/38/5107