Hearing loss is one of the most-claimed VA disabilities, and it is also one of the most misunderstood. Unlike most conditions, it is rated by a strict formula based on test results, not on how much you struggle to hear in daily life. This guide explains the process and what a nexus letter needs to do.
How the VA rates hearing loss
Hearing loss is rated under diagnostic code 6100, per 38 CFR 4.85. The rating is mechanical. It is driven entirely by two test results:
- Puretone audiometry: the average of your thresholds at 1000, 2000, 3000, and 4000 Hertz
- Maryland CNC speech discrimination: a controlled word-recognition test
Those two results are plotted on Table VI to assign each ear a Roman numeral (I through XI), then both ears are plotted on Table VII to produce the final percentage, from 0 to 100 percent.
Two rules to know:
- The exam must be done by a state-licensed audiologist and must include both the Maryland CNC test and puretone audiometry. It is done without hearing aids.
- For exceptional patterns of hearing loss (38 CFR 4.86), the VA may use an alternate table (VIA) that can produce a higher rating.
As of April 2026, these tables and the required tests have not changed.
Why so many veterans get 0 percent
Because the rating is purely formula-based, many veterans with real hearing trouble receive a 0 percent (noncompensable) rating. A 0 percent rating still matters: it establishes service connection, so if your hearing worsens, you can file for an increase without re-proving the connection.
Practical tips for the exam:
- Avoid loud noise for 24 hours beforehand. Temporary threshold shifts can skew results.
- Respond only when you genuinely hear the tone. Consistency matters; the test has reliability checks.
- Do your honest best on the word-recognition test. Poor effort is detectable and hurts your claim.
What a hearing loss nexus letter needs
The rating is mechanical, but service connection is not. That is where the nexus letter comes in:
- Documents in-service noise exposure (your MOS, weapons, aircraft, machinery, explosions)
- References entrance and separation audiograms and any threshold shifts
- Explains the medical link between that exposure and your current hearing loss
- States the opinion in VA terms ("at least as likely as not")
Hearing loss and tinnitus travel together
If you have noise-induced hearing loss, you very likely have tinnitus too, and vice versa. Tinnitus is rated separately at 10 percent. Claiming both together is efficient and can raise your combined rating.
A real-world example
A veteran who worked around jet engines had documented hearing complaints but a borderline audiogram. A provider tied his current loss to his documented in-service noise exposure and flagged the exceptional-pattern rules for his exam. He also claimed tinnitus alongside it.