The Ears

Topics:

Hearing Loss Rating System
Ear Conditions
Otitis (Earache)
Balance Disorders
Cancer and Tumors of the Ear
Other Ear Conditions
DBQ for Ear Conditions
Principles that Apply

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Additional compensation is given by the VA for serious hearing impairments. See the Special Monthly Compensation to see if your condition qualifies.

The ear is a unique sensory organ. Not only does it control hearing, it also controls the body’s balance.

When sound waves enter the ear from the outside auricle, they travel down the ear canal to the eardrum. The eardrum then vibrates in response to the sound waves, sending an even stronger wave through the middle ear. The waves then move into the inner ear, which is filled with fluid. When the waves disturb the liquid, electrical impulses are stimulated and sent up the nerves to the brain. The inner ear also houses the semicircular canals that send impulses to the brain that control balance.

the anatomy of the ear

 

 

Note: Your general examining physician CANNOT perform the tests necessary to rate a hearing impairment. Only a licensed audiologist can ensure a proper rating. Ratings are based on the results of two tests: a controlled speech discrimination test, and a puretone audiometry test. The VASRD also points out, kind of obviously, that these tests cannot be taken while wearing a hearing aid. Thank you, VASRD.

Please also note that it is almost impossible to fake hearing loss. The hearing test will be able to detect inconsistency in the responses and will invalidate the test. Sorry. Make sure you get the proper exam and tests so that can you get the most accurate rating possible.

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Hearing Loss Rating System

The rating system for hearing loss is a bit complicated, but we’re going to go through it step by step. Ratings for hearing loss are based on the hearing ability of BOTH ears. Each ear is not rated separately and only 1 rating can be given for both ears. Even if an ear has no hearing loss, it is factored in to determine the overall disability that results from hearing loss for both ears.

First, there are two tests that must be done to determine your hearing impairment. To get a proper rating, both ears need to be tested. If one has not been tested, it is assumed that that ear is perfectly normal.

The first test needing to be done is a speech discrimination test that determines your ability to understand words due to hearing loss. The tester will say various words in a controlled environment and you have to repeat them back. The results for this test are percentages. This percentage is what you’ll need to rate your condition.

There are cases where a speech discrimination test would not be a true reflection of hearing impairment. The audiologist may choose not to conduct this test in circumstances where there is already an impairment that is not related to hearing loss or in other conditions where language difficulties would not accurately demonstrate a true hearing impairment. If this is the case, the condition will be rated only on the second test, below.

The second test needed to rate hearing loss is a puretone audiometry test. This test measures the loudness (measured in decibels) and pitches (high or low; measured in frequencies) at which you can first hear a sound. These numbers are called hearing “thresholds”. The test scores various high and low pitches by playing them at different volumes. A score of 0 means that you can hear that pitch normally. The higher the score (0-110), the louder it had to be for you to hear it.

High numbers indicate significant hearing loss. The important final result is a reading at four different frequencies: 1000, 2000, 3000, and 4000 Hertz. These frequencies are the ones most used to hear people speak. To calculate hearing loss the 4 thresholds are averaged (the sum of the results of thresholds 1000, 2000, 3000, and 4000 Hertz, divided by 4).

Once we have these test results, a Roman numeral needs to be assigned to each ear. These Roman numerals are simply a tool used to keep the rating system from getting too confusing.

If both tests have been performed, then use the following table to determine the Roman numerals. This will have to be done twice, once for each ear. The results of the puretone test run across the top of the table, and the results for the speech test run down the left side of the table. Find the results for both tests for a single ear and then assign the Roman numeral in the intersecting square. So, if the puretone test result is 58, and the speech test result is 84%, then the Roman numeral for this ear would be III.

Puretone Threshold Average →   

% of Speech Discrimination ↓    

0-41

42-49

50-57

58-65

66-73

74-81

82-89

90-97

98 +

92-100%

I

I

I

II

II

II

III

III

IV

84-90%

II

II

II

III

III

III

IV

IV

IV

76-82%

III

III

IV

IV

IV

V

V

V

V

68-74%

IV

IV

V

V

VI

VI

VII

VII

VII

60-66%

V

V

VI

VI

VII

VII

VIII

VIII

VIII

52-58%

VI

VI

VII

VII

VIII

VIII

VIII

VIII

IX

44-50%

VII

VII

VIII

VIII

VIII

IX

IX

IX

X

36-42%

VIII

VIII

VIII

IX

IX

IX

X

X

X

0-34%

IX

X

XI

XI

XI

XI

XI

XI

XI

 

If a speech discrimination test was determined not necessary by an audiologist, then a Roman numeral can be assigned for each ear based on the following table.

Puretone Threshold Average

0-41

42-48

49-55

56-62

63-69

70-76

77-83

84-90

91-97

98-104

105 +

Roman Numeral

I

II

III

IV

V

VI

VII

VIII

IX

X

XI


If tests were not performed on an ear, it is assumed that that ear has perfect hearing, and is assigned a Roman numeral of I.

If the results for each puretone threshold (1000, 2000, 3000, and 4000 Hertz) are all 55 decibels or more, then it can be rated on either of the above tables, whichever results in the higher Roman numeral, even if a speech test was performed.

If the results of the puretone threshold of 1000 Hertz is 30 decibels or less and the results of the puretone threshold of 2000 Hertz is 70 decibels or more, then it is a special case which merits a greater hearing loss compensation. It can be rated on either of the above tables, whichever results in the higher Roman numeral, even if a speech test was performed. The Roman numeral calculated from the tables is then increased by one level. So, if the highest Roman numeral of the two tables is VI, then that ear is assigned a Roman numeral of VII.

Once a Roman numeral is assigned to each ear, a rating can be found using the table below. First find the Roman numeral down the left side for the ear that hears the best (one with the smaller Roman numeral). The Roman numeral of the ear that hears the worst (one with the bigger Roman numeral) can be found across the top of the table. Then find the rating in the intersecting box of these two Roman numerals. For example, if the best ear has a Roman numeral of III, and the worst ear has a Roman numeral of VI, then the total rating for hearing loss is 10%.

Worst Ear →
Best Ear ↓

I

II

III

IV

V

VI

VII

VIII

IX

X

XI

I

0%

0%

0%

0%

0%

0%

0%

0%

0%

10%

10%

II

 

0%

0%

0%

10%

10%

10%

10%

10%

10%

10%

III

 

 

0%

10%

10%

10%

20%

20%

20%

20%

20%

IV

 

 

 

10%

10%

20%

20%

20%

30%

30%

30%

V

 

 

 

 

20%

20%

30%

30%

40%

40%

40%

VI

 

 

 

 

 

30%

30%

40%

40%

50%

50%

VII

 

 

 

 

 

 

40%

40%

50%

60%

60%

VIII

 

 

 

 

 

 

 

50%

50%

60%

70%

IX

 

 

 

 

 

 

 

 

60%

70%

80%

X

 

 

 

 

 

 

 

 

80%

90%

XI

 

 

 

 

 

 

 

 

 

 

100%

 

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Ear Conditions

Code 6100: Hearing loss that is not caused by another condition is rated under this code. This condition is rated based on the hearing loss rating system.

Code 6202: Otosclerosis is an abnormal growth of bone in the middle ear. This condition is rated based on the hearing loss rating system. If the hearing is not impaired, it is not ratable.

Code 6207: Loss of the auricle is rated 50% if both are completely missing. If only one is completely missing, it is rated 30%. If neither are completely lost, but one has at least lost 1/3 or more of the tissues and is clearly deformed, it is rated 10%. If there is hearing loss as well, it is rated separately under code 6100.

Code 6211: If the tympanic membrane (eardrum) is torn or has a hole in it but there are no other symptoms, it is rated 0%. If there is any hearing loss that accompanies this, it is rated separately under code 6100.

Code 6260: Tinnitus is the ringing sound in the ear that often comes after exposure to serious aural trauma like explosions. It can come and go, or be always constant. The VASRD helpfully points out that tinnitus cannot be rated if other people can also hear the ringing. Wow.

Seriously, though, tinnitus can often be a symptom caused by psychological or other conditions. In cases like this where tinnitus is a direct cause of another condition, it cannot be rated separately unless clearly allowed by the rating system of the underlying condition. Additionally, only one rating is allowed for tinnitus whether or not the ringing is in one, both ears, or in the head.

If regular or recurrent tinnitus is present, it is rated 10%. Any hearing loss that accompanies this can be separately rated under code 6100.

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Otitis (Earache)

anatomy of the outer ear

Otitis is the swelling of the ear that causes pain. It can be caused by many things, like the flu or a bacterial infection. Most commonly, otitis clears up on its own in about 2-6 weeks, and so is not ratable. If, however, it persists despite treatment, it can then be rated on one of the following codes.

Code 6210: Chronic otitis externa is the swelling of the outer ear.

If this continues for an extended period of time and there is itchiness, a clear or yellowish liquid or dry flakes coming out of the ear, and it requires regular treatment, it is rated 10%.anatomy of the middle ear

Code 6200: Chronic suppurative otitis media is the swelling and bacterial infection of the middle ear with pus coming out of the ear because of a hole in the eardrum.

Two other conditions can also be rated under this code. Mastoiditis is an infection that spreads into the pockets of air behind the ear that can spread into the brain if left untreated. Cholesteatoma is the growth of cells in the middle ear that can destroy the functioning of the ear. Whether just one or all three of these conditions are present, only one rating is given under this code.

If there is pus coming out of the ear or if there is a growth in the middle ear that causes bleeding, it is rated 10%. If the condition causes other symptoms like hearing impairment, tinnitus, facial nerve conditions, etc., each symptom can be rated separately under their own code.

Code 6201: Chronic nonsuppurative otitis media with effusion is the swelling and bacterial infection of the middle ear, but no pus comes out of the ear because there is no hole in the eardrum. This condition is rated based on the hearing loss rating system.

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Balance Disorders

Code 6204: Peripheral vestibular disorders are conditions that affect the ears’ ability to sense proper body balance. Symptoms include dizziness, sense of being in motion or spinning, wooziness, or motion sickness. Before a condition can be rated under this code, definite evidence of the exact condition and a firm diagnosis must be made. A sense of being off-balance on its own is not ratable. If the diagnosed condition also causes hearing loss or liquid coming out the ear, then those symptoms can be rated in addition to a rating under this code.

If there is dizziness that occasionally causes staggering when walking, it is rated 30%. If there is occasional dizziness, it is rated 10%.

Code 6205: Meniere’s syndrome (endolymphatic hydrops) is a disorder of the inner ear that affects both hearing and balance. Symptoms include hearing loss, tinnitus, and dizziness or wooziness. This condition can be rated one of two ways: once under this code, or three ratings, one under tinnitus, one under hearing loss, and one as a peripheral vestibular disorder, can be combined. Choose the rating option that gives the higher rating.

If there is hearing impairment with episodes of dizziness and staggering while walking that occur more than once a week, whether or not there is tinnitus, it is rated 100%. If there is hearing impairment with episodes of dizziness and staggering while walking that occur one to four times a month, whether or not there is tinnitus, it is rated 60%. If there is hearing impairment with episodes of dizziness less than once a month, whether or not there is tinnitus, it is rated 30%.

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Cancer and Tumors of the Ear

Cancer is the growth of abnormal cells. These cells can be benign—they do not attack the good cells around them—or they can be malignant—they attack the cells around them.

Code 6209: Benign tumors affecting the ear are rated on how they affect the functioning of the ear. So, if the condition interferes with hearing, then it would be rated under the hearing loss rating system. If it affects the ear’s balance system, then it would be rated as a peripheral vestibular disorder.

Code 6208: Malignant tumors of the ear are rated under this code if they affect more than just the skin. If only the skin is involved, then it would be rated under the code 7833.

If the cancer is active, it is rated 100%. This 100% rating will continue for the first 6 months following the completion of the any treatment. The condition will then be reevaluated and rated based on any continuing symptoms, like hearing loss.

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Other Ear Conditions

All other ear conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQ for Ear Conditions

Here is the Disability Benefits Questionnaire (DBQ) used for ear conditions: Ear Conditions DBQ.

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Principles that Apply

Special Monthly Compensation: If your hearing condition is very severe, you may qualify for the VA’s Special Monthly Compensation.

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the ear condition (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

For conditions of the nerves or brain, see The Central Nervous System page. If the condition is caused by trauma to the brain, see the Traumatic Brain Injury (TBI) page. For all other related conditions, see The Skin, The Facial Muscles, The Eyes, the Taste and Smell, and The Skull pages

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