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VA Rating Assistant

DC 6260 · 38 CFR 4.85

Ear (Hearing / Tinnitus) C&P Exam Prep

To document the nature, frequency, severity, and functional impact of recurrent tinnitus in order to assign a rating under DC 6260 and to evaluate any co-existing ear conditions (hearing loss, vertigo, Meniere's disease) that may affect the overall evaluation.

Format:
Interview + Physical
Typical duration:
30 minutes
DBQ form:
Ear_Including_Vestibular_and_Infectious (Ear_Including_Vestibular_and_Infectious)
Examiner:
Audiologist

What the examiner evaluates

  • Presence and current diagnosis of tinnitus (unilateral or bilateral)
  • Frequency and duration of tinnitus episodes
  • Whether tinnitus is recurrent (intermittent) or constant
  • Functional impact of tinnitus on daily activities, sleep, and work
  • Audiometric testing results (pure tone averages, speech discrimination scores)
  • Presence of associated symptoms: vertigo, staggering, hearing loss
  • Physical examination of external ear canals and tympanic membranes
  • Vestibular function assessment (Romberg test, Dix-Hallpike maneuver, gait) if vertigo is present
  • History of noise exposure during military service
  • Current medications used to manage tinnitus or related conditions
  • History of relevant surgical procedures or therapeutic treatments
  • Whether tinnitus is objective (audible to others) or subjective (perceived only by veteran)

The exam typically occurs in an audiology clinic with a sound booth for audiometric testing. The examiner is a licensed audiologist. The interview portion covers symptom history, and the physical portion includes otoscopy and audiometric testing. If vertigo is also claimed, additional balance and vestibular tests may be performed. Veterans should bring their hearing aids if applicable but note whether they are service-connected.

Measurements and tests

Pure Tone Audiometry (Pure Tone Average - PTA)

What it measures: Hearing threshold levels at standardized frequencies (500, 1000, 2000, 3000, and 4000 Hz) to determine the degree of hearing impairment in each ear, used to assign Roman numeral designations under 38 CFR 4.85 Table VI.

What to expect: You will sit in a soundproof booth wearing headphones. Tones of varying loudness will be played at different pitches. Raise your hand or press a button each time you hear a tone, even if it is very faint. Testing is done for each ear separately. Bone conduction testing (vibrating device placed behind the ear) may also be performed.

Critical thresholds

  • Roman Numeral I (best hearing) through Roman Numeral XI (most severe) Roman numeral designations for each ear are combined using Table VII to determine the percentage evaluation for hearing loss under DC 6100. Tinnitus under DC 6260 is separately rated at a flat 10%.
  • Combined Table VII rating of 0% Even if hearing loss audiometry yields 0% under DC 6100, tinnitus may still independently receive a 10% rating under DC 6260 if recurrent tinnitus is documented.

Tips

  • Respond consistently - do not guess when you are unsure. It is acceptable to say you did not hear a tone.
  • Do not wear hearing protection to the exam - your unaided hearing is what is being measured.
  • If you use hearing aids, bring them but inform the examiner that testing should reflect unaided hearing acuity.
  • If you have a bad hearing day or a flare-up on exam day, tell the examiner before testing begins.
  • Inform the examiner of any recent ear infections, wax impaction, or illness that could temporarily affect hearing.

Pain considerations: Not applicable for audiometric testing. However, if the headphones cause discomfort due to a co-existing ear condition (e.g., otitis externa, ear canal swelling), inform the examiner immediately.

Speech Discrimination (Word Recognition Score - WRS)

What it measures: Your ability to correctly repeat spoken words at a comfortable loudness level. This score (expressed as a percentage of words repeated correctly) is used alongside PTA results to assign Roman numeral designations under Table VIa when appropriate.

What to expect: The audiologist will say a list of single-syllable words through headphones, and you repeat each word back. Testing occurs at a volume comfortable for you. It is done for each ear separately.

Critical thresholds

  • Speech discrimination score used in Table VIa Lower speech discrimination scores can increase the Roman numeral designation for an ear, potentially increasing the combined hearing loss rating under Table VII.

Tips

  • If you did not understand a word, say so - do not guess randomly, but also do not refuse to respond.
  • Speak clearly when repeating words back; the examiner needs to accurately score your responses.
  • If you experience significant difficulty understanding speech in daily life, mention this to the examiner as part of your functional impact statement.

Pain considerations: Not applicable.

Otoscopy (Physical Examination of Ear Canals and Tympanic Membranes)

What it measures: Visual inspection of the external ear canal and eardrum (tympanic membrane) for abnormalities such as perforations, effusion, scarring, polyps, or signs of infection.

What to expect: The examiner will use an otoscope (a small lighted instrument) to look inside each ear canal. This takes only a few seconds per ear and is generally painless.

Critical thresholds

  • Perforated tympanic membrane Documents objective physical finding that may support additional diagnoses (e.g., chronic suppurative otitis media) and could contribute to hearing impairment ratings.

Tips

  • Do not clean your ears excessively before the exam - the natural state of your ears is medically relevant.
  • If you have ear pain, drainage, or visible swelling, mention it before the examiner begins.
  • Inform the examiner of any history of ear surgeries, tube placements, or eardrum perforations.

Pain considerations: If you experience pain when anything is placed near or in your ear canal, inform the examiner immediately.

Romberg Test

What it measures: Balance and vestibular function. You stand with feet together and arms at your sides, first with eyes open and then with eyes closed. Swaying or falling suggests vestibular or proprioceptive dysfunction.

What to expect: The examiner may stand nearby to catch you if needed. The test takes about 1-2 minutes and involves standing still in two positions.

Critical thresholds

  • Positive Romberg (loss of balance with eyes closed) Supports vestibular involvement, which is relevant if claiming Meniere's syndrome or peripheral vestibular disorder in addition to tinnitus.

Tips

  • If you use a cane or walker for balance, bring it and inform the examiner.
  • Do not attempt to perform this test if you believe it will cause you to fall - communicate your limitations.

Pain considerations: If standing causes pain or is contraindicated due to another service-connected condition, inform the examiner.

Dix-Hallpike Maneuver

What it measures: Presence of benign paroxysmal positional vertigo (BPPV) by repositioning the head rapidly while transitioning from seated to supine. Positive result shows characteristic nystagmus and vertigo.

What to expect: You will be guided from a sitting position to lying down with your head turned and extended off the table. The examiner will observe your eyes for nystagmus.

Critical thresholds

  • Positive Dix-Hallpike Supports diagnosis of BPPV or vestibular disorder, which may allow evaluation under DC 6204 in addition to or separately from DC 6260.

Tips

  • Inform the examiner of any cervical spine conditions, severe vertigo episodes, or recent falls before this test.
  • If you have experienced severe vertigo recently, describe it clearly in your pre-exam history.

Pain considerations: If neck positioning causes pain due to a cervical condition, communicate this to the examiner before the maneuver is attempted.

Rating criteria by percentage

10%

Recurrent tinnitus - the only available rating under DC 6260. A single 10% evaluation is assigned regardless of whether tinnitus is unilateral or bilateral, or whether it is perceived in one ear, both ears, or in the head. The 10% rating applies so long as the tinnitus is documented as recurrent (not a one-time event). Under Note (2), only a single evaluation is assigned for recurrent tinnitus regardless of laterality. Under Note (1), this 10% may be combined with ratings under DC 6100, 6200, or 6204 unless tinnitus is already supporting one of those evaluations.

Key symptoms

  • Recurring ringing, buzzing, hissing, roaring, clicking, or other sounds perceived in one or both ears or in the head
  • Episodes that recur over time (not a single isolated incident)
  • Subjective tinnitus audible only to the veteran (objective tinnitus evaluated differently)
  • Functional impact on sleep, concentration, communication, or work
  • Aggravation by noise exposure, stress, fatigue, or caffeine

From 38 CFR: 38 CFR Part 4, DC 6260: 'Tinnitus, recurrent - 10%. Note (2): Assign only a single evaluation for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head.'

Describing your symptoms accurately

Tinnitus Character and Laterality

How to describe it: Describe the exact sound you hear: ringing, buzzing, hissing, roaring, chirping, clicking, or pulsing. Specify whether it occurs in your left ear, right ear, both ears, or seems to originate inside your head. If bilateral, describe whether one side is louder. Mention if the pitch or character changes.

Example: On my worst days, I hear a high-pitched ringing in both ears simultaneously that is so loud it drowns out conversations. It feels like someone is running a drill inside my skull, and I cannot tell which direction sounds are coming from.

Examiner listens for: Confirmation that the sound is subjective (not audible to others), description of laterality for proper DBQ documentation, and whether objective tinnitus characteristics are present that would require different evaluation.

Avoid: Do not say 'it's just a little ringing' or 'I only notice it sometimes.' Even intermittent tinnitus that is functionally disruptive qualifies as recurrent and deserves full description.

Frequency and Recurrence

How to describe it: Explain how often tinnitus occurs. Use specific language: 'daily,' 'multiple times per week,' 'constant with periodic spikes,' or 'intermittent but predictable.' Distinguish between baseline tinnitus and acute episodes. If constant, state that clearly.

Example: I have constant tinnitus every waking hour. On bad days, the volume spikes for hours at a time and I cannot sleep, read, or hold a conversation without being completely distracted.

Examiner listens for: Whether the tinnitus qualifies as 'recurrent' for DC 6260 purposes - any pattern of repeated occurrence supports this. The examiner will document frequency for the DBQ.

Avoid: Do not say 'it comes and goes so it's not that bad.' Recurrent means it returns repeatedly - even intermittent tinnitus that disrupts your life is significant. Report your typical week accurately, not just your best days.

Functional Impact on Sleep

How to describe it: Describe how tinnitus affects your ability to fall asleep, stay asleep, and the quality of your rest. Mention if you use white noise machines, fans, or medications to sleep. Report how many nights per week are disrupted.

Example: I cannot fall asleep without a white noise machine because the silence makes the ringing unbearable. I wake up 3-4 times per night because a spike in tinnitus jolts me awake. I average only 4 hours of sleep on my worst nights.

Examiner listens for: Functional impact documentation required under M21-1. Sleep disruption supports the severity and pervasiveness of the condition even though DC 6260 has only one rating level.

Avoid: Do not minimize sleep problems. Do not say 'I manage fine' if you have developed coping mechanisms - describe both the problem and the coping strategy, as reliance on aids is itself evidence of impact.

Functional Impact on Concentration and Cognitive Function

How to describe it: Explain how tinnitus interrupts focus at work, while reading, during conversations, or when performing tasks requiring sustained attention. Mention if you have had to leave jobs, reduce work hours, or change duties because of tinnitus.

Example: When my tinnitus spikes at work, I cannot concentrate on my tasks. I have to re-read documents multiple times and I frequently make errors I never made before service. I have been passed over for promotions because supervisors say I seem distracted.

Examiner listens for: Impact on occupational function, which directly informs the functional impairment narrative the examiner documents on the DBQ under Section 11 (remarks).

Avoid: Do not say 'it's not that bad at work' unless that is genuinely true. If you have developed workarounds (noise-canceling headphones, requesting quiet workspaces), mention them as evidence of impact, not evidence that the problem is resolved.

Functional Impact on Social and Emotional Wellbeing

How to describe it: Describe how tinnitus affects your ability to enjoy social situations, quiet activities, or leisure. Include emotional effects such as irritability, anxiety, depression, or withdrawal from activities you previously enjoyed.

Example: I no longer go to restaurants or social gatherings because the background noise triggers severe spikes in tinnitus that last for hours afterward. I have become increasingly isolated and my family notices I am constantly irritable due to lack of sleep.

Examiner listens for: Comprehensive functional impact narrative. The DBQ requires the examiner to describe the impact of each ear/peripheral vestibular condition on occupational and daily functioning.

Avoid: Do not omit emotional or psychological impacts. These are legitimate functional consequences that round out the full picture of how tinnitus affects your life.

Aggravating Factors

How to describe it: Identify what makes your tinnitus worse: loud environments, stress, fatigue, caffeine, certain medications, silence, or physical exertion. Be specific about how long the aggravation lasts.

Example: Any exposure to loud noise - even a car radio at moderate volume - causes my tinnitus to spike for 12 to 24 hours afterward. Stress from work reliably worsens it. On those days the ringing is constant and so loud I cannot carry on a normal conversation.

Examiner listens for: Aggravating factors help establish the recurrent and variable nature of the condition and demonstrate that the tinnitus is not simply background noise the veteran has adapted to.

Avoid: Do not say 'nothing really makes it worse' if you have noticed patterns. Think through your typical week before the exam to identify triggers you may have normalized.

In-Service Noise Exposure History

How to describe it: Clearly describe all sources of occupational and recreational noise exposure during military service: weapons fire, aircraft, vehicles, machinery, explosions, and other loud equipment. Include frequency of exposure and whether hearing protection was available and used.

Example: I was an infantryman and fired M16s, M4s, and M249s without consistent hearing protection at the range and in combat. I also rode in HMMWVs and helicopters regularly. After returning from deployment, I first noticed ringing in both ears that never fully went away.

Examiner listens for: Nexus between in-service noise exposure and current tinnitus. The examiner documents service history and exposure for the nexus opinion. Per M21-1, lay evidence of tinnitus onset during or after service is competent evidence.

Avoid: Do not minimize your noise exposure. Do not say 'everyone wore hearing protection' if that was not consistently true. You have the right to provide a full and accurate account of your exposure history.

Common mistakes to avoid

Describing tinnitus as 'constant' when it is actually intermittent, or vice versa

Why: Accurate characterization of frequency is required for proper DBQ documentation. Calling constant tinnitus 'intermittent' can undermine the severity picture; calling intermittent tinnitus 'constant' when it is not may be inaccurate.

Do this instead: Think through a typical week before your exam. If your tinnitus is present more days than not, describe your baseline level and note spikes separately. Use phrases like 'I have a baseline ringing that is always present, with spikes multiple times per week.'

Impact: 10% (the only available level under DC 6260, but accurate documentation supports nexus and functional impact)

Saying tinnitus 'doesn't really affect my life' or downplaying functional impact

Why: Under M21-1 guidelines, examiners are required to document functional impact. If you minimize symptoms, the DBQ will reflect minimal impact, which can affect combined ratings and secondary claims (e.g., secondary mental health conditions).

Do this instead: Describe your worst day accurately. Per M21-1 guidance, you should report the full range of how tinnitus affects you, including on your worst days - not just your average or best days.

Impact: 10% (impacts functional narrative and potential secondary conditions)

Failing to mention that tinnitus is bilateral or that it affects both ears

Why: Under DC 6260 Note (2), only a single evaluation is assigned regardless of laterality - but accurate documentation of bilateral tinnitus ensures the full picture is captured and may be relevant to the underlying hearing loss evaluation.

Do this instead: Clearly state 'I have ringing in both ears' or 'the ringing is in my left ear only' as applicable. The examiner needs to check the correct laterality boxes on the DBQ.

Impact: 10%

Not disclosing that tinnitus began during service or immediately after a specific in-service event

Why: The nexus between in-service noise exposure and current tinnitus is critical for service connection. If you do not clearly describe when and where tinnitus started, the examiner may not have enough information to provide an adequate nexus opinion.

Do this instead: Provide a clear timeline: 'I first noticed ringing in my ears during [specific training/deployment/event] and it has persisted since then.' If it worsened gradually, describe the progression.

Impact: Service connection determination - foundational to any rating

Confusing tinnitus with the symptoms of Meniere's disease or vertigo and failing to claim them separately

Why: Tinnitus under DC 6260 is evaluated separately from hearing loss and vestibular disorders. If you also experience vertigo, staggering, or episodic hearing fluctuation, these may warrant separate claims under DC 6204 or other codes.

Do this instead: Tell the examiner about all ear-related symptoms: hearing loss, vertigo, balance problems, fullness in the ear, and tinnitus. Do not assume they are all covered by a single claim.

Impact: Multiple diagnostic codes may apply beyond DC 6260

Not bringing prior audiological test records or private treatment records to the exam

Why: Examiners review evidence in the claims file, but records may be missing or incomplete. Prior audiograms, ENT records, or private hearing test results showing the progression of your condition are valuable.

Do this instead: Bring copies of any private audiological exams, ENT clinic notes, and records documenting prior treatment for tinnitus. Confirm with VA beforehand that your records have been uploaded to your file.

Impact: Service connection and rating accuracy

Failing to disclose use of sound therapy devices, white noise machines, or medications for tinnitus management

Why: Use of management devices and medications is evidence of the condition's ongoing severity and the veteran's need to actively manage it. This supports the functional impact narrative.

Do this instead: Disclose all management strategies: 'I use a white noise machine to sleep, wear sound-masking hearing aids during the day, and take [medication] for associated anxiety.' The examiner needs this for the treatment history section of the DBQ.

Impact: 10% (supports functional impact and treatment documentation)

Prep checklist

  • critical

    Review and write out your complete in-service noise exposure history

    List every military occupational specialty (MOS), duty station, deployment, weapons systems, vehicles, aircraft, and machinery you were regularly exposed to. Note whether hearing protection was consistently available and used. This history directly supports the nexus between your service and current tinnitus.

    before exam

  • critical

    Prepare a written symptom summary using your worst-day experience

    Write down: the character of your tinnitus (ringing, buzzing, etc.), which ear(s), how often it occurs, how long episodes last, what aggravates it, how it affects sleep, concentration, work, and social life. Per M21-1 guidance, report symptoms at their worst, not just on typical or good days.

    before exam

  • critical

    Gather all prior audiological records, ENT notes, and hearing test results

    Collect audiograms from VA, private providers, or military separation exams (DD-2215/2216). These records help establish a baseline and any progression of hearing loss and tinnitus over time.

    before exam

  • recommended

    Obtain and review your VA claims file (C-file) or e-file

    Request your C-file or review your VA.gov records to confirm that all prior service records, treatment records, and previous exam reports are in the file. Identify any gaps or missing records that should be submitted before the exam.

    before exam

  • recommended

    Check your state's laws on recording C&P examinations

    Many states permit veterans to audio or video record their C&P examinations. Check your state law and notify the exam facility in advance if you intend to record. Recording ensures an accurate record of what was discussed.

    before exam

  • recommended

    List all current medications used for tinnitus or related conditions

    Include prescription medications, over-the-counter drugs, supplements, and any hearing devices or sound therapy tools you use. The examiner will ask about medications, and this information is documented on the DBQ.

    before exam

  • recommended

    Identify and note any co-existing ear conditions (vertigo, hearing loss, Meniere's symptoms)

    If you also experience dizziness, balance problems, ear fullness, or episodic hearing changes, note these separately. They may support additional claims under different diagnostic codes (e.g., DC 6204, DC 6100, DC 6205).

    before exam

  • optional

    Prepare a buddy statement or lay statement if available

    Statements from family members, fellow veterans, or coworkers who have witnessed the impact of your tinnitus on your daily life can support your claim. Submit these to VA before or at the time of the exam.

    before exam

  • critical

    Do NOT wear hearing protection or earplugs to the exam

    Your unaided hearing is what is being tested. Wearing hearing protection or earplugs would artificially alter your audiometric results.

    day of

  • critical

    Bring your hearing aids but do not wear them during audiometric testing

    If you use hearing aids, bring them to the exam and inform the audiologist. Testing should reflect your unaided hearing acuity. The examiner may want to document that you use hearing aids.

    day of

  • critical

    Arrive with your written symptom summary and records in hand

    Bring printed copies of your symptom summary, any records not already in your VA file, and your medication list. If the examiner does not ask for them, offer them and ask that they be included in the exam record.

    day of

  • recommended

    Do not use caffeine, stimulants, or medications that could suppress tinnitus immediately before the exam

    Some substances can temporarily reduce tinnitus intensity. Go to the exam in your typical daily state so that your current condition is accurately represented.

    day of

  • recommended

    Note whether your tinnitus is at a typical, better-than-average, or worse-than-average level on exam day

    If your tinnitus is unusually quiet on exam day, tell the examiner. State: 'Today my tinnitus is quieter than usual. On my typical or worst days it is significantly more severe.' This ensures the record reflects your full condition.

    day of

  • critical

    Provide a complete and accurate history of in-service noise exposure when asked

    Do not minimize or omit noise exposures. Describe the specific equipment, frequency of exposure, and conditions (e.g., indoors, outdoors, with or without hearing protection). This forms the foundation of the nexus opinion.

    during exam

  • critical

    Clearly describe when tinnitus first began and its course since onset

    Specify whether tinnitus started during service, immediately after discharge, or gradually developed. Describe whether it has worsened, remained stable, or fluctuated over time.

    during exam

  • critical

    Describe functional impact on sleep, work, concentration, and social life

    Even though DC 6260 has only a single 10% rating level, comprehensive functional impact documentation supports the overall claims file and may underpin secondary claims (e.g., secondary anxiety, depression, insomnia).

    during exam

  • critical

    Respond consistently and honestly during audiometric testing

    Raise your hand or press the button every time you hear a tone, even if very faint. Do not artificially suppress or exaggerate your responses. Inconsistent results can flag the exam as potentially unreliable.

    during exam

  • critical

    If asked about the impact of your tinnitus, describe your worst days, not just average days

    Per M21-1 guidance, the VA recognizes that veterans typically underreport symptom severity. When describing impact, frame your answer around your worst-day experience: 'At its worst, my tinnitus...'

    during exam

  • recommended

    Mention all co-existing ear symptoms even if not directly asked

    If you experience vertigo, balance problems, ear pressure, or hearing fluctuations in addition to tinnitus, mention them. Do not assume the examiner will ask about all conditions.

    during exam

  • recommended

    Ask the examiner to clarify questions you do not understand

    You have the right to fully understand each question before answering. If a question is unclear, ask for clarification rather than providing an inaccurate answer.

    during exam

  • critical

    Write down everything discussed in the exam as soon as possible

    Immediately after leaving, write notes on what the examiner asked, what you said, what tests were performed, and any concerns you have about the accuracy of the exam. This record is useful if you need to submit a rebuttal or request a new exam.

    after exam

  • critical

    Request a copy of the completed DBQ from VA once it is available

    Once the exam is completed and uploaded, you can request a copy through VA.gov, the FOIA process, or your VSO. Review it carefully for accuracy and completeness, especially the nexus opinion and functional impact narrative.

    after exam

  • recommended

    If the DBQ is inadequate or contains errors, submit a written rebuttal or request a new exam

    If the examiner did not address all claimed conditions, provided an unsupported nexus opinion, or documented your symptoms inaccurately, you have the right to submit a written statement identifying the deficiencies and requesting a supplemental exam.

    after exam

  • recommended

    Consider submitting a personal statement (VA Form 21-4138 or direct upload) summarizing your symptoms

    A personal statement submitted after the exam reinforces your symptom history in the claims file and ensures your lay testimony is part of the record the rater must consider.

    after exam

Your rights during a C&P exam

  • You have the right to have a VSO, attorney, or claims agent accompany you to the C&P exam as an observer in most circumstances.
  • You have the right to audio or video record your C&P examination in states where recording laws permit it - check your state's laws in advance and notify the facility.
  • You have the right to a thorough and adequate examination - if the examiner does not address all claimed conditions or fails to provide a nexus opinion when one is required, the examination may be considered inadequate under M21-1.
  • You have the right to submit a written rebuttal challenging an inadequate or unfavorable C&P exam before a rating decision is issued.
  • You have the right to request a new C&P examination if the existing exam is found to be inadequate, based on changed circumstances, or if new evidence has been submitted.
  • You have the right to have your lay testimony considered as competent evidence for conditions that are capable of lay observation - tinnitus and hearing difficulty qualify under Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
  • You have the right to receive an explanation of how the rating decision was reached and to appeal any decision you disagree with through Supplemental Claim, Higher-Level Review, or Board of Veterans' Appeals.
  • Under M21-1, a claim for hearing loss or tinnitus is itself acceptable lay evidence that you are experiencing difficulty hearing - you do not need a prior medical diagnosis to initiate a claim.
  • You have the right to have all evidence in your claims file reviewed by the examiner before the exam - confirm that your service records, treatment records, and any private medical evidence have been uploaded prior to the scheduled exam.
  • You have the right to report exam misconduct, coercion, or inadequate examination procedures to VA's Office of Inspector General or through a formal complaint.
  • Under Note (1) of DC 6260, a separate 10% evaluation for tinnitus may be combined with hearing loss and vestibular ratings unless tinnitus is already supporting one of those evaluations - you have the right to the most favorable interpretation of how your conditions interact.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.