Secondary Conditions to Tinnitus for VA Disability Benefits

CCK Law: Our Vital Role in Veterans Law

What Is Tinnitus?

Generally speaking, tinnitus refers to the perception of noise or ringing in the ears. Tinnitus affects approximately 15 to 20 percent of people in the United States, and a disproportionate number of veterans (see more below).

Most often, tinnitus is a symptom of an underlying condition, such as hearing loss, ear injury, or a circulatory system disorder. Although it is very bothersome and can lead to significant impairment in everyday life, tinnitus is not typically life-threatening.

The most common tinnitus symptoms may include phantom noises in the ears, such as:

• Ringing
• Buzzing
• Roaring
• Clicking
• Hissing
• Humming

Such phantom noise may vary in pitch from low to high and can occur in one or both ears. In some cases, the noise can be so loud that it interferes with individuals’ ability to concentrate or hear external sounds.

Tinnitus may be present at all times, or it may come and go. There are two main types of tinnitus, one of which is significantly more common than the other:

Subjective tinnitus: Tinnitus only you can hear; the most common type of tinnitus. It can be caused by:

1. Problems in the outer, middle, or inner ear;
2. Problems with the auditory nerves; or
3. Problems with the part of the brain that interprets nerve signals as sound (i.e., auditory pathways).

Objective tinnitus: Tinnitus that the doctor can hear when they perform an examination; extremely rare. It can be caused by:

1. A blood vessel problem;
2. A middle ear bone condition; or
3. Muscle contractions.

Causes of Tinnitus

A number of health conditions can cause or aggravate tinnitus, but an exact cause is not always established. However, in many people, tinnitus is caused by one of the following:

• Age-related hearing loss – Hearing loss often occurs around age 60 and progresses over time. Such hearing loss may cause tinnitus.
• Exposure to loud noise – Loud noises (e.g., heavy equipment, firearms, etc.) can contribute to tinnitus and hearing loss. Both short-term and long-term exposure to loud sounds can cause permanent damage.
• Earwax blockage – Earwax protects the ear canal by trapping dirt and slowing the growth of bacteria. However, when too much earwax accumulates, it becomes too hard to wash away naturally, causing hearing loss or irritation of the eardrum, which can then lead to tinnitus.
• Ear bone changes – Stiffening of the bones in the middle ear (i.e., otosclerosis) may affect hearing and cause tinnitus.
• Meniere’s disease – Tinnitus can be an early indicator of Meniere’s disease (i.e., an inner ear disorder that may be caused by abnormal inner ear fluid pressure).
• Traumatic brain injury (TBI) – TBI can lead to tinnitus by causing auditory nerve damage.

Treatment

Tinnitus can often be improved with the appropriate treatment and intervention. For example, tinnitus may be treated with noise suppression, including:

• White noise machines – These devices (e.g., simulated environmental sounds) are often an effective treatment for tinnitus. Fans, humidifiers, and other noise-making machines may also be helpful.
• Hearing aids – The use of hearing aids may be beneficial when an individual suffers from hearing loss in addition to tinnitus.
• Masking devices – These devices are worn in the ear, like hearing aids, and produce continuous, low-level white noise that suppresses tinnitus symptoms.
• Tinnitus retraining – A wearable device that delivers individually programmed tonal music to mask the tinnitus sounds.

Although medications cannot cure tinnitus, they may help reduce the severity of symptoms. Examples of common medications for tinnitus include the following:

• Tricyclic antidepressants (e.g., amitriptyline, nortriptyline) – Generally used for severe tinnitus
• Alprazolam (Xanax) – May help reduce tinnitus symptoms, but it can become habit-forming, so it is often used as a last resort

Finally, there are several lifestyle adjustments and home remedies that may be helpful for individuals with tinnitus:

• Avoidance of possible irritants (e.g., loud noises, caffeine, and nicotine)
• Managing stress
• Reducing alcohol consumption
• Acupuncture
• Melatonin
• Zinc supplements
• B vitamins

In the video below, CCK Law Partner Michael Lostritto explains how VA calculates disability ratings for hearing loss: 

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Why Is Tinnitus Common Among Veterans?

Tinnitus is one of the most frequently claimed conditions for VA service connection. While on active duty, service members are consistently exposed to loud noises, including:

• Gunfire
• Heavy machinery
• Armored vehicles
• Aircraft
• Other combat-related noises

Many veterans also cope with TBIs stemming from traumatic injuries or exposure to improvised explosive devices (IEDs). As a result, tinnitus and hearing loss are common conditions veterans suffer from.

Symptoms of tinnitus can be more pronounced at night when one is lying down to sleep, simply because it is quieter. For service members on active duty, however, quiet may not be something they experience very often.

For this reason, a veteran may not even notice their tinnitus symptoms until long after they are discharged from service, at which point they may decide to file a claim for VA disability benefits.

How Can Veterans Get VA Service Connection for Tinnitus?

To establish direct service connection for tinnitus, veterans must prove that there is a connection between their diagnosis and their time in service. The following elements must be present:

1. A current diagnosis of tinnitus;
2. An in-service event, injury, or illness; and
3. A medical nexus linking the current diagnosis of tinnitus to the in-service event, injury, or illness.

The following types of evidence are often used to develop and strengthen claims for tinnitus:

• Service personnel records – These may show evidence of regular and prolonged noise exposure during training exercises or in combat.
• Medical records – These may help establish that a veteran did not have hearing-related issues prior to their military service.
• Doctors’ statements – These may establish when the veteran began complaining of tinnitus symptoms and what, if any, types of treatment the veteran received.
• Medical opinion – A medical expert can opine that the veteran’s tinnitus is “at least as likely as not” due to their time in service.

What Are the VA Disability Ratings for Tinnitus?

After service connection for tinnitus is established, VA will award a disability rating based on the severity of the condition. VA rates tinnitus under 38 CFR § 4.87, Schedule of Ratings – Ear, Diagnostic Code 6260.

Tinnitus almost always results in a 10 percent disability rating. Importantly, this singular 10 percent disability rating takes both ears into account.

Does Tinnitus Cause Other Conditions?

Tinnitus can cause significant impairments in a veteran’s everyday life and often results in a variety of other conditions as well. The most common secondary conditions to tinnitus are explained below.

Watch CCK Law Partners Christian McTarnaghan and Michael Lostritto and VA-Accredited Claims Advocate Bethany Cooke explain common secondary conditions to tinnitus:

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Migraine Headaches Secondary to Tinnitus

Migraines are a type of headache characterized by intense pain that can be accompanied by nausea, vomiting, sensitivity to light and sounds, lightheadedness, and blurred vision.

Migraines can be debilitating and can last anywhere from hours to days, depending on the person. It is unclear what causes migraines, but triggers can include:

• Hormonal imbalance
• Alcohol
• Stress
• Sensory stimulation (e.g., tinnitus)

According to one 2022 study, there is a strong relationship between tinnitus and migraine headaches. Specifically, as many as 45 percent of people with tinnitus could also suffer from migraines.

Some people also report a worsening of tinnitus symptoms during migraine attacks. Recent studies suggest that tinnitus and migraines co-occur as a result of spontaneous abnormal neural activity; however, more research needs to be done in this area.

Depression Secondary to Tinnitus

Depression is a serious mental health condition that affects the way a person thinks, feels, and acts. Symptoms of depression tend to vary among individuals; however, common symptoms include:

• Persistent feelings of sadness, worthlessness, and hopelessness
• Lack of motivation or interest in activities that usually derive pleasure
• Difficulty sleeping and concentrating
• Change in appetite resulting in weight loss or weight gain
• Irritability
• Fatigue

Current research also points to a significant relationship between tinnitus and depression. A 2021 study titled “Mental Health Symptoms Among Veteran VA Users by Tinnitus Severity” examined the relationship between tinnitus and depression among the veteran population.

The results revealed that, as the severity of a veteran’s tinnitus increased, so did their chances of screening positively for depression. Overall, tinnitus may cause stress, pain, and frustration that ultimately lead to depression.

Anxiety Secondary to Tinnitus

Anxiety is defined as intense, excessive, and persistent worry and fear about everyday situations. It is estimated that one-third of adults in the United States suffer from anxiety disorders.

The most common symptoms of anxiety disorders include the following:

• Feeling restless, jumpy, or on edge
• Excessive worrying
• Difficulty concentrating
• Rapid heartbeat
• Trembling or twitching
• Muscle tension
• Shortness of breath or difficulty breathing
• Feeling dizzy, nauseous, or lightheaded
• Difficulty sleeping

The study referenced above also found that a substantial number of veterans suffering from severe tinnitus also experienced feelings of anxiety.

Somatic Symptom Disorder Secondary to Tinnitus

Somatic symptom disorder is characterized by an extreme focus on physical symptoms, such as pain or fatigue, that cause major emotional distress and problems with social and occupational functioning.

Often, people with somatic symptom disorder have another diagnosed medical condition that is associated with these symptoms. However, the person’s reaction to the actual medical condition is excessive or disproportionate to the actual problem.

In short, some veterans may become overly focused on their tinnitus symptoms and begin to worry about them excessively.

How Can Veterans Get Service Connection for Conditions Secondary to Tinnitus?

A secondary service-connected condition is one that resulted from a separate condition that is already service-connected. For example, if a veteran is service-connected for tinnitus and later develops one of the above-mentioned conditions as a result, they may be eligible for secondary service connection.

Filing a claim for conditions secondary to tinnitus involves the same process as filing any claim for service connection. Veterans will fill out and submit VA Form 21-526EZ – an original claim for service connection. Veterans may do so online, in person at their local regional office, or with help from a veterans’ advocate.

There is certain evidence that veterans should include with their claims for secondary service connection. Specifically, veterans will need to demonstrate two things to VA:

1. A diagnosis for their secondary condition; and
2. Medical evidence showing the link between their service-connected tinnitus and the secondary condition.

Did VA Deny Your Tinnitus Claim? Contact CCK Law

Below, watch CCK Law Partners Emma Peterson and Michael Lostritto explain the advantages of hiring a VA-accredited attorney for assistance with appealing a VA claim denial:

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