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Veterans Law

VA Disability Ratings for Vertigo

July 22, 2020
senior asian man leaning on wall with head covered by left hand due to vertigo

Vertigo Explained

Vertigo is a sensation of feeling dizzy and off balance.  Individuals with vertigo may feel as though the room is spinning when in the midst of a “spell.”  In severe cases, vertigo may also result in nausea, vomiting, and nystagmus (i.e., abnormal or jerking eye movements).  Symptoms can last anywhere from few minutes to a few hours or more.

Common Symptoms of Vertigo

  • Migraines or headaches
  • Lightheadedness or dizziness
  • Balance issues
  • Motion sickness
  • Nausea
  • Vomiting
  • Tinnitus, or ringing in the ear(s)
  • Meniere’s Disease
  • Nystagmus, or other uncontrollable eye movements

It is important to note that vertigo is almost always a symptom of an underlying condition, oftentimes related to the inner ear.  Some of the most common causes include the following:

  • Benign paroxysmal positional vertigo (BPPV) – Occurs when tiny calcium particles (i.e., canaliths) build up in the canals of the inner ear.  The inner ear sends signals to the brain about head and body movements relative to gravity.  Therefore, if the particles are built up, the body does not recognize whether it is sitting, standing, or laying down.  BPPV is often triggered by specific changes in the position of your head.
  • Meniere’s disease– An inner ear condition thought to be caused by a build-up of fluid and changing pressure. It can cause episodes of vertigo along with tinnitus and hearing loss.
  • Vestibular neuritis or labyrinthitis– An inner ear problem usually related to a viral infection.  The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance.

Other causes, unrelated to the inner ear, may include head or neck injury, brain problems (e.g., stroke or tumor), certain medications, and migraine headaches.  Treatment for vertigo typically depends on what is causing the condition, and in many cases, it may go away on its own.  However, treatment can sometimes be necessary and may include:

  • Vestibular rehabilitation – Type of physical therapy aimed at helping strengthen the vestibular system (i.e., system that sends signals to the brain about head and body movements relative to gravity).
  • Canalith repositioning maneuvers– Series of specific head and body movements for BPPV.  The movements are intended to move the calcium deposits out of the canal into an inner ear chamber in order to be absorbed by the body.
  • Medication– Medication may be provided to relieve associated symptoms such as nausea or motion sickness.
  • Surgery– In very few and severe cases, surgery may be required for vertigo.

Service Connection for Vertigo

To receive disability benefits, veterans must first apply for service connection.  In order to do so, veterans should submit an initial claim using VA Form 21-526.  When filing a service connection claim for vertigo, veterans should also submit any evidence that is relevant to the claim.  For example, veterans who had a military occupational specialty (MOS) that caused regular exposure to loud engines, machinery, or gunfire should submit service personnel records detailing their work-related duties.

Veterans can also submit lay statements explaining how this exposure to loud noises may have caused an inner ear problem marked by symptoms of vertigo.  Overall, veterans will have to show the following elements of service connection: (1) a current diagnosis of vertigo; (2) evidence of an in-service event, injury, or illness; and (3) a medical nexus linking their current, diagnosed vertigo to the in-service occurrence.

Compensation and Pension (C&P) Exams for Vertigo

Once a claim has been filed for vertigo, VA may request a Compensation and Pension (C&P) exam to examine the veteran.  VA may send a letter or call the veteran to schedule this exam.  It is very important to follow up with scheduling the exam, and to attend it.  If a veteran fails to attend a C&P exam, without informing VA ahead of time, their claim could be denied.

The exam will typically be performed by a VA physician or VA contracted physician.  Prior the exam, the examiner will review the veteran’s c-file, which contains the veteran’s medical and service records.  During the exam, the examiner may ask the veteran questions about their vertigo or their service.  They may also physically examine the veteran.  As vertigo is usually the symptom of other conditions and is commonly caused by ear conditions, the examiner may examine the veteran’s ears.

The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim.  This is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities.

How VA Rates Vertigo

After service connection is established, VA will assign a disability rating based on severity.  Determining a disability rating is an important part of the claims process as it impacts the amount of monthly compensation that a veteran receives.  Importantly, vertigo does not have its own diagnostic code, but it is generally rated under one of the following balance disorders:

Diagnostic Code 6204 – Peripheral Vestibular Disorders

Generally speaking, peripheral vestibular disorders are conditions that affect the ears’ ability to sense proper body balance.  The rating criteria are as follows:

  • 30% – dizziness and occasional staggering
  • 10% – occasional dizziness

It is important to note that objective findings supporting the diagnosis of vestibular disequilibrium (i.e., feeling off balance) are required before a compensable evaluation can be assigned under this diagnostic code.  This means that it is not enough for a veteran to simply report that they feel dizzy or off balance.  Instead, there must be firm medical evidence confirming such symptomatology.

Diagnostic Code 6205 – Meniere’s Disease/Syndrome

As mentioned above, Meniere’s disease often results in symptoms of vertigo.  The rating criteria for this code are as follows:

  • 100% – hearing impairment with attacks of vertigo and cerebellar gait (i.e., staggering) occurring more than once weekly, with or without tinnitus
  • 60% – hearing impairment with attacks of vertigo and cerebellar gait occurring from one to four times a month, with or without tinnitus
  • 30% – hearing impairment with vertigo less than once a month, with or without tinnitus

Secondary Conditions to Vertigo

Vertigo is most commonly a symptom of an underlying condition.  Veterans who develop vertigo as a result of an already service-connected condition may be able to receive secondary service connection.

In claims for secondary service connection, a nexus is especially important.  A nexus is a medical opinion that can link a veteran’s secondary disability to their already service-connected disability.  A nexus between the primary and secondary disability must be clearly established in order for secondary service connection to be granted.

There are also multiple forms of evidence that may be submitted to support the theory of secondary service connection.  This could include studies that link vertigo to the primary service-connected condition.

Lay evidence can also help support the connection between the two conditions.  Lay evidence, or lay statements, are usually written by someone who knows the veteran well, such as a spouse, friend, or family member.  The person writing the statement can explain how the secondary condition is related to the primary one.  For example, if the veteran experiences tinnitus which triggers their vertigo, as is often the case in those with Meniere’s disease, the veteran’s spouse may be able to write a statement explaining that the connection.

Vertigo and Tinnitus

Vertigo and tinnitus are commonly linked through Meniere’s Disease.  Meniere’s disease can cause severe dizziness (vertigo), ringing in the ear (tinnitus), hearing loss, and the feeling of fullness or congestion in the ear.  Usually, Meniere’s disease only affects one ear.

Meniere’s disease can cause sudden attacks of vertigo, without warning.  These attacks can last for short or long periods of time.  They may also occur after a short period of tinnitus.  The vertigo with Meniere’s disease can be so severe it may even cause the veteran to lose their balance and fall over.

Veterans who experience vertigo, and are service connected for tinnitus, may be able to receive secondary service connection for Meniere’s Disease.

Secondary Conditions to Tinnitus VA Claims

Getting TDIU with Vertigo

TDIU, or total disability based on individual unemployability, is a VA disability benefit that compensates veterans at the 100 percent level, even if the veteran may not regularly meet the criteria needed to reach the 100 percent rating level.  Generally, there are two pathways to achieving TDIU:

  • 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
    • One condition rated at minimum 60 percent OR
    • Two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent
  • 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
    • In this instance, the veteran must prove that their condition is uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.

While vertigo does not have its own diagnostic code, it is rated under the diagnostic codes for balance disorders.  Veterans who receive a rating for a balance disorder may be eligible to receive TDIU benefits.  Additionally, ratings given for balance disorders may be combined with other disability ratings to help a veteran qualify for TDIU.  Vertigo as a secondary service-connected disability, rated as a balance disorder, can also be considered in a veteran’s combined disability rating.

Getting Help with VA Disability Benefits for Vertigo

The process to being awarded VA disability benefits for vertigo can be confusing, especially since VA does not have specific diagnostic codes for vertigo itself.  If your VA disability claim for vertigo, or another condition which causes vertigo, was denied, the VA disability lawyers at Chisholm, Chisholm & Kilpatrick may be able to help.  Contact our office to receive a free case evaluation.