Hearing Loss VA Claim Field Manual

Mission Brief

Hearing loss remains a top-five new award—108,105 veterans received ratings for it in FY 2024.¹ This manual shows you how to pair in-service acoustic trauma with Maryland CNC and pure-tone threshold data so Diagnostic Code 6100 works in your favor.

The VA only accepts tests performed by a state-licensed audiologist that include both a controlled speech discrimination test (Maryland CNC) and pure tone audiometry at 1000–4000 Hz.² If any piece is missing, the rater will zero out the exam.

Use this playbook to document acoustic trauma, ensure testing follows §4.85, and position exceptional patterns under §4.86 when thresholds hit 55 dB or higher.

Confirm compliant testing: schedule exams with a state-licensed audiologist who uses Maryland CNC and calibrated equipment per §4.85(a).²
Record threshold shifts: compare entrance/exit audiograms to show a positive threshold shift (PTS) tied to duty noise.
Log functional impact: capture how hearing loss affects communication, safety, and employment to support entitlement and secondary mental health claims.
Leverage exceptional patterns: apply §4.86 when thresholds hit 55 dB+ at the key frequencies or when 1000 Hz is 30 dB or less and 2000 Hz is 70 dB or more.³

Situation Brief

Hearing loss ratings rely on pairing acoustic trauma with current Maryland CNC scores and pure-tone averages. The VA plugs your results into Table VI (or VIA) and cross-references them with Table VII to determine the percentage.² You must blank out examiner errors before they land in your file.

Signals You Need This

You served around shipboard machinery, flight lines, artillery, or weapons fire without consistent hearing protection.
Service audiograms show threshold shifts or you filed in-service hearing conservation reports.
Post-service testing reveals speech discrimination below 94% or pure tone averages above 26 dB.

Stay on Course

Treat every audiology visit like evidence gathering. Ensure the provider documents calibration, testing method, and your functional impact narrative.

Bring copies of in-service audiograms, MOS noise exposure letters, and any line-of-duty reports to civilian exams.
Request the audiologist to annotate when masking was used, whether results are valid, and if reliability concerns exist.
Record examples of misheard commands, safety incidents, or communication breakdowns to justify occupational impairment.

Match your VA Form 21-4138 statements to the examiner’s remarks so adjudicators see a consistent pattern of difficulty.

Prep Checklist

Build the packet before you file or request a review so the VA can only say “yes.”

Schedule a private audiology exam that includes Maryland CNC word lists and pure tone thresholds at 500–4000 Hz.
Gather service treatment records and DD Form 2215/2216 audiograms to prove threshold shifts during service.
Collect buddy statements describing noise exposure events (gunfire, engine rooms, flight decks).
Document current functional loss—missed alarms, difficulty understanding speech, safety incidents on duty.
Print and review the Hearing Loss & Tinnitus DBQ so your audiologist hits every VA-required field.
Log tinnitus, vertigo, or mental health symptoms that may warrant secondary ratings.

Upload the audiogram as a PDF—never a photo—to preserve the examiner’s signature and calibration statement.

Step-by-Step Playbook

Document Noise Exposure: Pair MOS noise exposure factsheets, deck logs, or weapons qualifications with your personal statements and buddy letters.
Secure a Compliant Audiogram: Verify Maryland CNC was administered, note speech discrimination scores, and collect pure tone averages for each ear.
Evaluate for Exceptional Patterns: Check whether thresholds trigger §4.86 so you can argue for Table VIA if it yields a higher numeral.
Prep for the C&P Exam: Bring private test results, highlight duty noise exposure, and confirm the examiner used the Maryland CNC word list.
Cross-Check the Rating: After the decision, plug your scores into Table VII yourself. Appeal quickly if the VA misread the audiogram.

Evidence Arsenal

Combine acoustic trauma proof with compliant test results and you take the guesswork out of Diagnostic Code 6100.

Medical Proof

Maryland CNC and pure tone thresholds recorded by a state-licensed audiologist.²
Audiology reports that address test reliability, masking, and calibration.
ENT notes describing associated vertigo, eustachian tube dysfunction, or need for hearing aids.
VA Form 10-2464 or technician certifications confirming calibration of testing equipment.

Lay & Service Proof

Buddy statements covering weapons fire, aircraft, or machinery noise levels in your duty stations.
Service audiograms showing threshold shifts greater than 10 dB at key frequencies.
Performance reviews or safety reports noting communication errors tied to hearing loss.
Daily logs describing hearing aid adjustments, lip reading reliance, or spouse/family impact.

Reminder §4.85 requires both ears be evaluated—even unilateral loss must be paired with the non-service-connected ear using Table VII.

Intel & Tools

Stay aligned with VA audiology requirements before, during, and after the exam.

38 C.F.R. §4.85 — outlines Maryland CNC, pure tone thresholds, and Table VI/VII usage.
38 C.F.R. §4.86 — invoke exceptional pattern rules when thresholds are 55 dB+.
Hearing Loss DBQ — give this to your audiologist so speech discrimination and functional impact are fully described.
Google Trends: VA hearing disability — monitor when search interest spikes to time supplemental claims or content updates.

Related Tips

Update your file when hearing aids are issued, thresholds shift, or speech discrimination drops—it shows progression for future increases.

Next Actions & Support

Stay Organized

Reschedule audiology exams annually or sooner if your functional hearing worsens.
Log every adjustment, repair, or new programming of hearing aids.
Track workplace accommodations or telework approvals tied to communication difficulties.

More Routes

Secondary conditions. Develop claims for tinnitus, anxiety, or balance disorders stemming from hearing loss.
Denied? File a Supplemental Claim with a compliant private audiogram if the VA test skipped Maryland CNC.
Use the Intel Archive for scripts veterans used to challenge flawed audiology exams.

Hearing Loss Claim FAQs

What makes an audiogram “VA compliant”?

A state-licensed audiologist must perform a controlled speech discrimination test using the Maryland CNC word list and pure tone audiometry at 1000, 2000, 3000, and 4000 Hz. Both results feed into Table VI or VIA under 38 C.F.R. §4.85.

How do exceptional patterns help my rating?

If your thresholds hit 55 dB or more at each key frequency—or 30 dB at 1000 Hz and 70 dB at 2000 Hz—you may use Table VIA or the higher of Table VI/VIA for each ear under §4.86.

Can I use a civilian audiogram if the VA exam was poor?

Yes, as long as the civilian exam meets §4.85 requirements. Submit it with a statement explaining deficiencies in the VA exam and request the rater apply the private results or schedule a new compliant exam.

Get updates when VA rewrites audiology testing guidance or when new precedential decisions change Diagnostic Code 6100 outcomes.