Hearing Loss

Roughly 1.6 million veterans are service-connected for hearing loss. The most common rating in that group is zero percent. That isn't a fluke or a denial. It's how the rating schedule is built. 38 CFR § 4.85 runs your audiogram through a two-axis table: puretone threshold averages on one side, Maryland CNC speech discrimination scores on the other. The table pushes mid-range hearing loss with preserved speech discrimination into Roman numeral I or II in each ear, and Roman numerals I and II combine to zero percent every time.

The math doesn't care whether you can follow your spouse at a restaurant or hear your grandkids on the phone. The Maryland CNC test happens in a soundproof booth at amplified volume, and most veterans with classic noise-induced hearing loss score 92 to 100 percent on it. That preserved discrimination score is what holds the rating at zero. Real-world hearing impairment in noisy environments is substantially worse than the booth test reflects, but the schedule doesn't measure it that way.

There's one significant exception, and it's the part most veterans haven't read: 38 CFR § 4.86. When the audiogram shows either puretone thresholds at 55 dB or higher across all four frequencies, or a steep slope (30 dB or less at 1000 Hz and 70 dB or more at 2000 Hz), the rater uses Table VIa (puretone only) and assigns whichever Roman numeral is higher. The § 4.86(b) "steep slope" pattern is the classic audiometric signature of noise-induced hearing loss. Combat arms, aviation, artillery, armor crewmen: the population most likely to qualify, and the population most often rated under standard Table VI when § 4.86(b) would have produced a higher number. This page walks through Table VI, the § 4.86 exception, the Maryland CNC requirements, the Duty MOS Noise Exposure Listing, and how hearing loss combines with tinnitus.

TL;DR

• Hearing loss is rated under 38 CFR § 4.85 using a two-axis table: puretone threshold averages on one axis, Maryland CNC speech discrimination scores on the other. The output is a Roman numeral I through XI per ear, then a combined rating from Table VII.
• The default path through Table VI requires both puretone averages and Maryland CNC speech scores. Most veterans with documented service-connected hearing loss land at Roman numeral I or II in each ear, which combines to 0%.
• 38 CFR § 4.86 carves out an "exceptional patterns of hearing impairment" exception. When puretone averages hit 55 dB or higher across all four frequencies, or when there's a 30 dB gap at 1000 Hz versus 2000 Hz, the rater uses Table VIa (puretone only) and assigns whichever Roman numeral is higher.
• The audiogram has to come from a state-licensed audiologist using a controlled-environment booth and specific frequencies (1000, 2000, 3000, 4000 Hz). VA C&P audiograms qualify. Some private audiograms don't.
• Hearing loss and tinnitus are rated as two separate conditions. They almost always travel together, and the 10% tinnitus rating is independent of whatever the hearing loss rating works out to.
• For combat arms, aviation, artillery, armor, and similar MOS categories, in-service noise exposure is generally conceded based on the DD-214 alone. The nexus piece is the easier part of the claim. The rating math is the harder part.

The Schedule, in Two Tables and Three Steps

The rating process for hearing loss runs through three tables. Most veterans never see it laid out this way, because the decision letter just states the percentage without showing the math.

Step one: the audiogram data

The audiogram produces two pieces of data per ear:

• The puretone threshold average. Add the dB thresholds at 1000, 2000, 3000, and 4000 Hz, divide by four.
• The Maryland CNC speech discrimination score.

Step two: Table VI lookup

Look up the Roman numeral in Table VI using the puretone average on one axis and the speech score on the other. The result is a Roman numeral from I to XI.

Step three: Table VII combined rating

Plug the Roman numerals for both ears into Table VII. The intersection is the combined rating, from 0% to 100%.

Here's a partial slice of Table VI to make it concrete:

• Puretone average 0-41 dB, speech score 92-100%: Roman numeral I
• Puretone average 42-49 dB, speech score 84-90%: Roman numeral II
• Puretone average 50-57 dB, speech score 76-82%: Roman numeral III
• Puretone average 58-65 dB, speech score 68-74%: Roman numeral IV
• Puretone average 66-73 dB, speech score 60-66%: Roman numeral V

The full table goes higher. But notice where most service-connected hearing loss lives. A veteran with mid-range noise-induced hearing loss often comes in with puretone averages in the 30-45 dB range and speech scores in the 88-96% range. That puts them at Roman numeral I or II.

Now Table VII. The combined rating for two ears at I is 0%. I and II is 0%. II and II is 0%. The 10% rating doesn't show up until you hit roughly III and IV, or higher. A veteran has to be sitting at Roman numeral IV or higher in at least one ear before the combined rating starts moving above 0%.

That's the structural reason most ratings come back at 0%. The table is built so that mild-to-moderate hearing loss with preserved speech discrimination produces a 0% rating, regardless of how plainly the veteran can tell something is off.

Why Mid-Range Hearing Loss Lands at 0%

The schedule's logic is that hearing loss is rated on functional impairment, and the Maryland CNC score is meant to capture functional impairment. If you can still understand 92% of single-syllable words read at conversational volume in a quiet booth, the schedule says your speech discrimination is preserved, even if your puretone thresholds are 35 dB elevated.

Whether that captures real-world hearing impairment is a separate question. Real-world conversation happens in noisy environments, not soundproof booths. Speech discrimination in noise is substantially worse than speech discrimination in quiet, especially for noise-induced loss with the typical high-frequency drop. The Maryland CNC, conducted in a controlled booth at a controlled volume, isn't measuring the kind of impairment veterans experience at family dinners or in crowded rooms.

I'm not sure what to make of that gap as policy. The argument for it is that the controlled-booth test is reproducible across raters and across time. The argument against is that it produces ratings that don't reflect what the impairment actually does to people's lives. The data can't tell me which framing is right. The schedule does what it does.

The § 4.86 Exception: When Puretone Carries the Rating

38 CFR § 4.86 is the part most veterans haven't read. It says that for two specific "exceptional patterns of hearing impairment," the rater uses Table VIa instead of Table VI, and Table VIa is puretone-only. No Maryland CNC component.

The two exceptional patterns are:

§ 4.86(a). Puretone threshold of 55 dB or greater at each of the four frequencies (1000, 2000, 3000, and 4000 Hz). This is for severe across-the-board hearing loss. The rater compares Table VI to Table VIa and assigns whichever is higher.

§ 4.86(b). Puretone threshold of 30 dB or less at 1000 Hz and 70 dB or more at 2000 Hz. This is for the steep high-frequency slope pattern common in noise-induced hearing loss. The rater uses whichever of Table VI or Table VIa produces the higher Roman numeral, and then adds one level.

The § 4.86(b) exception matters most for veterans with classic noise-induced hearing loss, because the steep high-frequency drop is exactly the pattern combat arms, aviation, artillery, and armor crewmen tend to develop. The audiometric signature is preservation at low frequencies and significant loss at 3000 and 4000 Hz, sometimes with a notch at 4000 Hz.

A veteran whose 1000 Hz threshold is 20 dB but whose 2000 Hz threshold is 75 dB falls into § 4.86(b). Under default Table VI rules, the speech discrimination score might keep the Roman numeral low. Under § 4.86(b) with Table VIa, the puretone-only Roman numeral might land higher, and then one additional level gets added.

The exception is narrow. A veteran with mid-range hearing loss that doesn't fit either pattern stays on Table VI, with the speech discrimination component, and typically lands at 0%.

What I've seen in BVA decisions is that the § 4.86 exception is sometimes missed at the initial rating stage and surfaces on appeal.

The Maryland CNC Test: What It Actually Is

The Maryland CNC word list is the speech discrimination test VA uses in hearing loss exams. CNC stands for Consonant-Nucleus-Consonant, a phonetic structure describing one-syllable English words (cat, dog, ship, that kind of word).

The test consists of 50 words read at 40 dB above the speech reception threshold. The veteran repeats each word back. The score is the percentage correctly repeated. 92-100% is preserved discrimination, 50-92% is graded, below 50% is severely impaired. It's conducted in a sound-treated booth with headphones isolating each ear.

The thing to know about the Maryland CNC is that it isolates speech discrimination in quiet, with no background noise, at an amplified volume. The newer Hearing in Noise Test (HINT) and Words-in-Noise (WIN) test measure discrimination in background noise and typically produce substantially worse scores. VA's schedule doesn't use HINT or WIN. It uses Maryland CNC, and the standard hasn't been substantively revised since the 1987 hearing rating amendments.

Audiogram Requirements: State-Licensed Audiologist, Controlled Booth, Specific Frequencies

The audiogram VA accepts has to meet specific technical requirements. From 38 CFR § 4.85(a):

An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (specifically the Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids.

The requirements that matter:

• State-licensed audiologist. Hearing aid dispensers and non-audiologist physicians don't qualify unless an audiologist signs off.
• Controlled environment. Sound-treated booth or equivalent. Hallway screeners don't qualify.
• Maryland CNC specifically. Not W-22, not NU-6, not "speech discrimination test" generally.
• Puretone audiometry at 1000, 2000, 3000, and 4000 Hz.
• Tested without hearing aids.

The most frequent gap in private audiograms is the Maryland CNC piece. Many community audiologists use NU-6 or another word list. The audiogram might be technically excellent, but without a Maryland CNC score, VA can't plug it into Table VI.

VA's C&P audiologists produce audiograms that hit all of these requirements. The C&P exam is usually the rating-decision audiogram regardless of what's already in the file. A private audiogram can support service connection, but the rating itself usually flows from the C&P audiogram.

Bilateral Hearing Loss: How the Math Combines Two Ears

The Table VII step combines the Roman numerals from both ears into a single combined rating. It's not additive in the way veterans sometimes expect. Two ears at Roman numeral III don't double to Roman numeral VI.

Here's how some common pairings work out in Table VII:

• Both ears at I, or I and II, or II and II, or III and III: 0%
• III and IV, or IV and IV: 10%
• IV and V, or V and V: 20%
• V and VI, or VI and VI: 30%
• VI and VII: 40%
• VII and VII: 50%
• VIII and VIII: 70%

The pattern is that you generally need both ears at Roman numeral IV or worse before any rating above 0% shows up, and the rating climbs in 10% increments as the Roman numerals climb together.

For veterans whose hearing loss fits the § 4.86(b) exception, the Table VIa pathway and the one-level bump can change which Roman numeral applies and therefore change the Table VII result substantially. That's the practical reason the § 4.86 exception matters. It can shift a 0% rating to a 10% or 20% rating without any change in the underlying audiogram.

Hearing Loss + Tinnitus: Two Separate Ratings

Hearing loss and tinnitus are rated separately. They're clinically intertwined, almost always travel together, and often share the same in-service noise exposure as the cause. But the rating schedule treats them as two distinct diagnostic codes.

Tinnitus is under 38 CFR § 4.87 DC 6260, capped at 10%. See the Tinnitus condition page for the rating and the secondary chains it opens up. Hearing loss is under 38 CFR § 4.85 DC 6100, ranging from 0% to 100%.

When a veteran files for both, each gets its own rating decision. A tinnitus grant at 10% and a hearing loss grant at 0% combines as 10% (because 0% adds nothing). A tinnitus grant at 10% and a hearing loss grant at 10% combines to 19%, which rounds to 20%.

Some veterans assume tinnitus and hearing loss are one claim. They're not. They're two, with two diagnostic codes and two paths through the schedule. The audiogram is part of any tinnitus C&P exam anyway, so the data is already in the file. The veterans I've seen file for tinnitus alone and never follow up with a hearing loss claim are leaving the easier of the two ratings on the table.

Service Connection: Noise Exposure and the MOS Question

For hearing loss to be rated, it has to be service-connected. Standard three elements: current condition, in-service event or exposure, medical nexus.

The current condition piece is the audiogram. For VA purposes, the diagnostic threshold for sensorineural hearing loss is generally any puretone threshold of 26 dB or higher, or a speech discrimination score below 94%.

The in-service exposure piece is where MOS matters. For certain categories, hazardous noise exposure is essentially conceded based on the DD-214 alone:

• Combat arms (infantry, armor, artillery, cavalry, combat engineers): 11-, 13-, 19-series MOS codes and adjacent.
• Aviation: pilots, aircrew, flight deck, aircraft maintenance.
• Armor crewmen and tank mechanics.
• Combat engineers and EOD.
• Special operations across all branches.
• Naval gun crews, engineering rates.
• Marine infantry and reconnaissance.

For veterans in these MOS categories, the in-service noise side of the nexus is rarely contested. The C&P worksheet includes a Duty MOS Noise Exposure Listing that flags high-probability codes for conceded exposure. For non-combat MOS, exposure has to be proven with lay statements, unit assignments, and any in-service medical records.

The nexus piece is the medical opinion connecting current hearing loss to in-service exposure. Where it gets contested:

• Late-onset hearing loss with significant post-service occupational noise exposure (construction, manufacturing, civilian aviation).
• No in-service audiogram, or audiograms showing normal hearing at separation followed by hearing loss diagnosed decades later.
• Documented intervening medical events (head injury, ototoxic medications, ear infections).

The "no in-service audiogram" gap is common for veterans from earlier service eras. A Vietnam-era infantryman with current significant hearing loss but no service-treatment-record audiograms has a harder evidentiary path, even though the MOS and exposure history strongly support the claim.

What I've seen in BVA decisions is that the Board is fairly generous in granting service connection when the MOS supports hazardous noise, the audiogram shows a noise-induced pattern (preserved low frequencies, high-frequency drop), and lay statements are credible on continuity. That said, hearing loss has a higher denial rate than most conditions. Across 1,130 hearing loss cases in Claim Raven's analysis, 46.4% were denied outright, with another 30.8% remanded and only 21.1% granted. That denial rate is meaningfully higher than the 40.8% denial rate across all 101,518 condition records drawn from 49,876 Board decisions in the dataset, which fits the pattern of rating math producing 0% outcomes even when service connection is granted.

Common Evidence Gaps

The denials and 0% ratings I've seen for hearing loss tend to cluster around a few patterns.

No in-service audiogram. For older veterans, entry and separation audiograms weren't always performed or preserved. The claim has to rely entirely on post-service audiograms and credibility of in-service exposure and continuous symptoms. The Board often grants these anyway when the MOS and audiometric pattern align, but regional office raters sometimes deny initially.

Audiogram doesn't include Maryland CNC. A private audiogram is in the file, but the speech discrimination test was NU-6 or W-22 rather than Maryland CNC. The audiogram doesn't fit into Table VI cleanly. The rater either orders a C&P exam to redo the test or rates based on incomplete data, often producing 0%.

Speech discrimination preserved despite significant puretone loss. This is the structural 0% pattern. The audiogram shows 35-45 dB puretone average across the four key frequencies, but the Maryland CNC score is 94-100%. Table VI puts the Roman numeral at I or II, and the combined rating from Table VII is 0%.

Documented post-service occupational noise exposure. A veteran who spent 20 years in a noisy civilian job may face a C&P opinion that attributes the hearing loss primarily to post-service exposure. The nexus then turns on whether in-service exposure was a contributing cause or aggravating factor, which is a less demanding standard than "primary cause."

Late-onset claims with no continuous symptom history. A veteran first diagnosed 25 years after separation, with no documentation of in-service complaints or continuous symptoms, has a harder nexus argument. These claims sometimes succeed on the strength of the MOS exposure record and audiometric pattern, but the C&P examiner has more latitude to write an unfavorable opinion.

§ 4.86 exception not applied. The audiogram fits one of the two exceptional patterns under § 4.86, but the rater used Table VI by default and produced a 0% or low rating. This shows up on appeal when the representative catches that Table VIa with the one-level addition would have produced a different result.

How Hearing Loss Combines With Other Ratings, and What the Board Looks For

The combined ratings table at 38 CFR § 4.25 applies the same way it does to any condition: progressive reduction of remaining capacity, not addition. Common combinations with tinnitus:

• 0% hearing loss + 10% tinnitus: 10% combined
• 10% hearing loss + 10% tinnitus: combines to 19%, rounds to 20%
• 20% hearing loss + 10% tinnitus: combines to 28%, rounds to 30%
• 30% hearing loss + 10% tinnitus: combines to 37%, rounds to 40%

A 0% hearing loss adds nothing to the combined rating, but it preserves the diagnosis for future increase claims if the hearing deteriorates. Where hearing loss can matter more is in pushing a veteran across rounding thresholds. A veteran at 49% combined who picks up a 10% hearing loss moves to roughly 54%, rounding to 50%. That's the bump from the 40% pay tier to the 50% pay tier, in 2026 roughly the difference between $804/month and $1,159/month for a single veteran.

The Board's decisions on hearing loss appeals tend to focus on three things: whether the audiogram was conducted correctly, whether the rating math was computed correctly under the right table, and whether the C&P opinion on nexus was adequate. On nexus opinions, the Board applies the standard that comes up across most rating appeals:

"A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning."

A bare-bones "less likely than not" without rationale gets the case remanded. What the Board doesn't generally do is second-guess the rating math when the inputs are correct. The veteran's argument that "my hearing is worse than the rating reflects" doesn't carry weight against a properly computed schedule rating. The path to changing the rating runs through the audiogram results or the § 4.86 exception, not through subjective severity arguments.

Reading Your Own Audiogram for the § 4.86(b) Pattern

The first thing to check is the threshold at 1000 Hz and the threshold at 2000 Hz. If 1000 Hz is 30 dB or less and 2000 Hz is 70 dB or more, the ear may qualify for the § 4.86(b) exceptional-pattern rule. That rule uses Table VIa, compares it to Table VI, chooses the higher Roman numeral, and then adds one level.

The second pattern is broader: 55 dB or higher at all four rating frequencies, meaning 1000, 2000, 3000, and 4000 Hz. That is the § 4.86(a) path. It is less common for classic noise-induced claims than the steep-slope pattern, but it can move the rating when speech scores are preserved.

This is where a gap analysis can be useful when hearing loss is rated zero percent. A veteran may have service connection already, but the question is whether VA used the right table for the audiogram.

When a Private Audiogram Won't Count for Rating

Private audiograms can be excellent medical evidence and still fail the rating-table requirements. VA needs a state-licensed audiologist, a controlled environment, puretone thresholds at 1000, 2000, 3000, and 4000 Hz, and Maryland CNC speech discrimination specifically. NU-6, W-22, or a generic speech-discrimination test will not plug into Table VI the same way.

That does not make the private audiogram useless. It can support continuity, diagnosis, worsening, and nexus. It just may not be enough to assign the schedular percentage. The rating usually comes from a VA C&P audiogram because VA controls the required test format.

Before a C&P, use the C&P exam prep tool and an evidence checklist for hearing claims to make sure the file includes service noise exposure, post-service occupational exposure history, hearing-aid records, and any prior audiograms.

Filing Hearing Loss and Tinnitus Together

Hearing loss and tinnitus are separate claims. They often come from the same noise exposure, but they rate under different diagnostic codes. Tinnitus rates under DC 6260 and is capped at 10 percent. Hearing loss rates under DC 6100 using the audiogram tables and can range from zero to 100 percent.

The practical math is why filing both matters. A 10 percent tinnitus rating and a zero percent hearing loss rating still pay 10 percent. A 10 percent tinnitus rating and a 10 percent hearing loss rating combine to 19, which rounds to 20. Even a zero percent hearing loss grant preserves the condition for future increase claims if the audiogram worsens.

If ringing, buzzing, balance symptoms, or noise-environment difficulty are part of the record, use track ringing and noise-environment difficulty before the exam. The symptom history helps the examiner and makes future worsening easier to document.

The MOS Noise Presumption: Which Codes Get Conceded

The VA uses a duty MOS noise exposure framework to classify jobs by probability of hazardous noise. Combat arms, artillery, armor, aviation, flight deck, aircraft maintenance, naval gun crews, combat engineers, EOD, and similar jobs are commonly treated as high-probability exposure. For those veterans, the in-service event is often the easiest part of the claim.

For lower-probability MOS categories, the file needs more context. Lay statements, deployment records, weapon qualification, aircraft or vehicle proximity, generator exposure, shipboard noise, and unit records can all matter. Buddy statements for in-service noise exposure are useful when the DD-214 job title understates the actual noise environment.

The MOS evidence proves exposure. It does not set the percentage. The percentage still comes from the audiogram and, when applicable, the § 4.86 exception.

When the Rating Won't Move, and When It Will

The hardest truth about hearing loss claims is that real-world frustration does not move the schedular rating by itself. Difficulty hearing in restaurants, asking people to repeat themselves, turning up the TV, and missing conversation are real impairments. But if the Maryland CNC score and puretone averages land at Roman numeral I or II, the table usually returns zero percent.

The rating moves when the inputs move. That means worse puretone averages, lower Maryland CNC scores, a qualifying § 4.86 exceptional pattern, or a correctly documented change from a prior audiogram. Subjective testimony can support service connection and functional impact, but it usually cannot override correct table math.

Secondary conditions linked to hearing loss may also matter when the record shows vertigo, balance issues, tinnitus, anxiety from communication difficulty, or other downstream effects. Those claims need their own diagnosis and nexus path.

Bottom Line

Hearing loss is rated under 38 CFR § 4.85 through a two-axis table that combines puretone threshold averages with Maryland CNC speech discrimination scores, producing a Roman numeral per ear and a combined rating from Table VII. Most veterans with service-connected hearing loss land at 0%, because mid-range puretone loss with preserved speech discrimination produces Roman numerals I or II, which combine to 0%. The 38 CFR § 4.86 exception lets puretone-only ratings apply when the audiogram fits either of two exceptional patterns, and the most common pattern (the steep high-frequency drop at 2000 Hz) is the audiometric signature of noise-induced hearing loss. The audiogram has to come from a state-licensed audiologist in a controlled booth using Maryland CNC and the four standard frequencies. Service connection is generally favorable for combat arms, aviation, artillery, and similar MOS categories where in-service noise exposure is conceded. Hearing loss and tinnitus are rated as two separate conditions, and the combination at 10% each produces a 20% combined rating. The structural reason most hearing loss ratings come back at 0% isn't a denial. It's the table doing what the table is built to do.

Related Conditions

Hearing loss commonly travels with tinnitus, vertigo, balance problems, and communication-related functional impacts. Veterans with a zero percent grant should keep the rating active, track worsening, and review the gap analysis if the audiogram appears to fit an exceptional pattern.

Methodology and Limitations

• Data source: Rating criteria are quoted directly from 38 CFR § 4.85 and § 4.86. Table VI, Table VIa, and Table VII references are from the rating schedule's hearing loss tables. The 1.6 million service-connected veteran count is from VA's 2024 Annual Benefits Report. Maryland CNC test description follows the standard audiology reference. Combined rating math follows 38 CFR § 4.25. 2026 compensation figures are from the VA disability pay tables for a single veteran with no dependents.
• Sample size: Patterns in this post are drawn from Claim Raven's analysis of 101,518 condition records drawn from 49,876 Board decisions, including 1,130 hearing loss cases. Within that hearing loss subset, outcomes ran 46.4% denied, 30.8% remanded, and 21.1% granted. The dataset captures BVA-level outcome rather than schedular rating tier (the I-XI Roman numeral grid feeding into Table VII), so the rating-distribution framing in this post is regulatory rather than coded tier data.
• Classification approach: Rating tier definitions and tables are drawn from the regulatory text. Denial reason patterns and § 4.86 exception application rates are based on Claim Raven's review of BVA hearing loss decisions. Among 524 denied hearing loss cases in the dataset, named denial reasons broke down as 57.1% other, 14.3% nexus gap, and 9.9% missing service connection.
• Limitations:
• Compensation figures use 2026 VA disability rates for a single veteran with no dependents. Family rates differ above 30%.
• The "MOS noise presumption" referenced is a working concession that flows from the VA Duty MOS Noise Exposure Listing, not a formal statutory presumption. Practice varies across regional offices.
• Table VI / Table VIa / Table VII excerpts in this post are partial illustrations. The full tables in 38 CFR § 4.85 should be consulted for the complete grid.
• Audiogram standards described here reflect typical VA practice and the regulatory requirements. Private audiograms that don't include Maryland CNC speech discrimination are still useful for service connection and continuity of symptoms even if they can't be plugged into Table VI directly.
• The diagnostic threshold for VA-rateable sensorineural hearing loss is generally a puretone threshold of 26 dB or greater or a speech discrimination score below 94%. Veterans with audiograms below those thresholds may still have service connection arguments but generally not rateable conditions.
• These observations reflect patterns from the regulatory text, the relevant audiology standards, and BVA decisions. They are not predictions of individual outcomes.