Vertigo Secondary to Tinnitus

If your tinnitus is service connected and you have spells of vertigo or dizziness, you can claim the vertigo as secondary to the tinnitus. VA does not grant it just because both conditions are in your file. Tinnitus and vertigo often appear together, partly because one inner ear problem can produce both: Meniere's disease includes tinnitus and vertigo, and loud noise can damage the balance organs as well as hearing. An examiner who sees only that overlap may decide the tinnitus did not cause anything. This page covers what the research shows, how VA decides the claim, how vertigo is rated, and what a medical opinion has to explain.

Can tinnitus cause vertigo?

The research shows that tinnitus and vertigo are linked. It does not yet show that tinnitus on its own causes vertigo, and a careful opinion says so.

• A 2026 study of 7,634 Korean adults aged 40 and older (Kim and Kim, American Journal of Otolaryngology) found that dizziness rose with tinnitus severity. After full adjustment, moderate tinnitus carried 1.71 times the odds of dizziness and severe tinnitus 2.43 times the odds, compared with no tinnitus. Adjusting for anxiety and stress weakened that link by about 9% for moderate tinnitus and 19% for severe tinnitus, so most of it remained.
• A 2025 study of Korean national insurance records (Rim and colleagues, Journal of Clinical Medicine) followed 580,531 people with tinnitus and 572,937 people with benign paroxysmal positional vertigo (BPPV), vertigo set off by changes in head position. People with tinnitus developed BPPV at 12.3 per 1,000 a year, against 5.1 per 1,000 in matched controls, and the link also ran the other way. The authors called it a bidirectional association suggesting an interconnected pathophysiology, and said the mechanism still needs research.
• A 2023 systematic review of 19 studies (Nadri and colleagues, Iranian Journal of Public Health) found that occupational noise can damage the balance organs of the inner ear, with the saccule more vulnerable than the other balance structures. It concluded that noise exposure and noise-induced hearing loss are risk factors for vestibular dysfunction.
• The international diagnostic criteria for Meniere's disease (Lopez-Escamez and colleagues, Journal of Vestibular Research, 2015) require episodes of vertigo with low- to medium-frequency hearing loss and fluctuating ear symptoms, including tinnitus, in the affected ear. In Meniere's, tinnitus and vertigo are two symptoms of one disease.
• Among 916 post-9/11 service members and recently separated veterans in the NOISE Study (Sonstroem and colleagues, Military Medicine, 2023), 22% of service members and 31% of veterans reported dizziness. Those with a history of traumatic brain injury were three to four times more likely to report it. Blast exposure without a brain injury was not tied to more dizziness.

These are associations in large groups, and two of the studies rely on self-reported dizziness. They support asking the question. They do not prove that your tinnitus caused your vertigo. The explanations the studies point to are shared inner ear damage, as with noise or Meniere's disease, and anxiety and stress, which explained part of the tinnitus and dizziness link in the 2026 study. An opinion should say which one fits your records. If your records point to a shared cause, such as noise or a head injury in service, the doctor may find your vertigo is better tied to that cause. The vertigo VA rating page covers those other routes, and migraines secondary to tinnitus covers a related tinnitus claim.

How VA decides vertigo secondary to tinnitus

Secondary service connection is in 38 CFR § 3.310. VA grants it in two ways:

• Caused by. Your service-connected tinnitus caused the vertigo, at least as likely as not.
• Aggravated by. Your vertigo is aggravated by your service-connected tinnitus, meaning it would be less severe but for the tinnitus (M21-1 V.ii.2.D). VA rates only the part above the baseline level of the vertigo before the aggravation, so the opinion should describe that baseline.

The claim needs three things in the file: a current diagnosis of a vestibular disorder, service-connected tinnitus, and a medical opinion linking the two with reasoning.

Name the disorder, not just the symptom

Vertigo is a symptom. The rating schedule asks for more. Under Diagnostic Code 6204, objective findings supporting the diagnosis of vestibular disequilibrium are required before VA can assign a compensable rating. A primary care note that says "dizzy" does not meet that bar. A balance workup by an ear, nose and throat doctor or a neurologist, with a hearing test, is what usually names the disorder: BPPV, another peripheral vestibular disorder, or Meniere's disease.

When the diagnosis is Meniere's disease

If your vertigo is part of Meniere's disease, your tinnitus is a symptom of the same disease rather than its cause. The rating schedule handles that case on its own terms. VA rates Meniere's under Diagnostic Code 6205, or rates vertigo, hearing impairment and tinnitus separately, whichever gives the higher overall rating, and it does not combine a separate tinnitus, vertigo or hearing rating with a DC 6205 rating (38 CFR § 4.87). Ask your doctor to say plainly which disorder you have, because it changes both the theory of the claim and the rating.

VA rating for vertigo secondary to tinnitus

Vertigo secondary to tinnitus is rated the same way as any vertigo. A peripheral vestibular disorder is rated under Diagnostic Code 6204:

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

A compensable rating under DC 6204 requires objective findings that support a diagnosis of vestibular disequilibrium. Hearing impairment is rated separately and combined.

Meniere's syndrome is rated under Diagnostic Code 6205:

• 100%: hearing impairment with attacks of vertigo and cerebellar gait 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

The vertigo VA rating page covers what separates 10 from 30 percent and when DC 6205 is the better fit.

Your tinnitus keeps its own rating under Diagnostic Code 6260, which allows a single 10 percent. Note 1 to DC 6260 lets a separate tinnitus rating combine with a DC 6204 rating. The two then combine under 38 CFR § 4.25, larger rating first. A 30 percent vertigo rating and a 10 percent tinnitus rating combine to 37, because the 10 percent takes its share of the remaining 70. VA rounds 37 to 40 percent.

The C&P exam for vertigo secondary to tinnitus

VA usually orders an exam or a medical opinion for this claim. The examiner is asked whether your vertigo is at least as likely as not caused by your tinnitus and, separately, whether the tinnitus aggravated it. Both questions matter. An opinion that answers only the first one is inadequate under El-Amin v. Shinseki (2013).

What the examiner looks at:

• Whether a diagnosis exists and what objective findings from balance testing support it
• When the vertigo started compared with the tinnitus, and the noise or head injury history in your service records
• Your hearing test, since every DC 6205 level requires hearing impairment
• How often the spells happen, how long they last, and whether you stagger or fall
• Other causes of dizziness in your file, such as a head injury, migraine, medication side effects or a heart rhythm problem

Watch for an unfavorable opinion that says tinnitus is only a symptom and cannot cause vertigo, then stops. That answer does not deal with the studies above, and it skips aggravation. A denial because no balance testing was done is a reason to get the testing, not proof that nothing is there. Your own statement and a buddy letter from someone who has seen a spell can record what the chart misses: dates, how long it lasted, and whether you fell. The personal statement tool and C&P exam prep can help you describe the spells in plain terms. The Board section below shows how the Board ruled on these appeals.

Why vertigo secondary to tinnitus claims get denied

The gaps that lead to a denial are the same ones § 3.310 and the rating schedule point to:

• The file shows "dizziness" but no diagnosis and no objective findings from balance testing.
• The only medical opinion is a negative VA opinion, and nothing in the file answers it.
• A private opinion states a conclusion, or says only that both are ear problems, without explaining a mechanism.
• The opinion ignores a competing cause in your records, such as a head injury or migraine.
• No opinion addresses aggravation.

Nexus letter for vertigo secondary to tinnitus

A strong nexus letter for this claim does six things:

1. States that the doctor reviewed your records, including your service noise history, hearing tests, balance testing and ear, nose and throat notes.
2. Names your vestibular diagnosis and the objective findings that support it, and says whether Meniere's disease applies.
3. Gives an opinion on causation: your vertigo is at least as likely as not caused by your service-connected tinnitus.
4. Gives a separate opinion on aggravation: your vertigo is aggravated by your service-connected tinnitus, meaning it would be less severe but for the tinnitus, and describes the baseline before the aggravation.
5. Explains the reasoning in plain medical terms and cites the research, including that the studies show association rather than proof of cause.
6. Deals with your other possible causes directly, such as a head injury, migraine or medication.

Where these opinions break down is predictable: a conclusion with no reasoning behind it, an incomplete review of the records, no diagnosis beyond "vertigo," or a specialty that does not fit the question. Raven Nexus can organize your records and the research into a draft for your doctor to review.

Questions veterans ask about vertigo secondary to tinnitus

Can vertigo be secondary to tinnitus?

Yes. VA can grant vertigo secondary to service-connected tinnitus under 38 CFR § 3.310 when a medical opinion finds the tinnitus caused the vertigo or made it worse. The opinion has to explain the link in your records, not just note that both conditions exist.

Is vertigo secondary to tinnitus?

Not automatically. Large studies find that the two often occur together and may share a cause, such as noise damage to the inner ear, but the studies I found show association, not that tinnitus itself causes vertigo. Whether it is secondary in your case is the question the medical opinion answers.

What is the VA rating for vertigo secondary to tinnitus?

The same as any vertigo: 10 or 30 percent under Diagnostic Code 6204, or 30, 60 or 100 percent if the diagnosis is Meniere's syndrome under DC 6205. The rating combines with your 10 percent tinnitus rating under 38 CFR § 4.25.

Do I need balance testing for this claim?

For a compensable rating under DC 6204, you need objective findings that support a diagnosis of vestibular disequilibrium. Balance testing by a specialist is one way to document them.

Can I get separate ratings for tinnitus and vertigo?

Yes, under DC 6204. Note 1 to DC 6260 lets a tinnitus rating combine with a DC 6204 rating. If you are rated for Meniere's under DC 6205, VA does not add separate ratings for tinnitus, vertigo or hearing loss on top of it.

What if my doctor says I have Meniere's disease?

Then your tinnitus and vertigo are both symptoms of Meniere's, and VA rates it under DC 6205 or rates the parts separately, whichever is higher. Ask the doctor to put the diagnosis and its findings in writing, since it changes both the claim theory and the rating.

Sources

• 38 CFR § 3.310, secondary service connection; M21-1 V.ii.2.D, aggravation of a nonservice-connected disability by a service-connected one.
• 38 CFR § 4.87, Diagnostic Code 6204 (peripheral vestibular disorders), Diagnostic Code 6205 (Meniere's syndrome) and Diagnostic Code 6260 (tinnitus) with its notes; 38 CFR § 4.25, combined ratings table.
• El-Amin v. Shinseki, 26 Vet. App. 136 (2013), an opinion must address aggravation.
• Kim H, Kim K. Tinnitus severity and dizziness: The role of psychological distress in a population-based study. American Journal of Otolaryngology. 2026;47(3):104842. PMID 42048885.
• Rim HS, Lee R, Oh IH, Yeo SG, Kim SH. Association of Tinnitus with Benign Paroxysmal Positional Vertigo. Journal of Clinical Medicine. 2025;14(7):2473. PMID 40217922.
• Nadri H, Khavanin A, Kim IJ, Akbari M, Nadri F. Association between Simultaneous Occurrence of Occupational Noise-Induced Hearing Loss and Noise-Induced Vestibular Dysfunction: A Systematic Review. Iranian Journal of Public Health. 2023;52(4):683-694. PMID 37551182.
• Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière's disease. Journal of Vestibular Research. 2015;25(1):1-7. PMID 25882471.
• Sonstroem A, Thapa S, Pigott K, et al. Prevalence and Risk Factors of Self-reported Dizziness in Post-9/11 Service Members and Veterans. Military Medicine. 2023;188(Suppl 6):511-519. PMID 37948221.
• Board figures on this page: Claim Raven's read of every Board decision from 2021 to 2026 that it holds, and of every decision since 1992 for the longer view.