Tinnitus is, by far, the most claimed disability in the VA system. Veterans have filed almost 160,000 claims for tinnitus just in 2015 alone. What is this condition, what causes it, and why is it claimed so often?
What is Tinnitus?
Many people will tell you that tinnitus is “ringing in the ears,” which is partially correct. Tinnitus is actually defined as any perception of external noise that is not actually present. It can include ringing, but can also include whistling, hissing, buzzing, swooshing, clicking, or even, in some rare cases, the hearing of music. Tinnitus can be temporary (acute) or ongoing (chronic).
Tinnitus is not a disease, but a symptom of an underlying condition. Usually, the person experiencing tinnitus has a sensorineural reaction in the brain due to some type of damage in the ear or auditory system. There are several main factors that contribute to tinnitus:
- Hearing loss: whether age-related or noise induced; hearing loss is often associated with tinnitus. Often times the person notices the tinnitus but not the hearing loss itself. The brain receives less external stimuli and this process change around specific frequencies may be a way of the brain filling in the gap for sounds and frequencies that it has lost due to hearing loss.
- Obstructions of the ear: excessive wax, head congestion, loose hairs from the inner ear canals, and dirt or foreign objects. Often when the obstruction is removed, the tinnitus will be relieved. However, sometimes it can cause permanent damage.
- Head or neck trauma: trauma can cause nerve damage that can result in tinnitus.
- TMJ: the joint that connects the jaw to the skull is located directly in front of the ear canal. For this reason; the tightening of the jaw muscles due to conditions such as TMJ can cause tinnitus since the auditory system and the jaw share muscles.
- Sinus pressure and barometric pressure: any type of abnormal pressure on the middle ear can cause tinnitus symptoms; diving, flying, head colds; concussive explosions; and even just blowing your nose.
- TBI: Traumatic brain injuries can also lead to tinnitus again for similar reasons as head and neck trauma. The damage caused to the middle ear by concussive shock damages the auditory system. About 60% of all the tinnitus cases diagnosed by the VA system are due to mild-severe TBI.
- Ototoxic drugs: many prescription drugs have the side effect of tinnitus. In most cases it is a short-lived side effect, going away once the drug is no longer being used. However, in some cases it can be chronic. Drugs that are known to be more likely to cause chronic tinnitus include
- Non-steroidal Anti-inflammatories (NSAID)
- Certain antibiotics
- Certain cancer medications
- Water pills and diuretics
- Quinine based medications (these include Mefloquine; Chloroquine; and other medications ending with quine)
- Other medical conditions: tinnitus is actually a symptoms of the following medical conditions:
- Hypo and Hyperthyroidism
- Lyme Disease
- High Blood Pressure
- Meniere’s Disease
- Acoustic neuroma
How Do I Prove I Have Tinnitus?
How do you prove you hear something only you can hear? Audiologists have tests and protocols designed to diagnose and evaluate the severity of tinnitus. Because tinnitus is often linked with hearing loss, a hearing test is usually administered along with tinnitus testing. Most hearing/tinnitus testing includes:
- Speech recognition testing
- Pure tone audiogram
- Acoustic reflex test
- Otoacoustic emission test
The VA standards for disability for hearing loss are determined by the test results of speech recognition; pure tone threshold average; and/or combinations of both. Various levels of rating percentages can be issued based on the results of the testing. However, for tinnitus, there is specific ways to prove your case with the VA.
Having a nexus statement is very important. Were you exposed to loud noises such as working on a flight line, working with or near explosives; exposed to explosives or gunfire during combat, etc. These can all be used as a nexus statement to show that you had an exposure that probably caused tinnitus. As with most conditions, veterans need the statement “more likely than not caused by….” for their claim to be substantiated. If the tinnitus was not caused by one of those factors, there must be some link to what you are claiming caused it. For example, if you are claiming it was due to medications, you must be able to prove, either with documentation or through lay statements, that you took the medications you say caused the tinnitus. Same with exposure, if you are saying it was caused by exposure to noise or chemicals, you must have some type of statement or documentation backing that claim up.
One thing that is different here than many other medical conditions is that you can use only lay evidence to prove tinnitus. According to a ruling made by the United States Court of Appeals for Veteran Claims on February 9, 2015, in the case of Robert Fountain v. Robert McDonald, Secretary of Veteran’s Affairs; lay evidence may be used to prove the nexus, or link between the tinnitus and service. In the case of Robert Fountain, he had provided timelines of exposure to noises and symptoms to show how they had corresponded.
Also, and this is so important to the VA that they put it in their regulations, the ringing must only be heard by the claimant. Yes, that is true, the VA Schedule for Rating Disabilities (VASRD) actually states that the tinnitus cannot be rated if anyone else can hear the ringing. Hmmmmm.
How High Can I Get Rated?
Unlike most other conditions, there is a limit on how high tinnitus can be rated. Regular or recurrent tinnitus carries a maximum rating of 10%, regardless of how bad it is or whether it is present in one or both ears. It can be rated separately from the condition it is related to such as hearing loss, psychiatric conditions, TBI, or other conditions if it is linked to one, but whether linked to another conditions or not, the maximum rating will always be 10%.
How Many People Have Tinnitus?
Of the approximately 325 million people in the United States, it is estimated that over 45 million; or approximately 14% have tinnitus. Over 150,000 veterans were diagnosed with tinnitus in 2015 alone and over 1.5 million are currently receiving disability benefits for tinnitus. Almost twice as many claims for tinnitus were made last year than for hearing loss, which was the second most filed claim. Tinnitus accounts for almost 10% of all new VA claims and over 7% of total VA disabilities being compensated. Of all recipients of VA compensation; over 1.4 million veterans are receiving compensation for tinnitus; 50% more than the next highest disability, hearing loss.
What do I do if I Have Tinnitus?
If you think you have tinnitus, the first thing you need to do is get a hearing test done. There is no treatment for tinnitus, but you need to make sure it is not something more serious or it is a symptom of some other condition that can be treated. Then, if you have reason to believe it may be service connected, get with a representative or review our website for information on how to file a claim and get your claim started today.