Veterans make claims for tinnitus more than any other disability in the VA system. Veterans 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 defined as any perception of external noise that is not actually present. It includes ringing, but can also be whistling, hissing, buzzing, swooshing, clicking. 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.

What are the main factors of Tinnitus?

Hearing loss: hearing loss– whether age-related or noise induced— is often associated with tinnitus. A lot of times the person notices the tinnitus but not the hearing loss itself. The brain receives less external stimuli.  This process changes around specific frequencies may be a way of the brain filling in the auditory gap.  A gap of the sounds and frequencies it has lost due to hearing loss.

What are the other causes of Tinnitus?

• Obstructions of the ear: excessive wax, head congestion, loose hairs from the inner ear canals, and dirt. Often when the obstruction is removed, the tinnitus will stop. 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 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 lead to tinnitus again for similar reasons as head and neck trauma. The damage caused to the middle ear by concussive shock injures the auditory system. About 60% of all the tinnitus cases that VA diagnoses 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 symptom of the following medical conditions:
    • Hypo and Hyperthyroidism
    • Lyme Disease
    • Fibromyalgia
    • High Blood Pressure
    • Atherosclerosis
    • Depression/Anxiety/Stress
    • Meniere’s Disease
    • Otosclerosis
    • 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
• Tympanogram
• Acoustic reflex test
• Otoacoustic emission test

How does VA evaluate Tinnitus?

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. Did you work near loud noises like working on a flight line, working with or near explosives, explosives or gunfire.  These exposures are all proof and evidence for a nexus statement to show a nexus for your tinnitus. As with most conditions, veterans need the nexus “more likely than not caused by….” to substantiate their claim. If one of these factors didn’t cause the tinnitus, you need a link to you are claiming caused it. For example, if you are claiming it was due to medications, you must prove you took the medications. Same with exposure, if you believe noise or chemicals caused it, you must have evidence of it happening in service.

What kind of evidence do you need to show your tinnitus started in service?

To show exposure, you can use service records or lay statements.  Service records can be your own—coming from your service jacket.  These records would show helpful items like your MOS and active duty stations.  But you could also use service records of your unit or ship or base.  Lay statements are statements from friends or service members that knew you during military service.  These statements can speak to specific incidents that happened and help obtain service connection.  The statements can also discuss long term exposure that the witness saw you subjected to.

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.

What’s the highest VA disability rating for tinnitus?

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%.  Some veterans get secondary problems from tinnitus—like depression or hyperacusis.  These disabilities can be severely disabling.  Sometimes this leads to the veteran not being able to work.  If the disability gets this bad then the veteran can apply for unemployability.  Instead of receiving 10%, the veteran would receive 100% disability compensation.

How Many People Have Tinnitus?

Of the approximately 325 million people in the United States, over 45 million; or approximately 14% have tinnitus. Over 150,000 veterans found out they had tinnitus in 2015 alone.  More than 1.5 million are currently receiving VA disability benefits for tinnitus. Veterans claimed almost twice as many tinnitus claims last year than for hearing loss, the second most filed claim. Tinnitus accounts for almost 10% of all new VA claims and over 7% of total compensated VA disabilities.

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.  Additionally, you want to make sure 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.  Another option is to review our website for information on how to file a claim and get your claim started today.