If your C&P examiner asked for your audiogram and you don't have one, you're not alone, and the situation is fixable. Audiograms are the objective backbone of most tinnitus and hearing loss VA claims. Missing or misread audiograms are a primary reason hearing loss claims are under-rated, and the absence of audiometric evidence leaves raters without the objective data that most efficiently supports service connection. While tinnitus itself is a subjective symptom, audiometric data provides measurable evidence of cochlear damage that supports the causal connection between military noise exposure and your current condition. Knowing which records to gather, how to read your results, and how to present audiometric data effectively can make a concrete difference in your claim outcome.
Several categories of audiometric records may be available depending on your service history and post-service medical care:
Entry audiogram: The hearing test conducted at your enlistment or commissioning physical. This establishes your baseline hearing before military service and is critical for demonstrating any deterioration during service.
Annual audiograms: Service members enrolled in hearing conservation programs were required to receive annual audiometric testing. These sequential records, if available, can show the progressive deterioration of hearing over time during service.
Separation audiogram: The hearing test conducted as part of your separation physical. Comparing this to your entry audiogram shows any net change over the course of your service. This is often the single most valuable record in a hearing loss claim.
VA C&P audiogram: The audiometric testing conducted during a Compensation and Pension examination. Results from this exam feed directly into the rating decision.
Private or VA treatment audiograms: Any audiology evaluation conducted after separation, whether through the VA health care system or a private audiologist, documents your current hearing status and provides a reference point for tinnitus diagnosis.
Military hearing records can be harder to obtain than general service treatment records. Several pathways exist:
A standard audiogram tests hearing sensitivity at multiple frequencies, typically 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz. Results are expressed in decibels of hearing level (dB HL), with 0 dB HL representing the average threshold of normal young adult hearing.
The pattern of the loss matters as much as the severity. Noise-induced hearing loss produces a characteristic "notch" with the worst thresholds at 3,000 to 6,000 Hz, typically most pronounced at 4,000 Hz. If your audiogram shows this pattern, and particularly if your entry audiogram did not, this is direct audiometric evidence of noise-induced cochlear damage during service.
In addition to pure-tone thresholds, most audiometric evaluations include a speech recognition test (also called speech discrimination testing). This measures how accurately you can identify words presented at a comfortable listening level, and the score is expressed as a percentage.
Speech recognition scores matter enormously for VA rating purposes. The DC 6100 rating table combines the pure-tone average with the speech recognition score to assign a rating category for each ear. Veterans with moderate pure-tone loss but significantly impaired speech recognition may receive a higher combined rating than their pure-tone thresholds alone would suggest.
Make sure any audiogram presented with a VA claim includes the speech recognition score, not just the pure-tone results.
When submitting audiometric records with a tinnitus or hearing loss claim:
As noted in other resources in this cluster, a normal audiogram does not disprove tinnitus. Standard clinical audiometry tests frequencies up to 8,000 Hz, and subclinical cochlear damage producing tinnitus may not create measurable threshold shifts within that range.
If your audiogram is normal and you have tinnitus, include in your personal statement an explanation that you've been advised by a health care provider that your tinnitus is real and that normal audiometric results are consistent with noise-induced tinnitus at the scale of your exposure.
A physician nexus letter is particularly important in this scenario because the examiner must explain why tinnitus in the absence of audiometric hearing loss is still medically consistent with noise exposure.
See also: Tinnitus and hearing loss: how they relate for the clinical relationship between audiometric loss and tinnitus.
See also: High-frequency hearing loss and tinnitus for a deeper look at the audiometric signature of noise-induced damage and its implications for the rating decision.
Flat Rate Nexus provides physician-signed nexus letters that incorporate and address audiometric evidence directly. Visit flatratenexus.com/tinnitus.html for more information, or use the free tools available there to assess your current claim posture.
Thinking about your own claim? Every nexus letter we write goes through a full physician record review, cites peer-reviewed research, and is built around the actual evidence in your case.
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