When an individual joins the military, they are eligible for a specific set of benefits for the rest of their lives. One of these benefits includes monetary compensation from the U.S. Department of Veterans Affairs (VA). If a veteran is disabled from his/her time serving in the military, the individual can make a claim to the VA to receive financial aid for that disability. Making a connection between the disability and service, plus the severity of the disability, are all taken into account when determining a claim.
On the long list of disabilities, the single most common claim by veterans is tinnitus. Tinnitus is typically thought of as ringing in the ears, but it involves more than that. Tinnitus refers to the perception of noise when no auditory stimulus is present. Not to be confused with hearing loss, tinnitus is most often a symptom of an underlying condition. It’s a consequence of hearing loss or an ear injury. An afflicted individual could perceive any of the following nonexistent sounds:
These phantom noises can vary in pitch and occur in one or both ears. The noises can be so loud as to interfere with an individual’s ability to hear or concentrate. Tinnitus can be acute (temporary) or chronic (ongoing). It can also come in two different forms, subjective or objective.
Types of Tinnitus
Subjective tinnitus involves false auditory perception that is only heard by the patient. This form is usually linked to neurological reactions to hearing loss. It can be caused by problems in the ear, issues with the auditory nerve, or damage to auditory pathways. With subjective tinnitus, nobody else can hear the sounds, making the diagnosis more complicated and reliant on evidence.
Objective tinnitus, on the other hand, can be heard by the examining doctor. This can occur as the result of a blood vessel problem, middle ear bone condition, or muscle contractions. Objective tinnitus is extremely rare, making up less than 1% of tinnitus cases.
The number of U.S. citizens that are affected by tinnitus is currently estimated to be around 45 million — that’s almost 15% of the population. 20% of those with the condition report their tinnitus as disabling. Certain demographics are more likely to experience tinnitus, including men, seniors, musicians, and veterans.
In 2015 alone, veterans filed more than 160,000 VA disability claims for tinnitus, bringing the total number that are receiving benefits above 1.5 million. Nearly 10% of all veterans are receiving disability compensation for this condition.
Causes of Tinnitus
One of the reasons so many veterans end up with tinnitus, is due to the various environments and occurrences they’re exposed to while serving in the military. Here are some reasons an individual may experience tinnitus:
- Hearing loss — Whether age-related or noise-induced, the brain will sometimes create a sound to fill in for those it can no longer register. As people lose their ability to hear certain tones, they begin to experience tinnitus. Age-related hearing loss typically occurs around 60 years of age and continues to progress. Long-term and short-term exposure to loud sounds can cause permanent damage. Examples of loud sounds are firearms, explosions, and airplanes; these stimuli are all frequent occurrences in the military.
- Ear obstructions — Earwax is intended to protect the eardrum and slow the growth of bacteria. However, when too much builds up, it can irritate the eardrum and cause tinnitus. Usually the earwax can be removed and the problem will resolve itself, but it can also cause permanent damage. This issue can also be caused by congestion, loose hairs from the ear canal, and dirt obstructing the ear.
- Head or neck trauma — Intense physical trauma can damage nerves resulting in tinnitus.
- Traumatic brain injury (TBI) — Similar to head and neck trauma, brain injuries can result in lasting damage to auditory nerves. Concussive shock can damage the ears permanently. Roughly 60% of tinnitus cases diagnosed by the VA are due to mild to severe TBIs.
- Changes in ear bones — Tinnitus can be caused by the bones in the middle ear stiffening, or being pressured by different factors. Barometric pressure, head colds, even blowing your nose too hard can lead to the damage prompting tinnitus.
- Drugs — Tinnitus is a side effect of many prescription drugs. Though typically temporary, the condition can sometimes persist after the drug is no longer being used. Some drugs that are more likely to cause chronic tinnitus include:
- Certain cancer medications
- Water pills
- Certain antibiotics
- NSAIDs, or non-steroidal anti-inflammatories
- Other medical conditions — While usually associated with hearing loss, tinnitus is also a symptom of the following medical conditions:
- Lyme disease
- Acoustic neuroma
While there is no absolute cure for chronic tinnitus, the condition can be improved with proper treatment. The following methods aid in noise suppression and strive to repair hearing loss:
- Masking devices — By providing generic background noises and subtle sounds, these devices can reduce the intensity of noises from tinnitus.
- Tinnitus retraining — This exercise helps the auditory portion of the brain to adapt to the phantom noise so it becomes less of a nuisance to the patient.
- Hearing aids — These devices can sometimes allow an individual to hear tones they couldn’t before, erasing the need for the brain to fill that portion of the tone range with a phantom noise.
- White noise machines — These ambient-noise makers can help to drown out the noise with something that is typically more relaxing by stimulating the same areas of the brain.
Certain medications can also help to reduce the severity of tinnitus symptoms. Some common medications include:
- Alprazolam — Also known as Xanax, while effective, this drug is used as a last resort since it is habit-forming.
- Tricyclic antidepressants — When an individual has severe tinnitus, they may be given certain medications to address the mental health symptoms more than the condition itself.
Beyond these remedies, there are also different adjustments those with tinnitus can make at home to reduce triggers, including stress management, avoidance of irritants, and reducing alcohol consumption.
Most every case of tinnitus is subjective, meaning the patient is the only person who can hear the noises they report. Due to this perceptive nature, individuals with tinnitus must make a case to prove they are experiencing it. Luckily there are tests and protocols developed by audiologists designed to evaluate the severity of tinnitus. Hearing tests are also usually administered simultaneously. Most of these tests involve the following:
- Speech recognition test — Assesses the patient’s ability to comprehend different words at different volumes through repetition exercises
- Pure tone audiogram — A graph that displays an individual’s ability to hear tones
- Acoustic reflex test — Certain muscles are triggered in response to auditory stimuli to assess if they are working properly; for someone who doesn’t have hearing loss, this test can cause damage to the ear
- Otoacoustic emission test (OAE) — This test measures the response of an area in the middle ear; typically used on children who are too young to illicit a behavioral response
- Tympanogram test — Doctors administer a small puff of air to the eardrum to test its reflex
The VA typically evaluates tinnitus through test results from a combination of the speech recognition and pure tone threshold tests. This happens at a compensation and pension (C&P) exam. At a C&P exam, a physician contracted or employed by the VA will evaluate the severity of a condition with a series of predetermined tests. The C&P exam is viewed as the main factor in determining whether or not a veteran will receive benefits and the level of compensation.
Veterans are also asked to fill out a DBQ, or disability benefits questionnaire, where they can submit their claim and any statements that outline why they believe they’re entitled to compensation.
Proving a Tinnitus Claim
When trying to prove that you have tinnitus, it’s important to put forth as much information as possible. Even though it’s an extremely common condition, the VA may be hesitant to pay out benefits without concrete proof that it’s connected to time in the military. Establishing a service connection requires a few key components, such as:
- A current medical diagnosis stating that a patient has tinnitus
- Documents explaining an in-service event, illness, or injury
- A medical nexus linking the in-service event to the current medical diagnosis; the nexus letter is generated by an evaluator and grants service connection; without a link, there will be no rating
Types of evidence that can provide this information and bolster chances of receiving benefits include:
- Medical records — This helps to establish the official lack of tinnitus beforehand and presence after
- Medical opinions — An expert that can confirm probability of tinnitus being service connected
- Doctor’s statements — Can establish when the veteran began complaining of tinnitus symptoms and if treatment was received
- Service personnel records — Show evidence of noise exposure during active military time that can be linked to hearing loss or tinnitus
- Buddy letters — Statements from individuals in your life that can attest to how the condition has significantly affected you.
Another helpful piece of evidence is a sworn declaration. A sworn declaration is an official statement an individual can put together chronicling their entire experience. When filing a claim for tinnitus, make sure to include the following information:
- A list of every incident of significant noise exposure you remember with enough detail to show the exposure was credible and significant. This includes grenade blasts, simulators, machine-guns, loud vehicle engines, etc. Do not describe each event excessively. Use roughly 1-3 sentences to sum up each one and include the approximate month and year if possible.
- The approximate date you remember beginning to experience tinnitus symptoms.
- If the tinnitus started during service, an explanation is necessary for why you didn’t seek medical treatment at the time. Typically, the notion that there is no cure and therefore no imminent reason to cease training or stop a mission will suffice.
- An identification of how continuous the tinnitus is. Does it come and go? Is it chronic? Detail whether or not the symptoms have been present since exposure to the noise event(s).
- If the tinnitus is not continuous, provide an identification of how often you experience symptoms.
- The severity of your symptoms. This usually isn’t necessary, but if the tinnitus is debilitating or prevents you from working, this information should be included because it could change the nature of your rating.
All VA disabilities are given a rating when determining compensation. This number, called a VA rating, is given in a percentage and can only be in increments of 10 (10%, 20%, and so on). The deciding factors are typically the severity of a disability, the location, and how debilitating it is to the individual’s life. Tinnitus is unique because regardless of the severity, the VA has a limit on how high the rating can go. Whether acute or chronic, one ear or both ears, tinnitus on its own cannot be rated above 10%.
Tinnitus can lead to a higher disability rating if it is coupled with other disabilities. Not only can tinnitus be a secondary condition that develops after service as a result of TBIs, hearing loss, head and neck trauma, etc., but it can also lead to other conditions such as depression, anxiety, migraines, and sleep apnea.
If evidence can be provided that links the service-connected tinnitus to the secondary condition, a veteran can make a secondary claim for added benefits. They simply must have a medical diagnosis and proof that the secondary condition is a result of or aggravated by the first. Receiving an accurate rating for the sum of disabilities you’re experiencing is essential, because while tinnitus is limited to 10%, any combination with mental health problems or limitations that combine to result in unemployability can receive a 100% VA rating.
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