How is a VA Claim for Tinnitus Denied (2023)

How Is a VA Claim for Tinnitus Denied?

Your VA claim for tinnitus was denied. One of the most common reasons for VA claim denial regarding tinnitus is when the veteran’s specific duty MOS or specialty code is listed in the “low probability” column or not listed in the Duty MOS Noise Exposure Listing. If a veteran’s MOS falls in the low probability column, they must prove that their duty MOS created exposure to hazardous noise levels.

Here are some of the most common reasons why the VA denied your tinnitus claim:

  • Your tinnitus is not mentioned or diagnosed in medical records, such as those from service or VA hospitals or private physicians.
  • There is no evidence of hearing loss found.
  • Your tinnitus is not linked to a specific event or injury during military service, meaning there is no apparent connection between the condition and the veteran’s time in the military.
  • There is no clear indication of when the tinnitus began within a 60-day window of military service, which can make it harder to establish the onset of the condition.
  • The affected ear(s) are not specified, whether the right, left, or both, making it harder to evaluate the severity and impact of the tinnitus.

The veteran must provide lay evidence demonstrating this exposure event. If a VA tinnitus claim is denied, and the veteran believes their MOS caused exposure to hazardous noise, they can file a Supplemental Claim or Higher-Level Review claim to start the appeals process.

How to Avoid Being Denied in the First Place

VA claims for tinnitus, the constant ringing or buzzing sound in the ears that many veterans experience, are among the most commonly filed claims with the VA. In the past, tinnitus claims were relatively easy to prove, as veterans only needed to demonstrate four key elements:

  • Medical Diagnosis Of A Disability
  • Evidence of An In-Service Event
  • A Complete Nexus Letter or Link via Medical Evidence
  • The severity of Symptoms, such as Frequency and Duration

The process has become more complex in recent years, and it may be helpful to seek guidance from a Veterans Service Officer (VSO) to navigate the process successfully.

The best way to avoid having your tinnitus claim denied is to file a complete and accurate claim in the first place. Make sure to report all of your symptoms, even if they seem minor, and provide as much supporting evidence as possible. This may include medical records, statements from family and friends, and documentation of any hearing loss you’ve experienced.

It’s also essential to meet the eligibility requirements for a tinnitus claim. This includes serving in a qualifying period, having a current diagnosis, and reporting your symptoms within a specific timeframe.

TIP: Review your VA rating decision letter and closely examine the “Evidence” and “Reasons for Decision” sections. Ensure the VA rater lists and considers all your submitted evidence. It’s possible that crucial evidence, such as a Buddy Letter or Nexus Letter for Tinnitus, was not submitted or reviewed.

Additionally, carefully read the rationale and reason(s) for the denial in the “Reasons for Decision” section. Look out for common errors such as not considering all the evidence, discounting the probative value of medical evidence, or making an illogical argument against service connection.

Understanding Tinnitus VA Ratings

If you’re approved for a tinnitus claim, the VA will assign a rating based on the severity of your condition. The rating determines your compensation, so it’s essential to understand how the VA rates tinnitus.

Under 38 CFR § 4.87, Schedule of Ratings – Ear, Diagnostic Code 6260, the VA assigns a flat 10% disability rating for both ears for tinnitus. This means obtaining a rating higher than 10% for tinnitus is challenging.

Secondary Conditions to Tinnitus

A secondary service-connected condition refers to a condition that arises due to an existing service-connected condition. For instance, if a veteran has been service-connected for tinnitus and later develops a related condition, they may be eligible for secondary service connection. Tinnitus can also lead to secondary conditions, such as:

  • Depression
  • Anxiety
  • and Hearing Loss

If you’re experiencing any of these conditions due to your tinnitus, it’s important to file a claim for them as well. Specifically, veterans will fill out and submit VA Form 21-526 – an original claim for service connection.

To file a claim for conditions secondary to tinnitus, veterans must follow the same process as filing any other claim for service connection. You’ll need to provide evidence that it’s related to your tinnitus. This may include medical records, statements from your doctor, and documentation of any treatments you’ve received. You can submit claims online using the eBenefits portal, in person at a local Regional Office, or with the help of a Veterans Service Officer (VSO).

It’s crucial to provide specific evidence along with the claim, such as a diagnosis for the secondary condition and medical evidence that shows a link between the service-connected tinnitus and the secondary condition.

Migraines Secondary to Tinnitus

Migraines can also be considered a secondary condition to tinnitus, as the two conditions can be linked. Having regular migraine headaches is a prevalent secondary condition among individuals with tinnitus, characterized by a ringing in the ears. Over 25% of tinnitus patients report experiencing migraines regularly.

To file a claim for migraines secondary to tinnitus, you must provide evidence that they relate to your tinnitus. This may include medical records, statements from your doctor, and documentation of any treatments you’ve received.

Filing an Appeal

It’s common for veterans to feel overwhelmed by the VA appeals process, but you should know that you have options if your tinnitus claim is denied. The first step is to file a Supplemental Claim, which allows you to add new evidence to your claim, such as a lay statement detailing how your tinnitus started during active duty. It’s also critical to submit any relevant medical and service records that support your claim.

If you’re still unsatisfied with the decision and your Supplemental Claim is still denied, you can file a Higher-Level Review Claim, which a more senior staff member will review. However, this review does not allow for new evidence. In that case, you can appeal to the Board of Veterans’ Appeals, the highest level of review within the VA, and has the authority to overturn previous decisions.

Additionally, if you believe that your tinnitus was caused by a secondary condition, such as hearing loss or head trauma, you can also file a claim for that condition. It can be a long and frustrating journey, but staying organized and keeping track of deadlines and required documents is necessary.

  • Review the reasons for the denial: Carefully examine the VA letter explaining why your claim was denied. This can give you insight into what evidence or information was missing from your claim.
  • Gather more evidence: If your claim was denied due to a lack of evidence, gather more information to support your claim. This can include medical records, statements from family and friends, and documentation of any hearing loss you’ve experienced.
  • File an appeal: If you believe your claim was wrongly denied, you can file an appeal within the required timeframe and follow the proper procedures.
  • Be patient and persistent: The appeals process can be long and frustrating, but staying organized and keeping track of deadlines and required documents helps you fight for your benefits.
  • Seek assistance from a Veterans Service Organization (VSO): VSOs can offer guidance, support, and representation throughout the appeals process. They can also connect you with other resources and services that can help you in your efforts to receive benefits.
  • Read the denial letter carefully: The first step is to read the VA’s denial letter to understand the reasons for the denial and what evidence or documentation is missing from your claim.

The first step is to avoid being denied in the first place by filing a complete and accurate claim and meeting the eligibility requirements. If you are approved for a tinnitus claim, understanding the tinnitus VA rating and filing claims for secondary conditions can help you receive the maximum compensation you’re entitled to.

If your claim is denied, filing an appeal and being patient and persistent throughout the appeals process can help you achieve a successful outcome. Remember that you’re not alone in this process; many resources are available to help you.

Living with tinnitus can be challenging, but you can receive the benefits and compensation you deserve with the proper support and advocacy. Don’t give up on your tinnitus claim – take action today and pursue the benefits you’re entitled to as a veteran.

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