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Tinnitus Secondary to Traumatic Brain Injury: VA Claims

Tinnitus can be service connected secondary to a traumatic brain injury (TBI) when medical evidence shows your service-connected TBI caused it or made it worse. VA’s own rating instructions list tinnitus among the possible physical effects of a TBI, but tinnitus isn’t one of the conditions VA presumes are caused by TBI, so the claim still depends on your records and a medical opinion. If your ears started ringing after a blast, crash, or other head injury in service, understanding how the Department of Veterans Affairs (VA) evaluates this link can help you gather the right evidence.

Key takeaways

  • VA’s rating schedule for TBI names tinnitus as a physical residual to be rated under its own diagnostic code, and research has found tinnitus after head injury in people with and without hearing loss.
  • Tinnitus isn’t on VA’s list of conditions presumed to result from TBI, so you need medical evidence that it’s “at least as likely as not” related to your service-connected TBI.
  • Collect records that show when your tinnitus started relative to the injury, and consider talking with a VA-accredited representative about whether a direct or secondary claim fits better.

What does “tinnitus secondary to TBI” mean?

A secondary condition is one caused or worsened by a disability VA has already service connected. Under 38 CFR 3.310, a disability that is “proximately due to or the result of” a service-connected condition can itself be service connected, and VA can also service connect the amount a service-connected condition worsens another condition beyond its natural progress.

In this claim, the TBI is the service-connected condition, and tinnitus (ringing, buzzing, hissing, or other sounds in the ears or head with no outside source) is the secondary one. Many veterans also claim tinnitus directly, based on noise exposure during service. The two routes aren’t mutually exclusive, and the better fit depends on your history.

Knowing how VA treats TBI residuals helps explain why this connection is often recognized.

Does VA recognize tinnitus as a TBI residual?

Yes. VA’s rating instructions for TBI residuals under diagnostic code 8045 tell raters to evaluate physical effects of a TBI under the appropriate diagnostic code, and the list of examples in 38 CFR 4.124a includes “hearing loss and tinnitus.”

That instruction matters, but it doesn’t make the connection automatic. VA still has to find that your tinnitus actually resulted from your TBI rather than from something else, such as noise exposure or age-related hearing changes.

It also helps to know what isn’t presumed. Under 38 CFR 3.310(d), VA presumes certain conditions are caused by a service-connected TBI when timing and severity requirements are met:

  • Parkinsonism, following moderate or severe TBI.
  • Unprovoked seizures, following moderate or severe TBI.
  • Certain dementias, if they appear within 15 years of moderate or severe TBI.
  • Depression, if it appears within 3 years of moderate or severe TBI or within 12 months of mild TBI.
  • Hormone deficiency diseases, if they appear within 12 months of moderate or severe TBI.

Tinnitus isn’t on that list. The regulation also says conditions outside the list can still be service connected when evidence shows they’re due to the TBI, which is where medical evidence comes in.

How can a TBI cause tinnitus?

A head injury can affect the ear and the hearing pathways in the brain. The National Institute on Deafness and Other Communication Disorders lists several possible causes of tinnitus:

  • Head and neck injuries, which can affect the ear and the nerves and brain areas involved in hearing.
  • Loud noise exposure, which is common in military settings.
  • Hearing loss, which can occur along with tinnitus.
  • Certain medications, which can trigger or worsen ringing in the ears.
  • Ear problems, such as earwax buildup or ear infections.

In military settings, these causes often overlap. A blast can expose a service member to both a head injury and extremely loud noise at the same moment. A physician reviewing your case would consider both and explain which is more likely responsible, or whether both contributed.

What does the research say about tinnitus after TBI?

Research supports a link between head injury and auditory problems, though the evidence has limits. A 2024 systematic review of tinnitus after non-blast TBI found tinnitus in people with and without hearing loss after brain injury, but noted that most studies were lower-quality and that methods varied widely. The authors called for long-term studies to clarify how often it happens. A separate systematic review of 20 studies found that sensorineural hearing loss (hearing loss involving the inner ear or hearing nerve) was the most consistently reported hearing problem after non-blast TBI, though how often it happens remains unclear.

Among veterans, a review of hearing complaints after TBI reported that veterans with TBI face a higher risk of auditory problems, with damage seen in both the ear and the brain’s hearing pathways. The reviewers also noted that tests can’t always pinpoint which head injuries affect hearing, and that mental health conditions common among veterans may complicate results.

Together, these findings support the idea that TBI can contribute to tinnitus. They can’t prove the cause in any one person, which is why an individual medical opinion is usually needed.

What evidence helps a tinnitus secondary to TBI claim?

A strong claim usually shows a service-connected TBI, a current tinnitus diagnosis or consistent symptoms, and medical evidence linking the two. VA’s evidence guidance says it usually needs medical records or opinions from health care providers to support a secondary link, and may accept lay statements in some circumstances.

Useful evidence often includes:

  • Records of the injury, including any documentation of loss of consciousness, confusion, or memory gaps.
  • A timeline of symptoms, showing when tinnitus started compared with the injury.
  • Audiology results, including hearing tests that describe the tinnitus and any hearing loss.
  • Statements from you or others describing when the ringing began and how it affects you.
  • A medical opinion explaining whether tinnitus is “at least as likely as not” (a 50% or greater probability) caused or worsened by the TBI.

If your injury happened in combat, 38 CFR 3.304(d) allows satisfactory lay evidence of an injury in combat when it’s consistent with the circumstances of your service. Under VA’s benefit-of-the-doubt rule, when positive and negative evidence are roughly balanced, doubt is resolved in your favor.

A physician reviewing your records may conclude the evidence supports a link, or may conclude that it doesn’t. If you’d like an independent medical opinion (IMO) based on a genuine review, the veteran nexus services page explains how HealthSource physicians approach that review. You must be physically located in a state where the physician is licensed at the time of the visit.

How does VA rate tinnitus linked to TBI?

VA rates recurrent tinnitus at 10% under diagnostic code 6260, and that rating can sit alongside your TBI rating as long as the same symptoms aren’t counted twice.

Under the current ear rating schedule, recurrent tinnitus receives a single 10% evaluation, whether it’s heard in one ear, both ears, or the head. VA’s TBI instructions say each residual is evaluated separately and then combined, but no symptom can support more than one rating. The HealthSource guide to VA secondary conditions explains how secondary ratings combine with your existing ones.

These rules may change. VA published a proposed rule in 2022 that would remove the separate tinnitus code and rate tinnitus as part of its underlying condition, with TBI among the conditions listed. As of October 2026, no final rule had been published, so check the current rules before filing.

What happens at the C&P exam?

VA often schedules a compensation and pension (C&P) exam to decide a claim like this. Under 38 CFR 3.159, VA must provide an exam or medical opinion when the record shows a current disability that may be associated with a service-connected condition but lacks enough medical evidence to decide. The HealthSource guide to C&P exams explains how to prepare.

HealthSource physicians provide independent medical opinions but don’t prepare, file, or represent VA claims. Only VA-accredited attorneys, claims agents, and Veterans Service Organization (VSO) representatives can help with the claim itself, and you can find one through VA’s accreditation search.

When to seek medical attention

Get prompt care if your tinnitus is new, suddenly louder, affects only one ear, pulses with your heartbeat, or comes with sudden hearing loss, dizziness, or new headaches. After a head injury, the Centers for Disease Control and Prevention (CDC) advises emergency care for danger signs such as a headache that gets worse, repeated vomiting, confusion, weakness or numbness, slurred speech, or seizures.

This is not an emergency service. If you have chest pain, trouble breathing, signs of a stroke, or another emergency, call 911 or go to the nearest emergency room. TBI and tinnitus can both affect mood, so if you’re having thoughts of suicide or are in crisis, call or text 988 to reach the Suicide & Crisis Lifeline. Veterans can press 1.

Frequently asked questions

Is tinnitus automatically service connected if you have a service-connected TBI?

No. VA lists tinnitus as a possible TBI residual, but it isn’t one of the conditions presumed to result from TBI. You still need evidence that your tinnitus is related to the injury.

Should you claim tinnitus directly or secondary to TBI?

It depends on your history. If you had significant noise exposure in service, a direct claim may fit, while a secondary claim may fit better if tinnitus began after a documented head injury. An accredited representative can help you decide.

Can you get a separate rating for tinnitus and TBI?

Generally, yes, as long as the same symptoms aren’t used for both ratings. VA rates TBI residuals separately and then combines them.

Will a nexus letter make VA approve the claim?

No. A medical opinion is one piece of evidence, and the VA rater weighs all the evidence and decides. A physician may also conclude after reviewing your records that the evidence doesn’t support a link. The HealthSource guide to getting a nexus letter explains what a well-reasoned opinion includes.

Can a mild TBI cause tinnitus?

Research on hearing problems after TBI now includes mild closed head injuries, but the evidence is still developing. Whether your mild TBI contributed to your tinnitus depends on your records and a physician’s review.

Get an independent medical opinion

If you have a service-connected TBI and tinnitus and want a physician to review whether your records support a link, a HealthSource physician can review your records and provide an independent medical opinion in a secure video visit. The physician will give an honest opinion based on your evidence, which may or may not support a connection. Book an appointment; current pricing is shown on the booking page.

Sources

  1. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 3.310: Disabilities that are proximately due to, or aggravated by, service-connected disease or injury. https://www.law.cornell.edu/cfr/text/38/3.310
  2. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 4.124a: Schedule of ratings, neurological conditions and convulsive disorders. https://www.law.cornell.edu/cfr/text/38/4.124a
  3. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 4.87: Schedule of ratings, ear. https://www.law.cornell.edu/cfr/text/38/4.87
  4. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 3.304: Direct service connection; wartime and peacetime. https://www.law.cornell.edu/cfr/text/38/3.304
  5. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 3.102: Reasonable doubt. https://www.law.cornell.edu/cfr/text/38/3.102
  6. Legal Information Institute, Cornell Law School. Accessed October 31, 2026. 38 CFR 3.159: Department of Veterans Affairs assistance in developing claims. https://www.law.cornell.edu/cfr/text/38/3.159
  7. U.S. Department of Veterans Affairs. Accessed October 31, 2026. Evidence needed for your disability claim. https://www.va.gov/disability/how-to-file-claim/evidence-needed/
  8. U.S. Department of Veterans Affairs, Office of General Counsel. Accessed October 31, 2026. Accreditation Search. https://www.va.gov/ogc/apps/accreditation/index.asp
  9. Federal Register. Published February 15, 2022. Schedule for Rating Disabilities: Ear, Nose, Throat, and Audiology Disabilities; Special Provisions Regarding Evaluation of Respiratory Conditions; Schedule for Rating Disabilities: Respiratory System (proposed rule). https://www.federalregister.gov/documents/2022/02/15/2022-02049/schedule-for-rating-disabilities-ear-nose-throat-and-audiology-disabilities-special-provisions
  10. National Institute on Deafness and Other Communication Disorders. Updated May 1, 2023. What Is Tinnitus? Causes and Treatment. https://www.nidcd.nih.gov/health/tinnitus
  11. Le M, Šarkić B, Anderson RB. Prevalence of tinnitus following non-blast related traumatic brain injury: a systematic review of literature. Brain Inj. 2024;38(11):859-868. doi:10.1080/02699052.2024.2353798. https://pubmed.ncbi.nlm.nih.gov/38775672/
  12. Gallun FJ, Papesh MA, Lewis MS. Hearing complaints among veterans following traumatic brain injury. Brain Inj. 2017;31(9):1183-1187. doi:10.1080/02699052.2016.1274781. https://pubmed.ncbi.nlm.nih.gov/28981349/
  13. Šarkić B, Douglas JM, Simpson A. Peripheral auditory dysfunction secondary to traumatic brain injury: a systematic review of literature. Brain Inj. 2019;33(2):111-128. doi:10.1080/02699052.2018.1539868. https://pubmed.ncbi.nlm.nih.gov/30415586/
  14. Centers for Disease Control and Prevention. Updated September 15, 2025. Symptoms of Mild TBI and Concussion. https://www.cdc.gov/traumatic-brain-injury/signs-symptoms/index.html

 

Medical documentation supports your request but does not guarantee approval. Final decisions are made by your employer, insurance carrier, leave administrator, school, applicable state program, or the Department of Veterans Affairs.

This article is for informational purposes only and is not a substitute for professional medical advice.

This is not an emergency service. In an emergency, call 911 or go to the nearest emergency room.