Ringing In The Ears
Military noise and blast exposure as the direct cause of tinnitus — prospective new-onset incidence in service members against a civilian baseline, plus the cochlear-synaptopathy ("hidden hearing loss") mechanism that explains tinnitus with a NORMAL audiogram, which is the basis on which these claims are most often denied.
38 CFR diagnostic code 6260
Peer-reviewed evidence (18)
The verified studies behind a Ringing In The Ears claim — each links to its real PubMed or DOI record. These are sources our nexus drafts can draw from; none are invented.
- Arun P, Rossetti F, Wilder DM, Wang Y, Gist ID, Long JB. Blast Exposure Causes Long-Term Degeneration of Neuronal Cytoskeletal Elements in the Cochlear Nucleus: A Potential Mechanism for Chronic Auditory Dysfunctions. Front Neurol. 2021;12:652190. PMID:33841318. doi:10.3389/fneur.2021.652190.
- Theodoroff SM, Lewis MS, Folmer RL, Henry JA, Carlson KF. Hearing impairment and tinnitus: prevalence, risk factors, and outcomes in US service members and veterans deployed to the Iraq and Afghanistan wars. Epidemiol Rev. 2015;37:71-85. PMID:25600417. doi:10.1093/epirev/mxu005.
- Geronimo-Hara TRT, Belding JN, Warner SG, Trone DW, Rull RP. Incidence and Risk Factors for Tinnitus Among Military Service Members in the Millennium Cohort Study. Am J Audiol. 2025;34(2):330-343. PMID:40268697. doi:10.1044/2025_AJA-24-00198.
- Henry JA, Griest SE, Blankenship C, Thielman EJ, Theodoroff SM, Hammill T, Carlson KF. Impact of Tinnitus on Military Service Members. Mil Med. 2019;184(Suppl 1):604-614. PMID:30901434. doi:10.1093/milmed/usy328.
- Yankaskas K. Prelude: noise-induced tinnitus and hearing loss in the military. Hear Res. 2013;295:3-8. PMID:22575206. doi:10.1016/j.heares.2012.04.016.
- Henry JA, Griest S, Reavis KM, Grush L, Theodoroff SM, Young S, Thielman EJ, Carlson KF. Noise Outcomes in Servicemembers Epidemiology (NOISE) Study: Design, Methods, and Baseline Results. Ear Hear. 2021;42(4):870-885. PMID:33974792. doi:10.1097/AUD.0000000000000974.
- Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-965. PMID:27441392. doi:10.1001/jamaoto.2016.1700.
- Kujawa SG, Liberman MC. Adding insult to injury: cochlear nerve degeneration after "temporary" noise-induced hearing loss. J Neurosci. 2009;29(45):14077-85. PMID:19906956. doi:10.1523/JNEUROSCI.2845-09.2009.
- Liberman MC, Kujawa SG. Cochlear synaptopathy in acquired sensorineural hearing loss: Manifestations and mechanisms. Hear Res. 2017;349:138-147. PMID:28087419. doi:10.1016/j.heares.2017.01.003.
- Hickman TT, Smalt C, Bobrow J, Quatieri T, Liberman MC. Blast-induced cochlear synaptopathy in chinchillas. Sci Rep. 2018;8(1):10740. PMID:30013117. doi:10.1038/s41598-018-28924-7.
- Schaette R, McAlpine D. Tinnitus with a normal audiogram: physiological evidence for hidden hearing loss and computational model. J Neurosci. 2011;31(38):13452-7. PMID:21940438. doi:10.1523/JNEUROSCI.2156-11.2011.
- Bramhall NF, Theodoroff SM, McMillan GP, Kampel SD, Buran BN. Associations Between Physiological Correlates of Cochlear Synaptopathy and Tinnitus in a Veteran Population. J Speech Lang Hear Res. 2023;66(11):4635-4652. PMID:37889209. doi:10.1044/2023_JSLHR-23-00234.
- Bramhall NF, Konrad-Martin D, McMillan GP, Griest SE. Auditory Brainstem Response Altered in Humans With Noise Exposure Despite Normal Outer Hair Cell Function. Ear Hear. 2017;38(1):e1-e12. PMID:27992391. doi:10.1097/AUD.0000000000000370.
- Bramhall NF, Konrad-Martin D, McMillan GP. Tinnitus and Auditory Perception After a History of Noise Exposure: Relationship to Auditory Brainstem Response Measures. Ear Hear. 2018;39(5):881-894. PMID:29337762. doi:10.1097/AUD.0000000000000544.
- Vasilkov V, Caswell-Midwinter B, Zhao Y, de Gruttola V, Jung DH, Liberman MC, Maison SF. Evidence of cochlear neural degeneration in normal-hearing subjects with tinnitus. Sci Rep. 2023;13(1):19870. PMID:38036538. doi:10.1038/s41598-023-46741-5.
- Wu PZ, Liberman LD, Bennett K, de Gruttola V, O'Malley JT, Liberman MC. Primary Neural Degeneration in the Human Cochlea: Evidence for Hidden Hearing Loss in the Aging Ear. Neuroscience. 2019;407:8-20. PMID:30099118. doi:10.1016/j.neuroscience.2018.07.053.
- Chen F, Zhao F, Mahafza N, Lu W. Detecting Noise-Induced Cochlear Synaptopathy by Auditory Brainstem Response in Tinnitus Patients With Normal Hearing Thresholds: A Meta-Analysis. Front Neurosci. 2021;15:778197. PMID:34987358. doi:10.3389/fnins.2021.778197.
- Jafari Z, Baguley D, Kolb BE, Mohajerani MH. A Systematic Review and Meta-Analysis of Extended High-Frequency Hearing Thresholds in Tinnitus With a Normal Audiogram. Ear Hear. 2022;43(6):1643-1652. PMID:35612517. doi:10.1097/AUD.0000000000001229.
Controlling law
The CFR sections and cases the theories relevant to this condition rest on — the legal standard raters evaluate against, never a prediction about any claim.
Direct (§ 3.303)
Regulation
38 C.F.R. § 3.303
Direct service connection — a current disability linked to service. (Continuity of symptomatology under § 3.303(b) is limited by case law to the § 3.309(a) chronic diseases — Walker.)
Case law
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)
The three-element test: current disability, in-service event, and a nexus between them.
Holton v. Shinseki, 557 F.3d 1363 (Fed. Cir. 2009)
Federal Circuit restatement of the same three direct-service-connection elements.
Caluza v. Brown, 7 Vet. App. 498 (1995)
The evidentiary framework a rater weighs each element against.
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)
Continuity of symptomatology (§ 3.303(b)) is available ONLY for a chronic disease listed in § 3.309(a); any other condition must use the medical-nexus pathway.
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009)
A categorical 'a medical opinion is always required for nexus' is legal error — competent lay evidence can suffice.
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994)
A veteran is competent to report symptoms they personally observe (Layno), and lay evidence can even establish a simple diagnosis in the right case (Jandreau).
McLendon v. Nicholson, 20 Vet. App. 79 (2006)
A LOW threshold — evidence that merely indicates a nexus MAY exist obligates VA to provide a C&P exam.
38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990)
When the evidence is in relative equipoise, the tie goes to the veteran — the preponderance must be AGAINST the claim to deny it.
Build your Ringing In The Ears documentation
Generate and review your claim documents free — grounded in sources like these. When you want the nexus opinion signed, a licensed provider can review and sign it.
Generate your documentation — freeEducational information about the evidentiary standard — not legal or medical advice, and never a prediction about any claim.