Hearing loss, tinnitus, balance disorders, other ear conditions, and loss of smell or taste, rated under the hearing impairment tables, the ear schedule and §4.87a.
How Hearing & Ears conditions are rated
Hearing loss is rated from test numbers rather than from a description of symptoms. Under 38 CFR §4.85(a), the examination must be conducted by "a state-licensed audiologist," must include "a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test," and is done "without the use of hearing aids."
The rating then runs through two tables. The puretone threshold average is the sum of the thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four (§4.85(d)). Table VI combines that average with the speech discrimination score to give each ear a Roman numeral from I to XI. Table VII then crosses the two numerals, the better ear on one axis and the poorer ear on the other, to produce the percentage. Table VIa, which uses the average alone, applies when the examiner certifies that speech testing is not appropriate "because of language difficulties, inconsistent speech discrimination scores, etc." Because the percentage is read straight from the tables, the result depends on the test numbers themselves.
Two printed rules adjust that path. If hearing loss is service-connected in only one ear, the other ear is assigned a numeral of I, subject to §3.383 (§4.85(f)). And §4.86 sets out exceptional patterns. When the threshold is 55 decibels or more at each of the four frequencies, or 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rater uses whichever of Table VI or VIa gives the higher numeral, and in the second pattern elevates that numeral one step. Each ear is evaluated separately. Section 4.85(g) points the rater to §3.350 for special monthly compensation for deafness.
Tinnitus is DC 6260, and the schedule prints one figure for it: 10% for recurrent tinnitus. Note (2) reads "Assign only a single evaluation for recurrent tinnitus, whether the sound is perceived in one ear, both ears, or in the head." Note (1) lets that evaluation be combined with ratings under DC 6100, 6200, 6204 or another code, "except when tinnitus supports an evaluation under one of those diagnostic codes." Objective tinnitus, the kind other people can hear, is rated as part of the condition causing it.
Balance disorders have their own codes. Peripheral vestibular disorders (DC 6204) are rated at 10% for "Occasional dizziness" and 30% for "Dizziness and occasional staggering," and the note to that code requires "Objective findings supporting the diagnosis of vestibular disequilibrium" before a compensable rating can be assigned. Meniere's syndrome (DC 6205) is rated at 30%, 60% or 100% by how often attacks of vertigo occur alongside hearing impairment, with cerebellar gait at the two higher levels. Its note allows a choice: rate under DC 6205, or rate vertigo, hearing loss and tinnitus separately, whichever gives the higher overall evaluation, but not both ways at once.
For chronic suppurative otitis media (DC 6200), the schedule prints 10% "During suppuration, or with aural polyps" and directs that hearing loss and complications such as tinnitus be rated separately. Otosclerosis and serous otitis media are rated on the hearing impairment they cause. Complete loss of the sense of smell or taste (DC 6275 and 6276) is 10% each, assigned only where there is "an anatomical or pathological basis for the condition." The hearing loss and tinnitus pages walk through these steps in more detail.