Perforated Tympanic Membrane — VA Disability Rating (DC 6211)
Diagnostic Code 6211 · 38 CFR §4.87
What Is It?
A perforated tympanic membrane is a hole or tear in the eardrum. In veterans, this is most commonly caused by blast exposure (explosions, gunfire), barotrauma from diving or flying, direct trauma, or severe ear infections during service. The eardrum may heal on its own, require surgical repair (tympanoplasty), or remain permanently perforated. While the perforation itself receives only a 0% rating under DC 6211, it is significant as a service-connected condition because it commonly causes hearing loss, tinnitus, and recurrent ear infections — each of which can be rated separately and often at much higher percentages.
Rating Criteria
| Rating | Criteria |
|---|---|
| 0% | Perforation of the tympanic membrane. This condition receives a 0% rating regardless of symptoms. However, associated hearing loss is rated under DC 6100, tinnitus under DC 6260, and recurrent infections under DC 6200. Establishing service connection at 0% opens the door for these secondary claims. |
Evidence Needed
ENT examination documenting the perforation is needed. Service treatment records showing the injury or incident that caused the perforation establish nexus. Audiometric testing documenting associated hearing loss is important. If the perforation has caused recurrent infections, treatment records for those episodes are valuable. Surgical records if tympanoplasty was performed should be included.
C&P Exam Tips
The examiner will visually inspect the eardrum with an otoscope. Even if the perforation has healed, scarring may be visible. Describe the original injury, any surgical repairs, and current symptoms. Importantly, describe all associated problems: hearing loss, tinnitus, recurrent infections, ear drainage, pain. The 0% rating for the perforation itself is less important than establishing service connection, which opens the door to secondary claims for hearing loss and tinnitus at much higher ratings.
How to File
File on VA Form 21-526EZ with DC 6211. While the rating is 0%, establishing service connection for the perforated eardrum is strategically important because it supports secondary claims for hearing loss (DC 6100) and tinnitus (DC 6260). Submit ENT records, audiograms, and documentation of the in-service injury. File associated hearing loss and tinnitus claims simultaneously.
Common Mistakes
The most common mistake is not filing because the rating is 0%. A service-connected perforated eardrum at 0% is still valuable — it establishes the in-service ear injury that supports secondary claims for hearing loss and tinnitus, which are often rated at 10% or higher. Not filing for associated hearing loss and tinnitus as secondary conditions is a major oversight. Not documenting the original blast exposure or trauma weakens all related claims.
Frequently Asked Questions
Why file for a 0% rating?
A service-connected condition at 0% is still valuable. It establishes that the ear injury occurred during service, which makes it much easier to get secondary service connection for hearing loss (which can be rated 0-100%) and tinnitus (rated at 10%). The 0% rating is the gateway to higher-rated secondary conditions.
Can a healed perforation still be service-connected?
Yes. Even if the eardrum has healed, the fact that the perforation occurred during service is documentable. Scarring on the eardrum may be visible, and the residual effects (hearing loss, tinnitus) persist regardless of whether the perforation healed.
Should I file for hearing loss and tinnitus at the same time?
Yes. Filing for the perforated eardrum, hearing loss, and tinnitus simultaneously is recommended. This creates a clear chain of connection: the in-service blast or trauma caused the perforation, which caused hearing loss and tinnitus.