Hyperacusis is a rare condition. However, conditions that can cause this hearing disability are common among service members and veterans. Tinnitus, post-traumatic stress disorder (PTSD), head injury, and certain medications can all lead to hyperacusis.
The VA often has difficulty assigning a hyperacusis VA disability rating because it manifests differently in veterans. This leads to inconsistency in how veterans are compensated for service-connected hyperacusis.
In this article about veterans with hyperacusis:
- Overview of Hyperacusis
- What Criteria Does the VA Use to Assign a Hyperacusis VA Disability Rating?
- Analogues of Hyperacusis
- VA Hearing Tests Used for Hyperacusis VA Disability Ratings
- Links Between Tinnitus and Hyperacusis
- Establishing a Service Connection for Hyperacusis
- Hyperacusis as a Secondary Service-Connected Disability
- Secondary Service-Connected Disabilities Caused by Hyperacusis
- Difficulties in Filing a Hyperacusis VA Disability Claim
- How is a VA Claim for Hyperacusis Denied?
- Precedents on How the VA Handles Hyperacusis Claims and How a Lawyer Can Help
Overview of Hyperacusis
Hyperacusis is considered a hearing disability like hearing loss or tinnitus. It is, however, more related to how the brain interprets sounds than how the ears detect sounds or communicate the auditory signals to the brain. As a result, sounds within a safe range will seem uncomfortably or painfully loud to veterans suffering from the condition.
This can make a veteran’s life extremely difficult. Sounds at work may cause headaches and, in some cases, seem so loud that they could trigger nausea, dizziness, and difficulties with balance. Similarly, sounds at home may cause insomnia and the physical and mental problems that come from sleep deprivation.
The results of hyperacusis can also include behavioral changes. For example, a veteran with hyperacusis may stop leaving the home to avoid traffic noises. The veteran may also avoid social situations or situations that involve interactions with other people, like shopping or visiting family, because of the stress from experiencing uncomfortably loud voices. As a result, the VA’s regulations provide VA disability for sound sensitivity.
What Criteria Does the VA Use to Assign a Hyperacusis VA Disability Rating?
The VA does not rate hearing problems in one ear any differently than those that affect both ears. Thus, a veteran who experiences hyperacusis in both ears will not receive two disability ratings. Rather, a single hyperacusis VA disability rating is assigned whether hyperacusis manifests in one ear or both ears.
Analogues of Hyperacusis
There is no VA disability hearing loss table that lists hyperacusis VA disability ratings. Instead, the VA rates hyperacusis based on its closest analog.
For example, if a veteran’s hyperacusis causes dizziness and imbalance, hyperacusis might be rated using the VA rating table for peripheral vestibular disorder, an inner ear condition that leads to dizziness and imbalance. So, if the veteran experiences only occasional dizziness, a 10% hyperacusis VA disability rating is assigned. If the veteran experiences dizziness and occasional staggering, the VA will assign the veteran a 30% hyperacusis VA disability rating.
Another analog of hyperacusis is cranial nerve dysfunction. When the cranial nerves are damaged or malfunction, a patient may experience hearing loss and vertigo. The VA’s ratings schedules treat cranial nerve dysfunction as a symptom of traumatic brain injury (TBI). Thus, if a veteran suffers TBI, hyperacusis might be used as a symptom for rating TBI rather than a separately rated disability.
VA Hearing Tests Used for Hyperacusis VA Disability Ratings
A VA hearing test identifies the severity of hearing loss. The test results are fed into a VA hearing loss calculator that determines the severity. These tests are used for most bilateral hearing loss VA disability claims, such as assigning an acoustic neuroma VA disability rating or tinnitus VA disability rating.
Unfortunately, none of these tests is particularly helpful for gauging the severity of hyperacusis. These tests diagnose hearing loss, which is the opposite of the heightened hearing sensitivity of hyperacusis. This difficulty in confirming your diagnosis can sometimes cause the VA to dismiss your hyperacusis VA disability claim or rate it too low.
Links Between Tinnitus and Hyperacusis
Tinnitus is different from hyperacusis. However, they are analogous because they are both caused by overactive hearing. Tinnitus is a ringing or buzzing in the ears in the absence of external sounds. Hyperacusis is an amplification of external sounds to the point of discomfort or pain. Both can cause dizziness, imbalance, headaches, nausea, and heightened anxiety.
Tinnitus and hyperacusis can co-occur and, in at least one case, the VA granted separate disability ratings for tinnitus and hyperacusis by assigning a 10% tinnitus VA disability rating and a 30% hyperacusis VA disability rating.
Establishing a Service Connection for Hyperacusis
Many conditions and injuries can result in hyperacusis. This can make establishing a service connection for hyperacusis relatively easy.
If your hyperacusis manifested during your service, your hyperacusis is service-connected even if it was misdiagnosed. If you complained of vertigo and noise sensitivity, you meet the two primary symptoms of hyperacusis. Whether military doctors diagnosed your condition as hyperacusis or misdiagnosed it as fatigue, anxiety, or other disorders, this should be enough to prove that your hyperacusis manifested during your service.
Alternatively, if your hyperacusis did not manifest during your service, but some other ear injury or condition did, you may be able to establish that the same event that caused your ear injury was also responsible for an undiagnosed case of hyperacusis. Tinnitus, for example, is the most common ground for VA disability claims.
This is not surprising because most service members are exposed to loud noises, like gunshots, explosions, and engine noises that can result in tinnitus. By using records that show you suffered tinnitus during your service, you may be able to link your hyperacusis to the same event that caused your tinnitus.
The Nexus Letter is the missing link that can really help your VA appeal. Here one of our veterans’ disability lawyers talks about the importance of Nexus Letters.
Post-Service Manifestation of Your Disability
If your hyperacusis did not manifest until after your discharge, you may still be able to establish a service connection by showing that your hyperacusis was caused by some event or incident that occurred during your service. This is where the breadth of causes of hyperacusis works in the veteran’s favor. Many of the causes of hyperacusis were experienced by many, if not most, veterans during their service, including:
- Head injury
- Ear infection
- Toxic chemicals
- Quinine-based anti-malarial drugs
- Water pills and other diuretics
- Non-steroidal anti-inflammatory medications
- Temporomandibular joint (TMJ) disorder
- Loud noises
For example, if a veteran suffered a head injury due to a training accident during basic training, it might lead to hyperacusis even after the head injury has healed.
Similarly, if a veteran was prescribed medication known to cause hyperacusis during their service, the veteran might have a claim for hyperacusis VA disability benefits even if they no longer take the medication. For instance, valium has a known link to hyperacusis. If a veteran was prescribed valium during their time in the military, it might provide a basis for establishing a service connection for hyperacusis that manifests later. This might fall under an unintended side-effect or under the symptoms that develop.
Hyperacusis as a Secondary Service-Connected Disability
Hyperacusis can also be service-connected by showing that it was caused by a primary service-connected disability. That is, if a veteran has a disability that is clearly connected to the veteran’s service, it may be possible to establish a service connection for hyperacusis by showing a causal nexus with the veteran’s primary service-connected disability.
For Gulf War veterans, this strategy can provide a clear path to receiving VA disability benefits for hyperacusis. Specifically, chronic fatigue syndrome is a presumptive VA disability for Gulf War vets. This means Gulf War veterans do not need to prove their chronic fatigue syndrome was caused by their service. Instead, a service connection is presumed unless rebutted by specific evidence showing that there was some other cause.
Chronic fatigue syndrome is known to be associated with hyperacusis. This means that once a service connection for chronic fatigue syndrome is established, hyperacusis can be established as a secondary service-connected disability.
Other examples of primary service-connected disabilities with a known link to hyperacusis include:
Another way to establish a nexus between a primary disability and hyperacusis is to show that the treatment of the primary disability caused hyperacusis. Some anti-anxiety medications, for example, are known to cause hyperacusis. If you have been diagnosed with a service-connected anxiety state, your anti-anxiety medications might have hyperacusis as a side effect. If this happens, your hyperacusis will qualify as a secondary service-connected disability.
This highlights an important strategy in filing a VA disability claim. To maximize your overall disability rating, you need to include every secondary service-connected disability that you suffer. You should have your doctor document the occurrence and severity of each medical problem you have that could reasonably connect to your service.
Secondary Service-Connected Disabilities Caused by Hyperacusis
Hyperacusis can cause other problems. As mentioned above, the continuous discomfort caused by noises that have an objectively safe volume can lead to depression, anxiety, and insomnia. These mental disorders might be ratable as secondary service-connected disabilities.
Again, as you prepare your VA disability claim, you should review each disability to make sure you have included all the consequences of that disability that you experience. By including those secondary service-connected disabilities, you can increase your overall VA disability rating. These disabilities would be aggregated using a VA disability calculator programmed with VA math.
Difficulties in Filing a Hyperacusis VA Disability Claim
Many problems can arise when filing a hyperacusis VA disability claim because the VA hearing test is not geared toward measuring oversensitive hearing. Thus, it can be difficult for the VA to fully appreciate how much sensitivities, like tinnitus and hyperacusis, affect your hearing.
How is a VA Claim for Hyperacusis Denied?
The primary difficulty comes in proving the existence of your hyperacusis. There is no objective way to diagnose hyperacusis. While scientists believe hyperacusis is a neurological defect that causes audio gain in the brain across all frequencies, there is no way to measure that audio gain. Instead, doctors rely on the veteran’s description of how they experience sounds.
Besides the difficulties in objectively proving the existence of hyperacusis to the VA, it can also be difficult to describe the severity of hyperacusis. If hyperacusis is analogized to peripheral vestibular disorder, a minor case includes just vertigo, while a severe case includes vertigo and loss of balance. However, it is left to the veteran’s testimony to verify the existence and frequency of vertigo and loss of balance.
On either of these points, namely whether your symptoms support a claim for hyperacusis and whether those symptoms are ratable, the VA can deny a claim.
Here is one of our VA disability lawyers giving tips on your C&P Exam.
Precedents on How the VA Handles Hyperacusis Claims and How a Lawyer Can Help
The VA has relatively few precedents in handling hyperacusis claims. Among the few cases that exist, there’s no consensus on the VA ratings table to use to rate hyperacusis let alone how to review more nuanced arguments like the causal link between hyperacusis and some of the more common primary service-connected disabilities, like hearing loss.
Consequently, the margin for error in a hyperacusis VA disability claim is very narrow. As a result, you might want as much help as possible in documenting your disability, preparing your disability claim, and responding to any denial.
VA claims adjudicators rarely see hyperacusis VA disability claims because the condition is rare. Before filing a VA disability claim for hyperacusis, you may want to contact a VA attorney to discuss the pitfalls in filing such a claim and how to improve your chances of obtaining a successful outcome regardless of your location and whether you were deployed.
Other veterans have received ratings for both, so it is possible. You really want to make sure you have your paperwork and medical records in order to prove both are service connected or secondary-service connected.
Tinnitus is the most common VA disability, but only carries a 10% rating. Hearing loss can go higher than 10%, but it all depends on your tests. The VA is required to give you the highest possible rating for your condition, so work with a lawyer to make sure they do.