How to Get VA Disability for Vertigo Secondary to Tinnitus

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If you’re a veteran with service-connected Tinnitus rated at 10% and suffer from Vertigo, you may be eligible to get VA disability benefits for Vertigo secondary to Tinnitus.

There’s strong medical research supporting the link between these two conditions.

However, many veterans still face VA claim denials, even when submitting a strong case with a Nexus Letter.

In this expert-level blog post, Brian Reese the VA Claim Insider reveals tips and strategies to help you establish secondary service connection and maximize the VA disability benefits you’ve earned for serving our country.

Let’s begin!

Pro Tip: The VA is planning major rating changes that will impact VA claims and ratings for tinnitus, likely by Q1 or Q2 of 2025. Tinnitus will no longer be rated as a standalone condition under DC 6260; instead, it will be treated as a symptom of an underlying condition like hearing loss, Meniere’s disease, or TBI. This means veterans won’t qualify for a separate 10% rating for tinnitus alone. However, veterans will still be able to service-connect VA claims secondary to tinnitus for VA disability benefits.

Summary of Key Points

• Vertigo Secondary to Tinnitus for VA Disability: Veterans with a 10% service-connected rating for tinnitus who also suffer from vertigo may qualify for additional VA disability benefits by establishing vertigo as a secondary condition to tinnitus.

• Link Supported by Medical Research: Substantial research indicates that tinnitus can contribute to balance issues, with tinnitus-related inner ear disruptions potentially triggering or worsening vertigo. This connection is well-documented in multiple medical studies and BVA case decisions.

• Proving Secondary Service Connection: To establish secondary service connection for vertigo, veterans need three key elements: a formal diagnosis of vertigo, an established tinnitus service connection at 10%, and a strong Nexus Letter linking vertigo to tinnitus.

• Importance of Medical Evidence and a Nexus Letter: A detailed Nexus Letter and supporting documentation are critical for approval. Veterans should include detailed records of symptoms, treatment, and impact on daily life, with expert statements explaining how tinnitus exacerbates vertigo symptoms.

What Is Vertigo?

Vertigo is a type of balance disorder that causes a spinning or whirling sensation, making it feel as though you or your surroundings are moving when they aren’t.

This condition often stems from inner ear issues that affect balance and spatial orientation.

Common symptoms of vertigo include:

• Dizziness or unsteadiness

• Nausea and even vomiting due to the disorienting sensation

• Loss of balance or difficulty walking

• Headaches and light sensitivity

• Difficulty focusing or concentrating due to feeling off-balance

Vertigo episodes can vary in frequency and intensity, and for many veterans, it disrupts daily activities, making tasks like standing, walking, and driving unsafe.

In severe cases, vertigo can lead to falls, accidents, and a reluctance to engage in physical or social activities.

What Is Tinnitus?

Tinnitus is a condition where individuals perceive sound without an external source, often described as ringing, buzzing, or hissing in one or both ears.

It’s commonly linked to noise exposure, a frequent experience for veterans exposed to gunfire, explosions, aircraft, or machinery during service.

Tinnitus is the #1 most claimed VA disability, impacting more than 2 million veterans.

Common symptoms of tinnitus include:

• Persistent ringing, buzzing, or hissing sounds in the ears

• Sound perception that may vary in pitch or volume

• Difficulty focusing or concentrating due to the constant noise

• Sleep disturbances caused by an inability to escape the sound

• Irritability and frustration from the lack of silence

Vertigo Secondary to Tinnitus: Is There a Connection?

Yes, there is a well-established connection between tinnitus and vertigo, supported by substantial medical research.

Studies suggest that individuals with tinnitus are more likely to experience vertigo due to shared inner ear disruptions and neurological pathways.

Tinnitus can trigger or exacerbate vertigo through mechanisms such as altered balance processing, central nervous system hyperactivity, and chronic stress related to the persistent noise.

Research published in various medical journals shows a significant association between tinnitus and balance disorders, indicating that the two conditions often occur together rather than coincidentally.

Study: The Effect of Comorbidity between Tinnitus and Dizziness on Perceived Handicap, Psychological Distress, and Quality of Life

This study explores how having both tinnitus (ringing in the ears) and dizziness affects a patient’s perceived handicap, quality of life, and emotional distress compared to those experiencing just one of these conditions. It includes 736 patients who visited Hino Municipal Hospital, categorized into three groups: those with both tinnitus and dizziness, only tinnitus, and only dizziness.

Key Findings:

• Increased Handicap with Both Conditions: Patients who experienced both tinnitus and dizziness reported higher perceived handicap scores, indicating greater challenges in daily life, than those with only one of the symptoms. This underscores the compounded burden of dealing with both conditions simultaneously.

• Quality of Life Impacted by Dizziness: Physical quality of life scores were notably lower in patients with dizziness (either alone or with tinnitus) than in those with just tinnitus. This suggests dizziness may have a more direct impact on physical health perceptions and daily activities than tinnitus alone.

• Emotional Distress and Anxiety: Although patients with both conditions didn’t show higher anxiety or depression scores than those with only one condition, patients overall—especially females—reported higher levels of anxiety and distress with either tinnitus or dizziness.

Conclusion:

Patients dealing with both tinnitus and dizziness experience heightened physical and psychological challenges. For tinnitus patients also experiencing dizziness, it’s essential for healthcare providers to consider the added functional and emotional burdens to improve overall treatment and quality of life.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC5743934/

BVA Case Decisions Granting Vertigo Secondary to Tinnitus

#1. Vertigo Secondary to Hearing Loss and Tinnitus IS GRANTED

In BVA Citation Nr: 0211929, the VA granted service connection for vertigo as a secondary condition to the veteran’s already service-connected bilateral hearing loss and tinnitus. Here’s a simple breakdown of the decision:

Key Findings:

• Link Between Vertigo and Service-Connected Conditions: The Board found sufficient evidence that the veteran’s vertigo was linked to his bilateral hearing loss and tinnitus. Multiple medical reports indicated that the veteran’s hearing impairment and tinnitus contributed to symptoms of vertigo.

• Supporting Medical Opinions: Some VA treatment reports suggested a connection between vertigo and tinnitus-related balance issues. For instance, the veteran’s VA treatment records showed episodes of dizziness, nausea, and imbalance associated with his tinnitus. One VA examiner even stated that the veteran’s symptoms were consistent with vertigo linked to chronic hearing loss.

• Conflicting Opinions and Veteran Testimony: Although some medical opinions did not support the connection, the Board gave significant weight to the veteran’s consistent testimony about his symptoms dating back to his time in service. The veteran reported dizziness starting in the late 1950s, which he hadn’t formally reported until later. The Board found the veteran’s testimony credible and reliable, leading them to view the evidence as balanced between supporting and opposing opinions.

Conclusion:

The Board granted the veteran service connection for vertigo secondary to his bilateral hearing loss and tinnitus, ensuring he would receive VA disability benefits for this additional condition. Since the evidence for and against the connection was considered in equipoise (balanced), the Board ruled in the veteran’s favor, applying the “benefit of the doubt” principle. This means they granted service connection for vertigo as secondary to the veteran’s service-connected hearing loss and tinnitus.

#2. Vertigo and Meniere’s Disease Secondary to Hearing Loss and Tinnitus Granted IS GRANTED

In BVA Citation Nr: 21039420, the VA granted service connection for vertigo and related conditions (benign paroxysmal positional vertigo (BPPV), benign paroxysmal positional nystagmus (BPPN), and Meniere’s disease) as secondary to the veteran’s service-connected bilateral hearing loss and tinnitus.

Key Findings:

• Strong Medical Link Established: Medical opinions from two specialists linked the veteran’s Meniere’s disease, vertigo, and nystagmus to his service-connected hearing loss and tinnitus. The specialists explained that noise exposure, especially from aircraft, can cause inner ear damage, which may lead to these vestibular issues. Dr. D.B., a board-certified otolaryngologist, provided extensive research showing a connection between acoustic trauma and vestibular conditions.

• Veteran’s Consistent Symptom History: The veteran reported symptoms like dizziness, nausea, and balance problems dating back to his service, particularly from his role as a weather reconnaissance officer exposed to high noise levels on WC-130 aircraft. Although he didn’t initially report vertigo to avoid losing his flight status, he later sought treatment, and doctors confirmed vestibular issues.

• Positive Nexus Opinions: Dr. J.M., the veteran’s primary care provider, and Dr. D.B. concluded that the veteran’s conditions were “more likely than not” caused or aggravated by his hearing loss and tinnitus. Dr. D.B. specifically referenced studies linking prolonged noise exposure to inner ear disorders like Meniere’s disease.

• Benefit of the Doubt Applied: The Board found the evidence supporting the connection between the veteran’s hearing loss/tinnitus and his vestibular conditions was at least as compelling as any opposing evidence. By applying the “benefit of the doubt” principle, they ruled in favor of the veteran.

Conclusion:

The Board granted the veteran’s claim for Meniere’s disease, BPPV, and BPPN as secondary to his service-connected hearing loss and tinnitus. This ruling recognizes the impact of noise-induced inner ear damage on veterans and allows for disability compensation for related vestibular conditions.

How to Prove Secondary Service Connection

To establish secondary service connection for vertigo secondary to tinnitus, you must meet three key elements:

• #1. Medical Diagnosis of Vertigo: You need a formal diagnosis of vertigo in your medical records, whether from VA healthcare providers or private physicians. It’s beneficial to have a current diagnosis within the past 12 months to show the condition’s ongoing impact.

• #2. Existing Service-Connected Tinnitus: Tinnitus must already be recognized by the VA as a service-connected disability with a rating of 10%. The VA only provides one rating for tinnitus—either 10% or nothing.

• #3. Medical Nexus Evidence Between the Two Conditions: You need a strong Nexus Letter for vertigo as a secondary condition. This independent medical opinion should state that your vertigo is “at least as likely as not” caused or aggravated by your service-connected tinnitus. A well-supported Nexus Letter is often essential for getting your secondary VA claim approved.

What is the Vertigo Secondary to Tinnitus VA Rating?

VA ratings for vertigo secondary to tinnitus are either 10% or 30% under CFR 38, Part 4, VA Schedule of Ratings, DC 6204, Peripheral Vestibular Disorders, depending on the frequency, severity, and duration of symptoms as follows:

• 10%: Vertigo with occasional dizziness.

• 30%: Vertigo with dizziness and occasional staggering.

Note: Objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code. Hearing impairment or suppuration shall be separately rated and combined.

Important Medical Evidence to Help Service-Connect Vertigo Secondary to Tinnitus for VA Disability

To successfully file a VA claim for Vertigo secondary to service-connected Tinnitus, you’ll need to provide specific medical evidence that meets the VA’s criteria for establishing secondary service connection.

#1. Current Medical Diagnosis of Vertigo

The first essential step in establishing secondary service connection for vertigo is to obtain a current diagnosis from a qualified healthcare provider.

This diagnosis should be thoroughly documented in your medical records, clearly indicating the presence of vertigo and detailing its frequency, severity, and symptoms, such as dizziness, imbalance, or nausea.

Your documentation should also include information on how vertigo impacts your health, daily functioning, and well-being, which is vital for proving a secondary condition directly related to your service-connected tinnitus.

#2. Evidence of Service-Connected Tinnitus Rated at 10%

Since your vertigo claim relies on a secondary connection to tinnitus, you must have an established VA rating for tinnitus at 10%.

The VA requires documentation that confirms tinnitus is a service-connected disability.

You’ll need to submit evidence, such as your VA rating decision letter, that verifies tinnitus as a recognized service-connected condition.

This existing connection is the foundation for your vertigo claim as a secondary condition.

#3. Nexus Letter for a Secondary Condition from a Private Healthcare Provider

A Nexus Letter is a critical component of any secondary VA disability claim.

In this case, a Nexus Letter from a qualified healthcare provider should establish a clear link between your service-connected tinnitus and vertigo, explaining how tinnitus has contributed to or aggravated your vertigo.

The letter should state that it is “at least as likely as not” (a 50% or greater probability) that your vertigo is proximately due to, caused, or aggravated by your service-connected tinnitus.

Your healthcare provider should include:

• Detailed Medical Explanation: Describing the ways tinnitus can affect balance and contribute to vertigo.

• Relevant Medical Research: Citing studies or literature linking tinnitus and vertigo to strengthen the claim.

• Your Medical History: Personalizing the Nexus Letter with details from your records, showing the progression from tinnitus to vertigo.

A strong Nexus Letter with high-probative value that clearly links your conditions is essential to getting your VA claim for vertigo secondary to tinnitus approved.

#4. Documentation of Severity of Symptoms and Impact on Work, Life, and Social Functioning

The VA needs to understand how vertigo affects various aspects of your life, including work performance, personal relationships, and day-to-day activities.

It’s essential to demonstrate how vertigo, as it relates to your tinnitus, limits your quality of life and overall well-being.

Consider providing the following supporting evidence:

• Military, VA, or Private Medical Records: Documentation detailing your vertigo symptoms, any treatments you’ve undergone, and the impact on your daily life.

• Lay Evidence: Statements from yourself, family, or friends that provide firsthand accounts of how vertigo affects your life, helping to demonstrate the personal toll it takes.

• Disability Benefits Questionnaire (DBQ): If available, a DBQ for ear conditions, including vestibular disorders completed by your healthcare provider can offer comprehensive documentation of your symptoms, diagnosis, and any functional limitations.

Providing a complete package of evidence, including a Nexus Letter and supporting documentation, can strengthen your claim and improve your chances of establishing a secondary service connection for vertigo due to your service-connected tinnitus.

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