A tinnitus nexus letter for your VA claim, from your noise exposure records

What the clinician looks for in your tinnitus records

Tinnitus is ringing, buzzing or hissing in the ears that you hear and others cannot. For the flat $500, the clinician reviews your records for the noise you were exposed to in service and when the ringing began.

• Your job in service, from your DD-214 or personnel records, and what it exposed you to: weapons fire, artillery, aircraft and flight lines, engine rooms, armored vehicles, generators, or demolitions.
• Audiograms from service: the one at entry, routine hearing conservation tests, and the one at separation, with any noted threshold shifts.
• The first record of ringing in the ears, in service or after, and your own account of when it started.
• Blast exposures or head injuries in service, recorded in treatment or incident reports.
• Your noise history after service, at work and outside it. The clinician weighs it, and an honest record of it makes the opinion more credible.
• A hearing loss diagnosis, if you have one, and whether VA already connected it.

Common service-connection routes for tinnitus

Direct service connection under 38 CFR 3.303 is the main route: noise exposure your service records support, and ringing that began in service or that a clinician can connect to that exposure. Ringing in the ears is something you can describe yourself, and 38 CFR 3.159 counts that kind of firsthand description of what a person can observe as competent lay evidence.

Secondary service connection under 38 CFR 3.310 may fit when VA has already connected hearing loss, or a head injury, and the records show the ringing followed. A clinician may consider whether the same damage behind the hearing loss explains the tinnitus.

A clinician also looks at what else could explain the ringing, such as noise after service or certain medications, and addresses it in the letter rather than leaving it for the rater to find.

Is there a DBQ for tinnitus?

There is, but it is not one Commander Health completes. VA lists its Hearing Loss and Tinnitus DBQ as not available for public use, and VA's own examiners complete it, usually at a C&P exam with a hearing test.

So for tinnitus, Commander Health offers the nexus letter only, for a flat $500, with no DBQ or bundle. The letter addresses the question a VA examiner also has to answer: whether the ringing is at least as likely as not connected to your service.

VA's public ear DBQ does not stand in for it: that form itself says a hearing loss or tinnitus exam must also be completed for a veteran with tinnitus.

What it is not

• Physical conditions only: Commander Health does not write PTSD or other mental health opinions, or secondary opinions that run through a mental health condition.
• Not an exam or an appointment. There are no calls or video visits; the clinician works from your records, and any follow-up comes by email.
• Not a filing service. Commander Health does not file claims and is not a VSO, a law firm, or a VA-accredited representative. Free help filing a claim is available from a VA-accredited Veterans Service Organization.
• Not a guarantee. Clinical review never guarantees an outcome. A clinician signs only if your records support the opinion, and VA decides the claim.

Frequently asked questions

Why won't you complete the tinnitus DBQ?

VA lists the Hearing Loss and Tinnitus DBQ as not available for public use, so a private clinician's version is not a form VA uses. Commander Health offers the nexus letter only for tinnitus.

Do I need a hearing test before ordering?

No. A tinnitus opinion rests on your noise exposure and when the ringing began, not on a hearing test. Upload any service hearing tests you have, because they help show the exposure.

My job was not combat arms. Can I still claim tinnitus?

Yes, if your records show noise exposure. Many support jobs work around engines, aircraft, generators or weapons ranges. For the $500 fee, the clinician reviews what your records show about your duties.

Can tinnitus be secondary to my service-connected hearing loss?

A clinician may consider it under 38 CFR 3.310 when VA has connected the hearing loss and the records show the ringing followed. The $500 letter is signed only if your records and the medical literature support it.