February 3, 2020 Hello Jim, not really a question, just a comment. I was reading your answer to a veteran who asked you the odds of getting "anxiety, stress, etc" approved as secondary to s/c tinnitus. You answer seemed to indicate that it would be a "stretch" to get such a claim approved. With all due
respect, "anxiety, stress, depression and social isolation can be approved as secondary to s/c tinnitus." The main things needed are (1) diagnosis of tinnitus, (2) a strong paper trail showing counseling sessions with mental health professionals regarding how annoying and depressing the tinnitus is to the veteran. In New Jersey, we are seeing veteran get anywhere from 30% to 70% for "anxiety, stress, depression as service connected and secondary to service connected recurrent tinnitus."
The most important item is evidence of counseling sessions indicating that the anxiety is caused by the tinnitus. If you need more information, let me know. Keep up the good work. I hear you...but I stand by my answer. The 2 things you say are necessary to prevail in a claim of psych issues secondary to tinnitus aren't a part of most veterans' files. The diagnosis of tinnitus is easy enough to make but I don't know many veterans who could meet your standard of,
"a strong paper trail showing counseling sessions with mental health professionals regarding how annoying and depressing the tinnitus is to the veteran." I also believe that to isolate tinnitus without including the well documented anxiety and depression of hearing loss that often accompanies tinnitus would be a mistake. While I agree that a rated mental health diagnosis is possible as a secondary condition to tinnitus, it isn't the cakewalk you imply. When I think a veteran who has
come to me for advice may have a well grounded claim for such issues as tinnitus and hearing loss, I refer them to a clinical psychologist for an IMO to obtain a professional opinion that will support their claim or appeal. Without such evidence as, "a strong paper trail" of psych diagnosis, which not one veteran has come to me with, these claims will be denied...getting these awards is still a stretch. Overview of TinnitusGenerally speaking, tinnitus refers to the perception of noise or ringing in the ears. Tinnitus affects approximately 15 to 20 percent of people in the United States, and a disproportionate number of veterans (see more below). Most often, tinnitus is a symptom of an underlying condition, such as hearing loss, ear injury, or a circulatory system disorder. Although it is very bothersome and can lead to significant impairment in everyday life, tinnitus is not typically life-threatening. The most common tinnitus symptoms may include phantom noises in the ears such as:
Such phantom noise may vary in pitch from a low to high and can occur in one or both ears. In some cases, the noise can be so loud that it interferes with individuals’ ability to concentrate or hear external sounds. Furthermore, tinnitus may be present at all times, or it may come and go. There are two main types of tinnitus, one of which is significantly more common than the other:
Causes of TinnitusThere are a number of health conditions that can cause or aggravate tinnitus, but an exact cause is not always established. However, in many people, tinnitus is caused by one of the following:
TreatmentTinnitus can often be improved with the appropriate treatment and intervention. For example, tinnitus may be treated with noise suppression, including:
Although medications cannot cure tinnitus, they may help reduce the severity of symptoms. Examples of common medications for tinnitus include the following:
Finally, there are several lifestyle adjustments and home remedies that may be helpful for individuals with tinnitus:
Veterans and TinnitusTinnitus is one of the most frequently claimed conditions for service connection. While on active duty, service members are consistently exposed to loud noises, including gunfire, machinery, armored vehicles, aircraft, and other combat-related noises. In addition, many veterans cope with TBIs stemming from traumatic injuries or exposure to improvised explosive devices (IEDs). As a result, tinnitus and hearing loss are common conditions from which veterans suffer. Symptoms of tinnitus can be more pronounced at night when one is lying down to sleep simply because it is quieter. For service members on active duty, however, quiet may not be something that is experienced very often. For this reason, a veteran may not even notice their tinnitus symptoms until long after they are discharged from service at which point they may decide to file a claim for VA disability benefits. VA Service Connection for TinnitusTo establish service connection for tinnitus on a direct basis, veterans must prove that there is a connection between their diagnosis and their time in service. Specifically, the following elements must be present: (1) a current diagnosis of tinnitus; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current diagnosis of tinnitus to the in-service event, injury, or illness. The following types of evidence are often used to develop and strengthen claims for tinnitus:
After service connection for tinnitus is established, VA will award a disability rating based on the severity of the condition. VA rates tinnitus under 38 CFR § 4.87, Schedule of Ratings – Ear, Diagnostic Code 6260. The condition of tinnitus almost always results in a 10 percent disability rating. Importantly, this singular 10 percent disability rating takes both ears into account. Does Tinnitus Cause Other Conditions?Tinnitus can cause significant impairments in a veteran’s everyday life and oftentimes results in a variety of other conditions as well. The most common secondary conditions to tinnitus explained below. Migraine Headache Conditions Secondary to TinnitusMigraine headaches are a type of headache characterized by intense pain that can be accompanied by nausea, vomiting, sensitivity to light and sounds, lightheadedness, and blurred vision. Migraines can be debilitating and can last anywhere from hours to days depending on the person. It is unclear what causes migraines, but triggers can include hormonal imbalance, alcohol, stress, and sensory stimulation (e.g., tinnitus). According to the American Migraine Foundation, there is a strong relationship between tinnitus and migraine headaches. Specifically, about 27 percent of individuals with tinnitus also suffer from migraines. Some individuals also report a worsening in tinnitus symptoms during migraine attacks. Recent studies suggest that tinnitus and migraines co-occur as a result of spontaneous abnormal neural activity; however, more research needs to be done in this area. Depression Secondary to TinnitusDepression is a serious mental health condition that affects the way a person thinks, feels, and acts. Symptoms of depression tend to vary amongst individuals; however, common symptoms include:
Current research also points to a significant relationship between tinnitus and depression. A 2015 study titled “The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus” looked at the percentage of veterans with tinnitus who also suffered from depression. The results revealed that 58.2 percent of the sample (i.e., 91 veterans with a diagnosis of tinnitus) had depression. Overall, tinnitus may cause complications with sleep thereby leading to stress, fatigue, and ultimately, depression. Anxiety Secondary to TinnitusAnxiety is defined as intense, excessive, and persistent worry and fear about everyday situations. It is estimated that one-third of adults in the United States suffer from anxiety disorders. The most common symptoms of anxiety disorders include the following:
The study referenced above also found that 79.1 percent of the sample also suffered from anxiety. Importantly, 58.2 percent of the sample suffered from both anxiety and depression. Somatic Symptom Disorder Secondary to TinnitusSomatic symptom disorder is characterized by an extreme focus on physical symptoms, such as pain or fatigue, that causes major emotional distress and problems with social and occupational functioning. Oftentimes, individuals with somatic symptom disorder have another diagnosed medical condition that is associated with these symptoms. However, the individual’s reaction to the actual medical condition is excessive or disproportionate to the actual problem. Veterans may become overly focused on their tinnitus symptoms and begin to worry about them excessively. Sleep Apnea Secondary to TinnitusSleep apnea is a potentially serious sleep disorder in which a person’s breathing is repeatedly interrupted during the course of the night. There are three main types of sleep apnea, including the following: (1) obstructive sleep apnea; (2) central sleep apnea; and (3) complex (mixed) sleep apnea syndrome. Generally speaking, the most common symptoms include: loud snoring, gasping for air during sleep, awakening with a dry mouth, morning headache, insomnia, hypersomnolence (i.e., excessive daytime sleepiness), and difficulty concentrating. One previous study assessed the reported prevalence and severity of sleep disturbance in chronic tinnitus patients. Of these patients, 80 were military personnel with a diagnosis of tinnitus associated with noise-induced permanent hearing loss. Mini Sleep Questionnaire (MSQ) scores for sleep disturbance were found to be higher than those of normal controls in 77 percent of the patients. The highest MSQ scores in tinnitus patients were for delayed sleep, morning awakenings, mid-sleep awakenings, morning fatigue, and chronic fatigue. Secondary Service Connection for Secondary Conditions to TinnitusA secondary service-connected condition is one that resulted from a separate condition that is already service-connected. For example, if a veteran is service-connected for tinnitus and later develops one of the above-mentioned conditions as a result, they may be eligible for secondary service connection. Filing a claim for conditions secondary to tinnitus involves the same process as filing any claim for service connection. Specifically, veterans will fill out and submit VA Form 21-526 – an original claim for service connection. Veterans may do so online using the eBenefits portal, in person at their local Regional Office, or with help from a veterans’ advocate. Importantly, there is certain evidence that veterans should include with their claims for secondary service connection. Specifically, veterans will need to demonstrate two things to VA to be granted service connection for secondary conditions to tinnitus: (1) a diagnosis for their secondary condition; and (2) medical evidence showing the link between their service-connected tinnitus and the secondary condition. What secondary conditions can tinnitus cause?Secondary Conditions
Not only can tinnitus be a secondary condition that develops after service as a result of TBIs, hearing loss, head and neck trauma, etc., but it can also lead to other conditions such as depression, anxiety, migraines, and sleep apnea.
What is the VA rating for depressive disorder?70% Rating for Depression: The veteran's depression has led to occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to severe depressive symptoms such as suicidal ideation, obsessive rituals that interfere with day to day activities, ...
What is the VA rating for anxiety secondary to tinnitus?VA rates tinnitus under 38 CFR § 4.87, Schedule of Ratings – Ear, Diagnostic Code 6260. The condition of tinnitus almost always results in a 10 percent disability rating. Importantly, this singular 10 percent disability rating takes both ears into account.
Is anxiety secondary to tinnitus?Doctors link anxiety to several medical conditions, including tinnitus or ringing in the ears. Research indicates that up to 45% of individuals with chronic tinnitus present with anxiety symptoms, and that tinnitus often worsens after an individual experiences stress.
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