Mental Health Secondary to Tinnitus

by Deborah Miller, PhD, HSPP, Owner and Lead Psychologist at vetnexusletter.com

Please note - this blog post is educational only, and based on Dr. Miller's professional experiences as a psychologist who works with veterans on disability claims. This is not intended to be legal advice - always seek the advice of a certified Veteran Service Organization or attorney as these resources can provide direct guidance on the VA disability claim process

One of the most common VA disability claims I work on is anxiety, depression, and insomnia secondary to tinnitus. Many veterans are service-connected for tinnitus - a phantom ringing or buzzing sound - due to their exposure to hazardous noise during service. Some veterans find their tinnitus to be only mildly annoying, and are able to tune it out most of the time with no problem. Other veterans experience more severe and debilitating tinnitus that impairs their sleep, causes distraction while they're trying to focus, affects their ability to hear conversations, and is just generally annoying. This can lead to feelings of anxiety, depression, and clinical levels of insomnia - but the maximum rating for tinnitus is 10%, even if it is causing real problems in your life. That is where a secondary claim for the additional problems caused by tinnitus comes in handy and can get you the benefits that truly reflect the severity of the problems your tinnitus is causing.

But how do you build a claim that shows how tinnitus is impacting your daily life? Most veterans struggle with these things in silence, trying their hardest to manage symptoms on their own - so there usually isn't much evidence to connect their sleep problems, anxiety, and depression to their tinnitus, and their claim ends up being denied for lack of evidence. C&P examiners hired by the VA are likely to briefly state that "there is no medical literature that supports a causal relationship between tinnitus and mental health disorders" - but that simply isn't true. I've worked on countless cases for veterans who ended up getting service-connected for mental health secondary to tinnitus because the medical relationship IS clear - but you have to present the VA with solid evidence and a logical rationale that supports your claim.

You can establish evidence that your tinnitus symptoms are causing a diagnosable mental health disorder, like anxiety, depression, and/or insomnia in several ways.

1. Private/VA medical records: Talk to your primary care physician about how your tinnitus is affecting your mental well-being. Describe any sleep problems, feelings of anxiety/worry, concentration problems, social isolation, or other symptoms and make sure to DIRECTLY relate them to your tinnitus whenever you're talking to your care provider. Ask them specifically if they will make sure to note in your medical record that the mental health symptoms you are experiencing are directly resulting from your tinnitus, and not some other life stressor. This is important, as physicians are often too brief in their medical documentation and are not necessarily always focused on the CAUSE of your symptoms, but the treatment.

   
   

2. Lay Statements: Talk to friends and family about how tinnitus is affecting your life. Ask if they've noticed any difference in you - your spouse may notice that you have trouble falling asleep and need to use a white noise machine or fan to drown out the tinnitus; a friend may notice that you often have to ask them to repeat themselves, even though you have no documented hearing loss - and they may notice your frustration and avoidance of conversations due to this; your supervisor at work may notice that you often lose focus and take longer to complete tasks than normal, indicating difficulty with concentration that could be a result of your tinnitus. Lay statements are especially important if you have little to no official documentation of your mental health symptoms (and many veterans do not seek mental health care, so you're not alone in that).

   
   

3. Independent Expert Exam and Opinion: A private psychologist who specializes in independent mental health exams and medical opinions can provide a strong piece of evidence for your case. I do these all the time with much success for clients - even clients who have never had any mental health treatment. The in-depth exam I provide documents your personal history, your psychological history, your current symptoms, and how they affect your daily life. The exam comes with a Disability Benefits Questionnaire (DBQ) that the VA requires for all disability exams. I also provide a "nexus letter" to establish a strong logical medical explanation for how your mental health symptoms are caused by your tinnitus - supported by medical research from leading medical journals. You do NOT absolutely have to have an independent exam and nexus letter, especially if you have a lot of other evidence to support your claim, like medical records that clearly show your mental health diagnosis and medical notes where your doctor or therapist has documented the link between your tinnitus and mental health. If the VA denies your claim the first time around, you can always submit a supplemental claim with an independent exam/DBQ and nexus letter as a next step.

Establishing evidence is key for these types of claims. I work with veterans who were denied for mental health secondary to tinnitus because they thought the VA would connect the dots - but many times, unfortunately, you have to lead the VA by the hand along your path to service-connection. If you're interested in establishing evidence through an independent exam/DBQ and nexus letter, I can help. Fill out this form and I'll get in touch about the process: LINK.