38 CFR Part 4 — 38 CFR §§ 4.85–4.87
Chronic Suppurative Otitis Media
dc-6200-chronic-suppurative-otitis-media
Auditory / ENT
Diagnostic code
6200
Why your DC matters: DC 6200 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 6200 — Chronic Suppurative Otitis Media — is listed under 38 CFR §§ 4.85–4.87 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (6200) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “6200”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 6200 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 6200 in the subpart for your body system (use Find in Page if needed).
DC 6200 (chronic suppurative otitis media, mastoiditis, or cholesteatoma — any combination) is the active-disease code for chronic middle-ear infection with drainage. Face-value rating is small (10% during suppuration / aural polyps), but the strategic value is in the explicit schedule note that complications rate separately — hearing loss (DC 6100), tinnitus (DC 6260), labyrinthitis, facial nerve paralysis, bone loss of skull. The play here is stacking: most veterans with chronic OM have all four of these separately ratable conditions, and the rating decision often only lists one. The other quirk: cholesteatoma (a destructive epithelial cyst that erodes bone and ossicles) is the most aggressive of the three covered conditions and may warrant surgical management — post-tympanomastoidectomy residuals warrant careful audiology + facial nerve assessment.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 10% | Chronic suppurative otitis media, mastoiditis, or cholesteatoma — during suppuration OR with aural polyps. | Otologic exam documenting active drainage from middle ear via TM perforation OR aural polyps. Tympanic membrane (TM) examination, otomicroscopy, or otoendoscopy findings. |
| 0% | Inactive period without suppuration or aural polyps. | Quiescent disease without active drainage. Complications (hearing loss, tinnitus, etc.) rate separately. |
What Qualifies Under DC 6200?
Chronic suppurative otitis media (CSOM)
Chronic middle ear infection with TM perforation and active drainage. Distinguished from acute OM (resolves) and chronic nonsuppurative OME (intact TM, serous fluid).
Mastoiditis
Inflammation/infection of the mastoid air cells, typically from extension of middle ear disease. Can be acute (now rare with antibiotics) or chronic.
Cholesteatoma
Destructive epithelial cyst in the middle ear / mastoid that erodes bone and ossicles. Most aggressive of the three conditions. Often requires surgical removal.
10% during active disease + separate rating of complications
Face-value 10% when active (suppuration OR aural polyps). Complications (hearing loss, tinnitus, labyrinthitis, facial nerve, bone loss) rate SEPARATELY per § 4.87 note.
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“During suppuration OR with aural polyps”
10% gate is disjunctive — EITHER active drainage OR aural polyps qualifies. Aural polyps are inflammatory tissue growth in the ear canal from chronic infection. Either supports the 10% rating.
“Complications — hearing loss, tinnitus, labyrinthitis, facial nerve paralysis, bone loss of skull — rate separately”
Per § 4.87 explicit note, complications rate SEPARATELY from the underlying DC 6200 rating. This is anti-pyramiding override language — the schedule forces stacking. Most veterans with chronic OM have all four (hearing loss + tinnitus + balance + facial nerve) and the rating decision only lists one. Audit aggressively.
“Tympanic membrane perforation with drainage OR cholesteatoma OR mastoiditis”
Anchors DC 6200 vs. DC 6201 (chronic nonsuppurative OME, also caps at 10%). Suppurative = active drainage from middle ear, requires TM perforation. Nonsuppurative = serous fluid behind intact TM.
Evidence Checklist — Specific to This Condition
Otologic exam with otomicroscopy or otoendoscopy
CRITICALDocuments TM perforation, drainage, aural polyps, cholesteatoma. Anchors active disease for 10% tier.
Audiogram (recent within 12 months)
CRITICALAir-bone gap from middle ear pathology = conductive hearing loss. Rates separately under DC 6100. Most-missed stacking element.
Tinnitus assessment
CRITICALChronic OM frequently causes tinnitus. Rates separately under DC 6260 (10% cap). Many veterans never claim it separately.
ENG / videonystagmography for balance assessment
IMPORTANTLabyrinthitis or peripheral vestibular dysfunction from inner ear extension. Rates separately under DC 6204 (peripheral vestibular).
Facial nerve assessment
IMPORTANTCholesteatoma can erode facial nerve canal causing paralysis. House-Brackmann grade. Rates separately under DC 8207 (facial nerve).
Imaging — CT temporal bone (if cholesteatoma or mastoiditis)
IMPORTANTDocuments anatomical extent, bone erosion, ossicular destruction. Supports cholesteatoma diagnosis and surgical planning.
Surgical history (tympanomastoidectomy, tympanoplasty)
SUPPORTINGOperative reports document anatomy + residuals.
C&P Exam Tips
Demand otomicroscopy / otoendoscopy, not just pen-light otoscopy
Active drainage, polyps, and cholesteatoma are best seen on otomicroscopy. Pen-light alone misses these findings.
Bring recent audiogram showing air-bone gap
Conductive hearing loss from middle ear pathology rates separately under DC 6100.
Explicitly raise tinnitus + balance + facial nerve
Each of these complications rates separately per § 4.87. Don't leave any unmentioned.
Don't downplay drainage frequency or volume
10% requires 'during suppuration.' Intermittent drainage still qualifies if any active drainage period is documented.
Common Mistakes That Cost Veterans Points
Not stacking hearing loss (DC 6100) and tinnitus (DC 6260) separately
§ 4.87 explicitly says complications rate separately. Most veterans with chronic OM have conductive hearing loss + tinnitus — both rate independently of the DC 6200 10%. Audit your decision letter for missing companion ratings.
Filing under DC 6201 (nonsuppurative OME) instead of DC 6200
Both cap at 10%, but DC 6201 covers chronic serous OME with intact TM — different pathology. DC 6200 requires TM perforation with active drainage OR aural polyps OR cholesteatoma. Diagnosis matters for accurate coding and SC nexus.
Missing cholesteatoma-specific complications (facial nerve, bone erosion)
Cholesteatoma is the most destructive of the DC 6200 conditions. Facial nerve paralysis (DC 8207), bone loss of skull, vestibular dysfunction (DC 6204) all rate separately. CT temporal bone documents the extent.
Accepting 0% during inactive periods without complications rating
When active disease is in remission, the DC 6200 rating drops to 0%. But the COMPLICATIONS (hearing loss, tinnitus, balance, facial nerve) continue to rate separately regardless of active drainage status.
Tactical Plays
⚡ Stack hearing loss + tinnitus + balance + facial nerve separately — § 4.87 mandates it
The DC 6200 schedule note explicitly says complications 'will be rated separately.' This is anti-anti-pyramiding language. Most veterans with chronic OM have conductive hearing loss (DC 6100) + tinnitus (DC 6260) + vestibular dysfunction (DC 6204) + possibly facial nerve involvement (DC 8207). The rating decision typically only lists DC 6200 — audit for missing companion ratings and file supplemental for each.
⚡ Demand otomicroscopy / otoendoscopy
Pen-light otoscopy misses active drainage, aural polyps, and cholesteatoma. The 10% tier and the diagnosis depend on otologic findings best seen on otomicroscopy or otoendoscopy. Demand ENT consultation with magnified examination at every C&P.
⚡ Audit for cholesteatoma — most destructive of the three
Cholesteatoma is an epithelial cyst that erodes ossicles, mastoid bone, facial nerve canal, and can extend intracranially. CT temporal bone documents extent. Cholesteatoma-specific complications (facial nerve paralysis, intracranial extension, severe ossicular destruction) all rate separately.
⚡ Don't accept 0% during remission — complications continue to rate
When active drainage / polyps are in remission, the DC 6200 rating drops to 0%. But the residual hearing loss, tinnitus, vestibular dysfunction, and facial nerve impairment continue to rate separately regardless of DC 6200 active status. Maintain the companion ratings.
Secondary Conditions to File With This One
Conductive / mixed hearing loss
STRONGDC 6100
Chronic OM causes conductive hearing loss via TM perforation, ossicular erosion, mastoid disease. Per § 4.87 note, rates separately. Most-missed companion rating.
Tinnitus
STRONGDC 6260
Chronic OM frequently causes tinnitus. Caps at 10%, but stacks separately from DC 6200.
Peripheral vestibular dysfunction / labyrinthitis
STRONGDC 6204
Inner ear extension from chronic middle ear disease. Vertigo, balance dysfunction. Per § 4.87 note, rates separately.
Facial nerve paralysis
MODERATEDC 8207
Cholesteatoma can erode facial nerve canal causing House-Brackmann grade paralysis. Per § 4.87 note, rates separately.
Meniere's syndrome (if vestibular involvement)
SITUATIONALDC 6205
Inner ear extension can present with Meniere-like symptoms. Different rating mechanism than DC 6204.
Depression / anxiety secondary to chronic hearing/balance impairment
MODERATEDC 9434 / 9400
Chronic hearing loss has well-documented depression/anxiety comorbidity.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
0% — single, no dependents
TOTAL
$0.00/mo
Inactive — no active drainage or polyps.
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
Active DC 6200 — suppuration or aural polyps.
10% DC 6200 + 10% DC 6260 tinnitus + 10% DC 6100 hearing loss + 30% DC 6204 vestibular
Base rating
$1,132.90
TOTAL
$1,132.90/mo
Complications stacking — combined ~52% rounds to 50%. Common chronic OM presentation.
10% DC 6200 + 30% DC 8207 facial nerve + 30% DC 6204 vestibular
Base rating
$1,435.02
TOTAL
$1,435.02/mo
Post-cholesteatoma with facial nerve + vestibular sequelae.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
🦠What is Cholesteatoma?
Cholesteatoma = destructive epithelial cyst in the middle ear or mastoid. Squamous epithelium that grows abnormally into the middle ear and produces keratin debris, eroding ossicles, mastoid bone, facial nerve canal, and potentially extending intracranially. Most destructive of the DC 6200 conditions. Surgical removal (tympanomastoidectomy) is typically required.
↔️What's the Difference Between DC 6200 and DC 6201?
DC 6200 = chronic SUPPURATIVE otitis media (active drainage through TM perforation), mastoiditis, OR cholesteatoma. DC 6201 = chronic NONSUPPURATIVE otitis media with effusion (serous fluid behind intact TM, no drainage). Both cap at 10%. Diagnosis depends on TM status + drainage.
🌸What is Aural Polyp?
Aural polyp = inflammatory tissue growth in the ear canal or middle ear, arising from chronic infection or cholesteatoma. Visible on otomicroscopy. Either drainage OR aural polyps qualifies for the 10% DC 6200 tier.
⚖️Why Do Complications Rate Separately?
Per § 4.87 explicit note: 'Evaluate hearing impairment, and complications such as labyrinthitis, tinnitus, facial nerve paralysis, or bone loss of skull, separately.' This is written-in anti-pyramiding override language — the regulation forces separate stacking that would otherwise be combined.
How to File Your Claim
Pull ENT consult notes + otomicroscopy/otoendoscopy findings
Anchors active disease for 10% tier + cholesteatoma vs. CSOM vs. mastoiditis diagnosis.
Pull audiogram showing conductive hearing loss
Air-bone gap from middle ear pathology. Rates separately under DC 6100.
Assess for tinnitus, vestibular dysfunction, facial nerve involvement
Each complication rates separately per § 4.87 note.
File 21-526EZ specifying 'chronic suppurative otitis media / cholesteatoma (DC 6200)' + each complication separately
List each DC explicitly — DC 6100 hearing, DC 6260 tinnitus, DC 6204 vestibular, DC 8207 facial nerve as applicable.
Pull CT temporal bone if cholesteatoma or mastoiditis
Documents anatomical extent, ossicular destruction, facial nerve canal erosion.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Complications rate SEPARATELY — § 4.87 mandates it
Hearing loss, tinnitus, labyrinthitis, facial nerve paralysis, bone loss of skull — each rates independently. Most-missed stacking play.
Cholesteatoma is the most destructive — audit for facial nerve + intracranial extension
Bone erosion, ossicular destruction, facial nerve canal erosion. CT temporal bone documents extent.
Don't accept 0% during remission — complications continue
DC 6200 active rating drops to 0% in remission, but hearing loss / tinnitus / vestibular / facial nerve continue to rate separately.
10% gate is disjunctive — drainage OR polyps qualifies
Either active drainage OR aural polyps supports the 10% rating. Both elements not required.
Related Tools & Resources
Frequently Asked Questions
Can I rate hearing loss and tinnitus separately from chronic otitis media?
Yes — § 4.87 explicitly says complications including hearing loss (DC 6100), tinnitus (DC 6260), labyrinthitis (DC 6204), facial nerve paralysis (DC 8207), and bone loss of skull rate separately from DC 6200. This is anti-pyramiding override language. Most veterans with chronic OM have all four; audit for missing companion ratings.
What's the difference between DC 6200 and DC 6201?
DC 6200 = chronic SUPPURATIVE otitis media (active drainage through TM perforation), mastoiditis, or cholesteatoma. DC 6201 = chronic NONSUPPURATIVE otitis media with effusion (serous fluid behind intact TM, no drainage). Both cap at 10%. Diagnosis depends on TM status + drainage.
How is cholesteatoma rated?
Cholesteatoma rates under DC 6200 alongside chronic suppurative OM and mastoiditis (10% during active disease). The destructive complications — ossicular erosion (conductive hearing loss DC 6100), facial nerve paralysis (DC 8207), bone loss of skull, intracranial extension — rate separately per § 4.87 note. Post-tympanomastoidectomy residuals warrant careful audiology + facial nerve assessment.
Does the 10% rating continue when my ear isn't actively draining?
No — the DC 6200 10% rating applies 'during suppuration OR with aural polyps.' During remission (no active drainage, no polyps), the DC 6200 rating drops to 0%. BUT the residual complications (hearing loss, tinnitus, vestibular dysfunction, facial nerve impairment) continue to rate separately regardless of DC 6200 active status.
Can I claim Meniere's syndrome if I have chronic OM?
Possibly — if inner ear extension from chronic OM presents with the Meniere's triad (vertigo, hearing loss, tinnitus) and meets diagnostic criteria, DC 6205 (Meniere's syndrome) may rate. Per § 4.87 instructions, evaluate Meniere's under DC 6205 OR separately rate hearing loss + tinnitus + vertigo — whichever yields the higher rating. Run both calculations.
Official Regulatory Source
Chronic suppurative otitis media, mastoiditis, or cholesteatoma rates under 38 CFR § 4.87, DC 6200 — 10% during active disease, with complications rating separately per schedule note.
38 CFR § 4.87 — Ear (eCFR) →Scroll to DC 6200. The companion DCs that rate separately per § 4.87 note: DC 6100 (hearing loss), DC 6260 (tinnitus), DC 6204 (peripheral vestibular), DC 8207 (facial nerve). DC 6201 (nonsuppurative OME) covers chronic OM with intact TM.
Next Steps
If your rating decision lists DC 6200, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 6200 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.