When asked to consider the injuries that military veterans most commonly suffer from, most people would be quick to name brain damage, lost limbs, burns, or post-traumatic stress disorder as the most frequent injuries. However, they would be wrong; in fact, the most-widespread injury for returning veterans is hearing loss.

Hearing loss, which is caused by permanent damage to the hair cells within the inner ear, comes as a result of exposure to sounds 140 decibels and higher. These loud noises can also cause tinnitus, a type of hearing damage in which someone experiences a persistent ringing sound in their ears.

Surprisingly, hearing loss and tinnitus are currently the top two most compensated disabilities in the Veterans Benefits Association, and as of 2014, more than 400,000 veterans of U.S. campaigns in Afghanistan and/or Iraq report experiencing hearing loss, tinnitus, or both.

These incidents of hearing loss are rising at a rate of 13-18% per year, and with that increase, the VA is spending more and more money on major auditory disabilities. In 2010, the VA spent around $1.39 billion in disability payments for major auditory disabilities, and at the current rate of increase, the VA predicts that hearing-related payouts will reach more than $2 billion by 2016. Among the different branches of the military, Army veterans report the highest rate of hearing loss, with 50% of Army veterans reporting some hearing loss by the age of fifty, followed by Air Force veterans (42%) and Navy veterans (37%). To put that into perspective, only a few professions rank higher than the military for hearing loss, including construction and mining at 60% each.

Few people realize that the history of hearing loss in the military can be traced to the early 1940s. During this era, the U.S. Army concluded that military members who were regularly exposed to government should be provided with protective earplugs as part of their standard kit; however, their use was not required, and in fact, wearing protective ear coverings and ear plugs was seen as a sign of weakness.

In the 1960s, the army devoted more time and resources to studying hearing damage in the military. Their research found that 50-60% of situational awareness is based on a person’s hearing. Their findings were particularly useful for the military because they discovered that with good hearing, it takes a soldier approximately 40 seconds to identify a target, while a soldier with bad hearing will take approximately 90 seconds.

Of the specific causes of hearing damage in the military, roughly seven out of ten cases of hearing loss and/or tinnitus are caused by blasts, while roadside bombs result in half of the veterans involved getting some form of hearing damage. While relatively quiet military equipment exists (such as an Abrams tank or a Kiowa helicopter), the vast majority of military equipment is equal to commonly loud noises we hear in everyday life. For example, a rock concert typically measures 130 decibels, and an M9 handgun measures 157 decibels. An m3 recoilless rifle, meanwhile, can measure as much as 190 decibels.

However, it isn’t just military arms that cause hearing damage; in fact, sustained exposure to loud noises can cause hearing damage as well. For example, a 2.5 ton truck idling at 85 decibels is loud enough to cause permanent damage after only an eight hour work day. Also, military vehicles tend to be much louder than civilian vehicles, meaning that the risk of hearing loss is far more extensive to those who are constantly around these vehicles than to military members just in combat operations.

Since 2010, the Department of Veteran Affairs has required a hearing examination for veterans based on their Military Occupational Specialty. The hearing aid experts at MDHearingAid recommend that veterans schedule an appointment with an audiologist to determine if they have hearing loss caused by their military service. Since damage to your ear’s hair cells can’t be undone, it’s also recommended that veterans take preventative measures during their civilian activities, such as using ear plugs while mowing the lawn.

At this time, nothing can be done to replace hair cells in humans. Damaged hair cells must be compensated for with the use of hearing aids or cochlear implants. While it might be tempting to do nothing about your hearing loss, hearing loss can lead to social isolation and limited career opportunities for veterans struggling to reintegrate into society. Schedule a hearing appointment with an audiologist today to learn if you’re suffering from hearing loss related to your time in the military.