RATING HEARING LOSS AND TINNITUS

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RATING HEARING LOSS AND TINNITUS

• Sandra Covin
• TVC-Waco

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OBJECTIVE

• Demonstrate a general understanding of how
  hearing loss and tinnitus is rated by the
  Department of Veterans Affairs

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Rating Hearing Loss and Tinnitus

• Define hearing loss
• Understanding the hearing evaluation process
• How VA rates hearing impairment
• Explain the numeric tables of VI, VIA and VII
• Define tinnitus
• Causes of tinnitus
• Practice rating hearing loss

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REFERENCES

• 38 CFR 3.350, 3.383, and 3.385
• 38 CFR 4.85 thru 4.87b
• M21-1MR, III.iv.4.B.12
• Merck Manual

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What is Hearing Loss?

• Deafness is the complete or partial loss of the
  ability to hear.
• It may range from the inability to hear sounds
  of a certain pitch or intensity to a complete
  loss of hearing.

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Hearing Evaluation Process

• The 1945 Schedule used the voice testing to test
  for ability to hear conversation from 1 to 20
  feet.
• SMRs evaluated hearing using a whisper test with
  15/15 representing normal hearing.
• This practice continued into the 1970s although
  audiometric examinations were more common in the
  1960s.

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Hearing Evaluation Process

• Auditory threshold in any of the frequencies 500,
  1000, 2000, 3000 or 4000 Hz is 40 decibels or
  greater, or
• Auditory thresholds in any three are 26 decibels
  or greater, or
• Speech recognition scores using Maryland CNC Test
  are less than 94 percent.

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Hearing Evaluation Process

• Prior to January 1, 1976
• Audiology examinations were converted to ASA
  (American Standards Association) standards.
• Consequently
• ASA standards were applied to all ratings in
  effect prior to 9/9/75 in examination results
  dated before 1/1/76.
• From 1/1/76 to 12/17/87 ISO/ANSI (W-22 word
  discrimination and speech reception threshold)
  were used exclusively.

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Hearing Evaluation Process

• From 12/18/87 The evaluation of hearing
  impairment uses
• Speech discrimination (recognition) ability
  (Maryland CNC) along with
• Results of puretone audiometry tests and
• The evaluation tables VI and VIA (contained in
  38 CFR 4.85)

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RATING HEARING IMPAIRMENT

• In order to properly rate disabilities involving
  the ear the VA will need to know
• The degree of impairment in hearing acuity and
  whether or not there are other complications
  present .
• Must disregard differences in living habits.
• Handicap due to hearing loss is the result of
  amount of loss expressed in decibels.

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RATING HEARING IMPAIRMENT (cont.)

• When the evidence demonstrates that due to
  service one of the requirements as set forth in
  38 CFR 3.385 are met, service-connection will be
  established.
• Service connection cannot be established for
  hearing loss unless there is an in service event
  and/or nexus which would warrant a grant of
  service connection.
• Consider all of the evidence, as results from
  Audiology exams can vary.

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RATING HEARING IMPAIRMENT (cont.)

• Isolated instances of hearing loss may not be
  sufficient to grant service connection.
• Also, the lack of current evidence showing
  impairment may not preclude a grant a service
  connection if shown by other evidence. A review
  of all evidence is crucial.

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HEARING TESTS Qualitative vs. Quantitative

• Qualitative tests are used to classify auditory
  responses into general categories and DO NOT
  precisely measure amount of impairment.
• EXAMPLE
• Tuning fork test

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HEARING TESTS Qualitative vs. Quantitative

• Quantitative tests are designed to yield
  numerical information which indicates the
  magnitude of auditory defect.

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HEARING TESTS Qualitative vs. Quantitative

• The most widely used quantitative tests are the
  Puretone Audiometry and Speech Audiometry.
• Puretone Audiometry measures the ability of the
  human ear to perceive individual tones at minimal
  intensities.
• Speech Audiometry measures the ability of the
  human ear to understand speech at minimal
  intensity levels.

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HEARING TESTS Qualitative vs. Quantitative

• The minimum level is called the threshold of
  hearing and defined as the faintest intensity of
  discrete frequencies or speech that the ear can
  hear with accuracy.

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EVALUATION OF HEARING IMPAIRMENT (38 CFR 4.85)

• An examination for hearing impairment for VA
  purposes must be conducted by
• A state-licensed audiologist and must include a
  controlled speech discrimination test (Maryland
  CNC) and a puretone audiometry test.
• Examinations will be conducted without the use of
  hearing aids.

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PAIRED ORGANS38 CFR 3.383

• If one ear is service connected and one ear is
  not service connected
• Prior to December 6, 2002, the non-service
  connected ear was considered normal unless the
  claimant was totally deaf in BOTH ears.

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PAIRED ORGANS38 CFR 3.383

• However, effective December 6, 2002, the
  non-service connected ear will be considered
  service connected, if the hearing loss in that
  ear meets the definition of hearing loss as
  defined by 38 CFR 3.385, and the service
  connected ear hearing loss is evaluated 10 or
  more.

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Understanding the Numeric Tables

• Use of Table VI
• Use of Table VIA
• What is the puretone threshold average?
• Use of Table VII
• What to do when only one ear is service connected?

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Understanding the Numeric Tables

• Table VI Numeric Designation of Hearing
  Impairment Based Only on Puretone Threshold
  Average and Speech Discrimination

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Table VI Numeric designation of hearing
impairment based on pure tone threshold average
and speech discrimination.
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Understanding the Numeric Tables

• Table VIA Numeric Designation of Hearing
  Impairment Based only in Puretone Threshold
  Average

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Table VIA Numeric designation of hearing
impairment based only on puretone threshold
average Puretone Threshold Average
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Understanding the Numeric Tables

• Puretone threshold average as used in table VI
  and VIA is the sum of the puretone thresholds at
  1000, 2000, 3000, and 4000 Hertz, divided by
  four.
• This average is used in all cases (including
  4.86) to determine the Roman numeral designation
  for hearing impairment from Table VI and VIA.

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Understanding the Numeric Tables

• Table VII Percentage Evaluations for Hearing
  Impairment

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Table VII Percentage evaluation for hearing
impairment
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Understanding the Numeric Tables

• What happens when only one ear is service
  connected?
• In order to determine the percentage evaluation
  from Table VII the NSC ear will be assigned a
  Roman numeral designation for hearing impairment
  of I.

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TINNITUS

• What is tinnitus?
• A perception of sound in the absence of an
  acoustic stimulus.
• Maybe a buzzing, ringing, roaring, whistling, or
  hissing sound.

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Tinnitus

• It is subjective.
• An examiner cannot hear it.
• It may be intermittent, continuous, pulsate.
• An associated hearing loss is usually present.
• It maybe noise or drug induced.

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Tinnitus

• If tinnitus is first shown many years after
  service and the veteran has a high frequency
  hearing loss related to service, it is unlikely
  but not impossible that there is a relationship
  between the disabilities.

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Tinnitus

• A single evaluation for recurrent tinnitus,
  whether the sound is perceived in one ear, both
  ears or in the head is assigned. (Fed. Cir.
  05-7268, dated June 19, 2006, Smith v. Nicholson)
  overruled the Veterans Court decision that a
  separate compensable evaluation could be assigned
  for bilateral tinnitus.

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QUESTIONS???
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Review exercise
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Table VI Numeric designation of hearing
impairment based on pure tone threshold average
and speech discrimination.
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Table VIA Numeric designation of hearing
impairment based only on puretone threshold
average Puretone Threshold Average
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Table VII Percentage evaluation for hearing
impairment
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THANK YOU