M21-1MR, Part III, Subpart iv, Chapter 4, Section B
Section B. Conditions of the Organs of Special Sense
Overview
In this Section |
This section contains the following topics: |
Topic | Topic Name | See Page |
10 | General Information About Eye Conditions | 4-B-2 |
11 | Specific Eye Conditions | 4-B-6 |
12 | Hearing Impairment | 4-B-10 |
13 | Exhibit 1: Examples of Rating Decisions for Diplopia | 4-B-22 |
12. Hearing Impairment
Introduction |
This topic contains information about hearing impairment, including
|
Change Date |
June 5, 2012 |
a. Determining Impaired Hearing as a Disability |
Per 38 CFR 3.385, impaired hearing is considered a disability for VA purposes when
Notes:
|
Continued on next page
12. Hearing Impairment, Continued
a. Determining Impaired Hearing as a Disability (continued) |
– Audiometry results from before 1969 may have been in American Standards Association (ASA) units. – Current testing will be to standards set by the International Standards Organization (ISO) /American National Standards Institute (ANSI). – Test results should indicate the standard for the audiometry.
Important: If you have older results that are in ASA units or the results date to a time when a ASA units may have been used, and you cannot determine what standard was used to obtain the readings, an audiologist opinion will be needed to interpret the results and convert any ASA test results to ISO/ANSI units.
Reference: For more information on:
|
Continued on next page
12. Hearing Impairment, Continued
b. Reviewing Claims for Hearing Loss and/or Tinnitus |
Review each claim for hearing loss and/or tinnitus for
– hearing loss and/or tinnitus in service, or – an in-service event, injury, disease, or symptoms of a disease potentially related to an audiological disability.
If there is no documented evidence of an in-service disease, injury, or event with which the claimed condition could be associated, consider the Duty Military Occupational Specialty (MOS) Noise Exposure Listing to help determine the probability of the Veteran’s exposure to hazardous noise in service.
Veterans are not expected to be medical experts; therefore, claims must be read sympathetically. A common example of sympathetically reading claims is when a Veteran files a claim for hearing loss and tinnitus is diagnosed at the examination. If the examiner states that tinnitus is related to noise exposure during the Veteran’s military service or hearing loss of the same etiology, the date of claim (for purposes of determining the effective date) will be the same as the date of claim for the hearing loss, if service connection is otherwise warranted.
Note: If tinnitus is not specifically claimed, do not address tinnitus in the rating decision unless service connection can be granted.
Reference: For more information on considering the Duty MOS Noise Exposure Listing, see M21-1MR, Part III, Subpart iv, 4.B.12.c. |
Continued on next page
12. Hearing Impairment, Continued
c. Considering the Duty MOS Noise Exposure Listing |
The Duty MOS Noise Exposure Listing, which has been reviewed and endorsed by each branch of service, is available at http://vbaw.vba.va.gov/bl/21/rating/docs/dutymosnoise.xls
Based on the Veteran’s records, review each duty MOS, Air Force Specialty Code, rating, or duty assignment documented on the Duty MOS Noise Exposure Listing to determine the probability of exposure to hazardous noise.
If the duty position is shown to have a “Highly Probable” or “Moderate” probability of hazardous noise exposure, concede exposure to hazardous noise for the purposes of establishing the in-service event.
Note: The Duty MOS Noise Exposure Listing is not an exclusive means of establishing a Veteran’s in-service noise exposure. Evaluate claims for service connection for hearing loss in light of the circumstances of the Veteran’s service and all available evidence, including treatment records and examination results.
Reference: For more information on considering the circumstances of the Veteran’s service, see 38 U.S.C. 1154(a) and (b). |
Continued on next page
12. Hearing Impairment, Continued
d. Requesting Audiometric Examinations and Medical Opinions |
Request an audiometric examination whenever
– hearing loss in service, or – an event, injury, disease, or symptoms in service of a disease potentially related to an audiological disability, or
If there is sufficient evidence of a current disability, request a medical opinion with the audiometric examination to determine the relationship between current audiological disability and
Notes:
|
Continued on next page
12. Hearing Impairment, Continued
e. Requesting Medical Opinions to Determine Causation of Tinnitus |
A medical opinion regarding possible causation of tinnitus is not required to establish service connection if
– claims service connection for tinnitus, and – has current complaints of tinnitus. |
If … | Then … |
|
ask the audiologist to offer an opinion, if it is within the scope of his/her practice, about an association of tinnitus to
|
Note: Only ask the audiologist to offer an opinion about the association to hearing loss if hearing loss is also specifically claimed. |
Continued on next page
12. Hearing Impairment, Continued
f. Considering Medical Opinions in Cases Involving Tinnitus |
Use the table below when considering an examiner’s medical opinion in a case involving tinnitus. |
If … | Then … |
the examiner states tinnitus is a symptom of hearing loss |
Note: If the hearing loss is service connected, and the tinnitus is a symptom of the hearing loss, we concede that the hearing loss and tinnitus result from the same etiology. Therefore, service connection is warranted for tinnitus on a direct basis in these cases. |
– states tinnitus is not related to hearing loss, or – is unable to determine the etiology within reasonable certainty, or
|
determine, based on all the evidence of record, whether or not the etiology of tinnitus requires further assessment by one of more additional examinations.
Note: The type and need for any additional examination(s) will depend on the Veteran’s claim as to the cause of tinnitus. Examples:
– a general medical, ears/nose/throat (ENT), or other examination, and – an opinion as to the causation of tinnitus. |
Continued on next page
12. Hearing Impairment, Continued
f. Considering Medical Opinions in Cases Involving Tinnitus (continued) |
If … | Then … | ||||||||
the examiner states that tinnitus is related to noise exposure or an event, injury, or illness in service |
|
References: For more information on
– M21-1MR, Part III, Subpart iv, 5.9.b – Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), and – Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir. 2007).
– M21-1MR, Part III, Subpart iv, 5.12 – Coburn v. Nicholson, 19 Vet. App. 427 (2006) – Kowalski v. Nicholson, 19 Vet.App. 171 (2005), and – Reonal v. Brown, 5 Vet. App. 548 (1993). |
Continued on next page
12. Hearing Impairment, Continued
g. Handling Changed Criteria or Testing Methods |
If a decrease in evaluation is due to changed criteria or testing methods, rather than a change in hearing impairment, apply the old criteria and make no reduction.
Reference: For more information on handling changed criteria or testing methods, see 38 CFR 3.951. |
h. Applying Revised Hearing Loss Tables |
Veterans Health Administration (VHA) ceased converting audiology examinations to American Standards Association (ASA) standards after December 31, 1975.
Use the table below to apply revised hearing loss tables to claims of hearing loss. |
If the examination results are dated … | Then apply … |
before January 1, 1976 | the rating tables in effect prior to September 9, 1975. |
from January 1, 1976, through December 17, 1987 | evaluation tables VI and VII.
Note: The evaluations used ISO/ANSI, W-22 word discrimination and speech reception threshold standards exclusively. |
after December 18, 1987 | evaluation tables VI and VIa.
Note: Examiners use the speech discrimination or recognition ability of Maryland CNC with the results of the puretone auditory test. |
i. Reviewing for Functional Disturbances |
If, following an examination at an audiology clinic, a drastic reduction in rating for a hearing impairment is in order, thoroughly review the claims folder for evidence of a psychiatric disease entity, which might be manifested in part by a nonorganic hearing impairment. |
Continued on next page
12. Hearing Impairment, Continued
j. Granting Service Connection for Functional Hearing Impairment |
Determine entitlement to service connection for a psychiatric disability, manifested in part by a hearing impairment, by the usual regulations pertaining to the grant of service connection.
It is anticipated the psychiatric disorder will be identifiable by manifestations other than those relating to hearing complaints alone. Base the rating either on the organic hearing loss or the psychiatric disorder, but not both in combination.
Reference: For more information on evaluating psychiatric disorders, see 38 CFR 4.126. |
k. Considering Service Connection for Development of Subsequent Ear Infection |
If the disease of one ear, such as chronic catarrhal otitis media or otosclerosis, is held as the result of service, the subsequent development of similar pathology in the other ear must be held due to the same cause if
Note: If there is continuous SC infection of the upper respiratory tract, the time cited for the purpose of service connecting infection of the second ear should be extended indefinitely. |
l. Determining the Need for Reexamination |
Use the table below to determine whether reexamination is necessary.
Note: A single examination is often sufficient to meet the qualifying conditions of permanence under 38 CFR 3.327. |
If … | Then … |
the extent of hearing loss in an individual claim has been satisfactorily established by an examination | do not routinely schedule reexamination. |
Continued on next page
12. Hearing Impairment, Continued
l. Determining the Need for Reexamination (continued) |
If … | Then … |
the Veteran has hearing loss evaluated 100 percent under diagnostic code 6100 with a numeric designation of XI & XI |
Note: If hearing loss is functional, such as psychogenic, schedule at least one future examination to ensure that permanency is established before granting SMC. |
there is evidence that the hearing loss is likely to improve materially in the future |
|
the Veteran has had middle ear surgery |
|
m. Compensation Payable for Paired Organs Under 38 CFR 3.383 |
Even if only one ear is SC, compensation may be payable under 38 CFR 3.383 for the other ear, as if SC, if the Veteran’s hearing impairment
Reference: For more information on compensation payable for paired SC and non-SC organs, see |
Continued on next page
12. Hearing Impairment, Continued
n. Using the Hearing Loss Calculator |
The hearing loss calculator on the Compensation Service Intranet Rating Job Aids page generates stand-alone paragraphs for use in the Reasons for Decision section of the rating decision narrative. The calculator determines the appropriate diagnostic code, evaluation, and narrative based on data input by the decision maker.
Important: print the calculator worksheet and file it in the center of the claims folder or, for paperless claims, scan the worksheet into VirtualVA.
Reference: For more information on the hearing loss calculator, see the user’s guide. |