Claim For Hearing Loss & Tinnitus

[georgiapapa]

Hi,

I served with a U.S. Marine Corps artillery unit in Viet Nam in 1967 and 1968 and was exposed to the daily firing of 105 and 155 howitzers. We were not provided with hearing protection when firing the howitzers. I was also exposed to the noise of exploding mortars when we received incoming fire. During my stateside tour of duty with the Marine Corps from 1966 to 1970, I was exposed to all types of weapons firing as are most Marines. When I was discharged from the Marine Corps, I was not given a hearing test as part of my exit physical. I knew shortly after my discharge from the Marine Corps that I had tinnitus and a hearing loss but I did not file a claim with the VA at that time because I was trying to get a job in law enforcement and I was worried this could keep me from getting the job.

I was employed with the U.S. Marshals Service from 1978 until my retirement in 2004. Fortunately when I was hired by the Marshals Service, I never received any type of stringent hearing tests. During my career with the U.S. Marshals, I never fired my weapon in the line of duty. However, we did qualify with our weapons once or twice a year. We always wore hearing protection during weapons qualifying.

In June 1981 I went to a local hearing doctor and had my hearing tested because my hearing was getting worse and tinnitus was driving me crazy. The doctor tested my hearing which showed I had a bilateral high frequency hearing loss which he said was noise induced. In his report, he noted my exposure to artillery fire in the Marine Corps. He also diagnosed me with tinnitus. The doctor suggested I use a white noise device to mask the tinnitus noise when sleeping. I purchased the device and have been using it ever since. The doctor I went to in 1981 has since died but I have a copy of his report and the audiologist who performed the hearing test is now a doctor and has started her own practice. My hearing has gotten worse over the years so I plan to make an appointment with the same audiologist to get a current report of my hearing. Since she will be aware of my earlier hearing test, I am hoping she will give me an IMO report stating my hearing loss and tinnitus were more than likely caused by my exposure to artillery and mortar fire in Vietnam.

Since so much time has passed and since I was employed with a law enforcement agency for a long period of time, I am concerned the VA will claim my hearing problems were caused by my age or my exposure to gun fire with the U.S. Marshals.

I have a photo of me firing a 105 howitzer in Vietnam. In the photo I was not wearing hearing protection. I also have a receipt from 1983 showing the purchase of one of my white noise devices used for masking tinnitus. My DD-214 and my other military records show my service in Vietnam and my assignment to an artillery unit and my MOS as a Field Artillery Batteryman.

I would like any input from other hadit members as to whether they think I would be successful in filing a claim for hearing loss and tinnitus at this late date and and with the knowledge I had worked for over 25 years in civilian law enforcement. I am currently receiving 10% VA disability for a shoulder injury I received in Vietnam in 1968 and I am in the process of filing a claim for Multiple Myeloma due to exposure to Agent Orange. Any input or suggestions would be appreciated.

Thanks...

[carlie]

1) However, last year I went to my local VA outpatient center and asked about hearing aids and was told I could not get them unless my disability was for hearing loss.

I am wondering if I was given bad info at the VA outpatient center.

2) Would I be eligible for an audiological exam and hearing aids prior to my claim being rated for my hearing loss and tinnitus?

georgia,

1) You were provided with incorrect information.

2) Yes

Here's all you need - just print it out and take it to your VAMC medical provider and ask them to put

in a consult for you to Audiology.

It's the same for an eye exam and a set of RX eyewear.

Department of Veterans Affairs VHA DIRECTIVE 2008-070 Veterans Health Administration

Washington, DC 20420 PRESCRIBING HEARING AIDS AND EYEGLASSES

October 28, 2008

1. PURPOSE: This Veterans Health Administration (VHA) Directive provides policy for uniform criteria necessary for prescribing hearing aids and eyeglasses (sensori-neural aids) to veteran patients.

2. BACKGROUND: Public Law 104-262, the Veterans Health Care Eligibility Reform Act of 1996, changed eligibility laws to allow VHA to furnish prosthetic appliances to veterans. However, that law further provided that VHA could not furnish sensori-neural aids (hearing aids and eyeglasses) except in accordance with guidelines that the Department of Veterans Affairs (VA) prescribes. Subsequently, the Department published regulations (Title 38 Code of Federal Regulations (CFR), §17.149) in the Federal Register establishing such guidelines. In 2002, VHA issued Directive 2002-039 to establish uniform policy for the provision of hearing aids and eyeglasses.

3. POLICY: It is VHA policy that all enrolled veterans and those veterans exempt from enrollment are eligible for medical services that include diagnostic audiology and diagnostic and preventive eye care services, and that the prescription and provision of hearing aids and eyeglasses must be furnished to all eligible veterans in accordance with the parameters and criteria defined in this Directive.

4. ACTION

a. Veterans Integrated Service Network (VISN) Director. The VISN Director is responsible for ensuring that VISN and facility policies on eligibility for and access to diagnostic audiology, diagnostic and preventive eye care services, and the provision of hearing aids and eyeglasses comply with provisions of this Directive.

b. Facility Director. The facility Director is responsible for:

(1) Ensuring access to audiology and eye care services including preventive health (care) services and routine vision testing for all enrolled veterans and those veterans exempt from enrollment.

Eyeglasses and hearing aids must be provided to the following veterans:

(a) Those with any compensable service-connected disability.

(b) Those who are former Prisoners of War (POWs).

© Those who were awarded a Purple Heart.

(d) Those in receipt of benefits under Title 38 United States Code (U.S.C.) 1151.

THIS VHA DIRECTIVE EXPIRES OCTOBER 31, 2013

VHA DIRECTIVE 2008-070 October 28, 2008

(e) Those in receipt of an increased pension based on being permanently housebound and in need of regular aid and attendance.

(f) Those with vision or hearing impairment resulting from diseases or the existence of another medical condition for which the veteran is receiving care or services from VHA, or which resulted from treatment of that medical condition, e.g., stroke, polytrauma, traumatic brain injury, diabetes, multiple sclerosis, vascular disease, geriatric chronic illnesses, toxicity from drugs, ocular photosensitivity from drugs, cataract surgery, and/or other surgeries performed on the eye, ear, or brain resulting in vision or hearing impairment.

(g) Those with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living.

(h) Those who have vision and/or hearing impairment severe enough that it interferes with their ability to participate actively in their own medical treatment and to reduce the impact of dual sensory impairment (combined hearing and vision loss). NOTE: The term “severe” is to be interpreted as a vision and/or hearing loss that interferes with or restricts access to, involvement in, or active participation in health care services (e.g., communication or reading medication labels). The term is not to be interpreted to mean that a severe hearing or vision loss must exist to be eligible for hearing aids or eyeglasses.

(i) Those veterans who have service-connected vision disabilities rated zero percent or service-connected hearing disabilities rated zero percent if there is organic conductive, mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in the low, mid, or high- frequency range or a combination of frequency ranges which contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service- connected hearing disability.

(2) Ensuring that hearing aids are provided in accordance with the following policies:

(a) Hearing aids must be issued only to eligible veterans who are otherwise receiving VA care or services in accordance with 38 CFR §17.149 and this Directive.

(b) Veterans meeting the eligibility requirements to receive health care are eligible for diagnostic audiology services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans must not be denied access to audiology services covered by the Medical Benefits Package (38 CFR §17.38) because they do not meet the eligibility criteria for hearing aids.

© Audiologists must utilize the Remote Order Entry System (ROES) to review and request eligibility for hearing aids; by requesting the hearing aid in ROES, the audiologist stipulates that medical need exists based on the evaluation. Veterans in Priority Groups 1-5 are eligible for hearing aids.

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VHA DIRECTIVE 2008-070 October 28, 2008

(d) Non-service connected (NSC) veterans (Priority Groups 6, 7, and 8) must receive a hearing aid evaluation (HAE) prior to determining eligibility for hearing aids to establish medical justification for provision of these devices.

These veterans must meet the following criteria for eligibility based on medical need:

1. Be enrolled or exempt from enrollment and receiving a vested level of care from a VA medical facility; and

2. Have hearing loss that interferes with or restricts communication to the extent that it affects their active participation in the provision of health care services as determined by the audiologist (see paragraph 4.c).

(e) Prosthetics must approve the ROES request when medical need is established. The cost of hearing aids is not a basis for denying these devices.

(f) In those instances where the veteran presents to the audiology clinic with a hearing aid provided from a non-VA source, the audiologist determines the effectiveness of the device in meeting the veteran’s rehabilitative needs. If the device is sufficient for the veteran’s needs, no device will be prescribed, but the audiologist may register the hearing aids through ROES for battery and repair services. If the device is not sufficient for the veteran’s needs, the audiologist must apply the replacement provisions detailed in this Directive (see subpar. 4c(4)).

(3) Ensuring that eyeglasses are provided in accordance with the following policies:

(a) Eyeglasses are issued only to eligible veterans who are otherwise receiving VA care or services in accordance with 38 CFR §17.149 and this Directive.

(b) In accordance with 38 U.S.C .§1701 and enabling regulations (38 CFR §17.38), all enrolled veterans or those exempt from enrollment are entitled to optometric and ophthalmologic services as well as preventive health (care) services that include routine vision testing and eye care services.

© Veterans meeting the eligibility requirements to receive health care are eligible for eye care services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans must not be denied access to eye and vision care services covered under the Medical Benefits Package (38 CFR §17.38) because they do not meet the eligibility criteria for eyeglasses. Veterans in Priority Groups 1-5 are eligible for eyeglasses.

(d) NSC veterans (Priority Groups 6, 7, and 8) must receive an appropriate evaluation by an optometrist or ophthalmologist, prior to determining eligibility for eyeglasses, to establish medical justification for provision of these devices. In those instances where the veteran presents to the eye clinic with eyeglasses provided from a VA or non-VA source, the eye care practitioner or provider determines the effectiveness of the device in meeting the veteran’s

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VHA DIRECTIVE 2008-070 October 28, 2008

rehabilitative needs. If the device is sufficient for the veteran’s needs, no device will be prescribed. If the device is not sufficient for the veteran’s needs, the eye care practitioner or

provider will apply the replacement provisions detailed in this Directive. These veterans must meet the following criteria for eligibility based on medical need:

1. Be enrolled or exempt from enrollment and receiving a vested level of care from a VA medical facility; and

2. Have vision loss that interferes with or restricts communication, quality of life or activities of daily living to the extent that it affects their active participation in the provision of health care services as determined by the eye care practitioner or provider (see subpar. 4d).

(4) Replacing hearing aids and eyeglasses in accordance with VHA Handbooks 1173.7 and 1173.12, to include: NOTE: Hearing aids or eyeglasses are not to be replaced solely for cosmetic purposes.

(a) Hearing aids or eyeglasses are to be replaced when the device proves to be ineffective, irreparable, or the veteran’s medical condition has changed and a different device is needed.

(b) Hearing aids or eyeglasses are to be replaced if the device was destroyed or lost due to circumstances beyond the control of the veteran.

© Hearing aids or eyeglasses are not to be replaced because of availability of newer technology, unless there is evidence that the replacement will significantly benefit the veteran.

(d) For hearing aids, replacement may be based on age of the device, whether they are beyond economical repair, technical performance is reduced, parts or accessories are unavailable, or the device is no longer sufficient for the veteran’s communication needs.

(e) Replacement hearing aids can be prescribed at any time that change of amplification characteristics are required to maintain or improve communication function. Hearing aids have an expected life span of 3 to 4 years depending on the model of the instrument, daily hours of use, wear and tear, frequency of repair and maintenance, ear conditions, and user lifestyle.

(f) For eyeglasses, replacement of corrective eyeglasses necessitated by fair wear and tear, loss, or breakage due to circumstances beyond the control of the veteran, or due to required change of prescription, may be made at any time.

1. When replacement eyeglasses are prescribed because of a change in distance and/or near refractive error, the change must require at least a change in sphere, cylinder and/or axis specified below; or

Sphere power of + or - .25 diopter Cylinder power of + or - .50 diopter Axis change of + or - .25 to .75 diopters 5 degrees

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VHA DIRECTIVE 2008-070 October 28, 2008

+ or - 1.00 to 2.00 diopters 3 degrees + or - 2.25 diopters or more 2 degrees

NOTE: Appropriate prescriptions and resultant sphere, cylinder and/or axis changes must be determined by the examining optometrist or ophthalmologist. Replacement eyeglasses are procured and issued in the same manner as the initial prescription when the criteria are met.

2. Replacement eyeglasses can be prescribed at any time due to required refractive change of prescription to improve one line of visual acuity.

3. If one or both lenses are broken and there is any indication that the veteran’s vision has changed, or if it has been more than 1 year since the veteran’s eyes were last examined, the veteran is to be referred to an optometrist or ophthalmologist before replacement eyeglasses are ordered.

(5) Issuing spares or second pairs only as determined by the audiologist or eye care practitioner or provider (optometrist or ophthalmologist) in accordance with VHA Handbooks 1173.7 and 1173.12. NOTE: When providing spare or a second pair of eyeglasses from any existing prescription, the prescription must be current and appropriate for the visual needs of the veteran. Two pairs of single vision eyeglasses, one for reading and one for distance, are to be provided in cases where bifocal lenses are contraindicated.

c. Audiologist. The audiologist is responsible for applying all the following in prescribing hearing aids:

(1) To mitigate the impact of hearing impairment on quality of life and participation, the following degree of impairment is considered disabling and establishes the basis for consideration of hearing aid candidacy, subject to evaluation by an audiologist: hearing thresholds 40 decibels (dB) HL or greater at 500, 1000, 2000, 3000, or 4000 hertz (Hz); or hearing thresholds 26 dB HL or greater at three of these frequencies; or speech recognition less than 94 percent (38 CFR §3.385). This degree of impairment is disabling is considered justification for hearing aids.

(2) When determining candidacy for amplification, audiologists must consider the effect of impairment (i.e., activity and participation) using well-established, patient-centered clinical practices. It is the effect of impairment, specifically participation restrictions (e.g., access to health care), that is the justification for eligibility based on medical need. In making decisions about candidacy for amplification, audiologists must apply evidence-based clinical practices guidelines and recommendations including, but not limited to:

(a) Audiology Clinical Practice Algorithms and Statements. Joint Committee on Clinical Practice Algorithms and Statements. Statement 3 and Algorithm 3. Joint Audiology Committee Statements on Hearing Aid Selection and Fitting (Audiology Today, Special Issue, August 2000). See http://www.audiology.org/NR/rdonlyres/0BFA4442-81FA-4D06-A60A- C56DF888BAD3/0/ClinicalPracticeAlgorithms.pdf.

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VHA DIRECTIVE 2008-070 October 28, 2008

(b) Guidelines for the Audiologic Management of Adult Hearing Impairment, American Academy of Audiology. See http://www.audiology.org/NR/rdonlyres/5DE475B4-58F3-40A7- 934E-584AC11EABE9/0/haguidelines.pdf.

© Joint Audiology Committee on Clinical Practice. (1999). Clinical practice statements and algorithms. Rockville, MD: American Speech-Language-Hearing Association. See http://www.asha.org/NR/rdonlyres/5CC8E228-AF53-40A2-91CE 9D9124FDA8B5/0/18871_1.pdf.

d. Eye Care Practitioner or Provider. Since visual disorders requiring eyeglasses are so varied and complex that in some cases, a combination of acuity level and clinical practice guidelines does not address all possible prescribing indications, the eye care practitioner or provider, an optometrist or ophthalmologist, is responsible for applying all the following in prescribing eyeglasses:

(1) Visual Acuity and Visual Field. To mitigate the impact of vision impairment on quality of life and activities of daily living, eyeglasses must be provided to veterans who meet the following minimum criteria:

(a) 20/50 visual acuity or worse uncorrected refractive error at distance or near while using both eyes. NOTE: For the purposes of this Directive, 20/50 visual acuity or 40 degree average visual field radius corresponds to the 80th percentile of function and is considered justification for eyeglasses.

(b) Average visual field radius of 40 degrees or less when assessed monocularly conducted using Goldmann’s equivalent III/4e (e.g., altitudinal field loss; homonymous hemianopsia; generalized constriction or other significant visual field defects from eye and/or brain injuries, diseases or disorders, etc.) to ensure proper orientation and safe ambulation in the environment.

(2) Literature-based Clinical Practice Guidelines and Recommendations. Literature- based Clinical Practice Guidelines and Recommendations for optometrists and ophthalmologists. These include, but are not limited to:

(a) Optometric Clinical Practice Guidelines, American Optometric Association. See http://www.aoa.org/x4813.xml .

(b) Optometric Clinical Practice Recommendations, American Optometric Association. See http://www.aoa.org/x5495.xml .

© Preferred Practice Patterns, American Academy of Ophthalmology. See http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.'>http://one.aao.org/CE/PracticeGuidelines/PPP.aspx.

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VHA DIRECTIVE 2008-070 October 28, 2008

(3) Special Circumstances. Special circumstances for prescription eyeglasses are evaluated on an as-needed basis subject to review by the Section or Service Chief of Optometry or Ophthalmology, or other designated official, as appropriate. Not withstanding the visual acuity

and visual field criteria in this Directive, the eye care practitioner or provider must prescribe eyeglasses in the following special circumstances:

(a) Ophthalmic prescriptions are filled for veterans receiving medical care when determined medically necessary for the veteran’s care by an optometrist or ophthalmologist.

(b) Special eyeglasses or frames required for cosmetic facial restorations may be procured upon the recommendation and approval of an optometrist or ophthalmologist. In such cases, corrective lenses are authorized for any refractive error present.

© Veterans with a service-connected disability for the loss of vision in an eye (or the enucleation or evisceration of one eye) are eligible for eyeglasses for defective vision in the remaining eye or to protect the vision in the remaining eye (safety eyeglasses or polycarbonate lenses, as appropriate).

(d) Prescriptions by optometrists or ophthalmologists of safety eyeglasses or polycarbonate lenses and/or eyeglasses with photochromic or tinted lenses are filled for veterans who are monocular, and those with post-cataract surgery, chronic uveitis, severe corneal disease, clinically-significant macular degeneration, clinically-significant cataract, ocular toxicity from drugs, ocular photosensitivity from drugs, significant visual field loss, significant amblyopia or visual acuity loss in the fellow eye (worse than 20/40 correctable visual acuity by conventional spectacle lenses), traumatic brain injury, photophobia, and/or retinal or other medical eye conditions, as appropriate.

(e) The need for photochromic or tinted lenses must be documented by an optometrist or ophthalmologist; this need may include the need for ocular protection from undesirable incident radiations, such as ultra violet radiation, etc. Tinted lenses will not be provided solely for comfort;

(f) Progressive addition lenses may be procured for eligible veterans when prescribed by an optometrist or ophthalmologist.

(g) Eligible veterans may be furnished an initial pair of corrective eyeglasses when prescribed by an optometrist or ophthalmologist. Two pairs of single-vision eyeglasses, one for reading and one for distance, will be provided if prescribed by an optometrist or ophthalmologist in cases where bifocal lenses are contraindicated. Post-surgical aphakic cataract patients may also be provided two pairs of eyeglasses (in addition to contact lenses): a pair of cataract eyeglasses (aspheric lenticular), and a pair of eyeglasses for use over contact lenses when prescribed by an optometrist or ophthalmologist.

(4) By request, the veteran may obtain a copy of the prescription from the examining optometrist or ophthalmologist.

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VHA DIRECTIVE 2008-070 October 28, 2008

5. REFERENCES

a. Title 38 CFR, Section 3.385, Determination of service-connection for impaired hearing. b. Title 38 CFR, Section 17.149, Sensorineural Aids. c. Title 38 CFR, Section 17.30, Definitions. d. Title 38 CFR, Section 17.38, Medical Benefits Package.

e. Guidelines for the Audiologic Management of Adult Hearing Impairment, American Academy of Audiology.

f. Optometric Clinical Practice Guidelines, American Optometric Association (http://www.aoa.org/x4813.xml).

g. Optometric Clinical Practice Recommendations, American Optometric Association (http://www.aoa.org/x5495.xml).

h. Preferred Practice Patterns, American Academy of Ophthalmology (http://one.aao.org/CE/PracticeGuidelines/PPP.aspx).

i. Title 38 U.S.C. Section 1701(6)(A). j. Title 38 U.S.C. Section 1701(6)(A)(i). k. Title 38 U.S.C. Section 1701(6)©. l. Title 38 U.S.C. Section 1701(9)(I). m. VHA Handbook 1173.1. n. VHA Handbook 1173.7. o. VHA Handbook 1173.12.

6. FOLLOW-UP RESPONSIBILITY: The Chief Consultant, Prosthetic and Sensory Aids Service (113), is responsible for the contents of this Directive. Questions may be addressed to 202-461-1800.

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VHA DIRECTIVE 2008-070 October 28, 2008

7. RESCISSIONS: VHA Directive 2002-039, Prescribing Hearing Aids and Eyeglasses, dated July 5, 2002, is rescinded.

This VHA Directive expires on October 31, 2013.

Michael J. Kussman, MD, MS, MACP Under Secretary for Health

DISTRIBUTION: CO: E-mailed 10/29/08 FLD: VISN, MA, DO, OC, OCRO, and 200 – E-mailed 10/29/08

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[packrat]

Amazing the things you learn here. Not only did I purchase my own aids but I have been purchasing my own glasses for 25 years. Pride and trust have a real cost.

[COOL BREEZE]

Amazing the things you learn here. Not only did I purchase my own aids but I have been purchasing my own glasses for 25 years. Pride and trust have a real cost.

Yes-there is a lot of good information here. Now get an appointment with your local VA to get your glasses and hearing aids. Their hearing aids are now digital, much better than the initial ones I had when I retired in 1996. And best of all, once you qualify for hearing aids, you will never have to pay for the batteries ever again! You can go on to E-benefits and reorder for free which is much quicker. Welcome back!!