Using Studies From Medical Association And Other Sources

[Mil T]

Hi.

I'm not sure if this is the best place to ask this but I'll start here and if it is necessary to move it, I'll let Admin do it.

I have a question regarding using various study's regarding certain disability's that can be used as medical evidence.

Case in point is using the following;

NOISE AND MILITARY SERVICE

Implications for Hearing Loss and Tinnitus

Committee on Noise-Induced Hearing Loss and Tinnitus Associated with Military Service from World War II to the Present

Medical Follow-up Agency

Larry E. Humes, Lois M. Joellenbeck, and Jane S. Durch, Editors

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, DC www.nap.edu

http://www.nap.edu/openbook.php?record_id=11443&page=R1

This study was ordered by congress and commissioned by the VA. There is a lot of good evidence to counter what sometimes are flakey reasons for denials on claims from the VA. Such as the comment that there is no evidence from your medical service records of tests showing complaints of a hearing loss or tinnitus during or immediatly after seperation.

The study clearly showed that there mostly were no entry or seperation Auditory exams to show this could have happened. In the Army, for instance that from WWII to 1970 only 4% military personel were given auditory exams upon entry or seperation from Service. This stat should be able to support the idea that the VA should not or cannot use the comments that they use to deny a nexus. The fact is that the miltitary never gave adequate exams. They relied on the whisper tests in those days and most of the time never gave those correctly. If you were given one of those then how can the VA deny based on what the law criteria says now that must use an Audio Test to show the disability levels for award of disability. I know most Vets I talk with and also my own experience, (Vietnam) were given one choise of that if you wanted to wait around for the test they would let you but most of us were getting dero's out of Vietnam and certaily did not want to wait around for anything. We just wanted to get out of town and home as quickly as possible so the test was to line up on a wall and the examiner was 20 feet away asking everyone if they can hear him ok. Of course everyone could hear him ok. Usually a response would be YEA, Were's the closest bar??

There are other disabilities that are supported by different studies that the VA has commissioned in the past that can be used for evidence.

One comment in another study states that tinnitus is a symptom of hearing loss. I have seen award letters come back to say that tinnitus is denied but they get an award for Hearing Loss. Kind of an oxy-moron if you as me.

I'd like to get some opinions from others that file claims and assist others in filing claims such as VSO's etc.

I help Vets in my little town file claims all the time and have used some of these studies but have never really found out if they could be considered an IMO per-sey or if it is just good layman evidence.

Thanks,

Mil T

[Berta]

In my opinion , I think -regarding your Hearing loss/tinnitus reference, I would definitely use the VA FAst letter 10-35 to support the claimif the veteran's MOS put them into any situation where there was acoustical trauma.

I have friend who was a Diver during Vietnam and developed HL due to,he believed, decompression problems. Any vet who was exposed to the noise of an airport via MOS also could have a valid basis for a HL/tinnitus claim.

Good lay evidence helped me succeed in my FTCA case without an IMO years ago.

But these days, when I reopened my claim on another basis,I sure got 3 IMOs.

I had to be very aggressive in getting the VA to consider my medical evidence for the FTCA wrongful death claim.

I feel that medical treatises and studies can help a claim sometimes and have certainly used them but the VA needs positive medical evidence that relates doirectly to the claimant's claim, to make a proper award.

The VA is quick to say that studies and treatises,while they could support the premise of the claim, are not specific to the veteran making the claim.

However a lot of the evidence I used for my 2003 DMII claim was taking medical abstracts and even the VA's own DMII traing letter and then referencing these documents directlyly to entires in the veteran's medical records at VA.

In 2003 I had to prove my husband had DMII whioch was never diagnosed by VA and it was another misdiagnosed condition that caused his death.

My IMO doc considered all available med recs, past SOC and SSOCs, FTCA stuff and also the abstracts,studies, and citations I had used.

The best one I used however was VA's own DMII training letter, stating numerous symptoms of treated and even untreated DMII.

[Mil T]

yes I agree that there needs to be direct medical evidence for the Veteran in question.

I'm not sure if I really got my question presented correctly or not. What I am trying to figure is if these study's COULD be considered medical evidence? Many of them are by the Medical Association or by a group of doctors etc.

I do use the fast letters and training letters to help as evidence in filing claims for some of these guys I help.

Mil T

[john999]

If you were subjected to loud noise from Arty but did not have Arty MOS could you still use that as evidence for hearing damage? How do you prove this 40 years later?

[carlie]

yes I agree that there needs to be direct medical evidence for the Veteran in question.

I'm not sure if I really got my question presented correctly or not. What I am trying to figure is if these study's COULD be considered medical evidence? Many of them are by the Medical Association or by a group of doctors etc.

I do use the fast letters and training letters to help as evidence in filing claims for some of these guys I help.

Mil T

IMO - the VBA will ONLY consider "these study's" as "medical evidence" in relationship to your

claim issues, if a qualified medical provider refers to them and states that in their opinion your conditions

are supported by these "study's" and follow the opinion up with full medical rationale.

Medical treaties / studies that are related by a medical professional as specific to the veteran are

supposed to be afforded weight as evidence.

Medical treaties / studies that are submitted by the claimant and related to the populace

in general, will most likely not be afforded weight as evidence.

JMHO

[Berta]

“If you were subjected to loud noise from Arty but did not have Arty MOS could you still use that as evidence for hearing damage? How do you prove this 40 years later? “

If you can prove you were in close proxitiy to something that caused the artillery to go off (like hostile activity etc.)

This article makes a good point:

http://answers.google.com/answers/threadview/id/263147.html

In part:

“Hearing loss is the major consequence of the loud noises found in a

military environment. Loudness is measured by a unit called the

decibel. To get an idea of the intensity of a decibel, a quiet

library might be measured at about 40 decibels; a handsa equals 85

decibels; a power saw, 110 decibels; a jackhammer, 130; artillery fire

(at 500 feet), 150 decibels; and a rifle (close range), 165.

For every 10 decibel increase, there is a 10-fold increase in noise

energy. That means the intensity of a 50 decibel sound is ten times

that of a 40 decibel sound, and a 60 decibel sound is 100 times a 40

decibel sound. The the intensity of a rifle blast is many million

times more intense than the sound in a library.

The US Occupational Safety and Health Administration (OSHA), limits

the permissible exposure of workers to loud noises. For example, a

worker may be exposed to a 90 decibels or less of noise for 8 hours a

day, but to a sound of 115 decibels for only 15 minutes.

Hearing loss is one of the most common causes of workers' compensation

claims in the military. The highest rates of hearing loss are in the

combat-related occupations, for example infantry or artillery.”

Te article has some good references.

As we were saying, as to internet articles, studies, etc-this article cant stand alone to support a HL claim due to artillery fire but could enhance buddy statements of the proximity of the veteran to artillery fire, and would enhance an IMO.

Still the nexus would have to be proven.

You said 40 years ago so I assume you mean Vietnam War?

What was the veteran's MOS and can he prove the incident and how he was exposed to the arty fire? The MOS might not clearly reveal what he did there.

My husband was USMC -Truck driver MOS. He certainly was in firefights in Vietnam. And a major explosion due to a land mine. There was no hearing protection in those days-a point a claimant needs to stress to VA.He didnt have HL but the point is- regardless of the MOS,all this vet needs is proof of his exposure to acoustical trauma in service.

[Mil T]

Good point Carlie.

I may start issueing some of the studies to some of the vets I am helping that have not been awarded HL when they go to the VA or sometimes I will send them to Miracle Ear for a hearing test and tell them to ask the audiologist if their hearing loss could be as likely as not caused by their military service after they tell him what they did in the service. It has been helpful and counts as an IMO. If the MOS supports the high probability for hearing loss due to their service then I also send those study's as well. I have studies from the Navy, Air Force, Army that support job duties that experienced Acoustical Trauma.

Sometimes their MOS will not support but an incident or a constant job duty while serving can cause the problem. For instance. I have a person that was a typist/clerk at Long Binh in 1968. He ran a press machine many hours a day. Press machine was very noisy. His duty station was just a 1/4 mile from the Ammo Depot that was blown up leveling his building, barracks etc. 15,000 105 mm artilery shells were destroyed. The concussion and loud noise was deafning to those in close proximity. He also was a security driver for top secret documents that he had to escort in a jeep with a mounted m60 that was fired just above his head on occational runs to special forces camp. These incidents should qualify him for the HL and Tinnitus. I"ve submitted the studies, the dates of Ammo Depot explosion, What the MOS is for the other duties that he did. But his MOS was 71R which is typist/Clerk. What you have mentioned is that they should submit supporting evidence for the other occasions that he was exposed to the loud noises I mentioned. Perhaps daily journals or after action reports??

All sorts of duties are accomplished by different MOS's that do not match what they actually did while in Service. This is the area that is more difficult to process and get a rating.

If you have experience with this type of claim, I would appreciate any advise of other ways to help in this area.

Thanks,

Mil T