Question About My Hearing C&p Exam

[Smirak]

I had my C&P exam for hearing loss/tinnitus back on June 3. I just now got my notes in myhealthevet last week. I was looking over the notes just because (I've already been rated at combined 90%) and the hearing one was peculiar. I was denied any hearing loss though the notes clearly state the below...notice that according to the C&P examiner, my right ear hearing loss didn't exist prior to service, but my left ear did? Also, for my left ear, it say that my left ear hearing loss "...is at least as likely as not (50% probability or greater) caused by or a result of an event in military service? Yes", though it existed prior to service?

Below is the C&P exam notes from my hearing test. Just looking to see if you think it's screwed up and to see what my recourse is if so. I was awarded on 11 Jun.

Thanks,

Kevin

Hearing Loss and Tinnitus
Disability Benefits Questionnaire

Name of patient/Veteran: [Veterans Name]

Indicate method used to obtain medical information to complete this
document:
In-person examination

Evidence review
---------------
Was the Veteran's VA claims file reviewed: No

Record(s) Reviewed: Other: Veteran's electronic folder in VBMS

This exam is for: Hearing loss and/or tinnitus (audiologist, performing
current exam)

SECTION 1: HEARING LOSS (HL)
-----------------------------

1. Objective Findings
---------------------
a. Puretone thresholds in decibels (air conduction):

RIGHT EAR
+==============================================================+
| A | B | C | D | E | F | G |
|========+========+========+========+========+========+========+========+
| 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
| Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
|========+========+========+========+========+========+========+========|
| 15 | 15 | 10 | 15 | 20 | 15 | 20 | 15 |
+=======================================================================+

LEFT EAR
+==============================================================+
| A | B | C | D | E | F | G |
|========+========+========+========+========+========+========+========+
| 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
| Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
|========+========+========+========+========+========+========+========|
| 10 | 15 | 10 | 20 | 25 | 25 | 20 | 18 |
+=======================================================================+

* The puretone threshold at 500 Hz is not used in determining the
evaluation but is used in determining whether or not a ratable hearing
loss exists.
** The average of B, C, D, and E.
*** CNT - Could Not Test

b. Were there one or more frequency(ies) that could not be tested: No

c. Validity of puretone test results: Test results are valid for rating
purposes.

d. Speech Discrimination Score (Maryland CNC word list):
+=======================+
| RIGHT EAR | 96% |
|=============+=========|
| LEFT EAR | 96% |
+=======================+

e. Appropriateness of Use of Word Recognition Score (Maryland CNC word
list):
Right Ear:
Is Word Discrimination Score available? Yes
Word Discrimination Score appropriateness:
Use of word recognition score is appropriate for this Veteran.

Left Ear:
Is Word Discrimination Score available? Yes
Word Discrimination Score appropriateness:
Use of word recognition score is appropriate for this Veteran.

f. Audiologic Findings
Summary of Immittance (Tympanometry) Findings:

+=============================================================================+
| | RIGHT EAR | LEFT EAR
|

|=====================+===========================+===========================|
| Acoustic immittance | [X] Normal [ ] Abnormal | [X] Normal [ ] Abnormal
|

|=====================+===========================+===========================|
| Ipsilateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [X] Abnormal
|

|=====================+===========================+===========================|
| Contralateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [X] Abnormal
|

|=====================+===========================+===========================|
| Unable to interpret | |
|
| reflexes due to | [ ] | [ ]
|
| artifact | |
|

|=====================+===========================+===========================|
| Unable to obtain/ | |
|
| maintain seal | [ ] | [ ]
|

+=============================================================================+

2. Diagnosis
------------

RIGHT EAR
---------
[ ] Normal hearing

[ ] Conductive hearing loss ICD code:

[ ] Mixed hearing loss ICD code:

[ ] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
ICD code:
[ ] Sensorineural hearing loss (in the frequency range of 6000 Hz or
higher frequencies)** ICD code:
[X] Significant changes in hearing thresholds in service***

LEFT EAR
--------
[ ] Normal hearing

[ ] Conductive hearing loss ICD code:

[ ] Mixed hearing loss ICD code:

[ ] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
ICD code:
[ ] Sensorineural hearing loss (in the frequency range of 6000 Hz or
higher frequencies)** ICD code:
[X] Significant changes in hearing thresholds in service***

NOTES:
* The Veteran may have hearing loss at a level that is not considered to
be
a disability for VA purposes. This can occur when the auditory
thresholds are greater than 25 dB at one or more frequencies in the
500-4000 Hz range.

** The Veteran may have impaired hearing, but it does not meet the criteria
to be considered a disability for VA purposes. For VA purposes, the
diagnosis of hearing impairment is based upon testing at frequency
ranges
of 500, 1000, 2000, 3000, and 4000 Hz. If there is no HL in the
500-4000
Hz range, but there is HL above 4000 Hz, check this box.

*** The Veteran may have a significant change in hearing threshold in
service, but it does not meet the criteria to be considered a disability
for VA purposes. (A significant change in hearing threshold may
indicate
noise exposure or acoustic trauma.)

3. Etiology
-----------
Right Ear
Was there a permanent positive threshold shift (worse than reference
threshold) greater than normal measurement variability at any frequency
between 500 and 6000 Hz for the right ear? Yes
Opinion provided for the right ear: Yes
If present, is the Veteran's right ear hearing loss at least as likely as
not (50% probability or greater) caused by or a result of an event in
military service? Yes
Rationale (Provide rationale for either a yes, no answer or speculation
reason): The Veteran reporte
d the following military service history:

~Army April 1993-April 1996; infantryman; gunner on a Bradley fighting
vehicle; reported use of double hearing protection; reported onset of
tinnitus during this time; deployed to Somalia October 1993-February
1994 as a line infantryman with reported use of ear plugs as hearing
protection
~US Army Reserves June 1996-February 1997; drilling reservist
~Army National Guard February 2997-November 1998; personnel with a
field
artillery unit; significant noise with hearing protection from 155mm
howizter fire when training
~Active Duty Army National Guard November 2008-October 2004; 2008-2002
personnel without any significant noise exposure; March 2002-October
2004 supply sergeant with an MP battalion; deployed to Iraq September
2003-October 2004; was a supply sergeant in Iraq assigned to convoy
security and prison detail; reported he did convoy security twice a day
every other day and was in the gunner's hatch manning one of the
following weapons - .50 caliber machine gun, MK19 grenade launcher or
M240 Bravo; reported significant noise without hearing protection from
the firing of those weapons and the M16 and 9mm pistol he carried and
from vehicles, rocket attacks and IEDs
~Air National Guard April 2005-June 2012; Veteran reported he was
discharged completely in March 2014; April 2005-January 2007 drilling
guard member; January 2007-May 2008 activated in support of OEF, but
stationed in Mississippi; aerial port duty which involved the loading
and unloading of aircraft (C17s, C130s, C141s, C5s and various
commercial aircraft) 60% of the time with engines shut down and 40% of
the time with the engines running; Veteran reported wearing hearing
protection; May 2008-July 2009 went back to drilling but doing aerial
port duty; July 2009-June 2012, supply with no reported noise exposure

Eight pure tone threshold hearing tests were located in the service
treatment records (3-19-93, Army enlistment; 7-15-93, reference
audiogram; 1-25-96; 4-11-96; 4-12-97; 3-23-02; 7-11-08 and 4-4-09).
All
except the 4-11-96 test showed hearing acuity to be within normal
limits
bilaterally. The 4-11-96 test indicated a mild hearing loss in both
ears at most frequencies. No tests after 2009 were found in the
records. The results from this C&P exam indicate hearing acuity is
within normal limits bilaterally, but in compared these thresholds to
those from the Veteran's first enlistment test in March 1993, a
significant threshold shift (>10dB) is indicated at 1000 and 3000 Hz,
right ear and 1000, 3000 and 4000 Hz, left ear.

The Veteran denied any occupational noise exposure. While in the
Reserves and Guard he reported he attended college and worked in
retail.
Since leaving the service he reported he sold real estate and has
worked for a year as a purchasing manager. He denied ear surgery,
recent/chronic ear infections, head injury, familial hearing loss and
treatment with chemotherapy/radiation. He denied vertigo, but reported
occasional disequilibrium. He denied any significant recreational noise
exposure other than hunting occasional in childhood with hearing
protection.

The current testing indicates the Veteran's hearing acuity is within
normal limits bilaterally, but when compared his first enlistment
hearing test in 1993 to the current exam, a significant threshold shift
is indicated in both ears. Given the indirect evidence (MOS, combat
duty, award of the Combat Infantryman Badge, Veteran report) of
significant military noise exposure and the lack of any reported
occupational or significant recreational noise exposure, in my opinion,
the threshold shifts are at least as likely as not related to military
noise exposure.

Did hearing loss exist prior to service? No

Left Ear
Was there a permanent positive threshold shift (worse than reference
threshold) greater than normal measurement variability at any frequency
between 500 and 6000 Hz for the left ear? Yes
Opinion provided for the left ear: Yes
If present, is the Veteran's left ear hearing loss at least as likely as
not (50% probability or greater) caused by or a result of an event in
military service? Yes
Rationale (Provide rationale for either a yes, no answer or speculation
reason): see rationale for right ear above

Did hearing loss exist prior to service? Yes

4. Functional impact of hearing loss
------------------------------------
Does the Veteran's hearing loss impact ordinary conditions of daily life,
including ability to work: Yes
If yes, describe impact in the Veteran's own words: The Veteran stated "If
someone is speaking low I have to lean in and ask them what they said" and
"I can't hear my wife calling me from another room like I used to be able
to."

5. Remarks, if any, pertaining to hearing loss:
-----------------------------------------------
Otoscopy was unremarkable bilaterally. Tympanometry indicated normal
middle ear compliance and air pressure and a normal ear canal volume
bilaterally. Acoustic reflex thresholds could not be measured due to the
inability to maintain a pressure seal. Pure tone air and bone conduction
thresholds indicated hearing acuity is within normal limits bilaterally.

Edited July 6, 2015 by Tbird
�R�e�m�o�v�e�d� �P�e�r�s�o�n�a�l� �I�d�e�n�t�i�f�i�c�a�t�i�o�n� �I�n�f�o�r�m�a�t�i�o�n

[boomer2]

Smirak

Please read the following CFR to clarify your test.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div5&node=38:1.0.1.1.5#se38.1.4_185

[broncovet]

The VA "loves" to deny SC for hearing loss, even when you have a valid nexus. (That is the good news).

The bad news is that your hearing loss is so mild, that it does not meet VA criteria. Anything under 20 decibels is considered "normal".

YOur puretone average (15 for right 18 for the left).

If you think your hearing is worse than that, then you can have an IME/IMO by a private audiologist. Take this test with you so he can put his test in a format

that the VA requires, similar to what your VA audiologist did.

A problem with fighting this issue is this:

If you have a single 90 percent rating, it takes another 50 percent to get to 100 percent because of VA math, so even if you fought this hearing loss and got 10 percent, it wont likely increase you to 100 percent. You can plug your numbers into the calculator, but I doubt that it would.

[Smirak]

Thanks Bronco and Boomer. I am not trying to get to 100%, but did think the C&P results contradicted each other. My hearing is average, I'd say. Nothing that warrants a new claim or anything. I didn't even apply for hearing, but figured since they were doing the tinnitus, they tested hearing as well. When I read the results, I saw it as contradicting information and wanted to verify. I'm 90% combined with one at 70%, 2 at 20% and 2 at 10%. The probability that I'd get to 100% is very slim. Besides, I have a good job that I love and don't need to apply for unemployability.