Recent hearing CP exam for increase

[MKAH]

Hello,  I am currently SC and rated at 10% Tinnutis & 20% bilateral hearing loss.

Below is an examination and a review of that examination.  I am not sure how to interpret it?

Thanks for any help reading it.

Social Worker

Signed: 06/03/2016 17:04

Date/Time:

02 Jun 2016 @ 0824

Note Title:

C&P Audiology 13294

Location:

No CA Healthcare Sys-Martinez

Signed By:

BASS,ROBERTA

Co-signed By:

BASS,ROBERTA

Date/Time Signed:

02 Jun 2016 @ 0824

Note

LOCAL TITLE: C&P Audiology 13294

STANDARD TITLE: AUDIOLOGY C & P MULTIPLE EXAM NOTE

DATE OF NOTE: JUN 02, 2016@08:24:04 ENTRY DATE: JUN 02, 2016@08:24:04

AUTHOR: BA…ROBERTA EXP COSIGNER:

URGENCY: STATUS: COMPLETED

Hearing Loss and Tinnitus

Disability Benefits Questionnaire

Name of patient/Veteran m…..Xxxxxx 1234

Is this DBQ being completed in conjunction with a VA 21-2507, C&P

Examination

Request?

[X] Yes [ ] No

ACE and Evidence Review

-----------------------

Indicate method used to obtain medical information to complete this

document:

[X] Review of available records (without in-person or video telehealth

examination) using the Acceptable Clinical Evidence (ACE) process

because

the existing medical evidence provided sufficient information on which

to

prepare the DBQ and such an examination will likely provide no

additional

relevant evidence.

Evidence Review

---------------

Evidence reviewed (check all that apply):

[X] VA e-folder (VBMS or Virtual VA)

XXXXXX, MARK

CONFIDENTIAL

Page 18 of 44

 

[X] CPRS

This exam is for: Hearing loss and/or tinnitus (audiologist or

non-audiologist clinician, using audiology report of record that represents

Veteran's current condition)

If using audiology report of record, date audiology exam was performed:

2.16.16

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)**|

|========+========+========+========+========+========+========+========|

| 30 | 50 | 75 | 85 | 95 | 105+ | 100+ | 76 |

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

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)**|

|========+========+========+========+========+========+========+========|

| 35 | 50 | 70 | 80 | 85 | 105+ | 100+ | 71 |

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

* 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 | 56% |

|=============+=========|

XXXXXX, xxxxxx

CONFIDENTIAL

Page 19 of 44

 

| LEFT EAR | 56% |

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

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 | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal

|

|=====================+===========================+===========================|

| Ipsilateral | |

|

| Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal

|

|=====================+===========================+===========================|

| Contralateral | |

|

| Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal

|

|=====================+===========================+===========================|

| Unable to interpret | |

|

| reflexes due to | [ ] | [ ]

|

| artifact | |

|

|=====================+===========================+===========================|

| Unable to obtain/ | |

|

| maintain seal | [X] | [X]

|

XXXXXX, MARK

CONFIDENTIAL

Page 20 of 44

 

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

2. Diagnosis

------------

RIGHT EAR

---------

[ ] Normal hearing

[ ] Conductive hearing loss ICD code:

[ ] Mixed hearing loss ICD code:

[X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*

ICD code: H90.3

[X] Sensorineural hearing loss (in the frequency range of 6000 Hz or

higher frequencies)** ICD code: H90.3

[ ] Significant changes in hearing thresholds in service***

LEFT EAR

--------

[ ] Normal hearing

[ ] Conductive hearing loss ICD code:

[ ] Mixed hearing loss ICD code:

[X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*

ICD code: H90.3

[X] Sensorineural hearing loss (in the frequency range of 6000 Hz or

higher frequencies)** ICD code: H90.3

[ ] 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 signi

ficant change in hearing threshold may indicate

XXXXXXX, MARK

CONFIDENTIAL

Page 21 of 44

noise exposure or acoustic trauma.)

3. Etiology

-----------

[X] Etiology opinion not indicated as:

[X] Service connected condition

[X] VBA did not request etiology

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: DIFFICULTY

HEARING

5. Remarks, if any, pertaining to hearing loss:

-----------------------------------------------

PLEASE SEE PREVIOUS EVALUATIONS FOR FULL HISTORY.

SECTION 2: TINNITUS

--------------------

1. Medical history

------------------

Does the Veteran report recurrent tinnitus: Yes

Date and circumstances of onset of tinnitus: FROM 2.16.16 EVALUATION:

"Vet

describes a subjective, bilateral, constant tinnitus with an unsure

onset."

2. Etiology of tinnitus

-----------------------

[X] Etiology opinion not indicated as:

[X] VBA did not request etiology

3. Functional impact of tinnitus

--------------------------------

Does the Veteran's tinnitus impact ordinary conditions of daily life,

including ability to work: No

4. Remarks, if any, pertaining to tinnitus::

--------------------------------------------

No response provided

NOTE: VA may request additional medical information, including additional

examinations if necessary to complete VA's review of the

Veteran's

application.

NIC…., MARK

CONFIDENTIAL

Page 22 of 44

 

 

 

[Berta]

"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: DIFFICULTY"

But it also seems to state your HL is not at a ratable level....?????

Did the VA propose to reduce what you get now for hearing loss?

Or maybe this was for a higher HL rating???? I dont know how to read audio charts but many here do.

I think sometimes vets might do better on hearing loss issues if they went to Miracle Ear places.

I wonder how often VA calibrates their audio equipment.

This seems to be an odd C & P.....unless it just means that there is no change in your HL condition since their last rating for it.

 

Others will chime in.

 

 

[MKAH]

My problem is I do not know how to inturpret the C&P evluation?

I'm going to format the two reports so they can hopefully, be read better;

A C&P dated 6/2/16 based off of my local VA audiologist actual test and report of findings from 2/2/16.
I am currently service connected at 10% Tinitus ans 20% Hearing loss bilaterally.

I asked for a re-evaluation early this year due to my continued trouble with getting my hearing aids adjusted so could hear better and understand conversations. My original hearing loss service connection was over five years ago.

After getting my most recent HL report I filed for an increase in hearing loss and word recognition

LOCAL TITLE: C&P Audiology 13294
STANDARD TITLE: AUDIOLOGY C & P MULTIPLE EXAM NOTE
DATE OF NOTE: JUN 02, 2016@08:24:04 ENTRY DATE: JUN 02, 2016@08:24:04
AUTHOR: BASS,ROBERTA EXP COSIGNER:
URGENCY: STATUS: COMPLETED
Hearing Loss and Tinnitus
Disability Benefits Questionnaire
Name of patient/Veteran: MARK NICHOLSON 9191
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
Examination
Request?
[X] Yes [ ] No
ACE and Evidence Review
-----------------------
Indicate method used to obtain medical information to complete this
document:
[X] Review of available records (without in-person or video telehealth
examination) using the Acceptable Clinical Evidence (ACE) process
because
the existing medical evidence provided sufficient information on which
to
prepare the DBQ and such an examination will likely provide no
additional
relevant evidence.
Evidence Review
---------------
Evidence reviewed (check all that apply):
[X] VA e-folder (VBMS or Virtual VA)
[X] CPRS
This exam is for: Hearing loss and/or tinnitus (audiologist or
non-audiologist clinician, using audiology report of record that represents
Veteran's current condition)
If using audiology report of record, date audiology exam was performed:
2.16.16
SECTION 1: HEARING LOSS (HL)
-----------------------------
NICHOLSON, MARK
CONFIDENTIAL
Page 20 of 70
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)**|
|========+========+========+========+========+========+========+========|
| 30 | 50 | 75 | 85 | 95 | 105+ | 100+ | 76 |
+=======================================================================+
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)**|
|========+========+========+========+========+========+========+========|
| 35 | 50 | 70 | 80 | 85 | 105+ | 100+ | 71 |
+=======================================================================+
* 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 | 56% |
|=============+=========|
| LEFT EAR | 56% |
+=======================+
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
NICHOLSON, MARK
CONFIDENTIAL
Page 21 of 70
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 | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
|
|=====================+===========================+===========================|
| Ipsilateral | |
|
| Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
|
|=====================+===========================+===========================|
| Contralateral | |
|
| Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
|
|=====================+===========================+===========================|
| Unable to interpret | |
|
| reflexes due to | [ ] | [ ]
|
| artifact | |
|
|=====================+===========================+===========================|
| Unable to obtain/ | |
|
| maintain seal | [X] | [X]
|
+=============================================================================+
2. Diagnosis
------------
RIGHT EAR
---------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[ ] Mixed hearing loss ICD code:
NICHOLSON, MARK
CONFIDENTIAL
Page 22 of 70
[X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
ICD code: H90.3
[X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
higher frequencies)** ICD code: H90.3
[ ] Significant changes in hearing thresholds in service***
LEFT EAR
--------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[ ] Mixed hearing loss ICD code:
[X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
ICD code: H90.3
[X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
higher frequencies)** ICD code: H90.3
[ ] 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 signi
ficant change in hearing threshold may indicate
noise exposure or acoustic trauma.)
3. Etiology
-----------
[X] Etiology opinion not indicated as:
[X] Service connected condition
[X] VBA did not request etiology
4. Functional impact of hearing loss
------------------------------------
NICHOLSON, MARK
CONFIDENTIAL
Page 23 of 70
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: DIFFICULTY
HEARING
5. Remarks, if any, pertaining to hearing loss:
-----------------------------------------------
PLEASE SEE PREVIOUS EVALUATIONS FOR FULL HISTORY.
SECTION 2: TINNITUS
--------------------
1. Medical history
------------------
Does the Veteran report recurrent tinnitus: Yes
Date and circumstances of onset of tinnitus: FROM 2.16.16 EVALUATION:
"Vet
describes a subjective, bilateral, constant tinnitus with an unsure
onset."
2. Etiology of tinnitus
-----------------------
[X] Etiology opinion not indicated as:
[X] VBA did not request etiology
3. Functional impact of tinnitus
--------------------------------
Does the Veteran's tinnitus impact ordinary conditions of daily life,
including ability to work: No
4. Remarks, if any, pertaining to tinnitus::
--------------------------------------------
No response provided
NOTE: VA may request additional medical information, including additional
examinations if necessary to complete VA's review of the
Veteran's
application.
/es/ Roberta Bass, Au.D.
Audiologist
Signed: 06/02/2016 08:24
Date/Time:
01 Jun 2016 @ 1400
Note Title:


SNYDER,LEE
Co-signed By:
SNYDER,LEE
Date/Time Signed:
16 Feb 2016 @ 1740
Note
LOCAL TITLE: Audiology 10100
STANDARD TITLE: AUDIOLOGY NOTE
DATE OF NOTE: FEB 16, 2016@17:33 ENTRY DATE: FEB 16, 2016@17:34:09
AUTHOR: SNYDER,LEE EXP COSIGNER:
URGENCY: STATUS: COMPLETED
*** Audiology 10100 Has ADDENDA ***
NICHOLSON, MARK
CONFIDENTIAL
Page 18 of 30
Hearing Evaluation (60 mins)
Nicholson, Mark, MALE,
572-31-9191
S: Vet came to the clinic for an audiometric re-evaluation of his known HL. The
Vet identified himself by name and SS#.
Vet describes a subjective, bilateral, constant tinnitus with an unsure onset.
O: See Audiometric Evaluation in CPRS found in the Tools menu under Specialty
Applications, under Audiogram Display.
A: Audiologic evaluation was completed. Findings indicate:
AD: Mild sloping to a severe HF SNHL.
AS: Mild sloping to a severe HF SNHL.
Physical Examination (Objective Findings):
1. Measured pure tone thresholds in decibels HL at the indicated frequencies
(air conduction):
Right Ear Left Ear
A* 500 - 20 A* 500 - 35
B 1000 - 50 B 1000 - 50
C 2000 - 75 C 2000 - 70
D 3000 - 85 D 3000 - 80
E 4000 - 95 E 4000 - 85
**average 76 dB HL **average 71 dB HL
* The pure tone 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.
2. Speech Audiometry Results:
Speech Reception Thresholds were: 50 dBHL AD and 45 dBHL AS.
Maryland CNC word recognition scores were: 56 % right ear 56 % left ear
Comfortable listening levels were obtained. Bilateral BTE/RIC style hearing aids
were ordered. Also ordered remote, ComPilot and remote Mic.
P: Vet was counseled on test results, communication techniques and listening
strategies. Vet to RTC for a hearing aid evaluation 3/14 @ 9:00 AM.
/es/ Lee Snyder, MS
Audiologist, Audiology
Signed: 02/16/2016 17:40
NICHOLSON, MARK
CONFIDENTIAL
Page 19 of 30
02/19/2016 ADDENDUM STATUS: COMPLETED
Hearing Aid Service
S: Lt unit died while here for AE.
P: Returned this unit to Mnfctr for repair. Holding EM in cupboard. call Vet or
hold for appt. 3/14.
/es/ Lee Snyder, MS
Audiologist, Audiology
Signed: 02/19/2016 14:32
03/03/2016 ADDENDUM STATUS: COMPLETED
PT PICKED UP THE OLD/REPAIRED AID TODAY
/es/ CAMPBELL,ANNEMARIE
Signed: 03/03/2016 15:56
03/03/2016 ADDENDUM STATUS: COMPLETED
Vet p/u repaired aid.
/es/ DEBORAH M KUTZKEY
Health Technician, Audiology
Signed: 03/03/2016 15:59
Dat
 

[broncovet]

If you add your 1000, 2000, 3000, and 4000 then divide by four, you have an average loss of 76 for right, 71 for left ear.

If you put those in the charts, I get roman numeral VIII for both.  

The intersection between VIII and VIII is 50%.  

However, you "get" barely half of what is said.  (56% speech discrimination).  

I dont know what kind of work you could do with speech discrimination that bad.  You could maybe mop floors or wash dishes.  Any sort of communication would be very difficult in all but the best of conditions, say in a sound proof room where you are 18 inches from the speaker.  This is not the real world.  If you were given verbal instructions, you would miss 50 percent of what he said.  

Your rating should be increased to 50% for hearing loss, and, if you are not working, your audiologist already said it interferes with work.  

TDIU is very plausable.  

[MKAH]

Thanks brovnet.  I did see some odd a asterisks * & ** in the cp exam  stating I may not be eligible for compensation based on threshold and frequencies phycobable?  

Interestingly, I also noticed the C&P stated that no etiology (cause of loss) was not needed as  already service connected, and retesting would not provide any additional information.

I have not worked all year and I was a retail store manager.  The combination of my hearing loss and pending ptsd claim made it a nightmare to interact with employees and customers?  Using any of the phones in the store was effectively impossible. Fortunately I have taught myself how to read lips at a basic level.

My claim for ptsd & hearing loss increase were submitted separately by two months.  However the VA linked them together on one claim.

My cover sheet statement provided numerous things I could absolutely not hear.  Eg theft alarms, emergency exit alarms, vehicle backup alarms, refrigerator system alarms, the beeping sound of scanners used on the cash registers, ect ect ect.  I also pointed out how my hearing loss continued to my ptsd, especially while at work.

Anyway, thanks for your reply?..but I'm still worried about the comments that read "may not be rate able".  With astrikes next to my hearing results.

Sorry for the typos, I did this on my iPhone?  ?

Mark Nicholson