Hearing loss c&p - Hobbies mistake

[Usaf9498]

I got my Hearing Loss C&P Tuesday Morning.

This morning it was available on myhealthevet. When she asked about my hobbies, she specifically asked me if I rode motorcycles. I told her no. Never have. Sure enough under hobbies ( SEE below) It lists my hobbies as motorcycles and hunting. 

Good news is it looks like it will be easy to service connect my hearing loss, however, it is not enough for a rating. 

Tinnitus should be rated and looks to be service connected from what I can see. 

Other good news is she stated that there was not a hearing test done in STRs so hearing loss during service is not ruled out. Sounds to me like this should be fairly easy but I know not to count my chickens before they hatch.  

 

 

Date/Time: 10 Sep 2019 @ 0803 

Note Title: KC-AUDIOLOGY 

Location: VA Heartland-West VISN 15 Signed By: BREAUX,KATHERINE A Co-signed By: BREAUX,KATHERINE A Date/Time Signed: 10 Sep 2019 @ 0805 

Note LOCAL TITLE: KC-AUDIOLOGY STANDARD TITLE: AUDIOLOGY NOTE DATE OF NOTE: SEP 10, 2019@08:03 ENTRY DATE: SEP 10, 2019@08:03:23 

AUTHOR: BREAUX,KATHERINE A EXP COSIGNER: URGENCY: STATUS: COMPLETED 

S: The veteran has requested an Audiology Compensation/Pension examination. The 

case history information is included in the CAPRI report. 

O: The following procedures were performed: Work Related or Medical Disability Examination 99456, SP206, RVU=90 

A: The disability assessment included a review of medical and service records, 

 

review of past, social, family, occupational, and military history. A comprehensive audiometry examination, formulation of a diagnosis, assessment of capabilities, and completion of necessary documentation was administered. The audiological findings were discussed with the veteran and will be forwarded to the compensation pension department. 

P: The patient was informed to return for further treatment when necessary pending their eligibility status. 

Time: 90 mins 

/es/ Katherine A Breaux Clinical Audiologist Au.D., CCC-A Signed: 09/10/2019 08:05 

Date/Time: 10 Sep 2019 @ 0730 

Note Title: C&P AUDIO 

Location: VA Heartland-West VISN 15 Signed By: BREAUX,KATHERINE A Co-signed By: BREAUX,KATHERINE A Date/Time Signed: 10 Sep 2019 @ 1330 

Note LOCAL TITLE: C&P AUDIO STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: SEP 10, 2019@07:30 ENTRY DATE: SEP 10, 2019@13:30:56 

AUTHOR: BREAUX,KATHERINE A EXP COSIGNER: URGENCY: STATUS: COMPLETED 

Hearing Loss and Tinnitus Disability Benefits Questionnaire 

 

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] In-person examination 

Evidence Review --------------- Evidence reviewed (check all that apply): 

[X] VA e-folder (VBMS or Virtual VA) [X] CPRS [X] Other (please identify other evidence reviewed): 

Case History: 

Post: Union Iron Worker, tile setter helper, insurance sales, retial. Hobbies: Motorcycle, hunting 

Right: 10@ 500, 0 @1000, 10 @ 2000, 10 @ 3000, 10 @ 4000 Left: 0 @ 500, 0 @ 1000, 20 @ 2000, 0 @ 3000, 5 @ 4000 

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 | 25 | 30 | 60 | 50 | 40 | 33 | +=======================================================================+ 

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)**| |========+========+========+========+========+========+========+========| | 15 | 15 | 30 | 20 | 25 | 20 | 15 | 23 | +=======================================================================+ 

 

* 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 | 88% | |=============+=========| | 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 | [X] Normal [ ] Abnormal | [X] Normal [ ] Abnormal | |=====================+===========================+===========================| 

| Contralateral | | | 

| Acoustic Reflexes | [X] Normal [ ] Abnormal | [X] Normal [ ] 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: 

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

ICD code: H90.3 [ ] Sensorineural hearing loss (in the frequency range of 6000 Hz or 

higher frequencies)** ICD code: [ ] 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 [ ] Sensorineural hearing loss (in the frequency range of 6000 Hz or 

higher frequencies)** ICD code: [ ] 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? No 

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 C-file was reviewed. The compensation and pension exam request indicated a chief complaint of hearing loss and tinnitus. The service medical record was reviewed by the examiner. The veteran served honorably in the Air Force from 1994-1998. The veteran's MOS was Aircrew 

Egress Systems which is rated by the DOD as having a high probability of 

hazardous noise exposure. The veteran reported being exposed to flight line noise exposure, generators, and tools. Military records indicated an enlistment physical dated 3-11-1994 which showed normal hearing by calibrated audiometry. There were no other hearing exams within the STRs, therefore, hearing loss at military separation was not ruled out. Since hearing loss at military separation was not ruled out, it is at least as likely as not that hearing loss was caused by acoustic trauma during military service. 

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? No 

 

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? No 

Rationale (Provide rationale for either a yes, no answer or speculation reason): The C-file was reviewed. The compensation and pension exam request indicated a chief complaint of hearing loss and tinnitus. The service medical record was reviewed by the examiner. The veteran served honorably in the Air Force from 1994-1998. The veteran's MOS was Aircrew 

Egress Systems which is rated by the DOD as having a high probability of 

hazardous noise exposure. The veteran reported being exposed to flight line noise exposure, generators, and tools. Military records indicated an enlistment physical dated 3-11-1994 which showed normal hearing by calibrated audiometry. There were no other hearing exams within the STRs, therefore, hearing loss at military separation was not ruled out. The veteran currently does not have hearing loss in the left ear that meets VA criteria as disabling 21 years after his exit from the service. 

As stated in the Handbook of Standard Procedures and Best Practices for Audiology: Compensation and Pension Examinations, impaired hearing is considered to be a disability when the auditory thresholds in any of the 

frequencies 500, 1000, 2000, 3000, and 4000 Hertz is 40 dB HL or greater; or when the auditory thresholds for at least three of these frequencies are 26 dB HL or greater. The examiner is not denying exposure to noise, rather stating that the exposure did not result in hearing loss that meets criteria for service connection. Therefore, it is less likely as not that hearing loss was caused by acoustic trauma during military service. 

Did hearing loss exist prior to service? No 

4. Functional impact of hearing loss ------------------------------------ Does the Veteran's hearing loss impact ordinary conditions of daily life, 

including ability to work: No 

5. Remarks, if any, pertaining to hearing loss: ----------------------------------------------- No response provided 

SECTION 2: TINNITUS -------------------- 1. Medical history ------------------ Does the Veteran report recurrent tinnitus: Yes 

 

Date and circumstances of onset of tinnitus: The veteran reports constant bilateral tinnitus that started while was in the military during the bombing of "Khobar towers" in Saudi Arabia in 1996. 

2. Etiology of tinnitus ----------------------- The Veteran has a diagnosis of clinical hearing loss, and his or her tinnitus 

is at least as likely as not (50% probability or greater) a symptom associated with the hearing loss, as tinnitus is known to be a symptom associated with hearing loss. 

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/ Katherine A Breaux Clinical Audiologist Au.D., CCC-A Signed: 09/10/2019 13:30 

[GBArmy]

This is just my opinion. I think you will be rated 10% for tinnitus, and I'm not sure if they will give you the 0% for hearing."Therefore, it is less likely as not that hearing loss was caused by acoustic trauma during military service. " Also, one ear doesn't seem to be bad enough and you an average of the two I believe to make the minimum. If you get the tinnitus rated at 10%, that of course is great. If you get denied on the hearing, you can appeal if your values are there. You fight the statement that it didn't happen in service. Your MOS says it was a high risk MOS??? So, if I read this right, if you can get a certified audiologist to re do the exam and your values end up to meet the min. criteria, you should have a good chance. They have to do the testing to certain criteria, I think it is a Maryland test.

[GeekySquid]

Immediately, today I mean, reach out to the head of the C&P Examiners at your VAMC and tell them that there is an error in the C&P that is a flat out lie.

There is a window of time from the C&P until it gets entered in to the record that you can have it corrected or a new C&P issued without the faulty one being added to your C-File.

According to posts here on hadit I believe that time frame is 10 calendar days.

I had never heard that until I read it here, but if I were you I would try it at least.

That is false information and it is negative to your Calulza.

[GeekySquid]

59 minutes ago, Usaf9498 said:

The veteran currently does not have hearing loss in the left ear that meets VA criteria as disabling 21 years after his exit from the service. 

exactly where did this "criteria" of 21 years come from? It does not exist in any standards manual used by the VA that I have ever heard of.

read this link to understand how va rates hearing loss

https://veterans.perkinslawtalk.com/post/whats-the-right-rating-for-my-va-hearing-loss-claim/

1 hour ago, Usaf9498 said:

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)* 

this says you have a hearing loss in the left ear, but the justification is based on mythical standard of 21 years after service.

1 hour ago, Usaf9498 said:

Military records indicated an enlistment physical dated 3-11-1994 which showed normal hearing by calibrated audiometry. There were no other hearing exams within the STRs, therefore, hearing loss at military separation was not ruled out.

both ears say the exact same thing.

If you hear at entrance, but NO EXIT exam or other hearing exam. Then harm happened in service UNLESS they rely on that mythical 21 year later standard that I don't believe exists.

If I were you. I would print the Left and Right ear sections and look at each entry side by side. Highlight each sentence that is different.

This is setting a stage for any future claim you have on HL in the Left ear. Right now you don't have the numbers to meet a problem based on PureTone test results.

Your CNC however shows this

1 hour ago, Usaf9498 said:

d. Speech Discrimination Score (Maryland CNC word list): 

+=======================+ | RIGHT EAR | 88% | |=============+=========| | LEFT EAR | 96% | +=======================+ 

when the left ear gets to 92% on the cnc, things change for you rating.

I suggest you challenge the hobbies thing and you set the stage for future ratings.

I suggest you will likely get a 0% SC for HL in the right ear, Denied for Bilateral and NSC for Left until you challenge that 21 years thing You will still NOT have a rating for the left ear, but you will clean up this exam result in preparation for a future rating on HL or Bilateral HL>

[Usaf9498]

20 hours ago, GeekySquid said:

Immediately, today I mean, reach out to the head of the C&P Examiners at your VAMC

Geeky would you happen to know how to find the head of the c&p examiners? I definitely want to get the motorcycle thing corrected and maybe at the time, I can ask about the 21 year thing? 

[GeekySquid]

1 hour ago, Usaf9498 said:

Geeky would you happen to know how to find the head of the c&p examiners? I definitely want to get the motorcycle thing corrected and maybe at the time, I can ask about the 21 year thing? 

Call the VAMC and ask to speak to the Director of Compensation and Pension Programs... title like that. If the operator doesn't know, then try the Patient Advocate or better yet drive down there and stalk the administrative hallway until you find someone to help you. Camping in the Directors Office or the Change Management Agents office usually gets their attention.

As for that 21 year "rule", it doesn't exist in the Law. You can ask them sure. If they try and "explain" what the doctor meant stop the and ask for the written Policy Number or Law that describes it. They will NOT be able to produce one. Any attempt to explain it is an attempt to dissuade you from filing a NOD to appeal because they know it is not a valid parameter in a C&P exam.

Be clear, your personal doc telling that 21 years after XXX event it is unlikely YYY cropped up is not illegal, it is an opinion. Telling you in a C&P exam, one that already maybe flawed for other reasons, that it is the reason for denial of SC is just wrong.

As I said print the entries for Left ear and Right ear then line at a time compare what they wrote.

For the Right ear they said there were no hearing tests beyond your entrance exam, but then said because of your job your were SC for hearing loss. For the Left ear they said there were no hearing tests beyond the entrance exam but added that 21 year statement as a reason for denying.

Right now it does not matter as your Puretone and CNC readings don't show a level of loss that is rateable However your hearing will get worse (this is normal), and if you let this statement stand it will likely cause you problems later on when you reapply for the Left ear.

I don't know your situation and I am not a MD or AuD but reality is at some point your HL could be high enough to qualify for an actual compensable % (it is common to be SC at 0% for HL) and you don't want to have to fight over a stupid error you can correct from jump street.

The AMA process has mucked things up on many fronts and we can realistically expect more changes in the near future. Address these problems as they arise even if you think they are ticky tacky things.

Others may not agree and you are free to do what you want on the issue, but in my opinion getting it straightened out now will save you future headaches.

[Usaf9498]

I called the hospital this morning and spoke with the C and P scheduler. She stated that there was nothing that she could do there, that I had to go to the regional office and gave me their phone number. I called the regional office and spoke to Charles and he stated that their system was down this morning so he could not add notes to my file. He did state that he thinks I need to request  new exam. I stated that I don't think I need a whole new exam, just an addendum to the existing exam saying that I do not nor have I ever ridden motorcycles. He said that it will then be my word against the doctors at that point. He suggested that I call back later when his system was back up, or mail or fax in a written statement. I don't think he really knows what to do .