Anyone able to decipher this for me? Looks like it has the appropriate wording for Meniere's... I'm just a little concerned about my pre-existing hearing loss and history of ear infections. Dizzy spells less than once per month should be a cut and dry 30%, I'm thinking. Any thoughts? Thanks!
----------------------------------------------
Ear Conditions
(including Vestibular and Infectious Conditions)
Disability Benefits Questionnaire
Name of patient/Veteran:
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)
Evidence Comments:
right otitis media Mar2000
denies "dizziness" on enlistment Jan2000
documented "dizzy" on paperwork Dec04
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with an ear or
peripheral vestibular condition? Yes
Other diagnosis #1: dizziness
ICD code: R42
Date of diagnosis: 2004
Other diagnosis #2: eustachain tube dysfunction
Date of diagnosis: unknown
2. Medical history
CONFIDENTIAL Page 26 of 133
------------------
Description of the history (including onset and course) of the Veteran's
ear
or peripheral vestibular condition: **CLAIM TYPE: IDES
**SPECIAL CONSIDERATIONS: NOT APPLICABLE
**INSUFFICIENT EXAM: NO
ELECTRONIC CLAIMS FOLDER AVAILABLE.
Date of claim: 06/02/2016
Days pending: 0
Integrated Disability Evaluation System (IDES) Claim, please expedite.
SHA Required
Case # 00174187
VSCD
Active duty service dates:
Branch: Air Force
EOD: 03/02/2000
RAD:
The Veteran is claiming service connection for right ear eustachian tube
dysfunction. Please examine the Veteran for a chronic disability related
to his or her claimed condition and indicate the current level of
severity.
=======================================
vertigo, etd
AF 2000-current, at Luke AFB x 1.5 years
denies hx TBI,
dizziness "just hits me every once in a while", started about 10
years ago,
present about 4-5 times per year, describes as equilibrium issue "room
can be
spinning", denies syncopal events, recent trigger by bending over, no
symptoms supine
states has poor hearing, occasional flightline noise, prior childhood ear
infections
also for several years "I don't like to fly" because of pain
CONFIDENTIAL Page 27 of 133
and pressure in
both ears on landing.
denies sinus/allergies currently
quit tobacco smoking x 2 years.
Does the Veteran's treatment plan include taking continuous medication
for
the diagnosed condition: No
3. Vestibular conditions
------------------------
Does the Veteran have any of the following findings, signs or symptoms
attributable to Meniere's syndrome (endolymphatic hydrops), a
peripheral
vestibular condition or another diagnosed condition from Section 1: Yes
Vertigo
Frequency: Less than once a month Duration of episodes: <1 hour
4. Infectious, inflammatory and other ear conditions
----------------------------------------------------
Does the Veteran have any of the following findings, signs or symptoms
attributable to chronic ear infection, inflammation, cholesteatoma or any of
the diagnoses in Section 1: No
Does the Veteran have a benign neoplasm of the ear (other than skin only,
such as keloid) that causes any impairment of function: No
5. Surgical treatment
---------------------
Has the Veteran had surgical treatment for any ear condition: No
Does the Veteran have any residuals as a result of the surgery: No
6. Physical exam
----------------
External ear:
Normal
Ear canal:
Normal
Tympanic membrane:
Normal
Other abnormality: mild tympanosclerosis right tympanic membrane, normal
pneumotoscopy testing both ears
Gait:
Normal
CONFIDENTIAL Page 28 of 133
Romberg test:
Normal or negative
Dix Hallpike test (Nylen-Barany test) for vertigo:
Normal, no vertigo or nystagmus during test
Limb coordination test (finger-nose-finger):
Normal
7. Tumors and neoplasms
-----------------------
Does the Veteran have a benign or malignant neoplasm or metastases related
to any of the diagnoses in the Diagnosis section: No
8. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to the conditions
listed in the Diagnosis Section above?
[ ] Yes[X] No
b. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
Section above?
[ ] Yes[X] No
c. Comments, if any:
No response provided
9. Diagnostic testing
---------------------
Have diagnostic imaging studies or other diagnostic procedures been
performed: No
Has the Veteran had an audiogram: Yes
Attach or provide results: LOCAL TITLE: COMPENSATION AND PENSION EXAM
STANDARD TITLE: C & P EXAMINATION NOTE
DATE OF NOTE: JUN 14, 2016@14:30 ENTRY DATE: JUN 15, 2016@09:33:20
AUTHOR: FOX-HURKETT,JOAN EXP COSIGNER:
URGENCY: STATUS: COMPLETED
Hearing Loss and Tinnitus
Disability Benefits Questionnaire
Name of patient/Veteran:
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
CONFIDENTIAL Page 29 of 133
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)
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* | H
z | Hz | Hz | Hz | Hz | Hz |
(B-E)**|
|========+========+========+========+========+========+========+========|
| 35 | 35 | 40 | 45 | 40 | 35 | 30 | 40
|
+=======================================================================+
LEFT EAR
+==============================================================+
| A | B | C | D | E | F | G |
CONFIDENTIAL Page 30 of 133
|========+========+========+========+========+========+========+========+
| 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz
|
| Hz* | Hz | Hz | Hz | Hz | Hz | Hz |
(B-E)**|
|========+========+========+========+========+========+========+========|
| 35 | 40 | 45 | 45 | 40 | 40 | 45 | 43
|
+=======================================================================+
* 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 | 100% |
|=============+=========|
| LEFT EAR | 100% |
+=======================+
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:
+==========================================================================
===+
CONFIDENTIAL Page 31 of 133
| | RIGHT EAR | LEFT EAR
|
|=====================+===========================+========================
===|
| Acoustic immittance | [X] Normal [ ] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Ipsilateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Contralateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Unable to interpret | |
|
| reflexes due to | [ ] | [ ]
|
| artifact | |
|
|=====================+===========================+========================
===|
| Unable to obtain/ | |
|
| maintain seal | [ ] | [X]
|
+==========================================================================
===+
CONFIDENTIAL Page 32 of 133
2. Diagnosis
------------
RIGHT EAR
---------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[X] Mixed hearing loss ICD code: H90.6
[ ] 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:
[ ] Significant changes in hearing thresholds in service***
LEFT EAR
--------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[X] Mixed hearing loss ICD code: H90.6
[ ] 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:
[ ] 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
CONFIDENTIAL Page 33 of 133
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): REVIEW OF SMRS INDICATED A SIGNIFICANT SHIFT IN HEARING
LEVELS
DURING MILITARY SERVICE. THEREFORE, IT IS AT LEAST AS LIKELY AS
NOT THAT
THE HEARING LOSS IS RELATED TO INSERVICE 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): HEARING LOSS WAS DOCUMENTED AT ENLISTMENT. THERE WAS A
SIGNIFICANT THRESHOLD SHIFT NOTED WHILE IN THE SERVICE, THEREFORE
IT
APPEARS AT LEAST AS LIKELY AS NOT THAT THE PRE-EXISTING HEARING
LOSS WAS
CONFIDENTIAL Page 34 of 133
AGGRAVATED BY INSERVICE NOISE EXPOSURE.
Did hearing loss exist prior to service? Yes
If yes, was the pre-existing hearing loss aggravated beyond normal
progression in military services? Yes
Provide rationale for both yes or no: ENLISTMENT RECORD ON
1/14/00
REVEALED PRE-EXISTING HEARING LOSS AT THE LEFT EAR AND
TODAY'S(6/14/16)
FINDINGS REVEALED HEARING LOSS AT THE LEFT EAR WITH STSS PRESENT.
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: Patient noted
that his
right ear sounds "muffled." He noted that he hears better at
his
left ear.
5. Remarks, if any, pertaining to hearing loss:
-----------------------------------------------
Air Force 3/00-present, Cyber Security-exposed to jet engines with
ear
protection worn at times. Negative pre-military occupational noise
exposure. Patient is not employed outside of the military.
Negative
noisy hobbies. Patient noted a history of frequent ear infections
for
"most of my life." Patient noted that he has about one
ear
infection/year.
SMRS REVEALED NORMAL HEARING AT THE RIGHT EAR AND PRE-EXISTING
HEARING
LOSS AT THE LEFT EAR UPON ENLISTMENT ON 1/14/00.
TODAY'S(6/14/16)
FINDINGS REVEALED BILATERAL HEARING LOSS WITH STSS, BILATERALLY.
SECTION 2: TINNITUS
--------------------
1. Medical history
------------------
Does the Veteran report recurrent tinnitus: Yes
Date and circumstances of onset of tinnitus: Onset within the past
5-10
years.
2. Etiology of tinnitus
-----------------------
CONFIDENTIAL Page 35 of 133
At least as likely as not (50% probability or greater) caused by or a
result
of military noise exposure.
Rationale: SINCE TINNITUS WAS DOCUMENTED IN THE VETERAN'S SMRS, IT
APPEARS
AT LEAST AS LIKELY AS NOT THAT THE TINNITUS IS RELATED TO INSERVICE
NOISE
EXPOSURE.
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:
-------------------------------------------
VBMS REVIEW REVEALED DOCUMENTATION OF TINNITUS ON 12/14/04.
NOTE: VA may request additional medical information, including
additional
examinations if necessary to complete VA's review of the
Veteran's
application.
/es/ JOAN FOX-HURKETT
AUDIOLOGIST
Signed: 06/15/2016 09:33
Are there any other significant diagnostic test findings and/or results: No
10. Functional impact
---------------------
Do any of the Veteran's ear or peripheral vestibular conditions impact
his or
her ability to work? No
11. Remarks, if any:
--------------------
JR 23 JUN 2016
NOTE: VA may request additional medical information, including additional
examinations if necessary to complete VA's review of the Veteran's
application.
/es/ BLAIR W MCLAUGHLIN, MMS, PA-C
PHYSICIAN ASSISTANT, ENT/HEAD & NECK SERVICE
Signed: 06/22/2016 14:43
----------------------------------------------
Ear Conditions
(including Vestibular and Infectious Conditions)
Disability Benefits Questionnaire
Name of patient/Veteran:
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)
Evidence Comments:
right otitis media Mar2000
denies "dizziness" on enlistment Jan2000
documented "dizzy" on paperwork Dec04
1. Diagnosis
------------
Does the Veteran now have or has he/she ever been diagnosed with an ear or
peripheral vestibular condition? Yes
Other diagnosis #1: dizziness
ICD code: R42
Date of diagnosis: 2004
Other diagnosis #2: eustachain tube dysfunction
Date of diagnosis: unknown
2. Medical history
CONFIDENTIAL Page 26 of 133
------------------
Description of the history (including onset and course) of the Veteran's
ear
or peripheral vestibular condition: **CLAIM TYPE: IDES
**SPECIAL CONSIDERATIONS: NOT APPLICABLE
**INSUFFICIENT EXAM: NO
ELECTRONIC CLAIMS FOLDER AVAILABLE.
Date of claim: 06/02/2016
Days pending: 0
Integrated Disability Evaluation System (IDES) Claim, please expedite.
SHA Required
Case # 00174187
VSCD
Active duty service dates:
Branch: Air Force
EOD: 03/02/2000
RAD:
The Veteran is claiming service connection for right ear eustachian tube
dysfunction. Please examine the Veteran for a chronic disability related
to his or her claimed condition and indicate the current level of
severity.
=======================================
vertigo, etd
AF 2000-current, at Luke AFB x 1.5 years
denies hx TBI,
dizziness "just hits me every once in a while", started about 10
years ago,
present about 4-5 times per year, describes as equilibrium issue "room
can be
spinning", denies syncopal events, recent trigger by bending over, no
symptoms supine
states has poor hearing, occasional flightline noise, prior childhood ear
infections
also for several years "I don't like to fly" because of pain
CONFIDENTIAL Page 27 of 133
and pressure in
both ears on landing.
denies sinus/allergies currently
quit tobacco smoking x 2 years.
Does the Veteran's treatment plan include taking continuous medication
for
the diagnosed condition: No
3. Vestibular conditions
------------------------
Does the Veteran have any of the following findings, signs or symptoms
attributable to Meniere's syndrome (endolymphatic hydrops), a
peripheral
vestibular condition or another diagnosed condition from Section 1: Yes
Vertigo
Frequency: Less than once a month Duration of episodes: <1 hour
4. Infectious, inflammatory and other ear conditions
----------------------------------------------------
Does the Veteran have any of the following findings, signs or symptoms
attributable to chronic ear infection, inflammation, cholesteatoma or any of
the diagnoses in Section 1: No
Does the Veteran have a benign neoplasm of the ear (other than skin only,
such as keloid) that causes any impairment of function: No
5. Surgical treatment
---------------------
Has the Veteran had surgical treatment for any ear condition: No
Does the Veteran have any residuals as a result of the surgery: No
6. Physical exam
----------------
External ear:
Normal
Ear canal:
Normal
Tympanic membrane:
Normal
Other abnormality: mild tympanosclerosis right tympanic membrane, normal
pneumotoscopy testing both ears
Gait:
Normal
CONFIDENTIAL Page 28 of 133
Romberg test:
Normal or negative
Dix Hallpike test (Nylen-Barany test) for vertigo:
Normal, no vertigo or nystagmus during test
Limb coordination test (finger-nose-finger):
Normal
7. Tumors and neoplasms
-----------------------
Does the Veteran have a benign or malignant neoplasm or metastases related
to any of the diagnoses in the Diagnosis section: No
8. Other pertinent physical findings, complications, conditions, signs,
symptoms and scars
-----------------------------------------------------------------------
a. Does the Veteran have any other pertinent physical findings,
complications, conditions, signs or symptoms related to the conditions
listed in the Diagnosis Section above?
[ ] Yes[X] No
b. Does the Veteran have any scars (surgical or otherwise) related to any
conditions or to the treatment of any conditions listed in the Diagnosis
Section above?
[ ] Yes[X] No
c. Comments, if any:
No response provided
9. Diagnostic testing
---------------------
Have diagnostic imaging studies or other diagnostic procedures been
performed: No
Has the Veteran had an audiogram: Yes
Attach or provide results: LOCAL TITLE: COMPENSATION AND PENSION EXAM
STANDARD TITLE: C & P EXAMINATION NOTE
DATE OF NOTE: JUN 14, 2016@14:30 ENTRY DATE: JUN 15, 2016@09:33:20
AUTHOR: FOX-HURKETT,JOAN EXP COSIGNER:
URGENCY: STATUS: COMPLETED
Hearing Loss and Tinnitus
Disability Benefits Questionnaire
Name of patient/Veteran:
Is this DBQ being completed in conjunction with a VA 21-2507, C&P
CONFIDENTIAL Page 29 of 133
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)
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* | H
z | Hz | Hz | Hz | Hz | Hz |
(B-E)**|
|========+========+========+========+========+========+========+========|
| 35 | 35 | 40 | 45 | 40 | 35 | 30 | 40
|
+=======================================================================+
LEFT EAR
+==============================================================+
| A | B | C | D | E | F | G |
CONFIDENTIAL Page 30 of 133
|========+========+========+========+========+========+========+========+
| 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz
|
| Hz* | Hz | Hz | Hz | Hz | Hz | Hz |
(B-E)**|
|========+========+========+========+========+========+========+========|
| 35 | 40 | 45 | 45 | 40 | 40 | 45 | 43
|
+=======================================================================+
* 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 | 100% |
|=============+=========|
| LEFT EAR | 100% |
+=======================+
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:
+==========================================================================
===+
CONFIDENTIAL Page 31 of 133
| | RIGHT EAR | LEFT EAR
|
|=====================+===========================+========================
===|
| Acoustic immittance | [X] Normal [ ] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Ipsilateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Contralateral | |
|
| Acoustic Reflexes | [ ] Normal [X] Abnormal | [ ] Normal [ ]
Abnormal |
|=====================+===========================+========================
===|
| Unable to interpret | |
|
| reflexes due to | [ ] | [ ]
|
| artifact | |
|
|=====================+===========================+========================
===|
| Unable to obtain/ | |
|
| maintain seal | [ ] | [X]
|
+==========================================================================
===+
CONFIDENTIAL Page 32 of 133
2. Diagnosis
------------
RIGHT EAR
---------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[X] Mixed hearing loss ICD code: H90.6
[ ] 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:
[ ] Significant changes in hearing thresholds in service***
LEFT EAR
--------
[ ] Normal hearing
[ ] Conductive hearing loss ICD code:
[X] Mixed hearing loss ICD code: H90.6
[ ] 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:
[ ] 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
CONFIDENTIAL Page 33 of 133
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): REVIEW OF SMRS INDICATED A SIGNIFICANT SHIFT IN HEARING
LEVELS
DURING MILITARY SERVICE. THEREFORE, IT IS AT LEAST AS LIKELY AS
NOT THAT
THE HEARING LOSS IS RELATED TO INSERVICE 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): HEARING LOSS WAS DOCUMENTED AT ENLISTMENT. THERE WAS A
SIGNIFICANT THRESHOLD SHIFT NOTED WHILE IN THE SERVICE, THEREFORE
IT
APPEARS AT LEAST AS LIKELY AS NOT THAT THE PRE-EXISTING HEARING
LOSS WAS
CONFIDENTIAL Page 34 of 133
AGGRAVATED BY INSERVICE NOISE EXPOSURE.
Did hearing loss exist prior to service? Yes
If yes, was the pre-existing hearing loss aggravated beyond normal
progression in military services? Yes
Provide rationale for both yes or no: ENLISTMENT RECORD ON
1/14/00
REVEALED PRE-EXISTING HEARING LOSS AT THE LEFT EAR AND
TODAY'S(6/14/16)
FINDINGS REVEALED HEARING LOSS AT THE LEFT EAR WITH STSS PRESENT.
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: Patient noted
that his
right ear sounds "muffled." He noted that he hears better at
his
left ear.
5. Remarks, if any, pertaining to hearing loss:
-----------------------------------------------
Air Force 3/00-present, Cyber Security-exposed to jet engines with
ear
protection worn at times. Negative pre-military occupational noise
exposure. Patient is not employed outside of the military.
Negative
noisy hobbies. Patient noted a history of frequent ear infections
for
"most of my life." Patient noted that he has about one
ear
infection/year.
SMRS REVEALED NORMAL HEARING AT THE RIGHT EAR AND PRE-EXISTING
HEARING
LOSS AT THE LEFT EAR UPON ENLISTMENT ON 1/14/00.
TODAY'S(6/14/16)
FINDINGS REVEALED BILATERAL HEARING LOSS WITH STSS, BILATERALLY.
SECTION 2: TINNITUS
--------------------
1. Medical history
------------------
Does the Veteran report recurrent tinnitus: Yes
Date and circumstances of onset of tinnitus: Onset within the past
5-10
years.
2. Etiology of tinnitus
-----------------------
CONFIDENTIAL Page 35 of 133
At least as likely as not (50% probability or greater) caused by or a
result
of military noise exposure.
Rationale: SINCE TINNITUS WAS DOCUMENTED IN THE VETERAN'S SMRS, IT
APPEARS
AT LEAST AS LIKELY AS NOT THAT THE TINNITUS IS RELATED TO INSERVICE
NOISE
EXPOSURE.
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:
-------------------------------------------
VBMS REVIEW REVEALED DOCUMENTATION OF TINNITUS ON 12/14/04.
NOTE: VA may request additional medical information, including
additional
examinations if necessary to complete VA's review of the
Veteran's
application.
/es/ JOAN FOX-HURKETT
AUDIOLOGIST
Signed: 06/15/2016 09:33
Are there any other significant diagnostic test findings and/or results: No
10. Functional impact
---------------------
Do any of the Veteran's ear or peripheral vestibular conditions impact
his or
her ability to work? No
11. Remarks, if any:
--------------------
JR 23 JUN 2016
NOTE: VA may request additional medical information, including additional
examinations if necessary to complete VA's review of the Veteran's
application.
/es/ BLAIR W MCLAUGHLIN, MMS, PA-C
PHYSICIAN ASSISTANT, ENT/HEAD & NECK SERVICE
Signed: 06/22/2016 14:43