Military members who are about to retire or separate from the military are urged to begin the VA medical claims process as soon as they know they are going to separate. That doesn’t mean you can start submitting your VA claim whenever you want but you should begin to research the medical conditions you need to make claims for and how the VA rates them.
Hearing damage, hearing loss, tinnitus, and related conditions are among the most common types of medical issues for military people and getting the VA to take such claims seriously requires a qualifying medical diagnosis of the condition.
If you need to make a VA claim for hearing damage and similar problems, you may be able to get audio testing from a VA facility, but barring that you will need to submit medical evidence gathered by a licensed audiologist. In either case the VA will require two types of audio testing – one is called the Maryland CNC test, the other is a pure tone audiology test.
The Two Types Of Hearing Tests Required To Rate Hearing Loss
The Maryland CNC test measures hearing loss using a 50-word exam that is designed to score how well you recognize the spoken word. The results of the Maryland CNC test helps the VA determine your hearing damage, whether the severity of the damage qualifies for VA disability payments, etc.
The other hearing test is known as the Puretone Audiometric test, sometimes referred to as Pure Tone Audiometry or a Pure Tone Audiometry Test. This test measures overall hearing loss by determining the quietest tones you can hear while the test is administered.
These tests are done without the use of assistive devices such as hearing aids; the intent is to learn how diminished your hearing is without the use of these devices.
How The Pure Tone Audiometric Test Works
The patient is placed in a sound-isolated environment which could utilize a soundproof room, a sound booth, the use of headphones, etc. Both ears must be tested even if there is only hearing loss, tinnitus, etc. in only one ear.
The test, administered to measure the quietest sounds you can hear, is run at a variety of sound frequencies which may include the following frequencies for “bone conduction”:
- 1000 Hz
- 2000 Hz
- 3000 Hz
- 4000 Hz
The following frequencies are tested for “air conduction”:
- 250 Hz
- 500 Hz
- 1000 Hz
- 2000 Hz
- 3000 Hz
- 4000 Hz
- 6000 Hz
- 8000 Hz
A VA procedural manual from 2007 describes the Pure Tone test steps as including (but not limited to) the following:
- Exposing the patient to pure tones “well below the expected threshold” with a starting point recommended at 0 dB.
- Pure tones are played for the patient in “ascending 10-dB steps” until there is a patient response.
- The level is decreased by 10 dB and increased in 5-dB steps until there is a response from the patient.
- The lowest level at which responses occur (for at least 50% of ascending trials with a minimum of three responses at any single level) is considered to be the threshold.
Part of the VA mission for evaluating hearing loss in veterans using these tests is to differentiate between organic hearing loss and non-organic hearing loss. The official site of the National Library of Medicine contains studies that describe non-organic hearing loss as follows:
“Non-organic hearing loss (NOHL) may be either psychogenic, feigned or artefactual when there is either inattention or misunderstanding of the audiometric task.” There are many tests available to distinguish between organic and non-organic hearing loss including quantitative tests such as “evoked potentials” and “otoacoustic emissions.”
These may or may not be administered for veterans seeking VA compensation for hearing damage; such tests may be considered on a case-by-case basis to rule out false positives (depending on circumstances).
The 2007 VA procedural document mentioned above takes non-organic hearing loss issues quite seriously, stating that it “not sufficient” to simply observe “the existence of non-organicity”; the manual states that multiple tests may be required to determine “true organic thresholds.”
Furthermore, “The results of special procedures, inter-test inconsistencies, and uncooperative behavior, evasiveness, misrepresentation of facts, or unwillingness to respond or cooperate with testing, should be thoroughly documented.”
Since hearing can degrade over certain frequency ranges, the VA wants to test your ability to hear some of the most commonly lost (due to hearing damage) audio frequencies. These tones may be administered in certain ranges of loudness (measured in decibels). The results of this test, as well as the frequencies tested, will factor in for the second test, described below.
How The Maryland CNC Test Works
The Maryland Consonant-Vowel-Nucleus-Consonant test measures the patient’s ability to recognize speech. Part of this process is determining what is professionally known as the “speech reception threshold (SRT).”
SRT is described in VA medical documentation as the level, measured in decibels, “at which the patient correctly identifies 50% of a set of two-syllable (spondaic) words.”
This portion of VA hearing test requirements “should be in agreement” with the average of pure tone test thresholds from 500 to 2000 Hz. As you can guess, the pure tone test results are important for this portion of the required hearing examination.
The starting level for the CNC test is 0 decibels and in 10-dB steps “until the patient responds correctly.” The audio levels are then lowered by 10 dB with words presented in 2-dB or 5-dB ascending steps.
VA medical documents at this stage state that in cases of no response at the 100-decibel level, “100+ will be recorded.” The speech reception threshold for this test is defined as “the level at which 50% of the stimuli is correctly identified.”
The purpose of speech recognition testing in this context is described by the VA as being necessary “to obtain the patient’s best performance under optimum, controlled, and reproducible conditions.”
That means that “live voice presentation” of the test, in other words, having someone read the words into a microphone live and in person, is not permitted. Instead, the words must be pre-recorded.
Things To Remember About The Maryland CNC Test
- The VA says speech recognition scoring is not designed to “simulate real-world performance.”
- Normal speech recognition performance is defined by the VA as 94% or better for a 50-word list.
- If speech recognition is worse than 94% after presentation of 50 words, “a modified performance-intensity function must be obtained to determine best performance.”
- In addition to all the testing described above, VA rules require all patients to receive “an otoscopic examination by an audiologist or physician to determine the presence of middle-ear disease” and to make sure the ear canal is free of debris, cerumen, or conditions that “preclude audiometric testing.”
- A complete exam includes “external examination of the pinnae as well as otoscopic visualization of ear canals and tympanic membranes” according to the Department of Veterans Affairs.
What Else Should Veterans Do When Considering A Hearing Damage or Hearing Loss Claim
- Make detailed notes for submission to the VA and/or your healthcare provider describing any incidents where military service exposed you to loud sounds, gunshots, explosions, or airplane engines.
- Describe and date when you remember hearing damage, tinnitus, or other problems occurring for the first time, if possible.
- Explain why you didn’t seek medical treatment for any ear-related problems, when applicable.
- Note in detail how chronic or sporadic your hearing issues are or have become.
- Identify the severity of the hearing issues you have related to military service.
- Note how your hearing loss affects your ability to work, socialize, and live your life in general.
Making a medical claim with the VA for compensation involves submitting supporting evidence, medical documentation, and other paperwork.
If you suspect you are experiencing service-connected hearing damage, hearing loss, tinnitus, or physical damage to the ears above and beyond noise exposure, it is extremely important to seek medical attention as soon as possible for the purposes of adding this to your medical records.
Ideally this should be done while you are still serving in the military, but in cases where that is not possible, get an evaluation as soon as possible for best results in filing your VA claim.
Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News
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