Transcript Eye and Ear Ratings

VBR/CSO Quarterly Training
June 2013
Thomas Meadows
TDVA Training Officer
615-441-3384 or [email protected]
2
Rating Hearing
Loss
Presented By
David Jungquist
Course Objectives
To learn:
• How to rate ear disabilities
• Some basic factors of service
connection for ear conditions
Ratings of the
Ear
EAR REFERENCS
 Hearing Loss Definition
 Ear and Sense Organ
Regulations.
 Paired Organ
 38 CFR 3.385
 38 CFR 4.85 to 4.87(a)
 38 CFR 3.383
5
When is an exam required?
• Hearing loss is claimed
• Hearing loss is shown in the STR’s
• There is no hearing loss for VA purposes in
the STR’s AND there is a hearing shift in
service or acoustic trauma is conceded
AND there is a competent lay statement or
medical evidence of hearing loss/tinnitus.
Examinations
• Must be conducted by State-licensed
audiologist.
• Must be conducted without the use of
hearing aids.
Examinations (Cont.)
• Must include a controlled speech discrimination
test (Maryland CNC).
Expressed as percentage of correct
responses.
• Must include a puretone audiometry test.
Measures the dB (decibel) (loudness) level at
which a tone can be heard at various
frequencies. The puretone threshold
average is the sum of puretone thresholds at
1000, 2000, 3000 and 4000 Hz, divided by 4.
Hearing loss Criteria
38 CFR 3.385
• A single reading of 40 dB or higher in the range
500 to 4000 Hz.
• Three or more readings of 26 dB or higher in the
range 500 to 4000 Hz
• Maryland CNC Speech Recognition Scores of 93
or lower.
Hearing loss is present if any one of the three
criteria is met.
The criteria apply to individual ears.
Example 1
R
L
500 1000 2000 3000 4000
20 25 30 30
25
15 20
30 30 30
Speech recognition:
R 93%
L 96%
Does the audio test show hearing loss in the right
ear, left ear, or both?
Rating Hearing Loss
Turn to the Hearing Tables, 38 CFR 4.85(h).
Table VI or VI(a) is used to assign the
Numeric Designation for each ear based
on Puretone Threshold Average and
Percent of Discrimination.
Table VII is used to determine the
evaluation by combining the numeric
designations for both ears.
Example 2
R
L
1000 2000 3000 4000
30 50 75 85
40 50 55 60
Speech recognition:
R 88%
L 78%
What is the evaluation?
Average
60
51
Example 3
R
L
1000 2000 3000 4000
60 65 70 80
40 40 70 90
Speech recognition:
R 86%
L 87%
What is the evaluation?
Average
69
60
Exceptional Patterns of Hearing Loss
38 CFR 4.86a
If each of the four frequencies (1000-4000) is
55 dB or higher, use either Table VI or VIa,
whichever results in the higher numeral.
Exceptional Patterns of Hearing Loss
38 CFR 4.86b
If the 1000 Hz reading is 30 dB or less AND
the 2000 Hz reading is 70 dB or higher, use
table VI or VIa, whichever results in the higher
numeral, then elevate to next higher Roman
numeral.
Table VIa
Note that Table VIa does not have speech
discrimination (speech reception) scores. It is
used under 4.86a OR 4.86b OR when the
examiner certifies that the use of the speech
discrimination test is not appropriate because
of language difficulties, inconsistent
discrimination scores, etc…
Example 4
R
L
1000 2000 3000 4000
25 75 85 105
60 85 105 105
Speech recognition:
R 55%
L 78%
What is the evaluation?
Average
73
89
Paired Extremities or Organs
38 CFR 3.383 provides compensation as if
both ears were SC when
• the hearing impairment in the SC ear would
rate at least 10 percent, and
• there is hearing impairment in the NSC ear
that meets the VA definition for hearing loss
(38 CFR 3.385) in the other ear. (NSC
cause cannot be due to misconduct.)
Example 5
R
L
500 1000 2000 3000 4000
30 30 25 25 30
105 105 105 105 105
Average
28
105
Speech recognition:
R 96%
L 20%
The left ear is SC due to acoustic trauma.
Grant or denial for the right ear? What is the
evaluation?
Diseases of the Ear
Follow along in the Rating
Schedule, from DC 6200 to
DC6260
Otitis Media
DC 6200
Chronic suppurative otitis media (CSOM) is
a perforated tympanic membrane with
persistent drainage of pus from the middle ear.
Mastoiditis is an infection of the mastoid
bone of the skull. Cholesteatoma is a cyst
located in the middle ear and skull bone
(mastoid).
Otitis Media
DC 6200
Chronic suppurative otitis media (CSOM),
mastoiditis, or cholesteatoma is rated 10 percent
during suppuration, or with aural polyps.
Rate hearing impairment or complications
(labyrinthitis, tinnitus, facial nerve paralysis, or bone
loss of skull) separately.
Nonsuppurative Otitis Media
DC 6201
Chronic nonsuppurative otitis media with
effusion is rated on hearing impairment.
Middle ear effusion is caused by a presence
of fluid in the middle ear without an actual ear
infection.
Otitis Externa
DC 6210
Otitis externa is an inflammation or infection
of the external auditory canal and/or auricle.
Rated 10 percent when there is swelling, dry
and scaly or serous discharge, and itching
requiring frequent and prolonged treatment.
Peripheral Vestibular Disorders
DC 6204
The peripheral vestibular system is comprised of
structures within the inner ear which work with the
brain to govern balance.
30 percent
10 percent
Dizziness and occasional
staggering
Occasional dizziness
Rate hearing impairment or suppuration separately
and combine.
Meniere’s Syndrome
DC 6205
Meniere's disease is a syndrome
characterized by episodes of spinning
vertigo (sense of the room spinning),
hearing loss, and tinnitus (ringing in the
ear).
Meniere’s Syndrome
Rated 30, 60, or 100 percent based on
frequency of vertigo and cerebellar gait, with or
without tinnitus.
OR
Separately evaluate vertigo as a peripheral
vestibular disorder, hearing impairment and tinnitus,
whichever results in a higher evaluation.
Ratings under DC 6205 cannot be combined with
ratings for hearing impairment, tinnitus or vertigo.
Loss of Auricle
DC 6207
The auricle is the projecting outer portion of
the ear, aka: pinna.
50 percent:
30 percent:
10 percent:
Complete loss of both
Complete loss of one
Deformity of one, with loss of
one third or more.
Neoplasm
DC 6208 and 6209
Neoplasm means tumor. Can be malignant or
benign.
If benign, rated under DC 6209 on impairment
of function. If of the skin of the ear only, the
rating will be for a skin disorder.
Malignant Neoplasm of the Ear
(Other than Skin)
DC 6208
Rated 100 percent. A future exam will be
conducted six months after the cessation of
any surgical, x-ray, antineoplastic
chemotherapy or other therapeutic procedure.
If there has been no local recurrence or
metastasis, the evaluation will be based on
residuals, following due process procedures.
Perforation of Tympanic Membrane
DC 6211
The tympanic membrane (TM) is the
eardrum.
The rating is zero percent.
This can sometimes be used as evidence
of acoustic trauma.
Recurrent Tinnitus
DC 6260
The evaluation is 10 percent, whether the sound is
perceived in one ear, both ears, or in the head.
An evaluation for tinnitus can be combined with an
evaluation for hearing loss, otitis media, or
peripheral vestibular disorders. It can be combined
with an other DC, except when the tinnitus
supports an evaluation under that code (Such as
Meniere’s).
Questions?