Maximum Rating for Hearing Loss
Michael Lostritto: Hello everyone and welcome to CCK Live. My name is Michael Lostritto. I am an attorney here at Chisholm Chisholm & Kilpatrick. Joined with me today, I have Kaitlyn Degnan, an attorney on our core team here at CCK Live, as well as Rachel Foster, an accredited claims agent working cases at the regional office level and at the board. Today, we are going to be discussing a very popular topic. It is VA’s maximum rating for hearing loss and so hearing loss is one of the most common conditions among veterans, really among the population at large but specifically among veterans. We see in my practice and I think in our practice at large a number of claims are made for service connection for hearing loss and tinnitus and it is just a very common condition that many veterans suffer from. Hearing loss is really categorized into three main types. There is conductive hearing loss which involves the outer or middle ear. There is sensorineural hearing loss which really involves the inner ear and then there is mixed which is just a combination between the two. So to get us started, Rachel, maybe you can tell us a little bit about some of the symptoms that individuals with hearing loss typically suffer from.
Rachel Foster: So some of the more common symptoms that we see with people suffering from hearing loss are things like muffled speech or muffled sounds. That is probably one of the most noticeable and I have heard it described as something sounding like it is in the water. It is just really hard to distinguish. You can also have difficulty understanding words, especially against background noise or if you are in a crowd. You can have trouble hearing different parts of speech such as consonants and someone who has hearing loss may also frequently ask others to speak more slowly, clearly, and loudly. They may also need to turn up the volume of the television or radio even if it is already at a level that most people can hear. This is something people probably do not think about very often, but hearing loss can also negatively impact social interactions because it is difficult to hear what is being said in conversation. You might withdraw completely because you are not able to fully participate or avoid some social settings altogether.
Michael: Yeah, and that is certainly what we see in our practice here. Another real question that we deal with is the cause of hearing loss. So maybe Rachel you can touch a little bit upon that. What are the primary causes? There are a number of them. What are the primary causes for hearing loss?
Rachel: Some of the more common causes of hearing loss that we see are things like damage to the inner ear that is caused by exposure to loud noise over time. This is probably one of the most common causes I think that we see. So gradual build-up of earwax is also a cause that eventually will block the ear canal. Ear infections or chronic ear infections and abnormal bone growths or tumors in the outer or the middle ear, and lastly, hearing loss can occur after a ruptured eardrum. So there is actual damage caused by a loud blast of noise, sudden changes in pressure, or perforation or damage of the actual eardrum with an object.
Michael: Kaitlyn turning to you, the real question that we must answer first to get a veteran compensated for their hearing loss is, how do we establish service connection for hearing loss? What is service connection? What are the elements and how do veterans go about establishing that for their hearing loss condition? Can you walk us through that a little bit, please?
Kaitlyn Degnan: Of course. So like with any other disability, to receive VA disability benefits, a veteran has to demonstrate that their hearing loss is the result of their time in service. So they have to meet the three elements of service connection. The first hurdle is to have a diagnosed condition. VA is extremely strict about the types of diagnosis it will accept when it comes to hearing loss. It requires veterans to undergo an examination by a licensed audiologist who must administer two separate tests. The Maryland CNC test is a 50-word test that scores how well you can recognize speech and the Pure Tone Audiometric test determines your level of general hearing loss by measuring the faintest tones that you can pick up. One thing to know is that even if you have a diagnosis of hearing loss from your primary care doctor, this may not count as evidence towards your claim. A hearing loss diagnosis for VA purposes must meet the threshold requirements located in 38 CFR 3.385. So this means you might have decreased hearing but it might not meet the standards for a disability for VA purposes. The next element that veterans must meet is an in-service event. So, you need to submit evidence of something that happened in-service that may have caused or contributed to your hearing loss. Some common in-service events that we see include combat service, exposure to artillery fire, and small arms fire. Additionally, certain military occupational specialties that involve mechanical work such as work on vehicles or aircraft may have greater noise exposure that can lead to hearing loss. These are by no means the only possible in-service events just ones that we see very frequently. Then finally you are going to have to show a medical nexus and to do so you will need a medical nexus opinion that states that your hearing loss is as least as likely as not due to your time in service providing a link between your currently diagnosed hearing loss and that in-service event.
Michael: That is perfect Kaitlyn. I appreciate that. I mean, it is particularly your first point on the fact that veterans can think that they have hearing loss and maybe they do in fact have hearing loss, but if it is not to the level that VA determines is actually a disability, then they are not going to be able to establish service connection, and that is something in talking to veteran clients. I am sure you have all experienced this yourself. Sometimes it is hard to understand the fact that you do have a hearing disability, but for VA purposes, it is not going to be sufficient to actually get you a grant of service connection. So there is a little disconnect to there and it is an important point to remember so that is a great point. So, once a veteran now has established service connection for their hearing loss, the next step that VA undertakes is to rate that condition. So VA will assign a disability rating based on the severity of the veteran’s hearing loss. VA rates both ears together resulting in only one rating, one combined rating for hearing loss of both ears, which is an important point to remember and really as well walk through here the rating criteria and the application that rating criteria for hearing loss is fairly complicated and it is really just a mechanical application of the rating criteria whereas other conditions are rated based on a criteria that may leave some room for advocates to argue warrants an increased rating or perhaps veterans can submit additional evidence to establish that based on the criteria their condition warrants an increased rating. It is much more difficult to do so with hearing loss, again because really VA will look at the criteria. Will look at the testing results and will mechanically apply the rating criteria to that testing and come up with the veterans rating. So it is a little bit more difficult and it is a little bit more rigid so to speak than rating other conditions. So, to walk us through that, to determine a veteran’s rating, VA will take the results of their what is known as your pure tone threshold test and average it together for each ear. So VA does this with a grid chart that they use. That chart contains different frequencies that line up to the different thresholds and they use what is known as and this is a mouthful, but the numeric designation of hearing impairment based on pure tone threshold average and speech discrimination, which like I said is a lot but that is what they use to really rate the condition. Again, it is very formulaic and so what VA does is they will assign a Roman numeral designation for the veterans hearing impairment based on a combination of the percentage of speech discrimination and the pure tone threshold average. So this grid is located in VA’s regulations and it is important for advocates, for veterans to take a look at it and try to match the results of their test with this grid. Like I said, that can be very challenging but really VA is trying to assign a Roman numeral designation like I said, and then use that Roman numeral to further assign a specific rating criteria. The Roman numeral that I am speaking of is located at the point where the percentage of speech discrimination and pure tone threshold average meet on the grid. So that would then be the veteran’s Roman numeral designation for their hearing loss. So that is the first step. Rachel, maybe you can walk us through the next step that VA undertakes to determine how that Roman numeral designation is then used and applied to coming up with the veteran’s actual rating for their hearing loss.
Rachel: So we actually have a copy of the chart that VA uses on our blog. So feel free to check that out and follow along as well. But essentially once VA determines your Roman numeral designation for each ear, then you start figuring out what your disability rating is going to be as a percentage. So the first thing you want to do is find the Roman numeral going down the left side for the ear that has the greater auditory function. Next, you want to locate the Roman numeral of the ear with the less auditory functioning which can be found across the top of the table, and then finally, the veteran should locate the rating where the two Roman numerals intersect and that will tell you what your overall percentage is going to be.
Michael: It is very mechanical, right? You are finding a number on a chart, you are matching that number up with a rating and then VA spits out the appropriate rating. So as you can see, it is difficult, not impossible, but it is difficult for advocates to be able to argue that an increased rating is warranted unless they have new testing results that they can use to base their argument on. Very different than other disabilities that we see throughout the schedule of rating for disabilities. Rachel though, what happens if a veteran’s disability, if their hearing loss does not really fit into one of those boxes? What if they have what is known as kind of an exceptional pattern, so to speak, to their hearing loss? Is there a way for veterans to argue that their rating does not fit into that standard rating criteria?
Rachel: So, VA has what they call an exception pattern of hearing loss criteria. So essentially, there is a separate alternate rating table that exists if you fit that standard. We have listed links below for more information. You can get a little bit more information on what an exceptional pattern of hearing loss entails and see if this applies to you.
Michael: Kaitlyn, turning back to you now. Now that we have walked through the grid and the table, can you talk to us a little bit about some of the most common ratings that we see and that veterans see for their hearing loss?
Kaitlyn: It is possible for veterans to receive up to a 100% disability rating for their hearing loss. However, this is very uncommon. Most commonly, we see veterans receive only a 10% rating for their hearing loss and that is because, as you both said, it can be very difficult to show entitlement to a higher rating because the disability ratings for hearing loss are based on very specific audiometric tests. So this means that the rating schedule is strictly applied with very little room for variation and this can make it difficult for veterans to receive a higher disability rating for hearing loss than the one assigned based on their test results alone, but it is possible. Although the rating schedule is strict, a veteran can also establish a secondary service connection for conditions that are caused or aggravated by your hearing loss. So some common examples that we see include vertigo, depression, and tinnitus.
Michael: Although veterans may be locked into say a 10% rating for their hearing loss, their hearing loss may be the cause of a number of other conditions or it may aggravate a number of other conditions and so, you know in my experience, I have seen where a veteran may, because they have had hearing loss over a number of years related to their service, they may develop some depression secondary to that hearing loss or maybe they have had depression before but their hearing loss really aggravates it and makes the depression worse, same with vertigo as you said. So I think it is important for veterans to keep in mind despite the fact that they may only be rated at a 10%, say for their hearing loss, they should be thinking about other ways that their hearing loss impacts their functioning or other disabilities that they have. There is a way for veterans to go about being compensated for those secondary conditions if that is in fact the case. So yeah, that is a terrific point, something we really see a lot of here and I know other veterans do as well. So, I think that does it for going through the mechanical application of the rating criteria and how we can seek higher ratings for veteran’s disabilities related to hearing loss. So, I think that does it for today’s broadcast. Thank you as always for tuning in. For more information on hearing loss and other similar conditions, please visit our blog which we have provided a link below, or explore our video library on YouTube. As always, please remember to follow us on social media and we will see you next time.
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