VASRD: Impairment of Auditory Acuity

The Veteran Affairs Schedule for Rating Disabilities (VASRD) includes a section defining procedures and ratings for hearing impairment. Hearing impairment and related medical issues may be caused by direct damage to the ears or to their internal parts, but can also be caused by certain diseases or medical issues.

Some may be service-connected, some may not. It’s the evaluator’s job to make such determinations. The regulations for this type of VA disability rating include a requirement that the examination be carried out by a state-certified audiologist and “must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test.”

How do evaluators manage the testing? There are multiple tests possible, and all examinations are conducted with the patient using only the ears, and no assistive devices such as hearing aids.

• Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination: Testing used to asssign a designation for hearing impairment, “based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns).” The designation is determined by the point “where the percentage of speech discrimination and puretone threshold average intersects.”
• Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average: This test is used to make a determination “for hearing impairment based only on the puretone threshold average.” There may be cases where an examiner feels using the speech discrimination test is not appropriate because of language difficulties, or inconsistent speech discrimination scores. The puretone-only test is designed to address this.
• Percentage Evaluations for Hearing Impairment is used to determine the percentage evaluation by “combining designations for hearing impairment of each ear”.

How The Department Of Veteran Affairs Rates Impairment of Auditory Acuity

There are multiple considerations for assigning ratings based on auditory impairment. There may be issues that affect one ear but not the other, there may be medical problems that are service-connected that affect non-service connected conditions, etc.

The VA guidance for evaluators in such areas includes reminders to evaluators that a veteran may be entitled to VA compensation due to deafness, for example, OR deafness “in combination with other specified disabilities.”

VA ratings for hearing damage and related medical problems also include a section on “other sense organs”, assigning ratings with a maximum of 10% for a complete loss of the sense of smell or taste.

However, these issues may only be rated under the VA schedule of ratings for impairment of auditory acuity “only if there is an anatomical or pathological basis for the condition.”

VA ratings for these ear issues may, depending on the condition, result in a rating that has a maximum below 100%. Some ear problems do warrant a 100% disability rating, but far more have lower maximums. VA disability ratings may total 100% with a single condition or a combination of medical issues rated at a lower amount that add up to 100%.

VA-Ratable Conditions That Result in Impairment of Auditory Acuity

The actual list of conditions that may be assigned a VA rating in this area may seem small compared to other sections, but the following are the most commonly evaluated conditions of the ear reviewed at VA facilities.

Remember, VA ratings are subject to change due to legislation, VA policy, and changes in the condition itself. What follows is intended to communicate the VA approach to evaluating such conditions, but not as a comprehensive guide to disability ratings percentages for each condition.

Chronic suppurative otitis media, mastoiditis, or cholesteatoma

This VA rating is assigned for any combination of the medical issues listed above. The condition refers to certain “long-term problems with the middle ear, such as a hole (perforation) in the eardrum that does not heal” according to the Harvard Health Publishing official site. The condition may include a middle ear infection known as otitis media that recurs or does not get any better.

VA instructions to the evaluator include directions to review the amount of hearing impairment plus any complicating factors due to the following possible issues:

• labyrinthitis
• tinnitus
• facial nerve paralysis
• bone loss of skull, separately

Chronic nonsuppurative otitis media with effusion (serous otitis media)

The “non-suppurative” version of otitis media. The VA rater is expected to rate the patient’s level of hearing impairment associated with the condition.

Otosclerosis

This condition is described as a bony growth in the middle ear. It is considered abnormal and may cause hearing loss. VA raters are instructed to evaluate this condition with respect to the level of hearing impairment that may be present.

Peripheral vestibular disorders

Feeling vertigo or dizziness may be the result of a vestibular disorder, which is often caused by a head injury, an infection, or even simple aging. Environmental issues may complicate this medical condition. VA raters are directed to rate the severeness of the dizziness and whether it leads to staggering.

Occasional dizziness is rated lower than dizziness with occasional staggering. Furthermore, VA instructions to their raters state, “Objective findings supporting the diagnosis of vestibular disequilibrium are required before a compensable evaluation can be assigned under this code” and any associated hearing impairment is separately rated.

Meniere’s syndrome (endolymphatic hydrops)

Meniere’s syndrome refers to a condition where there is a buildup of hydraulic pressure in the ear. Raters are directed to observe patients with this condition for a variety of combinations including hearing problems AND attacks of vertigo or related problems (with or without symptoms of tinnitus).

The frequency of the problems will inform the rating–attacks of vertigo and something called “cerebellar gait” happening more than once per week could result in a 100% disability rating. Attacks happening less frequently may receive lower VA ratings.

Raters are instructed to review this syndrome “under these criteria or by separately evaluating vertigo (as a peripheral vestibular disorder), hearing impairment, and tinnitus.” Whatever method achieves the highest VA rating is preferred.

Loss of auricle

Loss of the physical structure of the ear is called a “loss of auricle.” VA ratings are basically determined by whether one or both ears have been lost. At the time of this writing VA compensation for loss of auricle includes the following percentages:

• Complete loss of both: 50%
• Complete loss of one: 30%

VA ratings also address “deformity of one, with loss of one-third or more of the substance” rating that condition at 10% at the time of this writing.

Malignant neoplasm of the ear (other than skin only)

Tumors or cancers of the ear rated under this section can be assigned 100% disability, and that rating “shall continue beyond the cessation of any surgical, radiation treatment, antineoplastic chemotherapy or other therapeutic procedure.” The VA provides a six month window following such treatments before a disability rating is issued via a “mandatory VA examination.”

Benign neoplasms of the ear (other than skin only)

Instructions to the VA rater for these issues is quite simple–the evaluator will make the review based on the impairment of function.

Chronic otitis externa

This is a condition with symptoms that include chronic inflammation of the skin lining the external ear canal leading to the ear drum. There may be swelling, discharge, and itching. When this condition requires prolonged care, or frequent visits, it may be rated at 10% at the time of this writing.

Tympanic membrane, perforation of

The Department of Veterans Affairs assigns a zero percent rating to this condition.

Tinnitus, recurrent

Recurrent tinnitus requires some special instructions for the rater as this condition may be combined with certain other diagnostic codes.

When tinnitus is present, it must be evaluated as affecting one or both ears. Something known as “objective tinnitus” where tinnitus has a “definable cause that may or may not be pathologic” is not to be rated under this VA diagnostic code. There is one evaluation performed no matter if one or both ears are affected by tinnitus.

Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter for Air Force Television News