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Routine: DVBCWAU7

DVBCWAU7.m

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  1. DVBCWAU7        ;BPOIFO/RLC AUDIO WKS TEXT - 1 ; 26 DEC 2006
  1.  ;;2.7;AMIE;**128**;FEB 2,2004;Build 5
  1.  ;
  1. TXT ;
  1.  ;;   The Handbook of Standard Procedures and Best Practices for Audiology
  1.  ;;   Compensation and Pension Exams is available online. ( This is a PDF file.
  1.  ;;   You need Acrobat Reader to open pdf files. It is a free download. )
  1.  ;;
  1.  ;;Narrative:  An examination of hearing impairment must be conducted by a
  1.  ;;state-licensed audiologist and must include a controlled speech
  1.  ;;discrimination test (specifically, the Maryland CNC recording) and a
  1.  ;;pure tone audiometry test in a sound isolated booth that meets American
  1.  ;;National Standards Institute standards (ANSI S3.1.1991) for ambient noise.
  1.  ;;Measurements will be reported at the frequencies of 500, 1000, 2000, 3000,
  1.  ;;and 4000 Hz.  The examination will include the following tests: Pure tone
  1.  ;;audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, and
  1.  ;;8000 Hz, and by bone conduction at 250, 500, 1000, 2000, 3000, and
  1.  ;;4000 Hz, spondee thresholds, speech recognition using the recorded
  1.  ;;Maryland CNC Test, tympanometry and acoustic reflex tests, and, when
  1.  ;;necessary, Stenger tests.  Bone conduction thresholds are measured 
  1.  ;;when the air conduction thresholds are poorer than 15 dB HL.  A modified
  1.  ;;Hughson-Westlake procedure will be used with appropriate masking.  A
  1.  ;;Stenger must be administered whenever pure tone air conduction
  1.  ;;thresholds at 500, 1000, 2000, 3000, and 4000 Hz differ by 20 dB or more
  1.  ;;between the two ears.  Maximum speech recognition will be reported with
  1.  ;;the 50 word VA approved recording of the Maryland CNC test.  When speech
  1.  ;;recognition is 92% or less, a performance intensity function will be
  1.  ;;obtained with a starting presentation level of 40dB re SRT.  If necessary,
  1.  ;;the starting level will be adjusted upward to obtain a level at least 5 dB
  1.  ;;above the threshold at 2000 Hz.  The examination will be conducted without
  1.  ;;the use of hearing aids.  Both ears must be examined for hearing 
  1.  ;;impairment even if hearing loss in only one ear is at issue.
  1.  ;;
  1.  ;;A.  Review of Medical Records: Indicate whether the C-file was reviewed.
  1.  ;;
  1.  ;;B.  Medical History (Subjective Complaints):
  1.  ;;
  1.  ;;      Comment on:
  1.  ;;
  1.  ;;        1.  Chief complaint.
  1.  ;;        2.  Situation of greatest difficulty.
  1.  ;;        3.  Pertinent service history.
  1.  ;;        4.  History of military, occupational, and recreational noise
  1.  ;;            exposure.
  1.  ;;        5.  Pertinent family and social history; history of ear disease,
  1.  ;;            head or ear trauma, etc.
  1.  ;;        6.  Tinnitus - Is there a current complaint of tinnitus? (yes/no)
  1.  ;;            If yes, indicate the following:
  1.  ;;
  1.  ;;              a.  Date and circumstances of onset.
  1.  ;;              b.  Whether it is unilateral or bilateral.
  1.  ;;              c.  Whether it is constant or recurrent.
  1.  ;;              d.  If recurrent (intermittent), indicate the frequency and
  1.  ;;                  duration of tinnitus episodes.
  1.  ;;
  1.  ;;              INSTRUCTIONS:
  1.  ;;              -------------
  1.  ;;
  1.  ;;              a.  Refer to 2507 for claimed disabilities.
  1.  ;;
  1.  ;;              b.  It veteran has filed a claim for tinnitus and there is a
  1.  ;;                  current complaint of tinnitus, answer the questions above.
  1.  ;;
  1.  ;;              c.  If tinnitus is claimed and the veteran denies complaints
  1.  ;;                  of tinnitus, answer no to the above question and do not
  1.  ;;                  answer subsequent questions.
  1.  ;;
  1.  ;;              d.  If tinnitus is not claimed but the veteran reports a
  1.  ;;                  complaint of tinnitus, then note the presence of tinnitus
  1.  ;;                  and answer subsequent questions.
  1.  ;;
  1.  ;;C.  Physical Examination (Objective Findings):
  1.  ;;
  1.  ;;    1.  Measure puretone thresholds in decibels at the indicated
  1.  ;;        frequencies (air conduction):
  1.  ;;
  1.  ;;    = = = = =RIGHT EAR= = = = = = = = = = = = = LEFT EAR = = = = = = 
  1.  ;;    A*    B    C    D    E    **       A*   B    C   D    E     **
  1.  ;;    500|1000|2000|3000|4000|average   500|1000|2000|3000|4000|average
  1.  ;;       |    |    |    |    |             |    |    |    |    |
  1.  ;;  
  1.  ;;    *  The puretone threshold at 500 Hz is not used in determining the
  1.  ;;       evaluation but is used in determining whether or not a ratable 
  1.  ;;       hearing loss exists.  Puretone thresholds should not exceed 105
  1.  ;;       decibels or the tolerance level.
  1.  ;;    ** The average of B, C, D, and E.
  1.  ;;
  1.  ;;    2.  Speech Recognition Score: Maryland CNC word list
  1.  ;;
  1.  ;;                         _____% right ear _____% left ear.
  1.  ;;
  1.  ;;    When only puretone results should be used to evaluate hearing loss, 
  1.  ;;    the examiner, who must be a state-licensed audiologist, should certify
  1.  ;;    that language difficulties or other problems (specify what the problems
  1.  ;;    are) make the combined use of puretone average and speech
  1.  ;;    discrimination inappropriate.
  1.  ;;
  1.  ;;    Thresholds should not exceed 100 decibels or the tolerance level.
  1.  ;;
  1.  ;;D.  Diagnostic and Clinical Tests:
  1.  ;;
  1.  ;;    1.  Report middle ear status, confirm type of loss, and indicate
  1.  ;;        need for medical follow-up.  In cases where there is poor
  1.  ;;        inter-test reliability and/or positive Stenger test results,
  1.  ;;        obtain and report estimates of hearing thresholds using a
  1.  ;;        combination of behavioral testing, Stenger interference levels,
  1.  ;;        and electrophysiological tests.
  1.  ;;    2.  Include results of all diagnostic and clinical tests conducted
  1.  ;;        in the examination report.
  1.  ;;
  1.  ;;E.  Diagnosis:
  1.  ;;
  1.  ;;    1.  Summary of audiologic test results.  Indicate type and degree 
  1.  ;;        of hearing loss for the frequency range from 500 to 4000 Hz.
  1.  ;;        For type of loss, indicate whether it is normal, conductive,
  1.  ;;        sensorineural, central, or mixed.  For degree, indicate whether
  1.  ;;        it is mild (26-40 HL), moderate (41-54 HL), moderately severe 
  1.  ;;        (55-69 HL), severe (70-89 HL), or profound (90+ HL).
  1.  ;;
  1.  ;;    [For VA purposes, impaired hearing is considered to be a disability
  1.  ;;    when the auditory threshold in any of the frequencies 500, 1000, 2000,
  1.  ;;    3000, and 4000 Hz is 40 dB HL or greater; or when the auditory thresholds
  1.  ;;    for at least three of these frequencies are 26 dB HL or greater; or when
  1.  ;;    speech recognition scores are less than 94%]
  1.  ;;
  1.  ;;    2.  Note whether, based on audiologic results, medical follow-up
  1.  ;;        is needed for an ear or hearing problem, and whether there is
  1.  ;;        a problem that, if treated, might cause a change in hearing 
  1.  ;;        threshold levels.
  1.  ;;
  1.  ;;    3.  If there is a current complaint of tinnitus, indicate whether or not
  1.  ;;        tinnitus is as likely as not a symptom associated with hearing loss,
  1.  ;;        if hearing loss is present.  If tinnitus is associated with
  1.  ;;        conditions other than hearing loss indicate that the complaint of
  1.  ;;        tinnitus requires referral to another provider (appropriate provider
  1.  ;;        to be determined by C&P Director) for determination of etiology.
  1.  ;;
  1.  ;;
  1.  ;;
  1.  ;;Signature:                                        Date:
  1.  ;;END