Veteranclaims’s Blog

October 4, 2012

Concession of Acoustic Trauma, What Does That Mean?

When VA concedes “acoustic trauma”, what does a concession of “acoustic trauma” by the VA really mean?

Does “acoustic trauma” mean that a permanent hearing loss has occured?

We are exploring this topic because, as the Federal Court Judge says during oral arguments in Reeves v. Shinseki, No. 2011-7085, what it means is not clear and why does the concession of acoustic trauma by the VA, which causes hearing loss, not end the the debate and mean a granting of hearing loss disability.

When Judges are baffled by an action or terms of use, the individual veteran is most surely going to be baffled and this will most likely cause the veteran to not present a proper defense of his claim.

So, first as a medical dictionay definition of acoustic trauma
http://medical-dictionary.thefreedictionary.com/acoustic+trauma

acoustic trauma, a sudden loss of hearing, partial or complete, caused by an extremely loud noise, a severe blow to the head, or other trauma. The greatest loss of hearing occurs at 4000 Hz. It may be temporary or permanent.”

Now a look at VA’s postion in Study v. Shinseki, No. 11-2475[CAVC Memorandun Decision] where they stated : “the examiner noted that medical research had shown that hearing loss due to acoustic trauma is immediate and not progressive in nature”. Aparently VA views “acoustic trauma” as a hearing loss which is not progressive, but is it permament in nature?, see difference between “acoustic trauma” and “noise-induced hearing loss”.

acoustic trauma
http://medical-dictionary.thefreedictionary.com/acoustic+trauma

acoustic trauma,
a sudden loss of hearing, partial or complete, caused by an extremely loud noise, a severe blow to the head, or other trauma. The greatest loss of hearing occurs at 4000 Hz. It may be temporary or permanent.”

noise-induced hearing loss,
a gradual loss of hearing caused by exposure to loud noise over an extended period of time, such as in an individual who works in a noisy environment. The hearing loss is sensorineural in nature and greatest in the higher frequencies. Although an early hearing loss may be temporary, it becomes permanent with increased exposure to noise.”

Now lets look at the Federal Circuit Oral Argument in Reeves v. Shinseki, No. 2011-7085, June 14, 2012 [oral argument] comments on “acoustic trauma” and what it means. The Federal Circuit cites to NIH definition and questions why concession of acoustic trauma, which accoding to NIH means that hearing loss has occured, that does not end the question regarding a veteran’s hearing loss claim, see http://www.cafc.uscourts.gov/oral-argument-recordings/2011-7085/all

The FedCir held that (1) “The fundamental flaw in the government’s argument is that it conflates the question of whether Reeves was exposed to acoustic trauma 7 with the issue of whether he suffered permanent hearing loss while on active duty.”, (2) “he still had the right to invoke the section 1154(b) presumption in order to show that he incurred the disability itself while in service.”, and (3) VA was required to apply 1154(b)[presumption] because “If Reeves had been able to use the section 1154(b) presumption to show that he incurred a permanent hearing disability in service, it presumably would have been far easier for him to establish that there was a nexus 9 between his military service and the severe bilateral sensorineural hearing loss with which he was afflicted after leaving the military.   Instead of attempting to establish that the acoustic trauma he suffered while in the military led to hearing loss following his service, Reeves would only have had to show that the hearing disability he incurred in service was a chronic condition that persisted in the years following his active duty.”, see Reeves v. Shinseki, No. 2011-7085(Fed. Cir. June 14, 2012)

++++++++++++
In Hensley, No. 91-1179(Decided May 18, 1993) the CAVC stated: “a claimant may establish direct service connection for a hearing disability initially manifest several years after separation from service on the basis of evidence showing that the current hearing loss is causally related to injury or disease suffered in service. See 38 U.S.C.A. ù 1113(b); 38 C.F.R. ù 3.303(d); Godfrey, supra; see also Cosman, supra; Triplette, supra; Douglas, supra.

+++++++++++++++++++++++++++++++
Army Clinical Practice Guidelines
http://www.usaisr.amedd.army.mil/…/Acoustic_Trauma_and_Hearing_Loss_9_Mar_12.pdf

This guidelines include a series of diagnostic procedures where the injured individual is moved through a diagnostic positions. Of note here is whether the veteran remembers being subjected to such an examination procedure following exposure to an acoustic trauma event.

+++++++++++++++++++++++++++++++
NIH
http://www.nlm.nih.gov/medlineplus/ency/article/001061.htm

Acoustic trauma
Acoustic trauma is injury to the hearing mechanisms in the inner ear due to very loud noise.

Causes
Acoustic trauma is a common cause of sensory hearing loss. Damage to the hearing mechanisms within the inner ear may be caused by:

An explosion near the ear
Gunshots
Long-term exposure to loud noises (such as loud music or machinery)

Symptoms
Hearing loss
Usually partial and involving high-pitched sounds
May slowly get worse
Noises, ringing in the ear (tinnitus)

Exams and Tests
The health care provider will usually suspect acoustic trauma if hearing loss occurs after noise exposure. Audiometry may determine how much hearing has been lost.

Treatment
The hearing loss may not be treatable. The goal of treatment is to protect the ear from further damage. Eardrum repair may be needed.

A hearing aid may help you communicate. You can learn coping skills, such as lip reading.

Outlook (Prognosis)
Hearing loss may be permanent in the affected ear. Ear protection may prevent the hearing loss from getting worse.

Possible Complications
Progressive hearing loss is the main complication of acoustic trauma.
Tinnitus (ear ringing) can also occur.
When to Contact a Medical Professional

Call for an appointment with your health care provider if:
You have symptoms of acoustic trauma
Hearing loss occurs or gets worse

Prevention
Wear protective ear plugs or earmuffs to protect against damage from loud equipment.
Be aware of risks connected with activities such as shooting guns, using chain saws, or driving motorcycles or snowmobiles.
Do not listen to loud music for long periods of time.

Alternative Names
Injury – inner ear; Trauma – inner ear; Ear injury

References:

Lonsbury-Martin BL, Martin GK. Noise-induced hearing loss. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2010:chap 151.
Update Date: 8/4/2010

Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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