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