Document ID: chunk:federal_register_of_legislation:F2023C00151:reg:70:p22
Version: federal_register_of_legislation:F2023C00151
Segment Type: reg
Provision Reference: reg 70 (pt 22/25)
Character Range: 260633–263922

if obesity is an accepted condition or if obesity is an integral feature of an accepted condition.

CHAPTER 7

EAR, NOSE, AND THROAT IMPAIRMENT

This chapter contains two parts:

Part 7.1 —  Hearing Loss and Tinnitus
Part 7.2 —  Ear, Nose, and Throat

PART 7.1: HEARING LOSS AND TINNITUS

Because it causes a single loss of function, accepted hearing loss is to be assessed as if it were a single condition even if the loss is described under several diagnostic terms. For example, a veteran who has accepted conditions of both "right conductive deafness" and "left conductive deafness" will have them rated as if the conditions had been described as "bilateral conductive deafness".

Only a single impairment rating may be made from Part 7.1 for accepted hearing loss irrespective of how many diagnostic terms have been used in describing the hearing loss.

However, a second impairment rating may be made from Part 7.1 (Table 7.1.11) for tinnitus if appropriate.

Definitions

For the purposes of this chapter:

  "Air Conduction"                              is the manner in which sound transmitted through the air reaches the inner ear in the normal way.
  "APHL" or "Accepted Percentage Hearing Loss"  is the percentage of total hearing that the veteran has lost due to accepted deafness. It is found by summing the losses at each of 6 important frequencies.
  "Bone conduction"                             is the manner in which sound is heard when the source of sound is placed directly over any bony part of the hearer's cranium.  In such a case the sound is conducted to the inner ear through the bones of the skull.
  "HTL" or "Hearing Threshold Level"            is, for any given frequency, the volume (loudness) of the faintest sound that the veteran can hear. For each frequency, there will be a hearing threshold level for the right ear and a hearing threshold level for the left ear. Hearing threshold levels can be determined using either bone or air conduction information.
  "Presbyacusis"                                is the normal loss of hearing which accompanies ageing.
  "TBHL" or "Total Bilateral Hearing Loss"      is the percentage of total hearing which the veteran has lost from all conditions whether accepted or not.

Calculation of the impairment rating for accepted hearing loss

Follow the steps below to calculate the accepted hearing loss.

(Each of these steps is elaborated in the following pages.)

STEP 1  Apply Table 7.1.1 to determine the type of accepted hearing loss.                                                                                                              Page 107
STEP 2  Determine whether the audiogram is reliable and suitable for hearing loss calculations.                                                                                        Page 108
STEP 3  Calculate the APHL.                                                                                                                                                            Page 109
STEP 4  Determine what age adjustment (if any) must be subtracted from the APHL. Subtract it.                                                                                          Page 120
STEP 5  Determine the functional impairment rating by applying