Disability due to impaired hearing is defined in 38 CFR 3.385.

There are two major forms of hearing impairment or hearing loss: conductive and sensorineural. Conductive hearing loss is usually due to abnormalities in the middle or external ear such as a punctured eardrum, fluid in the middle ear, or an accumulation of ear wax (cerumen) in the external ear canal.

Sensorineural hearing loss is usually caused by damage to the inner ear where sound vibrations are translated into nerve impulses. These impulses are relayed to the brain, which interprets them as sound. Sensorineural hearing loss that occurs with aging or that occurs from noise damage usually occurs in both ears and is gradual although one ear may be more affected than the other.

A third type of hearing loss is a mixed hearing loss that occurs when someone has both conductive and sensorineural hearing problems.

One in ten persons is affected by hearing impairment. Causes include congenital (present at birth) or genetic (inherited) disorders, diseases such as infections, tumors, head injury, direct trauma to the ear or any of its three component parts (external, middle or inner ear) or indirect trauma from a sudden explosion or loud noise. Other causes include certain medicines that can cause either permanent or temporary hearing impairment, long-term exposure to loud noises or the aging process.

Conductive hearing loss resulting from a blockage or structural problem that interferes with how sound gets conducted through the ear makes sound levels seem lower. Examples include a build-up of cerumen in the ear or damage to the bones within the middle ear that do not allow sound waves to reach the inner ear.

Sensorineural hearing loss resulting from damage to the hair cells inside the inner ear causes problems with patients hearing in situations where there is background noise and as a consequence they may have difficulty following conversations. Other symptoms include difficulty hearing words clearly along with a decrease in the level of sound that is heard.

Ringing in the ears (tinnitus) is often associated with hearing loss.

An otolaryngologist, a physician who specializes in ear, nose and throat problems and/or an audiologist who specializes in diagnosing and treating hearing problems may evaluate a person. The otolaryngologist will examine a person's ears and if necessary, refer to an audiologist. The audiologist will evaluate the patient for both conductive and sensorineural hearing loss. The evaluation usually includes an audiogram.

If the pattern of sensorineural hearing loss is not typical, a magnetic resonance imaging (MRI) study may be performed to determine if a tumor or other disease requiring specific treatment is causing the hearing loss.

In the case of conductive hearing loss, removal of ear wax, treatment of infections, injuries and removal of tumors usually improves hearing. Surgery can correct some defects in the ear that will improve hearing.

If a sensorineural hearing loss exists, a hearing aid(s) may be recommended. Sometimes the hearing loss is so severe that the most powerful hearing aids cannot amplify sound enough. In those cases, a cochlear device may be recommended. The surgically implanted device transmits sound waves to a receiver placed under the scalp. This receiver then transmits impulses directly to the auditory nerve where the impulses are perceived as sound and allow a person to hear.

Limiting exposure to loud noise can minimize hearing loss due to inner ear damage. Ear protection, such as ear plugs, should be worn to dampen sound if loud noise is unavoidable.

Telecommunication devices such as amplified telephones, closed-captioned TVs, and voice-recognition software can help improve life for the hearing impaired person.

• Sensorineural hearing loss shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309(a), Disease subject to presumptive service connection, chronic disease.]

Notes

• When evaluating any claim for impaired hearing, refer to 38 CFR 3.350  to determine whether the Veteran may be entitled to special monthly compensation due either to deafness, or to deafness in combination with other specified disabilities.

• Special consideration for paired organs-even if only one ear is service connected, compensation may be payable under 38 CFR 3.383 for the other ear.