Chapter 09 - Ears and Hearing Footnote 1
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9.01 - Hearing loss
Noise induced hearing loss claims under subsection 21(1) of the Pension Act:
Where there is no audiogram during service or at discharge, it should be demonstrated medically that the current loss is, in fact, a noise- induced one. This determination should be made by a departmental adjudicator who has examined the result of a current audiometric test and has been given the factual history of the applicant. The adjudicator will also consider any other medical evidence on file.
The evidence should show that the loss was attributable to or incurred during service (e. g. evidence of significant noise exposure, severe acoustic trauma, etc., during the period of service). Full entitlement should be considered:
- if there is no evidence of pre- enlistment loss but there is evidence of exposure to significant noise during service; and
- there is evidence of a noise- induced hearing loss.
In any event, each individual case should be considered on its own merits.
Noise- induced hearing loss claims under subsection 21(2) of the Pension Act:
Where there is no audiogram during service or on release, it should be demonstrated medically that the current loss is, in fact, a noise- induced one. This determination should be made by a departmental adjudicator who has examined the result of a current audiometric test and has been given the factual history of the applicant. The adjudicator will also consider any other medical evidence on file.
The evidence should show that the loss arose out of, was directly connected with or was aggravated by service (e. g. significant service- related noise exposure that seems reasonably to be the cause of the current disability).
In cases where there is an audiogram on release and it shows a noise- induced hearing loss, full entitlement may be considered:
- if there is evidence of significant service- related noise exposure; and
- there is no evidence of pre- enlistment hearing loss or of other contributing factors (e. g. an audiogram showing post- discharge deterioration, medical opinions to the effect that age or non- service noise exposure are factors, etc.).
Partial entitlement may be considered if there is evidence of pre- enlistment hearing loss or of other contributing factors (e. g. an audiogram showing post- discharge deterioration, medical opinions to the effect that age or non- service noise exposure are factors, etc.).
If the audiogram on release from service does not meet the requirements for hearing loss disability, any hearing loss demonstrated on subsequent audiograms is not considered due to service- related noise exposure and therefore, pension entitlement is not normally awarded.
In any event, each individual case should be considered on its own merits.
Revised Assessment (Assessment updated November 2007)
Revised General: (updated November 2007)
This chapter provides guidance in assessing entitled permanent ear and hearing conditions.
In assessing disability from hearing loss, all relevant information should be used, including the results of audiometric tests and the client's factual history. The audiogram gives a measure that helps to determine the extent of the disability from hearing loss.
In some cases, more precise tests, i. e. cortical evoked response audiometry, may be needed to determine the assessment of the hearing loss disability.
In cases where there is a loss of 50 decibels or more at the 4000 hertz frequency in both ears, an assessment of 1% is granted; however, this assessment would be increased and paid at the 5% rate (in accordance with the section of this policy which states that in cases where pension entitlement is granted for both ears with an assessment of at least 1%, the assessment will be increased to 5%).
Revised Hearing Loss - Both Ears: (updated November 2007)
The hearing loss in decibels (dBs) can be determined from the audiogram from the Pure Tone Averages (PTAs)Footnote 2 measured by pure tone audiometry. The PTAs are calculated by adding the loss in decibels at the 500, 1000, 2000 and 3000 hertz frequencies and dividing by 4. For example:
| 500 | 1000 | 2000 | 3000 | Total | Avg. | |
|---|---|---|---|---|---|---|
| Decibel loss, right ear | 40 | 50 | 50 | 60 | 200 | 50 |
| Decibel loss, left ear | 55 | 65 | 65 | 85 | 270 | 70Footnote 3 |
The above averages are used to read off the percentage of disability as given in the Table to Article 9.01. For example, using the values just obtained, under the horizontal column labelled "One Ear", find the 50 dB line. Follow along this line to the 70 dB under the vertical column labelled "Other Ear". The answer is 40%, which is the assessment of disability from hearing loss.
The maximum hearing loss is signified by "NR", meaning "no response" to the loudest sounds on the audiometer. If the "NR" line under the horizontal column labelled "One Ear" is followed along to the "20 dB or less" line under the vertical column labelled "Other Ear", the answer is 20%, which is the maximum disability for a total hearing loss in one ear. The table shows that the maximum for both ears is 80%.
If a client is granted full, i. e. five- fifths, pension entitlement with an assessment of at least 1%, as demonstrated by PTAs, the assessment will be increased to 5% (to compensate for tinnitus, vertigo and other symptoms, e. g. perforation of the ear drum).
In cases where partial, i. e. one- fifth to four- fifths, pension entitlement is granted with an assessment of at least 1%, the assessment will be increased to 5%; and the payable assessment will be calculated based on the level of entitlement (e. g. 1/ 5 X 5% = 1%). This 1% payable assessment would not again be increased to 5%.
Hearing Loss - One Ear:
If the hearing loss is in one ear only, the PTAs for that ear are calculated by adding the loss in decibels at the 500, 1000, 2000 and 3000 hertz frequencies and dividing by 4. For example:
| 500 | 1000 | 2000 | 3000 | Total | Avg. | |
|---|---|---|---|---|---|---|
| Decibel loss - one ear | 20 | 25 | 35 | 40 | 120 | 30 |
The above average is used to read off the percentage of disability as given in the Table to Article 9.01. For example, using the value just obtained, under the horizontal column labelled "One Ear", find the 30 dB line. Follow along this line to the 20 dB or less line under the vertical column labelled "Other Ear". The answer is 2%, which is the assessment of disability from hearing loss for payment purposes.
When the assessment for the pensioned ear is less than 5%, but there is a decibel loss in the non- pensioned ear of 50 decibels or more at the 4000 hertz frequency, the assessment for the pensioned ear becomes 5%.
Where fractional entitlement is granted for each ear:
In rare cases, each ear may be pensioned separately, i. e. where the cause of the hearing disability is different for each ear and one or both are partially service- related.
For example, if fractional entitlement (2/ 5ths) is given for one ear, and full entitlement (5/ 5ths) for the other, the total hearing loss is first calculated as has been explained. Then, the percentage of entitlement is determined based on the assumption that each ear is responsible for half the hearing, e. g. two- fifths of the hearing loss in one ear would be two- tenths of the total hearing loss, and five- fifths of the hearing loss in the other ear would be five- tenths of the total hearing loss. A simple way of doing the calculation is to add the numerators and denominators. Therefore, based on a total assessment of 20%, the calculation of the assessment for payment purposes would be as follows:
2/5 + 5/5 = 7/10 thus 7/10 X 20% = 14%
In this case, the pensionable assessment is rounded to the nearest 5%, i. e. 15%. The Table to Article 9.01, which is used to assess the extent of the disability from hearing loss, is on the next page.
| Ears and Hearing Table to Article 9.01 …Other ear… | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| One ear | NR | 85 dB | 80 dB | 75 dB | 70 dB | 65 dB | 60 dB | 55 dB | 50 dB | 45 dB | 40 dB | 35 dB | 30 dB | 25 dB | 20 or less |
| NR | 80% | 75% | 75% | 70% | 70% | 65% | 60% | 55% | 50% | 45% | 40% | 35% | 30% | 25% | 20% |
| 85 | 75% | 75% | 75% | 70% | 70% | 65% | 60% | 55% | 50% | 45% | 40% | 35% | 30% | 25% | 20% |
| 80 | 75% | 75% | 70% | 65% | 65% | 60% | 55% | 50% | 45% | 40% | 35% | 30% | 25% | 20% | 15% |
| 75 | 70% | 70% | 65% | 60% | 60% | 55% | 50% | 45% | 40% | 35% | 30% | 25% | 20% | 15% | 15% |
| 70 | 70% | 70% | 65% | 60% | 50% | 50% | 45% | 40% | 40% | 35% | 30% | 25% | 20% | 15% | 15% |
| 65 | 65% | 65% | 60% | 55% | 50% | 45% | 40% | 40% | 35% | 30% | 25% | 20% | 15% | 15% | 10% |
| 60 | 60% | 60% | 55% | 50% | 45% | 40% | 40% | 35% | 30% | 25% | 20% | 15% | 15% | 10% | 10% |
| 55 | 55% | 55% | 50% | 45% | 40% | 40% | 35% | 30% | 25% | 20% | 15% | 15% | 10% | 10% | 5% |
| 50 | 50% | 50% | 45% | 40% | 40% | 35% | 30% | 25% | 25% | 20% | 15% | 10% | 10% | 5% | 5% |
| 45 | 45% | 45% | 40% | 35% | 35% | 30% | 25% | 20% | 20% | 20% | 15% | 10% | 5% | 5% | 4%* |
| 40 | 40% | 40% | 35% | 30% | 30% | 25% | 20% | 15% | 15% | 15% | 10% | 5% | 5% | 4%* | 4%* |
| 35 | 35% | 35% | 30% | 25% | 25% | 20% | 15% | 15% | 10% | 10% | 5% | 5% | 4%* | 4%* | 3%* |
| 30 | 30% | 30% | 25% | 20% | 20% | 15% | 15% | 10% | 10% | 5% | 5% | 4%* | 4%* | 3%* | 2%* |
| 25 | 25% | 25% | 20% | 15% | 15% | 15% | 10% | 10% | 5% | 5% | 4%* | 4%* | 3%* | 2%* | 1%* |
| 20 or less | 20% | 20% | 15% | 15% | 15% | 10% | 10% | 5% | 5% | 4%* | 4%* | 3%* | 2%* | 1%* | Nil |
* As per policy, if pension entitlement is granted for both ears with an assessment of at least 1%, as demonstrated by PTAs, the assessment will be increased to 5%.
9.02 - Tinnitus
The word "tinnitus" refers to a subjective symptom of noises in the ear, e. g. ringing, hissing, buzzing, whistling, roaring, etc. In the majority of cases, tinnitus associated with a hearing loss. Tinnitus is generally considered part and parcel of the hearing loss disability, and will be accounted for in the assessment of the hearing loss. Therefore, where a client has been granted pension entitlement for both ears and assessed between 1% and 4%, an automatic 5% pension will be awarded to compensate for the tinnitus.
If the claim is for tinnitus alone, i. e. it is clearly due to causes other than hearing loss, then the claim should be dealt with on a case by case basis.
9.03 - Vertigo
The word "vertigo" is the name given to the sensation that surroundings are spinning or whirling; it does not mean any vague sensation of dizziness or unsteadiness. It is often caused by diseases of the ear. Menière's disease is the prime example; however, there are other causes, including heart disease (heart block), endocrine disease (diabetes, thyroid malfunction), blood disease, etc.
Vertigo is accounted for in the assessment of hearing loss if it is part and parcel of the hearing loss disability. Assessment will then be similar to that of tinnitus in cases where PTAs show an assessment of between 1% and 4%. Allowance for vertigo is made in the initial 5% assessment.
9.04 - Perforation of an Eardrum
Allowance for perforation of an eardrum is made in the initial 5% assessment.
9.05 - Previous Voice Testing Table
The previous table based on conversational voice (C. V.) testing is being retained in the Table of Disabilities solely for use in those cases where the only records of hearing tests are those recorded by conversational voice testing. It is not to be used otherwise.
The same percentage in either the conversational voice or audiometric table represents a comparable disability.
| Table to Article 9.05 …Other ear… | |||||||
|---|---|---|---|---|---|---|---|
| One Ear | Deaf | C. V. 1' | C. V. 3' | C. V. 5' | C. V. 10' | C. V. 15' | C. V. 20' |
| Deaf | 80% | 70% | 60% | 50% | 40% | 30% | 20% |
| C. V. 1' | 70% | 60% | 50% | 40% | 30% | 20% | 10% |
| C. V. 3' | 60% | 50% | 40% | 30% | 20% | 10% | 5% |
| C. V. 5' | 50% | 40% | 30% | 30% | 20% | 10% | 5% |
| C. V. 10' | 40% | 30% | 20% | 20% | 20% | 10% | less than 5% |
| C. V. 15' | 30% | 20% | 10% | 10% | 10% | 10% | less than 5% |
| C. V. 20' | 20% | 10% | 5% | 5% | less than 5% | less than 5% | Nil |
9.06 - Conversion Table ASA/ ISO Calibration
Audiograms before 1964 used the ASA calibration method of determining hearing loss intensity. To convert to the more modern ISO calibration, the following conversion is used:
| Hertz Frequency | ADD Decibels |
|---|---|
| 125 | 9 |
| 250 | 15 |
| 500 | 10 |
| 1000 | 10 |
| 1500 | 8.5 |
| 2000 | 8.5 |
| 3000 | 6 |
| 4000 | 9.5 |
| 6000 | 11.5 |
| Example: | An ASA threshold of 10 dB at the 1000 hertz frequency will be equivalent to an ISO threshold of 20 dB (10 dB + 10 dB). |
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