Somatic Symptom Disorder Secondary To Tinnitus
SomaticSymptom Disorder , a mental disorder previously called ChronicPain Syndrome under DSM-4, is described by The Mayo Clinic as an extreme focuson physical symptoms, such as pain or fatigue or Tinnitus that causes majoremotional distress and problems functioning.
While Tinnitus is often quite subjective in nature, if aveteran has an extreme focus on the physical symptoms of his/her constantringing in the ears, it can cause significant occupational and socialimpairment.
VA claims for Somatic Symptom Disorder secondary toTinnitus can be rated at 0%, 10%, 30%, 50%, 70%, or 100%, depending upon theseverity of your somatoform disorder, and how the symptoms affect your work,life, and social functioning.
While aveteran may have a 10% rating for Tinnitus, he/she may receive a 70% or 100%rating for Somatic Symptom Disorder secondary to Tinnitus.
How Does The Va Rate Migraine Headaches
First, its useful to understand how the VA rates migraine headaches. A migraine headache diagnosis has a maximum VA rating of 50%, which means that a veteran suffering from migraines may be eligible for up to 50% disability benefits because of the condition. This is not an automatic rating, however, and there are multiple stages of migraine headaches under consideration:
- 0% Disability Rating Someone who has only occasional migraines or symptoms that do not include prostrating attacks may only be eligible for a noncompensable, or 0% disability rating.
- 10% Disability Rating If a veteran suffers from migraines with prostrating attacks that occur on average every 2 months over a period of several months, a 10% disability rating is likely appropriate.
- 30% Disability Rating If a veteran suffers from migraines with prostrating attacks that occur on average once a month over a period of several months, a 30% disability rating is likely appropriate.
- 50% Disability Rating The maximum VA disability rating for migraine headaches requires very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. You are probably left wondering what this convoluted language means, and youre not alone. This language is broken down more below.
Of 10 Most Common Va Disability Claims: Lumbosacral Or Cervical Strain
92.2% of Veterans were rated between 0% and 20%.
Musculoskeletal system conditions include issues with joints and muscles and must involve limitation of range of motion and/or painful motion.
Lumbosacral or cervical strain is an injured, stretched, or torn muscle or tendon in your neck.
Lumbosacral or cervical strain is medically linked to overuse and trauma.
This condition can be very painful although its commonly treated with over-the-counter pain medications.
Because of this pain, veterans typically suffer from limitation of range of motion of the neck.
VA ratings for lumbosacral and cervical strain fall under Diagnostic Code 5237. Ratings are anywhere between 0 percent and 100 percent.
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What Should I Expect At A Va C& p Exam For Hearing Loss And Tinnitus
A VA C& P exam for Hearing Loss and Tinnitus involves a series of verbal questions, to include a physical examination, and diagnostic testing .
The following are a list of exam set-up methodology for the C& P examiner and the questions asked at a VA C& P exam for Hearing Loss.
Note: All testing must be conducted in accordance with the following instructions to be valid for VA disability evaluation purposes.
Instructions: An examination of hearing impairment must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test and a puretone audiometry test in a sound isolated booth that meets American National Standards Institute standards for ambient noise.
Measurements will be reported at the frequencies of 500, 1,000, 2,000, 3,000, and 4,000 Hz.
The examination will include the following tests: Puretone audiometry by air conduction at 250, 500, 1000, 2000, 3000, 4000, 6000 Hz and 8000 Hz, and by bone conduction at 250, 500, 1,000, 2,000, 3,000, and 4,000 Hz, spondee thresholds, speech discrimination 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.
Maximum speech discrimination will be reported with the 50 word VA approved recording of the Maryland CNC test.
**The average of B, C, D, and E.
How To Establish Service Connection Secondary To Tinnitus
In accordance with 38 CFR § 3.310disabilities that are proximately due to, or aggravated by, service-connecteddisease or injury, a current disability condition, which is proximately due toor the result of a service-connected disease or injury shall be serviceconnected.
Service connection on a secondary basis requires a showingof causation.
A showing of causation requires that the secondarydisability claim be shown to be proximately due to or aggravated by anotherservice-connected disability.
There are three evidentiary elements that must be satisfied for secondary conditions to Tinnitus to prove service connection under the law:
- A medical diagnosis of the secondary disability condition youre attempting to link to Tinnitus AND
- A current service-connected primary disability AND
- Medical nexus evidence establishing a connection between the service-connected Tinnitus and the current disability youre trying to connect
The first part can be satisfied with any existing medicalevidence in service treatment records, VA medical records, or any privatemedical records.
The second part can be satisfied with a veterans existingservice-connected disability rated at 0 percent or higher, which in this case,is Tinnitus.
The third part, and often the missing link needed to establish secondary service connection, can be satisfied with a credible medical nexus letter from a qualified medical provider.
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How Does The Va Rate Tinnitus
The standard VA disability rating for tinnitus is 10%. If you experience tinnitus symptoms in both ears, its still a maximum rating of 10% . If you have hearing loss along with tinnitus, which is the case for many disabled veterans, the VA will compensate for both. If you have both tinnitus and hearing loss, be sure to claim them both.
What if you experience hearing loss years after your active duty discharge? You can still claim hearing loss. Youll need to submit evidence that you were frequently exposed to high levels of noise during military operations. This can come in the form of lay evidence, sometimes referred to as buddy letters, that attest to the fact that your military duties included excessive noise exposure such as munition ranges, equipment maintenance, or aviation assignments.
Tinnitus can be hard to diagnose. The VA will conduct a C& P exam to verify your tinnitus diagnosis. You will take at least two tests at this exam, a speech recognition test, and a pure tone audiogram. Together, these test results are analyzed to come up with a tinnitus diagnosis.
Does The Va Rate Hearing Loss And Tinnitus The Same
No, Hearing Loss and Tinnitus are not the same thing, and are currently rated separately by the VA, although that could change.
Hearing Loss is objective, meaning it can be detected by an Audiologist during an Audiogram whereas Tinnitus is typically subjective, meaning it cant be discovered by a test.
Tinnitus, otherwise known as Ringing-in-the-Ear-Syndrome is the #1 most common VA disability claim.
Tinnitus is when you experience ringing, hissing, buzzing, or other noises in one or both of your ears.
The ringing in your ears isnt caused by an external sound, and other people usually cant hear it, which is a condition called Subjective Tinnitus.
The VA rates Tinnitus under CFR Title 38, Part 4, Schedule for Rating Disabilities, Diagnostic Code 6260, Tinnitus, Recurrent.
The only VA Rating for Tinnitus is 10%.
There are no higher or lower ratings.
Pro Tip: There is no test for Subjective Tinnitus, which is the most common type of Tinnitus. Only you can hear Subjective Tinnitus, and you either have it or you dont. Write a strong Statement in Support of a Claim for Tinnitus and explain the in-service event or injury that led to your ringing in the ear .
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Gerd Secondary To Migraines
Gastroesophageal Reflux Disease, or GERD, is a digestive disorder characterized by the occurrence of stomach acid flowing back up the esophagus from the stomach, causing discomfort and inflammation.
GERD is caused by frequent episodes of acid reflux. Symptoms can include heartburn, difficulty swallowing, regurgitation, and chest pain. Importantly, GERD can be caused by taking medications, such as NSAIDs, which are commonly used to treat migraines.
GERD is rated analogously to a hiatal hernia and can receive a rating of 10, 30, or 60 percent.
Of 10 Most Common Va Disability Claims: Migraines
Based on the latest 2018-2019 VA data, Migraines were the #9 most common VA disability claims for all Veterans, across all demographics.
Migraines are a high-value claim because there is a high likelihood of getting rated at 30 percent or higher.
Migraine headaches and tension headaches are two very different things.
Migraines are a serious neurological condition rated between 0 percent and 50 percent.
|8100 Migraines VA Rating Criteria:||Rating|
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How Do I Get 50% Va Disability For Migraines
As stated above, the highest schedular rating for migraines is 50%. So VA is looking to see if the veteran experiences extremely frequent completely prostrating and prolonged attacks that hamper your ability to work and earn money severely. Prostrating migraine headaches is referring to the veteran feeling extreme weakness due to migraines and must lie down for an extended amount of time.
As you can imagine, a 50% rating is not going to be enough to support someone who cannot work this is where TDIU benefits should be considered. Veterans who are unable to work due to migraines may be eligible for Individual Unemployability which is the equivalent of 100% rating.
IU requires specific evidence from a veteran to qualify for IU benefits. Even though VA doesnt provide a 100% schedular rating for migraines, a veteran could still get 100% through TDIU.
Common Medical Conditions Where Migraines Are Secondary
Ongoing medical research shows a clear association between migraines and other conditionsmost notably PTSD, tinnitus, and hypertensioncommonly known as high blood pressure. In a medical study among veterans nearly 50 percent of those with migraines were also diagnosed with PTSD. Migraine headaches are one of the most common secondary conditions for those who have ringing in their earsmedically known as tinnitus. More than one quarter of tinnitus patients also report having regular migraine headaches. And it is easy to understand how a veteran can develop intense headaches due to increased blood pressure.
These are all examples of secondary service-connected conditions. A secondary service-connected condition is when an established medical condition that was either caused or aggravated by an incident or event during a persons time in the military leads to a new and separate condition.
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Is Tinnitus A Permanent Va Disability
The VA can conduct a reevaluation to determine if the veterans condition has improved. Typically, these reevaluations occur six months after discharge or two to three years after the VA initially awarded disability. If this happens, youll receive a notice that the VA is reevaluating your disability, and they will conduct another hearing test along with any other required examinations.
Does The Va Recognize Migraines As A Disability
VA recognizes migraines as a service connected disability, so long as the veteran can prove a connection between the veterans disability and military service. In other words, if the veteran can prove that the migraines began in service it is service connected. Another way is a secondary service connection. If the migraine relates to other service-connected conditions, then she may obtain service-connected disability for this condition.
As mentioned above, the VA uses the schedule of ratings and diagnostic code 8100 to rate headaches, including migraine headaches. While the rating code itself is vague, the VAs internal adjudication manual, the M21-1, provides clarification for these terms for the decision-makers:
The magic word for an increased rating, therefore, would appear to be prostrating. We find that this is exactly the case for VA disability claims relating to migraines and it is key to obtaining VA benefits. The Disability Benefits Questionnaire for headaches, which the Compensation and Pension examiners use to conduct their exams, includes a whole section on prostrating attacks. The questionnaire prompts the examiner to ask the veteran if the migraine attacks occur:
- Less than once every two months
- Once in two months
- More frequently than once a month
- Very frequent prostrating and prolonged attacks of migraine headache pain
What Are The Va Disability Ratings For Hearing Loss And Tinnitus
Hearing Loss is the #2 overall most claimed VA disability while Tinnitus is the #1 most common VA claim.
The VA rates Hearing Loss under CFR Title 38, Part 4, Schedule for Rating Disabilities, DC 6100, Hearing Loss.
VA Ratings for Hearing Loss range from 0 percent to 100 percent, with breaks at 10 percent, 20 percent, 30 percent, 40 percent, 50 percent, 60 percent, 70 percent, 80 percent, and 90 percent although the average VA rating for Hearing Loss is 10 percent, and many veterans have a 0 percent rating.
The highest scheduler rating for Hearing Loss is 100 percent, which means you have total deafness in both ears.
Pro Tip: If youve been out of the military for more than 12 months, Hearing Loss is one of the most difficult claims to get service connected and rated above 0%. Get a Medical Nexus Letter to improve your odds of service connected Hearing Loss.
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Va Disability Ratings For Tinnitus
After service connection for tinnitus is established, VA will award a disability rating based on the severity of the condition. VA rates tinnitus under 38 CFR § 4.87, Schedule of Ratings Ear, Diagnostic Code 6260. The condition of tinnitus almost always results in a 10 percent disability rating. Importantly, this singular 10 percent disability rating takes both ears into account.
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Tdiu For Migraines And Secondary Conditions
The frequency or severity of a persons migraines, coupled with their migraine-related conditions may significantly impair their ability to work. Veterans who are prevented from gaining or maintaining substantially gainful employment may be entitled to a monthly VA disability benefit called total disability based on individual unemployability, or TDIU.
TDIU allows veterans to receive compensation at the 100 percent rate, even if their combined VA disability rating is less than that.
There are two forms of TDIU: schedular or extraschedular.
In order to be awarded schedular TDIU, veterans need to meet the criteria outlined under 38 CFR § 4.16a. The criteria requires that veterans must have one condition rated at 60 percent minimum OR two conditions that can be combined to reach 70 percent, where one condition is at a minimum of 40 percent. Importantly, the ratings for primary service-connected conditions and secondary service-connected conditions both contribute to a veterans combined rating.
Veterans who do not meet these qualifications may be eligible for extraschedular TDIU. In order to receive extraschedular TDIU, veterans must prove that their condition uniquely hinder their ability to maintain substantially gainful employment. Extraschedular TDIU is rated under 38 CFR § 4.16b.
Anxiety Secondary To Tinnitus: Is There A Connection
Plenty of medical research studies point to the prevalence of Anxiety and Depression mental disorders in veterans with Tinnitus.
For example, a 2015 joint study in coordination a VA Medical Center in California called, The Correlation of the Tinnitus Handicap Inventory with Depression and Anxiety in Veterans with Tinnitus, revealed that a shocking 79.1% of the 91 Tinnitus sufferers had a diagnosis of Anxiety, 59.3% had Depression, and 58.2% suffered from BOTH Anxiety and Depression.
According to theAmerican Tinnitus Association, Anxiety and Depression issues can be both a contributing factor to Tinnitus and a consequence of burdensome Tinnitus.
Tinnitus symptoms often result in feelings of anxiety and depression.
Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder.
13% of ATAs membership self-identified as being diagnosed with a mental health issue. At the same time, pre-existing behavioral conditions may make it more likely that the patient will experience tinnitus as a burdensome condition.
For example, one large cohort population study found that people with Generalized Anxiety Disorder are nearly 7x more likely to experience chronic, burdensome tinnitus.
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Secondary To Other Illness Or Injury
If you are experiencing tinnitus, it may be because of another illness or injury that you have. Tinnitus often occurs alongside hearing loss, so any condition that can lead to hearing loss can result in tinnitus. Any head or neck injury that damages nerves in the area may lead to tinnitus also.
Peripheral vestibular disorder, a condition that causes vertigo, can cause a ringing in the ear. Another similar inner ear disease called Menieres disease may also contribute to tinnitus. Along with inner ear problems, a circulatory condition that changes blood flow around the ears could be to blame for ringing.
Lastly, mental health conditions such as depression and anxiety often lead to tinnitus. Mental health problems can result in all sorts of symptoms in the body due to the balance of mind and body on overall wellness.
For cases where there seems to be no apparent cause for ringing in the ear, pay attention to other clues your body may be giving you about healthy changes you may need to make in dietary and exercise habits.