We receive frequent inquiries about filing New claims or questions about Denied claims for Hearing Loss.
In this blog we discuss our experience and suggestions with these claims.
- First, there are many types of hearing loss due to a variety of causes. Under EEOICPA, the primary consideration is whether exposure to chemicals in the workplace had the potential to cause the claimed condition. SNHL (sensorineural hearing loss) or BSHL (bilateral sensorineural hearing loss) are characterized by significant decrease in hearing of the higher frequencies. Not all forms of Hearing Loss apply under EEOICPA.
- Second, many claims focus on loud noise as causing, or contributing to, their hearing loss. Yes, that is likely true. However, the EEOICPA program is focused on addressing medical conditions which were (likely) caused by exposure to radiation or caused by exposure to chemicals. So, if someone says, “loud noise does not matter”, … well, it does, it is just not the primary factor under this program.
- SNHL implies that the tiny hair cells (any boney structures) in the inner ear or the auditory nerve (responsible for transmitting sound to the brain) are damaged. This condition is often caused by natural aging or exposure to loud sounds. When both ears are affected, this condition is referred to as Bilateral Sensorineural Hearing Loss (BSHL). Audiograms show a demonstrated loss of high frequency hearing in both ears. Exposure to industrial solvents is known to be causally related to BSHL.
- One common issue with denials on hearing loss claims is that people submit hearing test documents from an Audiologist, including the graph, an Audiogram, as the only medical evidence. EEOICPA does not consider this sufficient as there is no formal diagnosis signed by an MD or DO. In DOL’s view, an Audiologist is not a doctor (MD or DO). A formal diagnosis of BSHL must be signed by an MD or DO.
- What DOL requires is that your Primary Care Physician or an Ear, Nose, and Throat (ENT) specialist provide a medical record confirming you have the condition. That simply means an office visit at which they formally document, or diagnose, your hearing loss and provide notes as to how long you have had the condition.
- Doctor’s notes should confirm they reviewed the Audiologist records (Audiogram and notes), state you do have BSHL, and provide an approximate date it started (or first observed), or when you recall experiencing hearing issues.
- People with long-term hearing loss may also have tinnitus (ringing in ears), speech issues, balance, and dizziness issues. These may be considered “consequential” to the underlying hearing loss.
- To file for additional conditions related to your BSHL, a person must get approval for BSHL first, and then file for additional condition(s). Again, a doctor’s note stating that the secondary (or consequential condition(s)) were either caused by or exacerbated by the BSHL is necessary. You can file for both at the same time. However, our experience is that in most cases it serves the worker/claimant better to secure initial approval for hearing loss first, get new hearing aids, and then circle back to address other conditions.
And, then there are the EEOICPA Procedure Manual guidelines:
- Claims for hearing loss under this program have specific guidelines, and Claims Examiners are overly strict about applying those guidelines unfortunately.
- The Procedure Manual (PM) lists several industrial solvents, trichloroethylene (TCE) being one of those, as chemicals likely to cause any variety of issues, including hearing loss.
- Further, the PM lists job functions which historically would have used industrial solvents … most are construction trades jobs, machinists, mechanics, and some engineers.
- The PM also has a guideline that states that a worker had to have been in one of those specific job functions continuously for 10 years, prior to 1990. Job titles/functions vary from work site to work site, and often, the EEOICPA Claims Examiners are reluctant to budge if your documented job title does not align with guidance found in the PM. There is not a lot that can be done about this. We have tried!!
Denied in the past? Our suggestions to “Reopen” the claim follow:
- Review the medical records submitted as part of your initial claim. If there is no medical record with signature from an MD/DO attesting to the claimed condition, simply get to your doctor and have them document your hearing loss for the record.
- Ask your doctor to comment/note that in your job roles at a DOE facility, you routinely used industrial solvents, like trichloroethylene (TCE).
- Send a letter to DOL with this new medical evidence and ask for your hearing loss claim to be “Reopened”. Could take a few months for them to take any action.
- If they do reopen and come back to you questioning your job titles, make sure you focus on job functions, and not your job titles. Do not assume they will read back through your case file to see what you have stated in the past.
- EEOICPA Claims Examiners do not know the difference at times (job titles vs job functions), and they think that all “managers” or “supervisors” sat in the office and ate donuts all day. They do not understand that many of the best workers were promoted to Leads, Supervisors or Team Leader, paying them better, but they still did the same job function as subordinates. It is tough to convince them, but with the right formal documentation (job description from your personnel file, it can be done.
Hearing loss claims are not easy to win under this program. However, if you do prevail, you can be approved to purchase any hearing aids or hearing assist devices or surgical implants. Remember to secure at least two detailed quotes (model numbers, descriptions), BEFORE YOU PURCHASE, and a note from your doctor recommending a specific brand/model is helpful. Send the quote information to DOL with a request for pre-approval/authorization. Often, you will have to purchase directly from the retailer/doctor’s office and then submit a claim for reimbursement. If you had pre-approval for a specific amount, you should receive full reimbursement.
Good Luck! If you are struggling to get started on your claim, or have applied before and been denied, you can reach out to us via the website, email, or phone for more information. We are happy to review and provide advice on these types of claims.