Tinnitus

Example document — fictitious patient. Every report published here is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious: names, dates of birth, service numbers, units, locations and treating clinicians have been withheld or altered and all dates changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment — Tinnitus

Example 1 of 1 · fictitious patient (Veteran U)

Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment

SOP Codes: Balance of Probabilities - Instrument No. 85 of 2020; Reasonable Hypothesis - Instrument No. 84 of 2020

ADF History

The veteran, Aviation Technician (Avtech), enlisted Mar 1983, discharged September 2015.

Occupational History

The Aviation Technician role in the RAAF involves significant occupational hazards including exposure to high noise levels from aircraft engines and maintenance equipment, handling of heavy tools and components, working in confined aircraft spaces requiring awkward postures, exposure to chemicals including aviation fuels and solvents, and working on flight lines with prolonged exposure to aircraft noise exceeding 85 dB(A).

History

The veteran an RAAF Aviation Technician, developed bilateral sensorineural hearing loss during his service from 1986 to 2018, likely related to chronic noise exposure from aircraft engines and maintenance equipment in his role involving flight line operations and aircraft maintenance activities.

Timeline

27 Feb 1993: Initial audiogram showed significant threshold shift of 15dB or greater suggesting early sensorineural hearing loss. This was noted during routine hearing assessment, with comparison made to 1987 baseline audiogram. No recent illness or wax impaction was noted at the time.
12 Jan 2001: Failed audio test during health examination for reserve posting, with wax in ear canals noted. The hearing test failure prompted ear cleaning and retesting, indicating progression of hearing loss since 1999 assessment.
18 Jan 2001: Repeat audiogram following wax removal showed no significant threshold shift compared to immediate pre-test levels, but confirmed ongoing hearing impairment from previous baseline measurements.
14 Dec 2014: Health records documented sensorineural hearing loss - bilateral with hearing standard classification of HS1, confirming the ongoing nature of the condition and its impact on hearing capacity.

Symptoms

The veteran hearing loss was initially detected through routine audiometric testing rather than symptomatic presentation. The condition progressed from early threshold shifts in 1999 to confirmed bilateral sensorineural hearing loss requiring hearing standard classification by 2021. Current symptoms include reduced hearing capacity affecting both ears, classified as HS1 standard, indicating measurable hearing impairment that may impact communication and safety in certain environments.

Imaging

27 Feb 1993: Audiogram revealed significant threshold shift of 15dB or greater

12 Jan 2001: Audio test showed failure with wax in ear canals

18 Jan 2001: Repeat audiogram demonstrated no significant threshold shift following wax removal

14 Dec 2014: Hearing assessment confirmed sensorineural hearing loss - bilateral with hearing standard HS1

1. What is the formal diagnosis of the condition claimed above?

Bilateral Ears - Sensorineural Hearing Loss

DVA SOP Code: Tinnitus (Balance of Probabilities) - Instrument No. 85 of 2020; Tinnitus (Reasonable Hypothesis) - Instrument No. 84 of 2020
ICD-10 Code: H90.3

Sensorineural hearing loss is a type of hearing impairment caused by damage to the inner ear (cochlea) or the auditory nerve pathways. It results from dysfunction of the hair cells in the cochlea or neural pathways that transmit sound signals to the brain. This condition is typically permanent and may be caused by noise exposure, aging, genetic factors, infections, or ototoxic medications. The hearing loss can range from mild to profound and may affect specific frequency ranges, commonly the higher frequencies in noise-induced cases.

Note: While the veteran has documented sensorineural hearing loss, there is no documentation of tinnitus symptoms in the provided medical records. The SOP references above relate to tinnitus, not hearing loss. The appropriate SOP for sensorineural hearing loss would be the SOP for Sensorineural Hearing Loss.

2. For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition?

The veteran's sensorineural hearing loss was initially detected through audiometric testing rather than symptomatic presentation. First evidence of hearing loss was identified on 27 February 1993 through audiogram showing significant threshold shift.

When did the veteran first present to a health/medical provider for this condition?

The veteran first presented for hearing assessment on 27 February 1993 during routine audiometric screening, where significant threshold shift was identified by medical officers conducting the hearing assessment.

When was the condition confirmed/formally diagnosed?

The condition was confirmed on 12 Jan 2001 when the veteran failed audio testing during health examination, with formal documentation of bilateral sensorineural hearing loss recorded on 14 December 2014 with hearing standard classification HS1.

When did the veteran first present to you (or your practice) for this condition?

21 November 2014

3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.

The diagnosis was confirmed through serial audiometric testing demonstrating progressive sensorineural hearing loss. Key investigations included audiogram on 27 February 1993 showing significant threshold shift of 15dB or greater compared to 1987 baseline, failed audio test on 12 Jan 2001 during health examination, and repeat audiogram on 18 Jan 2001 following wax removal. The condition was formally documented with hearing standard classification HS1 on 14 December 2014, confirming bilateral sensorineural hearing loss affecting both ears.

4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.

Note: As this veteran has sensorineural hearing loss rather than tinnitus, the appropriate factors would be from the SOP for Sensorineural Hearing Loss, not the Tinnitus SOP. However, analyzing against potential tinnitus factors:

Being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3-dB exchange rate for a cumulative period of at least six months before the clinical onset - MET

The veteran role as an Aviation Technician involved daily exposure to aircraft engine noise and maintenance equipment noise on flight lines, which routinely exceeds 85 dB(A) levels, over his 32-year service period from 1986 to 2018.

Having sensorineural hearing loss at the time of clinical onset - NOT APPLICABLE

This factor relates to tinnitus onset in the presence of existing hearing loss, but the veteran's primary condition is the hearing loss itself.

Inability to obtain appropriate clinical management - NOT MET

The veteran received appropriate audiometric monitoring and assessment throughout his service period, with regular hearing evaluations and prompt investigation of hearing changes.

Sequelae

The sensorineural hearing loss is not a sequelae of another compensable condition but rather a primary condition resulting from occupational noise exposure.

Unintended Consequence

The condition is not an unintended consequence of medical management, as no procedures or medications were documented that could have caused the hearing loss.

Inability to Attain Appropriate Medical Management

The veteran received appropriate clinical management with regular audiometric assessments and prompt investigation of hearing changes. The Full Federal Court in Brew v Repatriation Commission (19 May 1990) establishes that inability includes both objective and subjective barriers to treatment. In this case, appropriate hearing monitoring was provided throughout service, and there were no documented barriers to accessing hearing healthcare. Therefore, this factor is NOT MET.

The % contribution of the causes is 100% and significant.

5. Please provide a Health Summary and a medication/prescribing history.

-see attached report

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