Over a million ears in AZ

Transcription

1 Over a million ears in AZ VA Hearing Healthcare Steve Huart, Au.D. VA Eastern CO Health Care System Denver

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4 Who has served? Air Force Army Marines Navy National Guard Coast Guard Thank you for your service!

5 Disclaimer Information is public Opinions are mine, not the VA s

6 Agenda Audiology in the VA Auditory disabilities in the VA Audiology services in the VA HA, HAT, and a whole lot more Eligibility Vets in AZ Vets then vs. Vets now How can you serve those who have served and I hate agendas so please ask???

7 Audiology in the VA

8 The Origin of the VA Motto 1865 in a month the Civil War would end, Lincoln would be assassinated March 4 th, Lincoln s second inaugural address.. With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation s wounds, to care for him who shall have borne the battle and for his widow, and his orphan With the words, To care for him who shall have borne the battle and for his widow, and his orphan, President Lincoln affirmed the government s obligation to care for those injured during the war and to provide for the families of those who perished on the battlefield.

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11 VISN: Veteran s Integrated Service Network

12 ECHCS: Eastern CO Health Care System

13 ECHCS - 11 locations in CO Denver main hospital* Move to Aurora CBOCs (Community Based Outpatient Clinic) Alamosa Aurora Burlington CO Springs* Golden (*2014) Jewell (Aurora)* La Junta Lakewood Lamar Pueblo (*TH) Salida *Sites w/ audiology 13 Auds 4 sound booths ~400,000 Vets comp/pen exam 2900 hearing exams >7000 HA for 3663 Vets

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15 3 medical centers in AZ Las Vegas

16 Auditory disabilities

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18 How much is too much? In most cases, the sound level from firing a weapon is sufficient to require the use of hearing protection, even if the weapon is fired only one time. Recent National Institute for Occupational Safety and Health (NIOSH) studies of sound levels from weapons fire have shown that they may range from a low of 144 db SPL for small caliber weapons such as a 0.22 caliber rifle to as high as a 172 db SPL for a caliber revolver.

19 Ouch! 115dB 90dB 85dB

20 Hair cells in the cochlea Normal Noise damage

21 AGE NOISE

22 Impact on hearing

23 All Vets don t have Hearing Loss 500 4K Audiograms for National Health and Nutrition Examination Survey respondents ( ) by age category. Statistically significant contrasts are indicated by stars FOLMER et al. Audiometric thresholds and prevalence of tinnitus among veterans JRRD, Volume 48, Number 5, 2011

24 The odds ratio for the association between veteran status and tinnitus is 2.3 FOLMER et al. Audiometric thresholds and prevalence of tinnitus among veterans JRRD, Volume 48, Number 5, 2011

25 HL is immediate, can recover, not latent FINDING: The evidence from laboratory studies in humans and animals is sufficient to conclude that the most pronounced effects of a given noise exposure on pure-tone thresholds are measurable immediately following the exposure, with the length of recovery, whether partial or complete, related to the level, duration, and type of noise exposure. Most recovery to stable hearing thresholds occurs within 30 days. FINDING: There is not sufficient evidence from longitudinal studies in laboratory animals or humans to determine whether permanent noise-induced hearing loss can develop much later in one s lifetime, long after the cessation of that noise exposure. Although the definitive studies to address this issue have not been performed, based on the anatomical and physiological data available on the recovery process following noise exposure, it is unlikely that such delayed effects occur. Institute of Medicine, Noise and Military Service

26 Listen to your mom* Hearing damage is the No. 1 disability in the war on terror 70,000 of the more than 1.3 million troops who have served in the two war zones are collecting disability for tinnitus 58,000 have disability for hearing loss True toll could take decades to become clear *Protect Your Ears, Not Just Mom Advice Stars and Stripes March 11, 2008

27 Department of Defense Hearing Center of Excellence Lt. Col Mark Packer, MD, Director?

28 Audiology services HA, HAT, and a whole lot more

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30 Hearing Aids and Hearing Assistive Technology Hearing aids and batteries 8 Manufacturers on contract Complete array of Hearing Assistive Technology Baha and Cochlear Implant

31 Vet s get the best

32 Audiologic Rehabilitation

33 Progressive Tinnitus Management Referral Individual Counseling Group Counseling Tinnitus Workshop Hearing Evaluation

34 J. Henry, 2013

35 Implantable solutions

36 VNG (Videonystagmography ) Rotational Chair

37 Other Peer support Multidisciplinary teams Polytrauma TBI Service dogs

38 Disability /Eligibility

39 USS Vogelgesang (DD-862) BLDG 215

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42 VHA DIRECTIVE PRESCRIBING HEARING AIDS AND EYEGLASSES October 28,

43 VHA DIRECTIVE (1) Ensuring access to audiology and eye care services including preventive health (care) services and routine vision testing for all enrolled veterans and those veterans exempt from enrollment. Eyeglasses and hearing aids must be provided to the following veterans: (a) Those with any compensable service-connected disability. (b) Those who are former Prisoners of War (POWs). (c) Those who were awarded a Purple Heart. (d) Those in receipt of benefits under Title 38 United States Code (U.S.C.) (e) Those in receipt of an increased pension based on being permanently housebound and in need of regular aid and attendance. (f) Those with vision or hearing impairment resulting from diseases or the existence of another medical condition for which the veteran is receiving care or services from VHA, or which resulted from treatment of that medical condition, e.g., stroke, polytrauma, traumatic brain injury, diabetes, multiple sclerosis, vascular disease, geriatric chronic illnesses, toxicity from drugs, ocular photosensitivity from drugs, cataract surgery, and/or other surgeries performed on the eye, ear, or brain resulting in vision or hearing impairment. (g) Those with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living. (h) Those who have vision and/or hearing impairment severe enough that it interferes with their ability to participate actively in their own medical treatment and to reduce the impact of dual sensory impairment (combined hearing and vision loss). NOTE: The term severe is to be interpreted as a vision and/or hearing loss that interferes with or restricts access to, involvement in, or active participation in health care services (e.g., communication or reading medication labels). The term is not to be interpreted to mean that a severe hearing or vision loss must exist to be eligible for hearing aids or eyeglasses. (i) Those veterans who have service-connected vision disabilities rated zero percent or service-connected hearing disabilities rated zero percent if there is organic conductive, mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in the low, mid, or high-frequency range or a combination of frequency ranges which contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service-connected hearing disability. Congressional Medal of Honor

44 VHA DIRECTIVE (2) Ensuring that hearing aids are provided in accordance with the following policies: (a) Hearing aids must be issued only to eligible veterans who are otherwise receiving VA care or services in accordance with 38 CFR and this Directive. (b) Veterans meeting the eligibility requirements to receive health care are eligible for diagnostic audiology services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans must not be denied access to audiology services covered by the Medical Benefits Package (38 CFR 17.38) because they do not meet the eligibility criteria for hearing aids. (c) Audiologists must utilize the Remote Order Entry System (ROES) to review and request eligibility for hearing aids; by requesting the hearing aid in ROES, the audiologist stipulates that medical need exists based on the evaluation. Veterans in Priority Groups 1-5 are eligible for hearing aids. (d) Non-service connected (NSC) veterans (Priority Groups 6, 7, and 8) must receive a hearing aid evaluation (HAE) prior to determining eligibility for hearing aids to establish medical justification for provision of these devices. These veterans must meet the following criteria for eligibility based on medical need:

45 VHA DIRECTIVE Be enrolled or exempt from enrollment and receiving a vested level of care from a VA medical facility; and 2. Have hearing loss that interferes with or restricts communication to the extent that it affects their active participation in the provision of health care services as determined by the audiologist (see paragraph 4.c). 3. Eyeglasses 4. Replacing hearing aids and eyeglasses in accordance with VHA Handbooks and , to include: NOTE: Hearing aids or eyeglasses are not to be replaced solely for cosmetic purposes.

46 VHA DIRECTIVE (a) Hearing aids or eyeglasses are to be replaced when the device proves to be ineffective, irreparable, or the veteran s medical condition has changed and a different device is needed. (b) Hearing aids or eyeglasses are to be replaced if the device was destroyed or lost due to circumstances beyond the control of the veteran. (c) Hearing aids or eyeglasses are not to be replaced because of availability of newer technology, unless there is evidence that the replacement will significantly benefit the veteran. (d) For hearing aids, replacement may be based on age of the device, whether they are beyond economical repair, technical performance is reduced, parts or accessories are unavailable, or the device is no longer sufficient for the veteran s communication needs. (e) Replacement hearing aids can be prescribed at any time that change of amplification characteristics are required to maintain or improve communication function. Hearing aids have an expected life span of 3 to 4 years depending on the model of the instrument, daily hours of use, wear and tear, frequency of repair and maintenance, ear conditions, and user lifestyle.

47 VHA DIRECTIVE c. Audiologist. The audiologist is responsible for applying all the following in prescribing hearing aids: (1) To mitigate the impact of hearing impairment on quality of life and participation, the following degree of impairment is considered disabling and establishes the basis for consideration of hearing aid candidacy, subject to evaluation by an audiologist: hearing thresholds 40 decibels (db) HL or greater at 500, 1000, 2000, 3000, or 4000 hertz (Hz); or hearing thresholds 26 db HL or greater at three of these frequencies; or speech recognition less than 94 percent (38 CFR 3.385). This degree of impairment is disabling is considered justification for hearing aids. (2) When determining candidacy for amplification, audiologists must consider the effect of impairment (i.e., activity and participation) using well-established, patient-centered clinical practices. It is the effect of impairment, specifically participation restrictions (e.g., access to health care), that is the justification for eligibility based on medical need. In making decisions about candidacy for amplification, audiologists must apply evidence-based clinical practices guidelines and recommendations including, but not limited to: (a) Audiology Clinical Practice Algorithms and Statements. Joint Committee on Clinical Practice Algorithms and Statements. Statement 3 and Algorithm 3. Joint Audiology Committee Statements on Hearing Aid Selection and Fitting (Audiology Today, Special Issue, August 2000).

48 HA Eligibility Priority Group 1-5 Any compensable serviceconnected disability Former POW Purple Heart Medal of Honor Receiving Title 38 US Code 1151 benefits Benefits for people disabled by treatment or vocational rehabilitation Increased pension for permanently housebound in need of aid and attendance HL resulting from disease or condition for which Veteran is receiving care from VHA, and/or surgeries performed on eye, ear, or brain resulting in hearing loss Significant functional or cognitive impairment evidenced by deficiency in ability to perform activities of daily living HL severe enough to interfere with their own medical treatment and to reduce impact of dual sensory impairment Service connected hearing loss (even if 0%) VHA Directive , 38CFR17.149, CFR, 38 CFR 3.38

49 Service Connected Compensation and Pension Vet reports problem Exit physical Veteran s service officer Claim filed Exams performed Service connection awarded or denied

50 Eligibility Priority Group 6-8 Be enrolled or exempt from enrollment and receiving a vested level of care from VA HL interferes with or restricts communication to the extent it affects active participation in health care services Hearing thresholds 40 dbhl or greater at.5, 1, 2, 3, or 4 khz Hearing thresholds 26 dbhl or greater at 3 of these frequencies Speech recognition less than 94% VHA Directive , 38CFR17.149, CFR, 38 CFR 3.38

51 ( 2010 SC = 3,210,261 Up 144,480 )

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53 Compensation for hearing benefits not limited to SC Vets NSC Vets are eligible too if they meet certain criteria

54 Vets in AZ

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56 Percent of the Civilian Population 18 Years and Over Who are Veterans Arizona Estimate: 11.9 Percent (universe = 4,631,972 people) United States Estimate: 10.1 Percent (universe = 307,006,550 people) Source: (2009)

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58 Vets by state by period (x1000) * * U.S. Census Bureau, Statistical Abstract of the United States: 2011 * =313,000 (56%) from VN and GWOT

59 Vets then vs. Vets now

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62 Most Prevalent Disabilities by Period of Service at end of FY 2011

63 Most Prevalent Disabilities by Period of Service at end of FY 2011

64 Most Prevalent Disabilities by Period of Service at end of FY 2011 As Viet Nam Vets age this could change.

65 Most Prevalent Disabilities by Period of Service at end of FY 2011

66 Most Prevalent Disabilities by Period of Service at end of FY 2011

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69 Vets then compared to Vets now Most reported disability? HL and tinnitus since gunpowder! Has history changed the problem? NO What has changed? Survivability!

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72 Next War? Please let me be wrong. Even as I support the troops, I work diligently for a world where their role is unnecessary. The real goal of Veteran s Day should not be only to honor veterans, but to commit ourselves to have fewer veterans to honor. The soldier s duty is to follow orders. The citizen s duty is to hold leaders accountable for the orders they give.* *

73 Bumpersticker: It'll be a great day when our schools have all the money they need and the Navy has to hold a bake sale to buy a battleship (circa 1970)

74 Front line to hospital in minutes

75 Results? What used to be fatal is not Survivors have greater injuries POLYTRAUMA Tinnitus Hearing loss TBI w/ co morbidities Physical, Cognitive, Psychological Amputations

76 How to serve those who have served

77 Vets in the private sector The majority of veterans in the United States do not use VA medical centers or clinics for healthcare and do not receive VA compensation payments. FOLMER et al. Audiometric thresholds and prevalence of tinnitus among veterans JRRD, Volume 48, Number 5, 2011

78 VBA Regional Office 3333 North Central Avenue Phoenix, AZ

79 PHX: Phoenix VA Health Care System 650 E. Indian School Road Phoenix, AZ TUC: Southern Arizona VA Health Care System 3601 S 6th Ave Tucson, AZ PRE: Northern Arizona VA Health Care System 500 Hwy 89N Prescott, AZ

80 VHA home page: AZ: Locations: Only going to use one site, use this one!!! All states:

81 References n_slideshow.pdf n_trends_finalv5.pdf

82 /REPORTS/abr/2011_ abr.pdf

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86 Thank you for your time! Thank you for your service!