[Federal Register Volume 67, Number 182 (Thursday, September 19, 2002)]
[Proposed Rules]
[Pages 59033-59034]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-23784]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 4

RIN 2900-AK86


Schedule for Rating Disabilities: Evaluation of Tinnitus

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to amend the Department of Veterans 
Affairs (VA) Schedule for Rating Disabilities to state more explicitly 
the method of evaluation of tinnitus under diagnostic code 6260 in the 
portion of the rating schedule that addresses evaluation of 
disabilities of the ear. The intended effect of this action is to 
codify current standard VA practice by stating that recurrent tinnitus 
will be assigned only a single 10-percent evaluation, whether it is 
perceived in one ear, both ears, or somewhere in the head.

DATES: Comments must be received by VA on or before November 18, 2002.

ADDRESSES: Mail or hand-deliver written comments to: Director, Office 
of Regulations Management (02D), Department of Veterans Affairs, 810 
Vermont Ave., NW., Room 1154, Washington, DC 20420; or fax comments to 
(202) 273-9289; or e-mail comments to [email protected]. 
Comments should indicate that they are submitted in response to ``RIN 
2900-AK86.'' All comments received will be available for public 
inspection in the Office of Regulations Management, Room 1158, between 
the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except 
holidays).

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff (211A), Compensation and Pension Service, Veterans 
Benefits Administration, Department of Veterans Affairs, 810 Vermont 
Ave., NW., Washington, DC 20420, (202) 273-7210.

SUPPLEMENTARY INFORMATION: This document proposes to amend the 
Department of Veterans Affairs (VA) Schedule for Rating Disabilities 
(the rating schedule) to state more explicitly the method of evaluation 
of recurrent tinnitus, diagnostic code 6260, in Sec.  4.87, the portion 
of the rating schedule that addresses evaluation of disabilities of the 
ear. The current rating schedule directs that recurrent tinnitus be 
evaluated at 10 percent. A note under diagnostic code 6260 indicates 
that a separate evaluation for tinnitus may be combined with an 
evaluation under other diagnostic codes for hearing impairment or 
certain diseases of the ear, except when tinnitus supports an 
evaluation under one of those diagnostic codes. Recently, VA has 
received claims for two separate evaluations for tinnitus in the same 
individual, one for each side, when recurrent tinnitus is perceived 
bilaterally. To avoid any possible misunderstanding, VA is proposing to 
amend the rating schedule to definitively state that recurrent tinnitus 
is assigned only one evaluation whether it is perceived in one ear, 
both ears, or an indeterminate site in the head. This amendment 
involves no substantive change and is consistent with current practice.
    ``The Merck Manual'' (665, 17th ed. 1999) states that tinnitus is 
the perception of sound in the absence of an acoustic stimulus, and the 
American Tinnitus Association defines tinnitus as the perception of 
sound when no external sound is present (http://www.ata.org/about_tinnitus/). ``Tinnitus: Facts, Theories, and Treatments (1982),'' 
published by the National Academy Press, states that tinnitus is the 
conscious experience of a sound that originates in the head of its 
owner (http://books.nap/books/0309033284/html).
    Tinnitus is classified either as subjective tinnitus (over 95% of 
cases) or objective tinnitus. In subjective or ``true'' tinnitus, the 
sound is audible only to the patient. In the much rarer objective 
tinnitus (sometimes called extrinsic tinnitus or ``pseudo-tinnitus''), 
the sound is audible to other people, either simply by listening or 
with a stethoscope. Objective tinnitus commonly has a definite cause 
that generates the sound, such as vascular or muscular disorders. 
Objective tinnitus may also be due to such nonpathologic causes as 
noise from the temporomandibular joints, openings of the eustachian 
tubes, or repetitive muscle contractions.
    True (subjective) tinnitus does not originate in the inner ear, 
although damage to the inner ear may be a precursor of subjective 
tinnitus. It is theorized that in true tinnitus the brain creates 
phantom sensations to replace missing inputs from the damaged inner 
ear, similar to the brain's creation of phantom pain in amputated limbs 
(Diseases of the Ear, H. Ludman, and T. Wright, 6th ed., chapter 11; 
Phantom auditory perception (tinnitus): mechanisms of generation and 
perception, Neuroscience Research 8:221-2, P. Jasterboff, 1990; and 
Mechanisms of Tinnitus. Allyn and Bacon, 1995, J. Vernon and A. Moller 
(Eds)). The Oregon Tinnitus Data Archive found in a study of 1630 
individuals with tinnitus that 63% reported tinnitus in both ears and 
11% reported it as filling the head (http://www.ohsu.edu/ohrc-otda/95-01/data/08.html). Therefore, in the great majority of cases, tinnitus 
is reported as either bilateral or undefined as to side.
    True tinnitus, i.e., the perception of sound in the absence of an 
external stimulus, appears to arise from the brain rather than the 
ears. We, therefore, propose to state more explicitly that recurrent 
tinnitus is assigned only one evaluation whether it is perceived in one 
ear, both ears, or an indeterminate site in the head.
    To assure that tinnitus is consistently and correctly evaluated, we 
propose to add a second note under diagnostic code 6260 directing that 
only a single evaluation be assigned for recurrent tinnitus, whether 
the sound is perceived in one ear, both ears, or in the head. We also 
propose to add a third note concerning the evaluation of objective 
tinnitus that would direct raters not to evaluate objective tinnitus 
(in which the sound is audible to other people and has a definable 
cause that may or may not be pathologic) under this diagnostic code, 
but to evaluate it as part of any underlying condition causing it.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Regulatory Flexibility Act

    The Secretary hereby certifies that this regulatory amendment will 
not have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act (RFA), 5 
U.S.C. 601-612. This amendment would not directly affect any small 
entities. Only VA beneficiaries could be directly affected. Therefore, 
pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial 
and final regulatory flexibility analysis requirements of sections 603 
and 604.

Executive Order 12866

    This document has been reviewed by the Office of Management and 
Budget under Executive Order 12866.

[[Page 59034]]

Unfunded Mandates

    The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that 
agencies prepare an assessment of anticipated costs and benefits before 
developing any rule that may result in an expenditure by State, local, 
or tribal governments, in the aggregate, or by the private sector of 
$100 million or more in any given year. This rule would have no 
consequential effect on State, local, or tribal governments.

Catalog of Federal Domestic Assistance Numbers

    The Catalog of Federal Domestic Assistance program numbers are 
64.104 and 64.109.

List of Subjects in 38 CFR Part 4

    Disability benefits, Pensions, Veterans.

    Approved: June 14, 2002.
Anthony J. Principi,
Secretary of Veterans Affairs.

    For the reasons set out in the preamble, 38 CFR part 4, subpart B, 
is proposed to be amended as set forth below:

PART 4--SCHEDULE FOR RATING DISABILITIES

    1. The authority citation for part 4 continues to read as follows:

    Authority: 38 U.S.C. 1155, unless otherwise noted.

Subpart B--Disability Ratings

    2. In Sec.  4.87, diagnostic code 6260 is revised to read as 
follows:


Sec.  4.87  Schedule of ratings--ear.

                           Diseases of the Ear
------------------------------------------------------------------------
                                                                Rating
------------------------------------------------------------------------
 
                                * * * * *
6260 Tinnitus, recurrent...................................           10
------------------------------------------------------------------------


    Note (1): A separate evaluation for tinnitus may be combined 
with an evaluation under diagnostic codes 6100, 6200, 6204, or other 
diagnostic code, except when tinnitus supports an evaluation under 
one of those diagnostic codes.


    Note (2): Assign only a single evaluation for recurrent 
tinnitus, whether the sound is perceived in one ear, both ears, or 
in the head.


    Note (3): Do not evaluate objective tinnitus (in which the sound 
is audible to other people and has a definable cause that may or may 
not be pathologic) under this diagnostic code, but evaluate it as 
part of any underlying condition causing it.


    Authority: 38 U.S.C. 1155

[FR Doc. 02-23784 Filed 9-18-02; 8:45 am]
BILLING CODE 8320-01-P