ISSUE: A Veteran contacted our office after being denied coverage for a treatment related to his pensioned condition. According to his audiologist, the Veteran’s service-related tinnitus could not be treated until another related condition causing noise sensitivity was resolved. Despite submitting supporting documentation including detailed expert medical evidence, the Veteran was denied coverage for noise sensitivity treatment after both an initial application and an appeal. After months of frustration, he turned to the OVO for help.
VAC's Entitlement Eligibility Guideline for tinnitus includes the Veteran’s specific secondary hearing condition, hyperacusis (noise sensitivity). Therefore, the client should have been eligible for hyperacusis treatment because he had the pensioned condition of tinnitus. The OVO reviewed the complaint and brought the issue to VAC’s attention.
ACTION: VAC re-examined the situation and confirmed that the requested treatment for noise sensitivity should have been covered because the client had entitlement for tinnitus. VAC clarified the policy and coverage guidelines and approved reimbursement for the treatment.
RESULT: Over a year after being unfairly denied hearing treatment coverage, the Veteran finally received reimbursement for the treatment he needed.