Veterans

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Q&A with James Kaufman, US Army Veteran

James Kaufman served in the US Army Medical Corps from July 1974 - November 1977.

How long did you wear hearing aids? Where did you obtain them? Privately or via the VA?  How did that work for you?

I have been wearing hearing aids since 1994, which I got from the VA. I was originally diagnosed with hearing loss when I was discharged from the Army. I first had a hearing aid only on the right, but after a couple of years also needed one on the left, and over the years needed progressively more powerful aids.

How did your CI journey begin? Did anyone from the VA suggest you might benefit from cochlear implants? Who told you that you might be a candidate for a cochlear implant?

I think that my hearing loss was due to playing in rock bands when I was younger, working in factories without any hearing protection, and genetics. My mother had progressive hearing loss in her later years and I saw how much it left her socially isolated. As I developed progressive hearing loss it became more difficult for me to understand in large meetings, on the telephone, and at movies. I had heard about cochlear implants, in fact they had been recommended for my mother, but she was 98 at the time and decided against them. I had an appointment with my VA audiologist and I was going to ask her about them, but before I could she recommended that I be evaluated for one, so I jumped at the suggestion.

How did you learn about the services at the VA?

Through my VA audiologist.

What was the hardest part about the process of getting a cochlear implant?

Nothing was actually hard. When I first got referred to ENT, I made an appointment not realizing they had a dedicated implant clinic, so I had to book another appointment, but that was the only glitch. 

What could be done to improve the process for veterans (of getting a cochlear implant)?

Most of the education prior to the surgery (and after) was done by the cochlear implant audiologist. It would have been nice if I had more interaction with the implant surgeon, but ultimately it did not matter.

What worked well for you?  What compliment(s) can you make of the VA process?

Everybody was great at the VA. The nursing care on the day of surgery was great, with everyone thanking me for my service, when I should have been the one thanking them for taking care of me.

Who performed your surgery and where was it done?  What about the follow up services?  Was follow up hard for you (i.e., travel, getting appointments scheduled)?

Surgery was done by an NYU surgeon, David Friedmann, but in the VA ambulatory OR. Follow-up services were at the Cochlear Implant Center at NYU. I live in Manhattan so getting to the Center was easy, a subway ride and a short walk, about 40 min each way. Scheduling appointments was easy.

Where there any mishaps and approximately how long did it take to get resolved?

No mishaps.

Can you provide some suggestions on what would have made the process of dealing with the VA better?

I had already been connected with VA Audiology and a long-term relationship with my audiologist, so the process was quite easy for me. I don’t know how it would be for someone new to the VA.

Did you have any rehabilitation besides mapping?

I did have some rehab sessions at the Cochlear Implant Center, but not sure they were that useful to me other than to direct me to some on-line sites.

Is there anything you’d change about the post-surgery rehabilitation?

No

Do you have any tips for those veterans who could be candidates for a CI?

My pre-implant expectations were mixed. Some times I felt that when I get the implant I will hear like a 16-year-old again (the Bionic Man) and other times I felt that it wouldn’t help much at all, plus I would be totally deaf in that ear (I have implant on my right ear and a hearing aid on my left). Like most things in life, it turned out somewhere in between. I still have trouble distinguishing some sounds, but I would say I am 75% better. Still difficult to hear when there is background noise, so restaurants and walking on the street is difficult. One on one in a quiet room is very much better and I can hear in theaters pretty well. I have an iPhone that allows streaming from by implant/hearing aid, so talking on the phone is quite easy.

I would tell Veterans whose hearing is bad enough to qualify for an implant to go ahead and do it. I saw the social isolation my mother went through and knew that my hearing would only get worse as I aged, so I should do it now (I was 72). Doing some rehab on-line will help, particularly in the first 6 months. I am quite glad I did it and very happy with the outcome.

Mr. Kauffman’s story highlights the importance of the relationship between a VA audiologist and proper referral for a CI. It is critical that VA audiologists are aware of the appropriate criteria for candidacy and refer vets on for a CI evaluation.

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Q&A with Margaret Pittman, US Army Veteran

Margaret Pittman served in the US Army from February 1990-November 1991 as a radio and satellite operator.

How long have you worn hearing aids? Where did you obtain them? Privately or via the VA?  How did that work for you?

I first was given a hearing aid at West Palm Beach VA Medical Center in 2016.  My left ear was worse than my right, which had hardly had any word recognition even when the volume was turned up. The audiologist did not suggest (or provide) a hearing aid for my left side. I went back about six months later and was referred to the Miami VA.  The audiologist there said the left ear gives the right ear a boost when working together and had custom molds made for both ears, which helped my hearing even more.

How did your CI journey begin? Did anyone from the VA suggest you might benefit from cochlear implants? Who told you that you might be a candidate for a cochlear implant? 

An otolaryngologist I was referred to at the Miami VA suggested a CI in 2017. I was hopeful that additional medications would help restore my hearing but they did not. I moved forward with plan for a CI in 2018. It took until March of 2019 before I qualified for the surgery.

How did you learn about the services at the VA? 

By asking the right questions and having a good doctor.

What was the hardest part about the process of getting a cochlear implant?

I was referred out of my VA for the surgery once I qualified. My CI surgeon is now located at the University of Miami and previously provided services at the Miami VA once a week. By the time I was referred to the Miami VA for a CI, the surgeon was no longer there. It took months for my doctor to be accepted by the Triwest Community Care Program. Triwest is one of the regional partnerships tasked with administering the Department of Veterans Affairs Community Care programs to provide improved access to health care to veterans. All medical providers must be accepted into the Community Care Program to provide VA care and be reimbursed via the VA.

What could be done to improve the process for veterans (of getting a cochlear implant)? 

As the West Palm VA does not have a cochlear department, I really don’t know if I would have a CI right now if I had not been referred to the Miami VA. If a veteran is receiving services at a VA that does not provide cochlear implant services, it can be hard to get information or a referral. An improved referral system is where help is needed.

What worked well for you?  What compliment(s) can you make of the VA process? 

I can say if I had been seen initially at the Miami VA, it would have been a much quicker and easier process. The audiologists and ENT team at Miami VA are great and once the surgeon was accepted into the community care program with Triwest, all systems were go! 

Who performed your surgery and where was it done?  What about the follow-up services?  Was follow-up difficult (i.e., travel, getting appointments scheduled)?

Dr. Christine Dinh at University of Miami did my surgery. My referrals for all follow-up appointments were through the Triwest Community Care Program and have been scheduled easily. 

Where there any mishaps and approximately how long did it take to get resolved?

No mishaps once I was able to get a referral and into the CI program in Miami.

Can you provide some suggestions on what would have made the process of dealing with the VA better? 

The process of a doctor getting into Triwest Community Care system needs to be improved. It seemed to me to take way too long and delayed my surgery.

Tell us about the care after your surgery. 

My activation of the cochlear implant by an audiologist was on February 24, 2020. So far, things are amazing.

Do you have any tips for those veterans who may be candidates for a CI?

Don’t give up, keep pushing. Ask questions and don’t worry about whether or not it’s important. Every question you have is important! Ask to speak to a patient or veteran who has received care from the surgeon that have been referred to. Conduct additional research. The more I knew about my surgeon and the other clinicians providing care, the more comfortable I felt. Join a hearing loss support group; there are many with local chapters. Making friends with others with hearing loss gives you a lot of support. You will learn a lot and maybe become a mentor yourself.

Ms. Pittman’s experience shows that while the VA Community Care program does work in providing excellent CI services to those who cannot receive them from their local VA, there are still issues that need to be addressed such as ensuring the timely acceptance of providers into the program.  

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Q&A with Gary Roush, US Army Veteran

Gary Roush is a Vietnam Veteran who served in the US Army as a helicopter pilot. He flew in Vietnam from 1968 to 1969 and was diagnosed with service connected bilateral hearing loss during his exit physical from the Army in 1970. He began wearing aids purchased from a private practice audiologist in 1981. After a local veterans’ service organization officer noticed his hearing aids, he was encouraged to seek hearing healthcare support from the local VA in 1985. He discovered that veterans could be compensated for tinnitus caused by service-related noise exposure in 2003 after reading about it in an audiologist’s waiting room. His journey to a cochlear implant began ten years later.

Q: How did your CI journey begin? Did anyone from the VA suggest you might benefit from cochlear implants? Who told you that you might be a candidate for a cochlear implant?

A:  I experienced additional hearing loss in late 2013 likely exacerbated by a tooth implant procedure.  I was referred to the Cleveland Clinic and told by an ENT there that I was a candidate for a hybrid cochlear implant.  I followed up with my VA audiologist in Bath, NY who referred me to the VA hospital in Buffalo, NY to be evaluated for a cochlear implant in late 2014.  No one at the VA had ever talked to me about cochlear implants up to this point, though one of my audiologists had a cochlear implant. After several appointments, I had the cochlear implant surgery in late 2015.  Some of the delay was likely due to this being the early days of hybrid implants as well my personal situation with my wife’s medical problems.

Q: How did you learn about the services at the VA?

A:  By chance from the local county veterans’ service agency and also reading about them in veterans’ publications.

Q: What was the hardest part about the process of getting a cochlear implant? 

A:  Having to hire someone to take care of my wife while I spent most of many days traveling 125 miles each way to Buffalo, NY for repeated appointments that lasted an hour or more each.  I had to work around my wife’s medical appointments (surgery, chemo, radiation), trips to the emergency room, multiple hospital and nursing home stays along with the schedule of the VA ENT cochlear implant surgeon—who was only available one day per month.

Another frustration I am still experiencing is reimbursement for travel, which is automatically based on the closest VA audiologist which is in Bath, NY.  However, that hospital is not equipped to treat someone for CI services; hence the reimbursement system must be adjusted for each trip I need to take to Buffalo.  After almost four years of complaining about this, I still have to explain each trip in order to get the proper travel reimbursement. It is tedious!

Q: What could be done to improve the process of getting a cochlear implant for veterans?

A:  Having access to a patient advocate similar to what the county veterans’ service agency provides to help someone through the process and also having the VA audiologists be proactive in explaining available hearing healthcare to veterans.

Q: What worked well for you?  What compliment(s) can you make of the VA process?

A:  Receiving hearing aids, batteries, etc. from the VA is very efficient.  Most of the VA audiologists I worked with over the years have been knowledgeable, friendly, and helpful.

Q: Who performed your surgery and where was it done?  What about the follow up services?  Was follow-up hard for you (i.e., travel, getting appointments scheduled)?

A:  The surgery was done by Dr. Ernesto Diaz-Ordaz, a civilian under contract with the VA.  Surgery was done at the Buffalo, NY VA Hospital.  Follow-up with the surgeon was not offered until I requested it. I then had to work with his one day per month availability so it was almost a full year before I saw him for a follow-up appointment.  I already discussed the challenges of travel and scheduling appointments. Mapping with the VA audiologist required many visits to the Buffalo VA Hospital.

Q: I understand that there were hiccups in the process, such as losing paperwork.  What was the nature of those mishaps and how long did it take to get them resolved?

A: There are two tracks here: one is treatment and the other is disability compensation.  Eight months after filing for disability payments, I received a letter saying my original paper work had been lost.  Another eight months after re-filing the claim, I received another letter asking for more information.  Nine months after that I was awarded disability retroactive for nine months.  One process does not automatically trigger the other.  It would seem to me that almost every step in the treatment process should automatically trigger a disability compensation review.  That never happened so I went years not receiving earned disability compensation. It was due to chance encounters with county veterans’ service officers that prompted me to explore compensation evaluations.  It is almost as if VA audiologists are under orders not to offer compensation advice unless specifically asked about it by the veteran.

Q: Can you provide some suggestions on what would have made the process of dealing with the VA better? 

A:  Having a VA patient advocate to help navigate through the process, having audiologists who offer full information to veterans and streamlining the process so that treatment and disability are related.

Q: Did you have any auditory rehabilitation besides mapping your sound processor?

A:  No. It just occurred to me that the services of a speech language therapist might have been helpful to me.

Q: Do you have any tips for those veterans who might be candidates for a CI?

A:  Contact their local county veterans’ service agency for help and be a self advocate.  If you do not ask for something, you are not likely to get it.  The key is knowing what to ask for. The website of American Cochlear Implant Alliance has excellent information about the process of cochlear implantation, candidacy, and outcomes.

Mr. Roush’s experience highlights that often a veteran must self-advocate for compensation and services. It also underscores ongoing issues with an insufficient amount of time allocated for appointments with VA CI surgeons as well as the complications of long-distance travel. Nonetheless, there are individuals within the VA and with veterans’ service organizations that are able to assist including https://www.va.gov/statedva.htm. The key can be knowing what to ask. Gary Roush hopes that by sharing his experiences and insights, other veterans will have a head start in their own journey.

The mission of the American Cochlear Implant (ACI) Alliance is to advance access to the gift of hearing provided by cochlear implantation through research, advocacy and awareness.