This list of questions is based on the DMA C&P Audio examination clinical quality review tool. Items would be checked as excellent, good, average, needs improvement, or not applicable for role in this encounter. Any average or below average findings would be explained in a comments section on the form.

  1. Agreement of Pure Tone Average and Speech Reception Thresholds: Is the SRT within + 10-12dB of the PTA?
  2. Acoustic reflex consistent with other thresholds: Is the pure tone air conduction threshold at least than 10 dB or more below the acoustic reflex threshold at each frequency tested (stimulus ear)?
  3. Did the examiner record and discuss entrance and exit exam? Based on in-service audiograms, was there permanent positive threshold shift (worse than reference threshold) greater than normal measurement variability at any frequency between 500 and 6000 HZ for the right ear/left ear?
  4. Were the masking levels reported when pure tone air conduction thresholds differed by 40 dB between ears? Were the masking levels reported when speech thresholds (SRTs) differed by 50 dB between ears?
  5. Were Bone Conduction thresholds reported for 250, 500, 1000, 2000, 4000 Hz if air conduction thresholds were greater than 15 dB HL?
  6. Was masking used if there was a 15dB or greater difference between air conduction and bone conduction thresholds for each ear?
  7. Were Stenger tests administered whenever pure tone air conduction thresholds at 500, 1000, 2000, 3000, or 4000 Hz differed by 20 dB HL or more?
  8. Was the required performance intensity function completed, with PB Max reported? If Speech/Word recognition score of less than 94% was obtained, does the VA Form 10-2364 (audiogram) report three or more scores for each ear, with the best score (50 Word list CNCs) reported on the DBQ?
  9. For each ear, were the presentation levels of CNC lists at least 5dB above the pure tone threshold at 2000 Hz?
  10. For tinnitus: are date, circumstance of onset and progression reported by the Veteran and/or noted in the STRs?
  11. Did the Veteran serve in combat? Is combat service verified in STRs, DD214, etc.? Was the Veteran exposed to combat noise? Were Pre- and Post-Deployment Questionnaires reviewed?