Mixed Hearing Loss

§ 4.85 methodology: (1) state-licensed audiologist performs Maryland CNC controlled speech discrimination test + puretone audiometry at 1000/2000/3000/4000 Hz, WITHOUT hearing aids per § 4.85(a). (2) Calculate puretone threshold average for each ear: sum of 4 thresholds / 4 per § 4.85(d). (3) Cross-reference Table VI (puretone + speech) → Roman numeral Level I-XI for each ear; use Table VIa (puretone only) if speech test inappropriate or per § 4.86 exceptional patterns. (4) Cross-reference Table VII with both ears (rows = better ear, columns = poorer ear) → final percent rating. (5) Per § 4.86(a), if puretone ≥55 dB at ALL four frequencies, use whichever of Table VI/VIa gives the higher numeral. Per § 4.86(b), if puretone ≤30 dB at 1000 Hz AND ≥70 dB at 2000 Hz, use higher of VI/VIa, then ELEVATE one Roman numeral level. Representative Table VII combinations yielding 0%: Level I + Level I (mild bilateral); Level I + Levels II/III/IV (one ear mild, other ear mild-moderate); Level II + Level II/III; Level III + Level III/IV.

Representative Table VII combinations yielding 10%: Level I + Level V/VI (one ear mild, other ear moderate); Level II + Level V/VI; Level III + Level V; Level IV + Level IV/V; Level V + Level V (both ears moderate). Typical for moderate bilateral noise-induced loss or one moderate / one mild ear.

Representative Table VII combinations yielding 20%: Level III + Level VII; Level IV + Level VI/VII; Level V + Level VI/VII; Level VI + Level VI (both ears moderate-severe). Typical for both ears at moderate-severe levels or asymmetric moderate-to-severe.

Representative Table VII combinations yielding 30%: Level V + Level VIII; Level VI + Level VII/VIII; Level VII + Level VII (both ears severe). Significant bilateral functional impact; hearing aids often required for everyday communication.

Representative Table VII combinations yielding 40%: Level V + Level IX; Level VI + Level VIII/IX; Level VII + Level VIII; Level VIII + Level VIII. Severe bilateral loss; conversation requires shouting, lip-reading, or assistive listening devices.

Representative Table VII combinations yielding 50%: Level VI + Level X; Level VII + Level IX; Level VIII + Level VIII/IX (both ears severe/profound). Profound bilateral hearing loss; significant social/occupational disability.

Representative Table VII combinations yielding 60%: Level VII + Level X; Level VIII + Level IX; Level IX + Level IX. Severe-to-profound bilateral; cochlear implant candidacy threshold typically discussed at this level.

Representative Table VII combinations yielding 70%: Level VIII + Level XI; Level IX + Level X. Profound bilateral hearing loss approaching deafness.

Representative Table VII combinations yielding 80%: Level IX + Level XI; Level X + Level X. Near-total bilateral deafness.

Representative Table VII combinations yielding 90%: Level X + Level XI. Near-complete bilateral deafness with minimal residual hearing.

Representative Table VII combinations yielding 100%: Level XI + Level XI (profound deafness in both ears) — also triggers § 3.350 SMC entitlement review for total deafness under 38 USC § 1114(l).