Hearing loss is a growing problem for veterans

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DAVID BROOKS / Union-Tribune

Now that his world is quieter, what Vietnam War veteran Romeo Rasing remembers about Navy life is the noise.

"My battle station was right above the turret. We had to keep bombing day and night," said Rasing, 56, who served on the cruiser Oklahoma City early in a 22-year Navy career that included 13 years of sea duty. "When the ship was in the yard, there were all kinds of noises – grinding, chipping, banging, pounding, welding."

Fourteen years after his retirement, Rasing, of San Diego, has lost much of the hearing in his right ear and almost all of it in his left ear. Veterans Affairs doctors say he is 100 percent disabled, 30 percent of it from hearing loss he sustained during his years of exposure to the bedlam of shipboard life.

A few years ago, concern on Capitol Hill about the rising number of partially deaf veterans prompted Congress to order a study of hearing loss in the military.

The survey by the National Academy of Science's Institute of Medicine, released in September, documented the burgeoning problem and suggested further research. Already, it has focused the armed forces' attention on hearing loss like never before.

The cost of VA claims for hearing-related disability jumped 100 percent between 2000 and 2004. That's partly because the VA recently changed its rules to make it easier to collect disability benefits for hearing loss. Also, audiologists now routinely test the hearing of service members who leave the military, so partial deafness is discovered much earlier.

A third factor is time. Vietnam-era veterans are in their 50s and 60s, the years in which a lifetime of noise exposure finally hits their aging ears.

"Most of the people who served on board the ship (with me) have a hearing problem," Rasing said.


The number of hearing-loss claims is expected to grow because of U.S. wartime involvement in Iraq and Afghanistan. Tens of thousands of American troops have served in those countries, and medical experts think that many of them have lost part of their hearing because of exposure to blasts or close-range weapons fire.

Retired Air Force Lt. Col. Theresa Schulz, who now works as a hearing conservation consultant, said a 2004 survey showed that 28 percent of troops coming home from a war zone have diminished hearing.

"Noise-induced hearing loss is preventable," Schulz said in a phone interview from her home in Tennessee. "It shouldn't be a condition of (military) employment that you end up with hearing loss." But for many service members, it is.

In 2004, the VA paid $633.8 million to 378,982 veterans whose main disability was hearing loss, according to the Army's Center for Health Promotion and Preventive Medicine.

More than half of these veterans had served in the Army. Navy veterans received almost $108 million that year, and Marine Corps veterans got nearly $51 million.

It's hardly surprising to learn that exposure to the loud noises of war – such as artillery and rifle fire or jet engines screaming from carrier flight decks – would cause hearing loss.

"Before I went in, my hearing was above normal," said James Afanesko, 56, a San Diego veteran who lost about half of his hearing after serving 13 months in Vietnam as an Army infantryman. "My ears would ring after a firefight and explosions. You lose a little bit every time."

However, exposure to the typical sounds of military life can also cost service members their hearing, the Center for Naval Analyses said in a report published in February.

In studying the hearing-test results of 251,000 sailors who left the Navy between 1979 and 2004, the naval center's researchers Geoffrey Shaw, Robert Trost and Alan Marcus found widespread hearing loss, particularly among sailors who served aboard surface warfare ships.

After correcting for factors such as age, race and gender, the researchers determined that a sailor who spent most of a 24-year career on ships had a 46 percent chance of suffering hearing loss. That compared with 27 percent for those serving mostly ashore, in submarines or in aviation.

"It's the constant noise, 24 hours a day, when you're at sea," Marcus said during a phone interview from the center's headquarters in Washington, D.C.

Carl Dustin, 82, of La Jolla knows about the clamor firsthand.

During World War II, he served on a destroyer escort with a thin steel hull, which amplified noise with a clangy echo. He wears a hearing aid because of hearing loss that started back then.

"They had diesel engines. You could hear them from a mile away," Dustin said. "The decks were steel. You could hear people clattering around. It's a lot of noise. Pretty soon you just block it out."

In your mind, maybe, but not your ears.

"It's cumulative. It sneaks up on you. I've seen lots of people who were surprised that they had a hearing loss," said David Miller, chief of audiology and speech pathology since 1972 at the Veterans Affairs Medical Center in La Jolla. "It's just the nature of the environment in which they work."

Looking inside a noise-damaged ear leaves little mistake about what happened, Miller said. Sound flattens tiny hairs in the ear and damages the sensory cells beneath them, as if a meteor struck in a forest.

"It looks like a crater," he said. "The sensory cells are literally wiped out."

Hearing loss first affects the sensing of higher tones, which give speech clarity. That means sufferers can hear the voice of a football announcer just fine, but they can't hear their wives telling them to mow the lawn.

"When I got in my 60s, people started to mumble," joked Dustin, the World War II Navy veteran. "Finally, I realized something needed to be done. My wife started throwing things at me."

For most veterans, getting help means wearing a hearing aid. But most people don't like wearing them because they're an imperfect tool. Unlike the ear, a hearing aid doesn't filter out background noise. It simply amplifies everything.

"They work for watching television, terrific; going to the movies, great," Dustin said. "Big parties, I hate it. I don't even want to go."

Rasing also wears a hearing aid. Surgery failed to help his nearly deaf left ear. His partial deafness nags at him.

"It's so hard to adjust. It still aggravates me," he said.

The Air Force set up the military's first hearing-conservation program in 1956, followed by the Navy and Marine Corps in 1970 and the Army in 1980.

The Navy's program calls for identifying noisy industrial areas, posting warnings, giving sailors and workers earplugs or noise-blocking headphones, and routinely testing hearing, according to the Navy's Web site.

But it's one thing to set up a program and quite another to see it followed. Audiologists said the military's culture of bravado and the silent, painless onset of hearing loss make it difficult to get troops to comply.

"You have young men who have typically kind of a macho image of themselves," Miller said. "Noise loud enough to cause hearing loss isn't necessarily painful."

Lynn Betzig, now Miller's assistant at the medical center, helped start a hearing-conservation program for the Marines at Camp Pendleton in the late 1980s and early 1990s.

That meant setting up hearing clinics at the sprawling base, conducting hearing tests and teaching Marines and medical corpsmen how to prevent and treat hearing problems.

The key, Betzig said, is to get senior officers and noncommissioned officers to buy into the need to wear ear protection. That's not always easy in such a masculine, tradition-bound service.

"I didn't see a lot of compliance," she said. "It starts from the top. When you've got the master sergeants who have been around for 30 years and haven't been doing it, it's hard to get recruits to do it, too."

Even for troops willing to wear earplugs, the demands of war in Afghanistan or Iraq don't necessarily lend themselves to protecting one's ears. Sometimes, life depends on hearing a whispered order or an enemy's muffled footstep.

"Being in a line company, we didn't have earplugs," said Afanesko, the Vietnam infantryman. "I (didn't) think about my hearing loss. I was thinking about surviving."

Some audiologists said troops' hearing could be saved with combat ear plugs, which are designed to block loud sounds such as rifle shots but not normal tones such as speech.

When bought in bulk, the ear plugs cost about $5.75 a pair. That's much more expensive than soft foam plugs that muffle all noise, which the military now uses. But Betzig believes that a modest investment now might prevent much larger VA hearing-loss claims in the future.

Even out of the line of fire, ear care frequently gets short shrift, sailors said.

"It's not realistic for us to us to wear hearing protection," said Rasing, the retired Navy chief. "There are times you take it off, and you forget to put it back on. That's how it is onboard ship."

The naval center's Trost and Marcus said the Navy was interested enough in their $115,000 initial study – which identified surface warfare sailors as most vulnerable to hearing loss – that it ordered a $300,000 follow-up just before Christmas.

The second study, to be finished by September, will estimate the dollar cost of hearing loss to the Navy and, its authors hope, suggest cost-effective ways of preventing it. Potential measures range from adding sound insulation to moving sleep areas away from loud machinery on future warships.

"To the extent that you can reduce your noise levels and not hurt your strategic mission," Trost said, "certainly it's worth it."