Post-Traumatic Stress Disorder (PTSD) and Depression are common in Veterans.  They are often associated with other disorders (e.g., Migraine).  The interface of psychological disorders with other comorbidities represents a challenge for cross discipline care. Conditions that negatively impact Mental Health may hamper treatment efficacy/outcome for other disorders.  Identifying stressors may improve clinical decision making by suggesting new treatment strategies.  Disorders of the Auditory System are also common in Veterans (hearing loss is the second most common service-connected disability).  Central Auditory Processing Disorder (CAPD) is associated with difficulty understanding speech in noisy environments.  Complaints from affected individuals may be interpreted as hearing loss.  Routine Audiological testing that does not assess for CAPD and typically finds normal/near-normal hearing can contribute to patient anxiety due to a "negative" test result with a disturbing clinical symptom. 

This Study is part of an ongoing assessment of cognitive issues in Veterans reporting difficulty understanding speech in noisy environments. Diagnosis of CAPD required impaired performance on at least two tests of central auditory processing. Exclusion criteria included psychotic behavior and profound hearing loss.     

Veterans seen in Neurology Clinic were typically referred for headaches. All had multiple comorbidities (often including PTSD, Depression and Migraine).  22/36 (61%) had CAPD.  Multiple Veterans expressed frustration reporting problems understanding speech, but most were not referred for evaluation. Impaired communication was a significant stressor in some families.  For many Veterans who felt lost when told their hearing was normal, diagnosis with CAPD provided validation and relief.

CAPD may be highly prevalent in Veterans.  Screening should be considered when difficulty understanding speech in noisy environments is reported and hearing is normal/near-normal.  Stress from impaired speech comprehension may increase psychological symptoms.  Increased awareness of CAPD may improve quality/delivery of care.