Sir, - As a physician recently returned from Canada, I have been following with interest the reports of multiple claims for hearing loss due to alleged occupational injury by members or ex-members of the Defence Forces, and the news that a prominent ENT consultant, Mr Kelly, together with a committee of experts has been established to look into this question.While in Canada I trained in the application of the American Medical Association Guides to the Evaluation of Permanent Impairment. This is rapidly becoming the bible for physicians, lawyers, insurance claims adjusters, workers' compensation board adjudicators or anyone involved in assessment of impairment, disability, fitness-to-work, causation and apportionment generally, not just in the area of hearing loss.I can attest wholeheartedly to the Guide's usefulness and demonstrable objectivity (insofar as that is ever entirely possible in medicine). A thorough examination according to the principles described in them includes review of all previous relevant medical assessments, consultations, investigation results together with a well-directed physical assessment of the examinee and psychosocial functional assessment by the examining, non-treating independent medical examiner.Such a process results in an efficient, unbiased medical assessment which is fair to all involved and usually results in more timely settlement of claims, less frustration for insurance companies, employers, solicitors (both plaintiff and defendant), reduced costs and generally more satisfaction all round. The written report of the independent medical examiner should provide credible, objective results which will stand up in courtIn short, I have no doubt Mr Kelly, consultant, ENT, surgeon and his colleagues are very wise to have chosen to follow the American Medical Association model for assessment. - Yours, etc.,Michael C. Kirwan,MB BCh, DCH, DObs, MRCPI,Licentiate of the MedicalCouncil of Canada,Certified IndependentMedical Examiner,Upper Kilmacud Road,Goatstown,Dublin 14.