HEARING LOSS

Determining Eligibility for Social Security Benefits

Committee on Disability Determination for Individuals with Hearing Impairments

Robert A. Dobie and Susan B. Van Hemel, Editors

Board on Behavioral, Cognitive, and Sensory Sciences

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Hearing Loss: Determining Eligibility for Social Security Benefits HEARING LOSS Determining Eligibility for Social Security Benefits Committee on Disability Determination for Individuals with Hearing Impairments Robert A. Dobie and Susan B. Van Hemel, Editors Board on Behavioral, Cognitive, and Sensory Sciences Division of Behavioral and Social Sciences and Education NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Hearing Loss: Determining Eligibility for Social Security Benefits THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 0600-02-60012 between the National Academy of Sciences and the Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Hearing loss : determining eligibility for Social Security benefits / Committee on Disability Determination for Individuals with Hearing Impairments, Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education ; Robert A. Dobie and Susan Van Hemel, editors. p. ; cm. Includes bibliographical references. ISBN 0-309-09296-5 (pbk.) 1. Deafness—Diagnosis—United States. 2. Disability evaluation—United States. 3. Insurance, Disability—United States. 4. Social security—United States. [DNLM: 1. Hearing Loss—diagnosis—United States. 2. Disability Evaluation—United States. 3. Eligibility Determination—United States. 4. Hearing Tests—United States. 5. Social Security—United States. WV 270 H4348 2004] I. Dobie, Robert A. II. Van Hemel, Susan B. III. National Research Council (U.S.). Committee on Disability Determination for Individuals with Hearing Impairments. RF294.H435 2004 362.4'264'0973--dc22 2004019993 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu Printed in the United States of America. Copyright 2005 by the National Academy of Sciences. All rights reserved. Cover credit: Nautilid Echo (detail), ©Laura Cater-Woods. Mixed media/fibers (acrylic inks and paints on cotton, embroidered and quilted). Photo credit: Dan Tilton, Photographic Solutions, Billings, MT. Suggested citation: National Research Council. (2005). Hearing Loss: Determining Eligibility for Social Security Benefits. Committee on Disability Determination for Individuals with Hearing Impairments. Robert A. Dobie and Susan B. Van Hemel, editors. Board on Behavioral, Cognitive, and Sensory Sciences, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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Hearing Loss: Determining Eligibility for Social Security Benefits THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Hearing Loss: Determining Eligibility for Social Security Benefits COMMITTEE ON DISABILITY DETERMINATION FOR INDIVIDUALS WITH HEARING IMPAIRMENTS ROBERT A. DOBIE (Chair), Department of Otolaryngology, School of Medicine, University of California, Davis ROBYN COX, Department of Audiology and Speech Pathology, University of Memphis ROBERT R. DAVILA, National Technical Institute for the Deaf (retired) and National Council on Disability, Washington, DC MARILYN E. DEMOREST, Office of the Provost, University of Maryland, Baltimore County BRUCE J. GANTZ, Department of Otolaryngology, University of Iowa Hospitals and Clinics SANDRA GORDON-SALANT, Department of Hearing and Speech Sciences, University of Maryland, College Park SUSAN W. JERGER, School of Human Development and Communication Sciences, University of Texas at Dallas WILLIAM G. JOHNSON, School of Health Administration and Policy, Arizona State University KAREN ILER KIRK, Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Indiana University IRENE W. LEIGH, Department of Psychology, Gallaudet University YVONNE S. SININGER, Division of Head and Neck Surgery, School of Medicine, University of California, Los Angeles WILLIAM A. YOST, Parmly Hearing Institute and the Graduate School, Loyola University of Chicago SUSAN B. VAN HEMEL, Study Director JESSICA G. MARTINEZ, Senior Program Assistant

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Hearing Loss: Determining Eligibility for Social Security Benefits BOARD ON BEHAVIORAL, COGNITIVE, AND SENSORY SCIENCES ANNE PETERSEN (Chair), W.K. Kellogg Foundation, Battle Creek, Michigan STEPHEN J. CECI, Department of Human Development, Cornell University EUGENE K. EMORY, Department of Psychology, Emory University ANTHONY W. JACKSON, Asia Society, Los Angeles ELISSA L. NEWPORT, Department of Brain and Cognitive Sciences, University of Rochester MICHAEL L. RUTTER, Institute of Psychiatry, University of London JAMES W. STIGLER, Department of Psychology, University of California, Los Angeles CHRISTINE R. HARTEL, Board Director

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Hearing Loss: Determining Eligibility for Social Security Benefits Preface This report is the product of over two years’ work by a committee of 12 diverse experts in hearing and other subjects, convened by the National Research Council (NRC) in response to a request from the Social Security Administration (SSA). The committee was tasked to review the tests and criteria used to determine hearing disability for purposes of eligibility for Social Security benefits. The committee evaluated the tests currently used to determine disability for people with hearing loss and examined other possible ways to assess such disability, including new tests of hearing function. Special attention was given to finding ways to improve the reliability and validity of tests of hearing and to reviewing evidence bearing on the ability of such tests to predict job performance capabilities. On behalf of the committee, I would like to acknowledge the contributions of a number of people who helped us to complete the work reported here. First, we are grateful to Sigfrid Soli and Carren Stika, who prepared reviews and analyses for the committee. We also wish to thank Sandra Salan, the project sponsor at the SSA’s Office of Disability. She and her associate, Michelle Hungerman, provided much useful information on SSA disability programs and procedures. Also at SSA, Susan David and her staff prepared data analyses from SSA statistical files in response to our queries. In the service and advocacy community, we are grateful to the organizations that nominated speakers and otherwise supported the public forum the committee held on May 7, 2003. We are especially grateful to the forum participants, listed in Appendix C, who gave thoughtful and ex-

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Hearing Loss: Determining Eligibility for Social Security Benefits pert responses to the difficult questions we posed, providing the committee with valuable insights on the issues that are most important to people with hearing loss. At the NRC, Susan B. Van Hemel was the study director for this project. Special thanks are due to Christine Hartel, director of the Center for the Study of Behavior and Development, for her guidance and support; to Christine McShane, for editing our manuscript with skill and insight; to Eugenia Grohman of the DBASSE Reports Office, who managed the review process; and to Jessica Gonzalez Martinez, our skilled and dedicated project assistant, whose contributions to this study were invaluable. The excellent interpreters from Sign Language Associates who supported all of our meetings, including the public forum, were vital to the success of this project as well. I would also like to recognize the committee members for their generous contributions of time and expertise and for their professionalism. Although members often had disparate opinions, they invariably expressed and discussed them with respect and grace. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the NRC. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their participation in the review of this report: Monroe Berkowitz, Program for Disability Research, Rutgers University; Judy R. Dubno, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina; George Gates, Hearing Research Center, University of Washington; Walt Jesteadt, Boys Town National Research Hospital, Omaha, NE; Gerald Kidd, Programs in Communication Disorders, Boston University; Doris Kistler, Heuser Hearing Institute, Louisville, KY, and Department of Psychological and Brain Sciences, University of Louisville; Robert Shannon, Auditory Implants and Perception Research, House Ear Institute, Los Angeles, CA; and Alice Suter, independent consultant, Ashland, OR. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dennis McFadden of the University of Texas at Austin. Appointed by the NRC, he was responsible for making sure that an independent examination of

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Hearing Loss: Determining Eligibility for Social Security Benefits this report was carried out in accordance with institutional procedures and that all reviewers’ comments were considered carefully. Responsibility for the final content of this report, however, rests entirely with the authoring committee and the institution. Robert A. Dobie, Chair Committee on Disability Determination for Individuals with Hearing Impairments

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Hearing Loss: Determining Eligibility for Social Security Benefits Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   11 2   BASICS OF SOUND, THE EAR, AND HEARING   42 3   ASSESSMENT OF THE AUDITORY SYSTEM AND ITS FUNCTIONS   69 4   TESTING ADULT HEARING: CONCLUSIONS AND RECOMMENDATIONS   101 5   SENSORY AIDS, DEVICES, AND PROSTHESES   140 6   IMPACT OF HEARING LOSS ON DAILY LIFE AND THE WORKPLACE   163 7   HEARING LOSS IN CHILDREN   180     REFERENCES   224     APPENDIXES     A   Definitions and Technical Terms   255 B   American National Standards on Acoustics   279 C   Public Forum Participation   283 D   Biographical Sketches of Committee Members and Staff   286     INDEX   291

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