Hearing Loss Determining Eligibility for Social Security Benefits (2005) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-10
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to survey published research on assessment of hearing and the auditory demands of everyday life, and to advise them whether the process of determining eligibility for Social Security disability benefits for persons with hearing loss could be improved. SSA also asked for recommendations for a research agenda in these areas.
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Committee Response: In general, for adults, the committee recommends the continued use of the current medical listing of impairments to establish disability, with a modified and specific protocol for speech testing. We also recommend that a battery of tests be administered prior to applying the medical listing criteria, in order to improve the reliability and validity of all stages of the SSA disability determination process.
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In the absence of good data, the committee developed basic auditory task descriptions and estimates of the probable effects of hearing loss of various degrees of severity on auditory performance on the job, based on our collective expertise. The fact of life that most complicated our work is that it is clear to those who study disability that many personal, environmental, educational, and social factors contribute in significant ways to the relationship between a person's hearing ability and the ability to work.
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LIMITATIONS OF CURRENT FORMULA AND TESTING PROTOCOL Hearing impairment in adults that qualifies for disability benefits under the existing SSA determination in Step 3 is a loss of hearing that is not restorable by a hearing aid. In Social Security programs, eligibility for disability benefits is all or nothing; there is no partial disability.
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General Recommendations for All Testing During Step 2 of the SSA Process · The committee recommends that the standard otolaryngological examination follow the audiological examination (but by no more than 6 months) , because a physician cannot provide a competent report without recent audiometric data (see Action Recommendation 4-1)
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It is recommended that this entire test battery be completed in Step 2 before a determination of disability is formulated: -- pure-tone thresholds in each ear presented via air and bone conduction transducers; -- speech thresholds under earphones in each ear; -- monosyllable word recognition performance for test materials presented in the sound field at average conversational levels in quiet and in noise; -- tympanometry; and -- acoustic reflex thresholds. · The committee recommends that SSA require a checklist to be completed by the clinical audiologist at the time of testing, as an indication of the quality of the data collected for use in the disability determination process and to provide additional useful information for evaluating a claim in Steps 3, 4, and 5 (see Action Recommendation 4-5)
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Presentation of the speech perception test should be via sound field using personal amplification or cochlear implant if such is used by the child. If no device is used by the child, testing is performed unaided (see Action Recommendation 7-2)
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Research Recommendations Related to Adult Disability Determination · Develop and standardize new tests of basic hearing functions-including speech recognition for words and sentences in quiet and in noise, localization, and sound discrimination -- that correlate with auditory performance in the workplace (see Research Recommendations 4-1 and 4-2)
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. · Conduct research to validate tests that purport to measure or predict functional hearing ability in daily life against real-world criteria measured in natural settings (see Research Recommendations 4-8 and 5-3)
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