Hearing Loss Determining Eligibility for Social Security Benefits (2005) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 11-41
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 11... ...
KEY ISSUES According to the committee's scope of work, the key issue is whether or not standardized tests exist or can be developed "that provide adequate prediction of real-world performance capacities to reflect individuals' auditory abilities and disabilities in normal life situations with average background noise." Such tests would need to be valid, reliable, well-standardized, and "simple and inexpensive to administer in a standard physician's or audiologist's office setting." 1Throughout this report we use the term "hearing loss" whenever possible in preference to "hearing impairment." When impairment is meant in a generic sense or is used as a term in referenced documents under discussion (as in SSA regulations and guidance) , we use the term "impairment." 11
|
From page 12... ...
For adults, SSA disability is defined as "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months." For children, in contrast, any stable impairment that is "marked or extreme" may result in eligibility, and SSA regulations explicitly define this statistically rather than in terms of inability to successfully perform the learning tasks of childhood. "Marked" limitation is "the equivalent of the functioning we would expect on standardized testing with scores that are at least two, but less than three, standard deviations below the mean," whereas "extreme" limitation begins at three standard deviations below normal.
|
From page 13... ...
Speech discrimination tests done by different audiologists frequently differ in several ways that affect the difficulty and the reliability of the test: the word lists chosen, the number of words presented, the intensity (loudness) of the words, male versus female speaker, the use of live voice versus recorded word lists, and whether people who use hearing aids or cochlear implants are tested with or without their devices.
|
From page 14... ...
The AMA continues to recommend pure-tone audiometry for the evaluation of hearing impairment (American Medical Association, 2001) , and no state or federal agency uses speech tests to determine eligibility for workers' compensation benefits (the Veterans Administration uses both pure tones and speech for eligibility for disability benefits, but has an alternate procedure using only pure-tone audiometry for cases in which speech tests are deemed unreliable)
|
From page 15... ...
, while false positive errors in Step 3 are generally irreversible. Many -- perhaps most -- adults with severe to profound hearing loss do work, and some who use hearing aids and cochlear implants work in jobs that require frequent speech communication (some of those will be false positives, if the 90 dB criterion is used)
|
From page 16... ...
While it is generally accepted that persons with conductive hearing losses usually function better with hearing aids than people with purely sensorineural hearing losses of the same severity, this may not be true for people with profound mixed hearing losses. The speech discrimination criterion for adults (40 percent or worse for monosyllables)
|
From page 17... ...
. The validity of monosyllable speech discrimination tests given in quiet, often at levels considerably above the levels of conversational speech, has been severely criticized because most real-world speech involves sentences, with variable types and amounts of background noise.
|
From page 18... ...
No such tools have been described that can either detect exaggeration on speech discrimination tests or estimate "true" performance for an uncooperative subject. The SSA medical listings for children use the same tests as for adults, but with different criteria for pure-tone audiometry.
|
From page 19... ...
. Some of these people derive significant benefit from hearing aids and cochlear implants, enabling them to do jobs that require some hearing abilities.
|
From page 20... ...
731) has stated "The feeling of a significant number of researchers today is that no particular speech test or speech stimulus has been shown to be a reliable or valid predictor of performance with a hearing aid." Of dispensing audiologists who responded to a recent mailed survey, only about half used aided speech discrimination tests at all; of those who used such tests, most used monosyllables in quiet.
|
From page 21... ...
. Any speech test that is proposed for use in disability determination will be vulnerable to these nonauditory effects.
|
From page 22... ...
The National Health Interview Survey (Pleis and Coles, 2002) , which publishes the prevalence of chronic health conditions reported by adults, estimates that 17 percent of adults in the United States, or 34 million people, indicate some hearing difficulty.
|
From page 23... ...
. In the Beaver Dam Epidemiology of Hearing Loss Study, the prevalence of hearing aid use among adults ages 48 to 92 with hearing loss was 14.6 percent (Popelka et al., 1998)
|
From page 24... ...
For people who do not meet the medical listings criteria, additional tests of hearing may be used to evaluate functional capacity, but there are no clear guidelines at present for evaluating hearing losses that do not meet the medical listings criteria. 4Parts of this section describing SSA programs and procedures have been adapted from the corresponding section in an earlier NRC report, Visual Impairments: Determining Eligibility for Social Security Benefits (National Research Council, 2002)
|
From page 25... ...
The methodology used to make this decision is discussed in a later section. Social Security Disability Determinations and Caseload for Hearing Impairment Early in this study, the SSA provided the committee with statistical tables on claimants and beneficiaries with hearing impairments for the years 1997-2001 for determinations and 1998-2001 for numbers of beneficiaries.
|
From page 26... ...
SSA did not provide figures for dollar costs of hearing impairment benefits. However, SSA was recently able to provide us with the number of beneficiaries in current pay status (as of May 2004)
|
From page 27... ...
Adults For adults covered by SSDI and for adult SSI claimants, the disability determination process follows the steps shown in Figure 1-1. The first step of the sequential evaluation process requires that the disability examiner working on behalf of SSA determine whether the claimant is engaged in SGA.
|
From page 28... ...
. In Step 4, the decision makers must determine whether any of the claimant's physical and mental limitations cited in the evaluations of residual functional capacity precludes the performance of "past relevant work." If the claimant is found able to perform past relevant work in spite of cited physical and mental limitations, he or she is found ineligible for
|
From page 29... ...
Because Steps 4 and 5 for adults are not appropriate for children, an additional decision point has been added to Step 3 of the process for children. Under rules that took effect January 2, 2001, when a child is found to have a medically determinable impairment that does not meet or medically equal a listed criterion, SSA must make a determination of whether the child's impairment(s)
|
From page 30... ...
Current Disability Criteria for Hearing In the discussion of Step 3 of the sequential evaluation process, we mentioned the listing of impairments found in Appendix 1 of Subpart P of 20 CFR Part 404. The hearing listings are based on measures of pure-tone threshold, using air and bone conduction, and on speech discrimination testing.
|
From page 31... ...
. Speech discrimination should be determined using a standardized mea sure of speech discrimination ability in quiet at a test presentation level sufficient to ascertain maximum discrimination ability.
|
From page 32... ...
26) : · Average hearing threshold sensitivity for air conduction of 90 deci bels or greater, and for bone conduction to corresponding maximal lev els, in the better ear, determined by the simple average of hearing thresh old levels at 500, 1000, and 2000 Hz.; or · Speech discrimination scores of 40 percent or less in the better ear.
|
From page 33... ...
THE COMMITTEE'S APPROACH5 Models of Disability The conceptual model underlying disability determination has been undergoing changes over the past several years, especially since the passage of the Americans with Disabilities Act (ADA)
|
From page 34... ...
In reviewing data on audiological testing and functional status, the working hypothesis was deceptively simple: increasingly severe hearing loss, by some measure, is associated with increasing inability to carry out activities associated with employment or, in the case of children, age-appropriate activities. The data bearing on this issue present a more complicated picture, because the same level of hearing loss can result in a wide spectrum of disability level, depending on such diverse factors as duration and age of onset of hearing loss, availability and quality of habilitation or rehabilitation services, education, age, gender, psychological adjustment, presence of other comorbid conditions, and social and environmental support.
|
From page 35... ...
The agency uses the terms to describe the relationship of the person to the criteria for its programs, not necessarily as a description of his or her personal functional status. The SSA disability determination process follows a path starting with a medical model, embodied in the listings of impairments, through Step 3 of the decision process.
|
From page 36... ...
functional loss after maximal medical improvement has been achieved and which abnormality or loss, medically, is considered stable or nonprogressive at the time of evaluation. Permanent impairment is a basic consideration in the evaluation of permanent disability and is a contributing factor to, but not necessarily an indication of, the entire extent of permanent disability (Idaho Code section 72-422)
|
From page 37... ...
The inability to engage in any Determine impairment, Physicians and substantial, gainful activity by may assist with the nonphysicians need reason of any medically disability determination to work together to determinable physical or mental as a consultative examiner. define situational impairment(s)
|
From page 38... ...
The decision maker considers the claimant's age, education, and work experience as well as, by inference, transferable skills. At this time, SSA prescribes no formal tests or evaluation protocols (beyond the Residual Functional Capacity form completed by a physician)
|
From page 39... ...
A medical condition that precludes highly exertional physical activity may be "totally" disabling for an older individual with little education and an unskilled work his tory and not disabling for another individual who is highly skilled and educated. In a theoretical sense, accurately determining disability for Social Secu rity disability benefits would require that each individual be evaluated to determine how their medical condition limits their functional capaci ty and then how these limitations interact with each individual's age, work history, and education.
|
From page 40... ...
NET, the available job analysis inventories (and their de rived job demand variables) may not adequately reflect the fast chang ing world of work, especially the dot-com industry; while O*
|
From page 41... ...
Chapter 5 is devoted to a discussion of technological aids that can mitigate the effects of hearing loss: hearing aids, prostheses such as cochlear implants, and assistive listening devices. We review the state of the art for each type of device, discussing what is known about how well each can improve the functioning of people with hearing loss.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.