Timothy C. Hain, MD, Most recent update: June 10, 2003.
Disability has several meanings. Here we are speaking of it in the legal sense. Persons who have a medical impairment, may be able to obtain financial support from an insurance company or the government. Evaluation and documentation of hearing or vestibular disability is somewhat of a formal process, involving a thorough examination, a set of tests prescribed by regulations, and regular (typically every 3 month) followups during the evaluation process. In the United States, the government rules set the general standard for disability evaluations. Another useful source is the "AMA guide" for evaluation of impairment and disability.
The SSA policy site is at http://policy.ssa.gov/pnpublic.nsf/LawsRegs!OpenPage
The rules for hearing and vertigo are in Part III (listing of Impairments), Part A (adults), Section 2.00 (Special Senses and Speech).
1. Hearing impairment. Hearing ability should be evaluated in terms of the person's ability to hear and distinguish speech.
Loss of hearing can be quantitatively determined by an audiometer which meets the standards of the American National Standards Institute (ANSI) for air and bone conducted stimuli (i.e., ANSI S 3.6-1969 and ANSI S 3.13-1972, or subsequent comparable revisions) and performing all hearing measurements in an environment which meets the ANSI standard for maximal permissible background sound (ANSI S 3.1-1977).
Speech discrimination should be determined using a standardized measure of speech discrimination ability in quiet at a test presentation level sufficient to ascertain maximum discrimination ability. The speech discrimination measure (test) used, and the level at which testing was done must be reported.
Hearing tests should be preceded by an otolaryngologic examination and should be performed by or under the supervision of an otolaryngologist or audiologist qualified to perform such tests.
In order to establish an independent medical judgment as to the level of impairment in a claimant alleging deafness, the following examinations should be reported: Otolaryngologic examination, pure tone air and bone audiometry, speech reception threshold (SRT), and speech discrimination testing. A copy of reports of medical examination and audiologic evaluations must be submitted.
Cases of alleged "deaf mutism" should be documented by a hearing evaluation. Records obtained from a speech and hearing rehabilitation center or a special school for the deaf may be acceptable, but if these reports are not available, or are found to be inadequate, a current hearing evaluation should be submitted as outlined in the preceding paragraph.
2. Vertigo associated with disturbances of labyrinthine-vestibular function, including Meniere's disease. These disturbances of balance are characterized by an hallucination of motion or a loss of position sense and a sensation of dizziness which may be constant or may occur in paroxysmal attacks. Nausea, vomiting, ataxia, and incapacitation are frequently observed, particularly during the acute attack. It is important to differentiate the report of rotary vertigo from that of "dizziness" which is described as light-headedness, unsteadiness, confusion, or syncope.
Meniere's disease is characterized by paroxysmal attacks of vertigo, tinnitus, and fluctuating hearing loss. Remissions are unpredictable and irregular, but may be long-lasting; hence, the severity of impairment is best determined after prolonged observation and serial reexaminations.
The diagnosis of a vestibular disorder requires a comprehensive neuro-otolaryngologic examination with a detailed description of the vertiginous episodes, including notation of frequency, severity, and duration of the attacks. Pure tone and speech audiometry with the appropriate special examinations, such as Bekesy audiometry, are necessary. Vestibular function is accessed by positional and caloric testing, preferably by electronystagmography. When polytomograms, contrast radiography, or other special tests have been performed, copies of the reports of these tests should be obtained, in addition to appropriate medically acceptable imaging reports of the skull and temporal bone. Medically acceptable imaging includes, but is not limited to, x-ray imaging, computerized axial tomography (CAT scan), or magnet resonance imaging, (MRI) with or without contrast material, myelography, and radionuclear bone scans. "Appropriate" means the technique used is the proper one to support the evaluation and diagnosis of the impairment.
2.01 Category of Impairments, Special Senses and Speech.
2.07 Disturbance of labyrinthine-vestibular function (Including Meniere's disease), characterized by a history of frequent attacks of balance disturbance, tinnitus, and progressive loss of hearing. With both A and B:
A. Disturbed function of vestibular labyrinth demonstrated by caloric or other vestibular tests; and
B. Hearing loss established by audiometry.
2.08 Hearing impairments (hearing not restorable by a hearing aid) manifested by:
A. Average hearing threshold sensitivity for air conduction of 90 decibels or greater, and for bone conduction to corresponding maximal levels, in the better ear, determined by the simple average of hearing threshold levels at 500, 1000, and 2000 hz. (see 2.OOB 1); or
B. Speech discrimination scores of 40 percent or less in the better ear.
Private disability insurance varies considerably according to the carrier. Often in this situation the "AMA guide" is used to quantify disability and impairment. The process is very similar to that for social security, and in fact, often there are applications for both social security and private disability coverage at the same time.
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