The CE report content guidelines in this section are in addition to the general report content guidelines in DI 22510.100, and the adult CE report content guidelines for speech sound disorders in DI 22510.102 E.

The CE provider will describe and discuss, as appropriate:

1. 1. 

   New information per claimant report which is not in the medical history or any information reported that is inconsistent with records already in the file;

2. 2. 

   Any effects of a diagnosed hearing impairment or other medical condition on communication skills;

3. 3. 

   Language(s) spoken in the home and the claimant's preferred language;

4. 4. 

   Whether the CE was conducted in person or via telehealth. If a telehealth CE, document confirmation that the claimant could clearly see any visual stimuli presented;

5. 5. 

   Whether the speech-language pathologist (SLP) is familiar with the claimant;

6. 6. 

   Information obtained by claimant report rather than by direct clinical observation and assessment, which the SLP must clearly identify as such; and

7. 7. 

   Any test(s) and subtests administered. Subtests of multiple tests may be used to establish an alleged impairment rather than administering all subtests of only one test. Additionally, if appropriate, the SLP may use portions of a cognitive-communication test depending on the nature of the communication impairment being evaluated. Document deviations from the administration procedures outlined in the test manual.

When the claimant's functioning in articulation, voice, and fluency is within normal limits, provide a general statement to indicate that. When an individual component(s) of speech requires detailed evaluation, the CE report must include the following:

1. 1. 

   Information regarding the structure and functioning of the oral mechanism (e.g., diadochokinetic rates, lingual mobility, and strength);

2. 2. 

   When articulation is evaluated in detail, the report must include information regarding:

   a. Intelligibility of the claimant’s speech at sentence level (percentage based on sentences produced spontaneously in a narrative or picture description);

   b. Overall intelligibility percentage (not a range) in conversation as judged by the SLP;

   c. General nature of the impairment (e.g., muscle weakness, motor sequencing); and

   d. Any use of mechanical or electronic devices that improve articulation.

3. 3. 

   When voice is evaluated in detail, the report must include information regarding:

   a. Any clinical abnormalities identified;

   b. Observed or reported voice use patterns and how these may contribute to any identified impairment;

   c. How the voice impairment would affect audibility in interactions with co-workers or supervisors;

   d. How the voice impairment would affect audibility in interactions with individuals who have less frequent contact with the claimant, such as customers of an employer;

   e. How the voice impairment would affect the claimant’s ability to sustain voice for brief conversations and for tasks requiring constant voicing; and

   f. Any use of mechanical or electronic devices that improve voice.

4. 4. 

   When fluency is evaluated in detail, the report must include information regarding:

   a. Length of the speech sample and a description of its characteristics (e.g., narrative, conversation);

   b. Length of the second speech sample (if claimant is bilingual) and a description of its characteristics;

   c. Claimant’s fluency pattern (e.g., word or part-word repetitions, prolongations, blocks);

   d. Duration of the disfluent episodes and impact on sentence delivery;

   e. Percent stuttered words;

   f. Observed and reported secondary behaviors and their frequency;

   g. The SLP’s perception of claimant’s response to disfluencies, if diagnosed;

   h. How the fluency impairment would affect interactions with co-workers or supervisors; and

   i. How the fluency impairment would affect interactions with individuals who have less frequent contact with the claimant, such as customers of an employer.

If the claimant's language functioning is within normal limits, provide a general statement to indicate that. When detailed language evaluation is needed, the CE provider will:

1. 1. 

   Determine formal and informal assessment approaches to evaluation of the alleged impairment. As part of the assessment of the claimant’s ability to communicate in the workplace, incorporate:

   a. Conversation; and

   b. A portion of one published test, at minimum, that is appropriate for the claimant's age and diagnosis.

2. 2. 

   Use the specific requirements below to complete the CE report for a language impairment:

   a. Describe and discuss, as appropriate, receptive language skills critical to workplace performance, including but not limited to:

   1. Receptive vocabulary;

   2. Response to single- and multi-step instructions;

   3. Comprehension of non-literal meaning or intent;

   4. Awareness and correction of communication errors; and

   5. Response to questions about a short narrative.

   b. Describe and discuss, as appropriate, expressive language skills critical to workplace performance, including but not limited to:

   1. Sentence repetition;

   2. Ability to communicate a simple message clearly;

   3. Explanation of how to complete a simple task; and

   4. Word-finding ability in conversation.

   c. Describe and discuss, as appropriate, the verbal communication aspects of pragmatics critical to workplace performance, including but not limited to:

   1. Discourse (e.g., topic maintenance/shift, reciprocity, communication breakdown/repair, contingency);

   2. Use of language to request assistance when necessary;

   3. Use of appropriate rather than inappropriate language; and

   4. Avoidance of perseverative comments.

   d. Describe and discuss, as appropriate, receptive and expressive language skills associated with the nonverbal communication aspects of pragmatics (e.g., body language, facial expression, tone of voice, proxemics).

3. 3. 

   Provide observations about social cognition (e.g., perspective-taking, presupposition).

Use the following additional guidelines to provide the minimum content in a CE report for a claimant who:

• •

  comes from an environment where a language other than English is present and could or has had a significant impact on the claimant's level of English language proficiency; or

• •

  comes from a cultural or linguistic background that has resulted in factors that indicate a language difference rather than a language disability.

1. 1. 

   Follow American Speech-Language-Hearing Association (ASHA) guidelines for collaborating with interpreters. Use interpreters in direct assessment of the claimant in the non-English primary language (see DI 23040.001 DDS: Interpreters for Individuals with Limited English Proficiency (LEP) or Individuals Requiring Language Assistance). Consider asking the interpreter whether the claimant mispronounces or omits speech sounds in the non-English language, and whether the claimant’s responses are easily followed and relevant;

2. 2. 

   When possible, administer speech and language tests in the claimant’s primary language (using tests normed for the claimant’s language if commercially available, such as Spanish tests), or use an interpreter (per ASHA guidelines) for tests in which the claimant’s language has not been normed. Do not report standard scores;

3. 3. 

   Provide a comprehensive description of functional communication performance in both languages. Use alternative tools (e.g., clinical observation, language sampling, ASHA's National Outcomes Measurement System (NOMS), narratives, a vocabulary test) to assess language skills critical to workplace performance;

4. 4. 

   Include a statement of how articulation affects intelligibility in the primary language and in English, with reference both to familiar and unfamiliar listeners in known and unknown contexts; and

5. 5. 

   When fluency is evaluated in detail, document a spontaneous speech sample of statements (not words) obtained in the non-English language (or in both languages if the claimant also speaks English, totaling two samples), with percent stuttered words for each.

The CE report must include the following:

1. 1. 

   A statement of conclusions correlated with information from the history, clinical observations, and formal assessment;

2. 2. 

   A statement of whether test data are generally consistent with observations and impressions about the claimant's speech and language skills, and that explains or comments on any discrepancies;

3. 3. 

   If the claimant uses a hearing aid or glasses but did not bring them to the examination, a statement regarding the validity of the examination results;

4. 4. 

   If a diagnosis is established, a statement that explains whether and to what extent the identified speech or language impairment may reasonably be expected to affect the claimant's ability to perform the demands of work activities over the next 12 months; and

5. 5. 

   The CE provider's signature, educational degree, and certification or licensure credentials.