TN 4 (02-11)

DI 24535.020 Evaluating Continuing Disability Review (CDR) Claims for Beneficiaries with Cochlear Implants

Citations:

20 CFR 404.1594, 416.994, and 416.994a

A. Background

We evaluate hearing loss for people with cochlear implants under listings 2.11 and 102.11, which went into effect on August 2, 2010. Under listing 2.11, we consider an adult disabled for 1 year after the initial cochlear implantation. Under listing 102.11, we consider children disabled until the attainment of age 5 or for 1 year after the initial cochlear implantation, whichever is later. If more than 1 year has passed since the initial implantation or upon attainment of age 5, we require a word recognition score of 60 percent or less determined using the Hearing in Noise Test (HINT)

See also

Before August 2, 2010, we did not have listings specifically for people with cochlear implants. Under our prior policy interpretation, we used the results of pre-implant hearing testing to evaluate hearing loss in people with cochlear implants for determining both initial and continuing disability.

B. How we evaluate the hearing loss of beneficiaries with cochlear implants

When evaluating the hearing loss of beneficiaries with cochlear implants the approach on CDR depends

  • on the date of the comparison point decision (CPD), and

  • when the beneficiary received the cochlear implant.

1. CPD before August 2, 2010, beneficiary had a cochlear implant(s) at the time of CPD, and the CPD was based on the results of pre-implant hearing testing  

Use the results of the pre-implant hearing testing and find that no medical improvement (MI) occurred since CPD.  Continue benefits on that basis if no exception to medical improvement (MI) applies. 

2. All other cases of hearing loss for beneficiaries who currently have a cochlear implant(s)  

Apply the appropriate medical improvement review standard for adults or SSI children to determine whether the person's hearing impairment has improved since the CPD, regardless of whether we made the CPD before August 2, 2010, or on or after August 2, 2010. 

NOTE: In all cases, do not apply the Group I exception to medical improvement for advances in medical technology in any adult CDR. (See, Advances in Medical or Vocational Therapy or Technology DI 28020.100)

C. References


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0424535020
DI 24535.020 - Evaluating Continuing Disability Review (CDR) Claims for Beneficiaries with Cochlear Implants - 07/20/2012
Batch run: 07/20/2012
Rev:07/20/2012