TN 25 (04-19)
DI 34005.102 Special Senses and Speech - Child
2.00 Special Senses and Speech (Effective Date:
04/29/13)
A. How do we evaluate visual disorders?
1. What are visual disorders? Visual disorders are abnormalities of the eye, the optic nerve, the optic tracts,
or the brain that may cause a loss of visual acuity or visual fields. A loss of visual
acuity limits your ability to distinguish detail, read, do fine work, or perform other
age-appropriate activities. A loss of visual fields limits your ability to perceive
visual stimuli in the peripheral extent of vision.
2. How do we define statutory blindness? Statutory blindness is blindness as defined in sections 216(i)(1) and 1614(a)(2)
of the Social Security Act (Act).
a. The Act defines blindness as central visual acuity of 20/200 or less in the better
eye with the use of a correcting lens. We use your best-corrected central visual acuity
for distance in the better eye when we determine if this definition is met. (For visual
acuity testing requirements, see 102.00A5.)
b. The Act also provides that an eye that has a visual field limitation such that
the widest diameter of the visual field subtends an angle no greater than 20 degrees
is considered as having a central visual acuity of 20/200 or less. (For visual field
testing requirements, see 102.00A6.)
c. You have statutory blindness only if your visual disorder meets the criteria of
102.02A, 102.02B, or 102.03A. You do not have statutory blindness if your visual disorder
medically equals the criteria of 102.02A, 102.02B, or 102.03A or meets or medically
equals the criteria of 102.03B, 102.03C, 102.04A, or 102.04B because your disability
is based on criteria other than those in the statutory definition of blindness.
3. What evidence do we need to establish statutory blindness under title
XVI? To establish that you have statutory blindness under title XVI, we need evidence
showing only that your central visual acuity in your better eye or your visual field
in your better eye meets the criteria in 102.00A2, provided that those measurements
are consistent with the other evidence in your case record. We do not need documentation
of the cause of your blindness. Also, there is no duration requirement for statutory
blindness under title XVI (see §§416.981 and 416.983 of this chapter).
4. What evidence do we need to evaluate visual disorders, including those that
result in statutory blindness under title II? To evaluate your visual disorder, we usually need a report of an eye examination
that includes measurements of your best-corrected central visual acuity (see 102.00A5)
or the extent of your visual fields (see 102.00A6), as appropriate. If you have visual
acuity or visual field loss, we need documentation of the cause of the loss. A standard
eye examination will usually indicate the cause of any visual acuity loss. A standard
eye examination can also indicate the cause of some types of visual field deficits.
Some disorders, such as cortical visual disorders, may result in abnormalities that
do not appear on a standard eye examination. If the standard eye examination does
not indicate the cause of your vision loss, we will request the information used to
establish the presence of your visual disorder. If your visual disorder does not satisfy
the criteria in 102.02, 102.03, or 102.04, we will request a description of how your
visual disorder affects your ability to function.
5. How do we measure your best-corrected visual acuity?
a. Visual acuity testing. When we need to measure your best-corrected central visual acuity, which is your
optimal visual acuity attainable with the use of a corrective lens, we use visual
acuity testing for distance that was carried out using Snellen methodology or any
other testing methodology that is comparable to Snellen methodology.
(i) Your best-corrected central visual acuity for distance is usually measured by
determining what you can see from 20 feet. If your visual acuity is measured for a
distance other than 20 feet, we will convert it to a 20-foot measurement. For example,
if your visual acuity is measured at 10 feet and is reported as 10/40, we will convert
this measurement to 20/80.
(ii) A visual acuity recorded as CF (counts fingers), HM (hand motion only), LP or
LPO (light perception or light perception only), or NLP (no light perception) indicates
that no optical correction will improve your visual acuity. If your central visual
acuity in an eye is recorded as CF, HM, LP or LPO, or NLP, we will determine that
your best-corrected central visual acuity is 20/200 or less in that eye.
(iii) We will not use the results of pinhole testing or automated refraction acuity
to determine your best-corrected central visual acuity. These tests provide an estimate
of potential visual acuity but not an actual measurement of your best-corrected central
visual acuity.
(iv) Very young children, such as infants and toddlers, cannot participate in testing
using Snellen methodology or other comparable testing. If you are unable to participate
in testing using Snellen methodology or other comparable testing due to your young
age, we will consider clinical findings of your fixation and visual-following behavior.
If both these behaviors are absent, we will consider the anatomical findings or the
results of neuroimaging, electroretinogram, or visual evoked response (VER) testing
when this testing has been performed.
b. Other test charts.
(i) Children between the ages of 3 and 5 often cannot identify the letters on a Snellen
or other letter test chart. Specialists with expertise in assessment of childhood
vision use alternate methods for measuring visual acuity in young children. We consider
alternate methods, for example, the Landolt C test or the tumbling-E test, which are
used to evaluate young children who are unable to participate in testing using Snellen
methodology, to be comparable to testing using Snellen methodology.
(ii) Most test charts that use Snellen methodology do not have lines that measure
visual acuity between 20/100 and 20/200. Some test charts, such as the Bailey-Lovie
or the Early Treatment Diabetic Retinopathy Study (ETDRS), used mostly in research
settings, have such lines. If your visual acuity is measured with one of these charts,
and you cannot read any of the letters on the 20/100 line, we will determine that
you have statutory blindness based on a visual acuity of 20/200 or less. For example,
if your best-corrected central visual acuity for distance in the better eye is 20/160
using an ETDRS chart, we will find that you have statutory blindness. Regardless of
the type of test chart used, you do not have statutory blindness if you can read at
least one letter on the 20/100 line. For example, if your best-corrected central visual
acuity for distance in the better eye is 20/125+1 using an ETDRS chart, we will find
that you do not have statutory blindness because you are able to read one letter on
the 20/100 line.
c. Testing using a specialized lens. In some instances, you may have visual acuity testing performed using a specialized
lens, such as a contact lens. We will use the visual acuity measurements obtained
with a specialized lens only if you have demonstrated the ability to use the specialized
lens on a sustained basis. We will not use visual acuity measurements obtained with
telescopic lenses.
d. Cycloplegic refraction is an examination of the eye performed after administering cycloplegic eye drops
capable of relaxing the ability of the pupil to become smaller and temporarily paralyzing
the focusing muscles. If your case record contains the results of cycloplegic refraction,
we may use the results to determine your best-corrected central visual acuity. We
will not purchase cycloplegic refraction.
e. VER testing measures your response to visual events and can often detect dysfunction that is
undetectable through other types of examinations. If you have an absent response to
VER testing in your better eye, we will determine that your best-corrected central
visual acuity is 20/200 or less in that eye and that your visual acuity loss satisfies
the criterion in 102.02A or 102.02B4, as appropriate, when these test results are
consistent with the other evidence in your case record. If you have a positive response
to VER testing in an eye, we will not use that result to determine your best-corrected
central visual acuity in that eye.
6. How do we measure your visual fields?
a. General. We generally need visual field testing when you have a visual disorder that could
result in visual field loss, such as glaucoma, retinitis pigmentosa, or optic neuropathy,
or when you display behaviors that suggest a visual field loss. When we need to measure
the extent of your visual field loss, we use visual field testing (also referred to
as perimetry) carried out using automated static threshold perimetry performed on
an acceptable perimeter. (For perimeter requirements, see 102.00A9.)
b. Automated static threshold perimetry requirements.
(i) The test must use a white size III Goldmann stimulus and a 31.5 apostilb (asb)
white background (or a 10 candela per square meter (cd/m2) white background). The stimuli test locations must be no more than 6 degrees apart
horizontally or vertically. Measurements must be reported on standard charts and include
a description of the size and intensity of the test stimulus.
(ii) We measure the extent of your visual field loss by determining the portion of
the visual field in which you can see a white III4e stimulus. The "III" refers to
the standard Goldmann test stimulus size III (4 mm2), and the "4e" refers to the standard Goldmann intensity filter (0 decibel (dB) attenuation,
which allows presentation of the maximum luminance) used to determine the intensity
of the stimulus.
(iii) In automated static threshold perimetry, the intensity of the stimulus varies.
The intensity of the stimulus is expressed in decibels (dB). A perimeter's maximum
stimulus luminance is usually assigned the value 0 dB. We need to determine the dB
level that corresponds to a 4e intensity for the particular perimeter being used.
We will then use the dB printout to determine which points you see at a 4e intensity
level (a "seeing point"). For example:
A. When the maximum stimulus luminance (0 dB stimulus) on an acceptable perimeter is
10,000 asb, a 10 dB stimulus is equivalent to a 4e stimulus. Any point you see at
10 dB or greater is a seeing point.
B. When the maximum stimulus luminance (0 dB stimulus) on an acceptable perimeter is
4,000 asb, a 6 dB stimulus is equivalent to a 4e stimulus. Any point you see at 6
dB or greater is a seeing point.
C. When the maximum stimulus luminance (0 dB stimulus) on an acceptable perimeter is
1,000 asb, a 0 dB stimulus is equivalent to a 4e stimulus. Any point you see at 0
dB or greater is a seeing point.
c. Evaluation under 102.03A. To determine statutory blindness based on visual field loss in your better eye (102.03A),
we need the results of a visual field test that measures the central 24 to 30 degrees
of your visual field; that is, the area measuring 24 to 30 degrees from the point
of fixation. Acceptable tests include the Humphrey Field Analyzer (HFA) 30-2, HFA
24-2, and Octopus 32.
d. Evaluation under 102.03B. To determine whether your visual field loss meets listing 102.03B, we use the mean
deviation or defect (MD) from acceptable automated static threshold perimetry that
measures the central 30 degrees of the visual field. MD is the average sensitivity
deviation from normal values for all measured visual field locations. When using results
from HFA tests, which report the MD as a negative number, we use the absolute value
of the MD to determine whether your visual field loss meets listing 102.03B. We cannot
use tests that do not measure the central 30 degrees of the visual field, such as
the HFA 24-2, to determine if your impairment meets or medically equals 102.03B.
e. Other types of perimetry. If your case record contains visual field measurements obtained using manual or
automated kinetic perimetry, such as Goldmann perimetry or the HFA "SSA Test Kinetic,"
we can generally use these results if the kinetic test was performed using a white
III4e stimulus projected on a white 31.5 asb (10 cd/m2) background. Automated kinetic perimetry, such as the HFA "SSA Test Kinetic," does
not detect limitations in the central visual field because testing along a meridian
stops when you see the stimulus. If your visual disorder has progressed to the point
at which it is likely to result in a significant limitation in the central visual
field, such as a scotoma (see 102.00A6h), we will not use automated kinetic perimetry to determine the extent of your visual field loss. Instead, we will
determine the extent of your visual field loss using automated static threshold perimetry
or manual kinetic perimetry.
f. Screening tests. We will not use the results of visual field screening tests, such as confrontation
tests, tangent screen tests, or automated static screening tests, to determine that
your impairment meets or medically equals a listing, or functionally equals the listings.
We can consider normal results from visual field screening tests to determine whether
your visual disorder is severe when these test results are consistent with the other
evidence in your case record. (See §416.924(c) of this chapter.) We will not consider
normal test results to be consistent with the other evidence if the clinical findings
indicate that your visual disorder has progressed to the point that it is likely to
cause visual field loss, or you have a history of an operative procedure for retinal
detachment.
g. Use of corrective lenses. You must not wear eyeglasses during visual field testing because they limit your
field of vision. You may wear contact lenses to correct your visual acuity during
the visual field test to obtain the most accurate visual field measurements. For this
single purpose, you do not need to demonstrate that you have the ability to use the
contact lenses on a sustained basis.
h. Scotoma. A scotoma is a field defect or non-seeing area (also referred to as a "blind spot")
in the visual field surrounded by a normal field or seeing area. When we measure your
visual field, we subtract the length of any scotoma, other than the normal blind spot,
from the overall length of any diameter on which it falls.
7. How do we determine your visual acuity efficiency, visual field efficiency, and
visual efficiency?
a. General. Visual efficiency, a calculated value of your remaining visual function, is the combination of your
visual acuity efficiency and your visual
field efficiency expressed as a percentage.
b. Visual acuity efficiency. Visual acuity efficiency is a percentage that corresponds to the best-corrected central
visual acuity for distance in your better eye. See Table 1.
Table 1 - Visual Acuity Efficiency
Snellen best-corrected central visual acuity for distance
|
Visual acuity efficiency (%) (102.04A)
|
English
|
Metric
|
20/16
|
6/5
|
100
|
20/20
|
6/6
|
100
|
20/25
|
6/7.5
|
95
|
20/30
|
6/9
|
90
|
20/40
|
6/12
|
85
|
20/50
|
6/15
|
75
|
20/60
|
6/18
|
70
|
20/70
|
6/21
|
65
|
20/80
|
6/24
|
60
|
20/100
|
6/30
|
50
|
c. Visual field efficiency. Visual field efficiency is a percentage that corresponds to the visual field in your
better eye. Under 102.03C, we require kinetic perimetry to determine your visual field
efficiency percentage. We calculate the visual field efficiency percentage by adding
the number of degrees you see along the eight principal meridians found on a visual
field chart (0, 45, 90, 135, 180, 225, 270, and 315) in your better eye and dividing
by 5. For example, in Figure 1:
A. The diagram of the left eye illustrates a visual field, as measured with a III4e stimulus,
contracted to 30 degrees in two meridians (180 and 225) and to 20 degrees in the remaining
six meridians. The visual efficiency percentage of this field is: ((2 x 30) + (6 x
20)) 5 = 36 percent.
B. The diagram of the right eye illustrates the extent of a normal visual field as measured
with a III4e stimulus. The sum of the eight principal meridians of this field is 500
degrees. The visual efficiency percentage of this field is 500 5 = 100 percent.
The following is a Chart of Visual Fields:
d. Visual efficiency. Under 102.04A, we calculate the visual efficiency percentage by multiplying your
visual acuity efficiency percentage (see 102.00A7b) by your visual field efficiency
percentage (see 102.00A7c) and dividing by 100. For example, if your visual acuity
efficiency percentage is 75 and your visual field efficiency percentage is 36, your
visual efficiency percentage is: (75 x 36) 100 = 27 percent.
8. How do we determine your visual acuity impairment value, visual field
impairment value, and visual impairment value?
a. General. Visual impairment value, a calculated value of your loss of visual function, is the combination of your visual acuity impairment
value and your visual field impairment value.
b. Visual acuity impairment value. Your visual acuity impairment value corresponds to the best-corrected central visual
acuity for distance in your better eye. See Table 2.
Table 2 - Visual Acuity Impairment Value
Snellen best-corrected central visual acuity for distance
|
Visual acuity impairment value (102.04B)
|
English
|
Metric
|
20/16
|
6/5
|
0.00
|
20/20
|
6/6
|
0.00
|
20/25
|
6/7.5
|
0.10
|
20/30
|
6/9
|
0.18
|
20/40
|
6/12
|
0.30
|
20/50
|
6/15
|
0.40
|
20/60
|
6/18
|
0.48
|
20/70
|
6/21
|
0.54
|
20/80
|
6/24
|
0.60
|
20/100
|
6/30
|
0.70
|
c. Visual field impairment value. Your visual field impairment value corresponds to the visual field in your better
eye. Using the MD from acceptable automated static threshold perimetry, we calculate
the visual field impairment value by dividing the absolute value of the MD by 22.
For example, if your MD on an HFA 30-2 is -16, your visual field impairment value
is: |-16| 22 = 0.73.
d. Visual impairment value. Under 102.04B, we calculate the visual impairment value by adding your visual acuity
impairment value (see 102.00A8b) and your visual field impairment value (see 102.00A8c).
For example, if your visual acuity impairment value is 0.48 and your visual field
impairment value is 0.73, your visual impairment value is: 0.48 + 0.73 = 1.21.
9. What are our requirements for an acceptable perimeter? We will use results from automated static threshold perimetry performed on a perimeter
that:
a. Uses optical projection to generate the test stimuli.
b. Has an internal normative database for automatically comparing your performance
with that of the general population.
c. Has a statistical analysis package that is able to calculate visual field indices,
particularly mean deviation or mean defect.
d. Demonstrates the ability to correctly detect visual field loss and correctly identify
normal visual fields.
e. Demonstrates good test-retest reliability.
f. Has undergone clinical validation studies by three or more independent laboratories
with results published in peer-reviewed ophthalmic journals.
B. How do we evaluate hearing loss?
1. What evidence do we need?
a. We need evidence showing that you have a medically determinable impairment that
causes your hearing loss and audiometric measurements of the severity of your hearing
loss. We generally require both an otologic examination and audiometric testing to
establish that you have a medically determinable impairment that causes your hearing
loss. You should have this audiometric testing within 2 months of the otologic examination.
Once we have evidence that you have a medically determinable impairment, we can use
the results of later audiometric testing to assess the severity of your hearing loss
without another otologic examination. We will consider your test scores together with
any other relevant information we have about your hearing, including information from
outside of the test setting.
b. The otologic examination must be performed by a licensed physician (medical or
osteopathic doctor) or audiologist. It must include your medical history, your description
of how your hearing loss affects you, and the physician's or audiologist's description
of the appearance of the external ears (pinnae and external ear canals), evaluation
of the tympanic membranes, and assessment of any middle ear abnormalities.
c. Audiometric testing must be performed by, or under the direct supervision of, a
licensed audiologist or an otolaryngologist.
2. What audiometric testing do we need when you do not have a cochlear
implant?
a. General. We need either physiologic or behavioral testing (other than screening testing, see
102.00B2g) that is appropriate for your age at the time of testing. See 102.00B2c-102.00B2f.
We will make every reasonable effort to obtain the results of physiologic testing
that has been done; however, we will not purchase such testing.
b. Testing requirements. The testing must be conducted in accordance with the most recently published standards
of the American National Standards Institute (ANSI). You must not wear hearing aids
during the testing. Additionally, a person described in 102.00B1c must perform an
otoscopic examination immediately before the audiometric testing. (An otoscopic examination provides a description of the appearance of your external ear canals and an evaluation
of the tympanic membranes. In these rules, we use the term to include otoscopic examinations
performed by physicians and otoscopic inspections performed by audiologists and others.)
The otoscopic examination must show that there are no conditions that would prevent
valid audiometric testing, such as fluid in the ear, ear infection, or obstruction
in an ear canal. The person performing the test should also report on any other factors,
such as your ability to maintain attention, that can affect the interpretation of
the test results.
c. Children from birth to the attainment of age 6 months.
(i) We need physiologic testing, such as auditory brainstem response (ABR) testing.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hertz (Hz). If you do not have a response
at a particular frequency, we will use a threshold of 5 decibels (dB) over the limit
of the audiometer.
d. Children from age 6 months to the attainment of age 2.
(i) We need air conduction thresholds determined by a behavioral assessment, usually
visual reinforcement audiometry (VRA). We can use ABR testing if the behavioral assessment
cannot be completed or if the results are inconclusive or unreliable.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hz. If you do not have a response at a particular
frequency, we will use a threshold of 5 dB over the limit of the audiometer.
(iii) For this age group, behavioral assessments are often performed in a sound field,
and each ear is not tested separately. If each ear is not tested separately, we will
consider the test results to represent the hearing in the better ear.
e. Children from age 2 to the attainment of age 5.
(i) We need air conduction thresholds determined by a behavioral assessment, such
as conditioned play audiometry (CPA), tangible or visually reinforced operant conditioning
audiometry (TROCA, VROCA), or VRA. If you have had ABR testing, we can use the results
of that testing if the behavioral assessment cannot be completed or the results are
inconclusive or unreliable.
(ii) To determine whether your hearing loss meets 102.10A, we will average your hearing
thresholds at 500, 1000, 2000, and 4000 Hz. If you do not have a response at a particular
frequency, we will use a threshold of 5 dB over the limit of the audiometer.
(iii) For this age group, behavioral assessments are often performed in a sound field
and each ear is not tested separately. If each ear is not tested separately, we will
consider the test results to represent the hearing in the better ear.
f. Children from age 5 to the attainment of age 18.
(i) We generally need pure tone air conduction and bone conduction testing, speech
reception threshold (SRT) testing (also referred to as "spondee threshold'' or "ST''
testing), and word recognition testing (also referred to as "word discrimination''
or "speech discrimination'' testing). This testing must be conducted in a sound-treated
booth or room and must be in accordance with the most recently published ANSI standards.
Each ear must be tested separately.
(ii) To determine whether your hearing loss meets the air and bone conduction criterion
in 102.10B1 or 102.10B3, we will average your hearing thresholds at 500, 1000, 2000,
and 4000 Hz. If you do not have a response at a particular frequency, we will use
a threshold of 5 dB over the limit of the audiometer.
(iii) The SRT is the minimum dB level required for you to recognize 50 percent of
the words on a standard list of spondee words. (Spondee words are two-syllable words
that have equal stress on each syllable.) The SRT is usually within 10 dB of the average
pure tone air conduction hearing thresholds at 500, 1000, and 2000 Hz. If the SRT
is not within 10 dB of the average pure tone air conduction threshold, the reason
for the discrepancy must be documented. If we cannot determine that there is a medical
basis for the discrepancy, we will not use the results of the testing to determine
whether your hearing loss meets a listing.
(iv) Word recognition testing determines your ability to recognize an age-appropriate,
standardized list of phonetically balanced monosyllabic words in the absence of any
visual cues. This testing must be performed in quiet. The list may be recorded or
presented live, but in either case, the words should be presented at a level of amplification
that will measure your maximum ability to discriminate words, usually 35 to 40 dB
above your SRT. However, the amplification level used in the testing must be medically
appropriate, and you must be able to tolerate it. If you cannot be tested at 35 to
40 dB above your SRT, the person who performs the test should report your word recognition
testing score at your highest comfortable level of amplification.
g. Screening testing. Physiologic testing, such as ABR and --
otoacoustic emissions (OAE), and pure tone testing can be used as hearing screening
tests. We will not use these tests to determine that your hearing loss meets or medically
equals a listing, or to assess functional limitations due to your hearing loss, when
they are used only as screening tests. We can consider normal results from hearing
screening tests to determine that your hearing loss is not "severe'' when these test
results are consistent with the other evidence in your case record. See § 416.924(c).
3. What audiometric testing do we need when you have a cochlear
implant?
a. If you have a cochlear implant, we will consider you to be disabled until age 5,
or for 1 year after initial implantation, whichever is later.
b. After that period, we need word recognition testing performed with any age-appropriate
version of the Hearing in Noise Test (HINT) or the Hearing in Noise Test for Children
(HINT-C) to determine whether your impairment meets 102.11B. This testing must be
conducted in quiet in a sound field. Your implant must be functioning properly and
adjusted to your normal settings. The sentences should be presented at 60 dB HL (Hearing
Level) and without any visual cues.
4. How do we evaluate your word recognition ability if you are not fluent in
English?
If you are not fluent in English, you should have word recognition testing using an
appropriate word list for the language in which you are most fluent. The person conducting
the test should be fluent in the language used for the test. If there is no appropriate
word list or no person who is fluent in the language and qualified to perform the
test, it may not be possible to measure your word recognition ability. If your word
recognition ability cannot be measured, your hearing loss cannot meet 102.10B2 or
102.11B. Instead, we will consider the facts of your case to determine whether you
have difficulty understanding words in the language in which you are most fluent,
and if so, whether that degree of difficulty medically equals 102.10B2 or 102.11B.
For example, we will consider how you interact with family members, interpreters,
and other persons who speak the language in which you are most fluent.
5. What do we mean by a marked limitation in speech or language as used in
102.10B3?
a. We will consider you to have a marked limitation in speech if:
(i) Entire phrases or sentences in your conversation are intelligible to unfamiliar
listeners at least 50 percent (half) of the time but no more than 67 percent (two-thirds)
of the time on your first attempt; and
(ii) Your sound production or phonological patterns (the ways in which you combine
speech sounds) are atypical for your age.
b. We will consider you to have a marked limitation in language when your current
and valid test score on an appropriate comprehensive, standardized test of overall
language functioning is at least two standard deviations below the mean. In addition,
the evidence of your daily communication functioning must be consistent with your
test score. If you are not fluent in English, it may not be possible to test your
language performance. If we cannot test your language performance, your hearing loss
cannot meet 102.10B3. Instead, we will consider the facts of your case to determine
whether your hearing loss medically equals 102.10B3.
C. How do we evaluate impairments that do not meet one of the special senses and
speech listings?
1. These listings are only examples of common special senses and speech disorders
that we consider severe enough to result in marked and severe functional limitations.
If your impairment(s) does not meet the criteria of any of these listings, we must
also consider whether you have an impairment(s) that satisfies the criteria of a listing
in another body system.
2. If you have a medically determinable impairment(s) that does not meet a listing,
we will determine whether the impairment(s) medically equals a listing or functionally
equals the listings. (See §§ 416.926 and 416.926a.) We use the rules in § 416.994a
when we decide whether you continue to be disabled.
102.01 Category of Impairments, Special Senses and Speech
102.02 Loss of central visual
acuity.
A. Remaining vision in the better eye after best correction is 20/200 or less.
OR
B. An inability to participate in visual acuity testing using Snellen methodology or
other comparable testing, clinical findings that fixation and visual-following behavior
are absent in the better eye, and one of the following:
1. Abnormal anatomical findings indicating a visual acuity of 20/200 or less in the
better eye (such as the presence of Stage III or worse retinopathy of prematurity
despite surgery, hypoplasia of the optic nerve, albinism with macular aplasia, or
bilateral optic atrophy); or
2. Abnormal neuroimaging documenting damage to the cerebral cortex which would be
expected to prevent the development of a visual acuity better than 20/200 in the better
eye (such as neuroimaging showing bilateral encephalomyelitis or bilateral encephalomalacia);
or
3. Abnormal electroretinogram documenting the presence of Leber's congenital amaurosis
or achromatopsia in the better eye; or
4. An absent response to VER testing in the better eye.
102.03 Contraction of the visual field in the better eye,
with:
A. The widest diameter subtending an angle around the point of fixation no greater than
20 degrees.
OR
B. An MD of 22 decibels or greater, determined by automated static threshold perimetry
that measures the central 30 degrees of the visual field (see 102.00A6d.).
OR
C. A visual field efficiency of 20 percent or less determined by kinetic perimetry
(see 102.00A7c).
102.04 Loss of visual efficiency, or visual impairment, in the better
eye:
A. A visual efficiency percentage of 20 or less after best correction (see 102.00A7d).
OR
B. A visual impairment value of 1.00 or greater after best correction (see 102.00A8d).
102.10 Hearing loss not treated with cochlear implantation.
A. For children from birth to the attainment of age 5, an average air conduction hearing
threshold of 50 decibels or greater in the better ear (see 102.00B2).
OR
B. For children from age 5 to the attainment of age 18:
1. An average air conduction hearing threshold of 70 decibels or greater in the better
ear and an average bone conduction hearing threshold of 40 decibels or greater in
the better ear (see 102.00B2f); or
2. A word recognition score of 40 percent or less in the better ear determined using
a standardized list of phonetically balanced monosyllabic words (see 102.00B2f); or
3. An average air conduction hearing threshold of 50 decibels or greater in the better
ear and a marked limitation in speech or language (see 102.00B2f and 102.00B5).
102.11 Hearing loss treated with cochlear
implantation.
A. Consider under a disability until the attainment of age 5 or for 1 year after initial
implantation, whichever is later.
OR
B. Upon the attainment of age 5 or 1 year after initial implantation, whichever is later,
a word recognition score of 60 percent or less determined using the HINT or the HINT-C
(see 102.00B3b).