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 S3.6—1969 and ANSI S3.13—1972, or subsequent comparable revisions)
and performing all hearing measurements in an environment which meets the ANSI standard
for maximal permissible background sound (ANSI S3.1—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 longlasting;
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 magnetic resonance imaging (MRI), with or without contrast material,
myelography, and radionuclear bone scans. "Appropriate" means that the technique used
is the proper one to support the evaluation and diagnosis of the impairment.
3. Loss of Speech. In evaluating the loss of speech, the ability to produce speech by any means includes
the use of mechanical or electronic devices that improve voice or articulation. Impairments
of speech may also be evaluated under the body system for the underlying disorder,
such as neurological disorders, 11.00ff.
2.01 Category of Impairments, Special Senses and Speech
2.02 Impairment of Visual Acuity. Remaining vision in the better eye after best correction is 20/200 or less.
2.03 Contraction of Peripheral Visual Fields in the Better Eye.
-
A.
To 10 degree or less from the point of fixation; or
-
B.
So the widest diameter subtends an angle no greater than 20 degrees; or
-
C.
To 20 percent or less visual field efficiency.
2.04 Loss of visual efficiency. The visual efficiency of the better eye after best correction is 20 percent or less.
(The percent of remaining visual efficiency is equal to the product of the percent
of remaining visual acuityefficiency and the percent of remaining visual field efficiency.)
2.05 [Reserved.]
2.06 Total Bilateral Ophthalmoplegia.
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
2.00B1); or
B. Speech discrimination scores of 40 percent or less in the better ear.
2.09 Loss of speech due to any cause, with inability to produce by any means speech
that can be heard, understood, or sustained.
TABLE NO. 1.
PERCENTAGE OF VISUAL EFFICIENCY CORRESPONDING TO VISUAL ACUITY NOTATIONS FOR DISTANCE
IN THE PHAKIC AND APHAKIC EYE (BETTER EYE).
Snellen
|
|
PERCENT VISUAL ACUITY EFFICIENCY
|
|
|
English
|
Metric
|
Phakic1
|
Aphakic Monocular2
|
Aphakic Binocular3
|
20/16
|
6/5
|
100
|
50
|
75
|
20/20
|
6/6
|
100
|
50
|
75
|
20/25
|
6/7.5
|
95
|
47
|
71
|
20/32
|
6/10
|
90
|
45
|
67
|
20/40
|
6/12
|
85
|
42
|
64
|
20/50
|
6/15
|
75
|
37
|
56
|
20/64
|
6/20
|
65
|
32
|
49
|
20/80
|
6/24
|
60
|
30
|
45
|
20/100
|
6/30
|
50
|
25
|
37
|
20/125
|
6/38
|
40
|
20
|
30
|
20/160
|
6/48
|
30
|
—
|
22
|
20/200
|
6/60
|
20
|
—
|
—
|
Column and Use
1 Phakic—1. A lens is present in both eyes. 2. A lens is present in the better eye
and absent in the poorer eye. 3. A lens is present in one eye and the other eye is
enucleated.
2 Monocular—1. A lens is absent in the better eye and present in the poorer eye. 2.
The lenses are absent in both eyes; however, the visual acuity in the poorer eye after
best correction is 20/200 or less. 3. A lens is absent from one eye and the other
eye is enucleated.
3 Binocular—1. The lenses are absent from both eyes and the visual acuity in the poorer
eye after best correction is greater than 20/200.
TABLE NO. 2
Chart of visual field showing extent of normal field and method of computing percent
of visual field efficiency.
1. Diagram of right eye illustrates extent of normal visual field as tested on standard
perimeter at 3/330 (3 mm. white disc at a distance of 330 mm.) under 7 foot-candles
illumination. The sum of the eight principal meridians of this field total 500 degrees.
2. The percent of visual field efficiency is obtained by adding the number of degrees
of the eight principal meridians of the contracted field and dividing by 500. Diagram
of left eye illustrates visual field contracted to 30 degrees in the temporal and
down and out meridians and to 20 degrees in the remaining six meridians. The percent
of visual field efficiency of this field is: 620+230 = 180 divided by 500 = 0.36 or
36 percent remaining visual field efficiency, or 64 percent loss.