Hearing Loss: From Audiogram to RFC Learn How to Effectively Represent Deaf and Hard of Hearing Claimants

Transcription

1 V Hearing Loss: From Audiogram to RFC Learn How to Effectively Represent Deaf and Hard of Hearing Claimants Michael Liner, Esq. Mark Mehle, MD Andrew November, Esq.

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3 Hearing Loss: From Audiogram to RFC Section V Hearing Loss: From Audiogram to RFC Effectively Representing Deaf & Hard of Hearing Claimants Submitted By: Michael Liner, Esq. Mark Mehle, MD Andrew November, Esq. 643

4 Section V National Social Security Disability Law Conference Hearing Loss: From Audiogram to RFC Effectively Representing Deaf & Hard of Hearing Claimants NOSSCR DISABILITY LAW CONFERENCE Phoenix, AZ September 13 16, 2017 Presenters Dr. Mark Mehle, M.D. Andrew November, Esq. Michael Liner, Esq. HEARING LOSS AND DISABILITY A physician s perspective Dr. Mark Mehle, M.D. 644

5 Hearing Loss: From Audiogram to RFC Section V EAR ANATOMY EAR ANATOMY EAR ANATOMY 645

6 Section V National Social Security Disability Law Conference EAR ANATOMY Hearing Loss: Common Causes Genetics Aging (presbycusis) Noise exposure Infections Tumors or cystic growths (cholesteatoma) Birth complications Trauma Ototoxic medications Medical conditions such as Meniere s Disease Hearing Loss epidemiology 1.1 billion people worldwide as of 2013 Some degree of disability in 5% ( million people) Moderate to severe disability in 124 million Began in childhood in approximately 65 million people 646

7 Hearing Loss: From Audiogram to RFC Section V Main Types of Hearing Loss Sensorineural (nerve related) Conductive Mixed Central Deafness (e.g. Brain injury with an anatomically normal ear) Hearing Loss Secondary symptoms Hyperacusis (recruitment) heightened sensitivity to certain volumes or frequencies of sound Tinnitus ringing, buzzing, hissing without actual sound being present Vertigo or disequilibrium Tympanophonia (autophonia) hearing ones own voice louder than normal (Eustachian tube dysfunction, rarely SCC issues) Facial weakness (e.g. When an acoustic nerve tumor is present) Ear Examination OtologicExam Thorough History, including discussion of limitations Outer ear exam Otoscopy Audiometry Tympanometry Tuning fork testing Otoacoustic Emissions Auditory Brainstem Responses (ABR) 647

8 Section V National Social Security Disability Law Conference HEARING ASSESMENT Understanding the Audiogram Audiometric assessment Pure tone air and bone conduction testing Each ear tested separately American National Standards Institute (ANSI) standardization, sound booth used Appropriate masking has been used 648

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16 Section V National Social Security Disability Law Conference Audiometric assessment (cont d) PTA pure tone average of multiple frequencies (typically 500,1000,2000 Hz) SRT speech reception threshold minimum db level to recognize 50% of standard list of spondee words (e.g. baseball) usually within 10dB of PTA WDS word discrimination score (speech descrimination) uses monosyllabic phonetically balanced words, presented db above SRT 656

17 Hearing Loss: From Audiogram to RFC Section V Hearing Loss treatments SNHL o hearing aids o Bone anchored hearing aids (BAHA) o Cochlear Implantation (CI) in severe or profound cases CHL o Surgery in many cases is an option o PE tubes o Repair of ossicular chain INNER EAR Vestibular/balance disorders Special Considerations Inner ear balance issues Vertigo o Benign Positional Vertigo common, may be posttraumatic, no auditory component o Migraine associated Vertigo (episodic, seldom auditory) o Vestibular Neuronitis (seldom has an auditory component) o Tumors, CNS causes 657

18 Section V National Social Security Disability Law Conference Special Considerations Meniere s disease o Episodic vertigo o One sided SNHL (fluctuating, usually lower frequencies) o Tinnitus (asymmetrical, fluctuating) o Unilateral ear pressure Michael A. Liner, Esq. Andrew November, Esq. Liner Legal, LLC 658

19 Hearing Loss: From Audiogram to RFC Section V Deafness & Disability Evidentiary Requirements Establishing Hearing Loss Otologic examination and audiometric testing required Audiometric testing within 2 months of the otologic examination Otologic examination must be performed by a licensed physician (medical or osteopathic doctor) or audiologist The Otologic Examination Medical history; Description of the functional limitations; 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 659

20 Section V National Social Security Disability Law Conference The Audiometric Test Must be performed by, or under the direct supervision of: o A licensed audiologist; or o An Otolaryngologist Listing 2.10 No CI Pure Tone Air Conduction & Bone Conduction Testing Speech Reception Threshold Testing (SRT) Word Recognition Testing o AKA Word Discrimination o AKA Speech Discrimination Sound treated booth or room American National Standards Institute (ANSI) Each ear must be tested separately Listing 2.10 No CI Must not wear hearing aids Otoscopic examination performed immediately before testing Must show that no conditions prevented valid testing Discuss validity (e.g. cooperation) 660

21 Hearing Loss: From Audiogram to RFC Section V Listing 2.10 No CI A: An average air conduction hearing threshold of 90 decibels or greater in the better ear and an average bone conduction hearing threshold of 60 decibels or greater in the better ear. OR B: A word recognition score of 40 percent or less in the better ear. Listing 2.10 No CI A: SSA will average air and bone conduction hearing thresholds at 500, 1000, and 2000 Hertz (Hz) If no response at a particular frequency, SSA will use a threshold of 5 (db) over the limit of the audiometer. Listing 2.10 No CI B: The ability to recognize a standardized list of phonetically balanced monosyllabic words without visual cues. Words presented db above SRT If unable to tolerate db above SRT, test should be performed at highest comfortable level 661

22 Section V National Social Security Disability Law Conference Listing 2.10 No CI About the SRT o SRT is the minimum db level required to recognize 50 percent of the words on a standard list of spondee words. (e.g. baseball / toothbrush) Should be within 10 db of avg pure tone air condition thresholds at 500, 1000, & 2,000 Hz Document the medical basis for discrepancy Listing 2.11 CI A: Considered under a disability for 1 year after initial implantation OR B: If more than 1 year after initial implantation, a word recognition score of 60 percent or less determined using the HINT Listing 2.11 CI Date of Implantation Functioning properly Adjusted to normal settings Sentences presented at 60 db 662

23 Hearing Loss: From Audiogram to RFC Section V Language Concerns Fluent language required Administrator should be fluent too Medically equals o SSA will consider how person interacts with family members, interpreters, and other persons who speak the language in which the person is most fluent. Signal to Noise Ratio Measurement of how loud a signal is in comparison to background noise The signal is the noise that is meant to be heard above the noise For our purposes; the signal is speech Signal to Noise Ratio There is a very low correlation between the amount of hearing loss a person has as measured by pure tone thresholds and what their signal to noise ratio loss is Donald J. Schum, PHD 663

24 Section V National Social Security Disability Law Conference Signal to Noise Ratio Life does not occur in a soundproof booth! Functional limitations increase in noisier environments Medical equivalence? Need a Medical Expert! Competing Signals Background noise Acoustic Distortions Reverberation Channel Telephone VE Considerations Hearing Use of telephones at work Volume of conversational speech (contact with public, co workers, supervisors) Training issues (demonstration, written instruction vs. oral) Hazards in workplace 664

25 Hearing Loss: From Audiogram to RFC Section V VE Considerations Meniere s Balance issues Devices Workplace hazards Excessive computer use Heights Working around objects that move Bright/fluorescent lights Reasonable Accomodations SSA cannot rely upon reasonable accommodation to satisfy its burden. See SSR 00 1c; see also Poulos v. Comm r of Soc. Sec., 474 F.3d 88, 95 (3d Cir. 2007) ( We further remind the ALJ that, under the Supreme Court s decision in Cleveland v. Policy Management Systems Com, 526 U.S. 795, 803 (1999), [claimant] is not entitled to consider potential accommodation by employers in determining the availability of jobs in the national economy that Appellant can perform. ) Deafness & Disability 665

26 Section V National Social Security Disability Law Conference THANK YOU!!! Questions? Feedback? CONTACT INFORMATION Andrew November, Esq. Michael Liner, Esq. Liner Legal, LLC 4269 Pearl Road, Suite 104 Cleveland, OH (216) anovember@linerlegal.com mliner@linerlegal.com Dr. Mark E. Mehle, M.D. ENT And Allergy Health Services Cleveland, Ohio DR.M.MEHLE@ATT.NET 666