SSR 82-57


PURPOSE: To state the policy and describe the necessary elements for the evaluation of organic loss of speech when determining disability under titles II and XVI of the Social Security Act.

CITATIONS (AUTHORITY): Sections 223(d), 216(i), and 1614(a) of the Social Security Act, as amended; Regulations No. 4, Subpart P, section 404.1525, and Appendix 1, Part A, sections 2.00.B.3, 2.09 and 11.00-11.19; and Regulations No. 16, Subpart I, section 416.925.

INTRODUCTION: Regardless of the cause of organic loss of speech, disability occurs when the individual is unable, by any means, to produce speech which can be heard, understood, and sustained. This policy statement explains in detail how loss of speech is to be evaluated. Functional loss of speech is addressed in sections 2.00.B.3 and 2.09 of the Listing of Impairments. Neurological disorders resulting in loss of speech are evaluated under sections 11.00-11.19. (Note: Medical criteria for evaluating impairments for children under age 18 are generally contained in Part B of the Listing. When a particular impairment is not included in the "childhood listings," it should be evaluated under Part A of the Listing).

POLICY STATEMENT: Ordinarily, when an individual's impairment prevents effective speech, the loss of function is sufficiently severe so that an allowance under Listing 2.09 is justified on the basis of medical considerations alone, unless such a finding is rebutted by work activity. To speak effectively, an individual must be able to produce speech that can be heard, understood, and sustained well enough to permit useful communication in social and vocational settings. These criteria are applicable to the production of speech whether by natural function of the voice mechanism or by the use of a prosthetic device.

Three attributes of speech pertinent to the evaluation of speech proficiency are: (1) audibility -- the ability to speak at a level sufficient to be heard; (2) intelligibility -- the ability to articulate and to link the phonetic units of speech with sufficient accuracy to be understood; and (3) functional efficiency -- the ability to produce and sustain a serviceably fast rate of speech output over a useful period of time. When at least one of these attributes is missing, overall speech function is not considered effective.

When a refined assessment of speech proficiency is necessary, it should be made by an otolaryngologist or a speech therapist whose evaluation should be based both on personally listening to the claimant's speech and on a history of the claimant's performance in everyday living. The findings should be sufficient to provide the reviewer with a clear picture of the individual's speech capacity. Such an analysis covering the attributes of speech discussed above would include a detailed description of the following points:

1. The intensity of speech (audibility) -- the conditions under which the individual can and cannot be heard (e.g., in quiet surroundings, noisy places, a moving automobile); the maximum distance at which individuals can be heard; whether their voices tend to become inaudible, and if so, after how long;
2. The ability to articulate (intelligibility) -- the frequency of any difficulties with pronunciation, the extent to which the individual is asked to repeat, how well he or she is understood by strangers unaccustomed to hearing esophageal speech; and
3. The rate of speech and the degree of ease with which the individual's speech flows (functional efficiency) -- how long he or she is able to sustain consecutive speech; the number of words spoken without interruption or hesitancy; whether he or she appears fatigued, and if so, after how long.

If medical considerations alone are not determinative of the issue of disability for a title II worker or childhood disability claimant or for a title XVI claimant age 18 or older, consider the individual's vocational factors (age, education, training and work experience) as these factors relate to the ability to perform past relevant work or any other work.

EFFECTIVE DATE: The policy explained herein was effective on August 20, 1980, the date the regulations covering the basic policy in the subject area were effective (45 FR 55566).

CROSS-REFERENCE: Program Operations Manual System, section DI 2202.

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