Why determining the work-relatedness of a hearing loss case is so important.
Whether or not a hearing loss case ultimately is related to on-the-job exposure, determining work-relatedness can help employers prevent noise-induced hearing loss by identifying patterns of hearing loss and instituting hazard controls. Here, your questions about work-relatedness are answered.
When an employee is found to have a standard threshold shift (STS) on the annual audiogram as part of the hearing conservation program, certain evaluation and follow-up actions are required. If the STS is confirmed or if no retest is completed within 30 days, and the decrease in hearing results in hearing levels that are consistent with at least a mild hearing loss (25 dB average hearing level), the STS must be recorded on the OSHA Illness and Injury Log (OSHA 300 Log).
These “recordable” hearing loss cases have received some attention since the new rules for recordable hearing loss went into effect in January 2003. Prior to that, hearing loss was lumped in with “other” illnesses. Now, under the revised record keeping final rule, hearing loss cases are recorded in a separate column.
In an October 2009 Government Accountability Office (GAO) report, “Workplace Safety and Health,” auditors noted that there was pressure on physicians and health care professionals to determine hearing loss as not work-related. The OSHA occupational injury and illness recording and reporting requirements final rule states that although work-relatedness is not presumed, the determination of work-relatedness is made on a case-by-case basis.
This article will answer some of the questions surrounding this issue and will examine the decision points that affect the recordability of hearing loss.
Q: What does “work-related” mean in OSHA context?
A: Recordable determination is done on a case-by-case basis and the employer is allowed to seek guidance from a physician or licensed health care provider. In the case of hearing loss, we use the term “professional supervisor” of the audiometric testing portion of the hearing conservation program to describe that health care professional. The Council for Accreditation in Hearing Conservation (CAOHC) offers training and certification for physicians and audiologists as a professional supervisor of the audiometric monitoring program (PS/A). These are the two professions that are qualified by their credentials to evaluate hearing and hearing loss.
OSHA specifies some situations that are not recordable in the recordkeeping standard. See Figure 1 for more information on OSHA’s specifications.
Q: What information can help the professional supervisor make a determination regarding work-relatedness?
A: The National Hearing Conservation Association has recently published “NHCA Guidelines for Recording Hearing Loss on the OSHA 300 Log.” These guidelines provide general principles for professional supervisors. The primary principle is that professional supervisors must be able to substantiate their determinations. Therefore, “unless there are clear and cogent reasons why the loss is entirely unrelated to the work environment,” it should be considered work-related and thus recordable.
Q: What are the common pitfalls in work-relatedness determinations?
A: Common pitfalls include:
• Ascribing hearing loss to non-occupational exposures without adequate documentation. Be very careful not to jump to conclusions. The burden of proof is on the PS/A and thus the employer to show that occupational exposure did not contribute and that non-occupational factors are sufficient to cause the entire hearing loss. The PS/A has both ethical and medical-legal obligations to get the diagnosis right.
• Assuming a given decrease in exposure due to use of hearing protection device. You must measure this to be able to confidently assume protection. This can be measured by point measurement with earplug fit testing or with continuous monitoring of protected exposure levels.
• Bending to pressure to reduce recordable cases. PS/As must follow legal and ethical standards as they use their professional judgment. Both physicians and audiologists are held to ethics codes in order to maintain their license to practice.
• Missing a diagnosis of other cause of hearing loss. This brings up the issue of who pays for the evaluation of hearing loss cases. While OSHA does not require the employer to pay, it may be in the employer’s best interest to pay for initial evaluation of the hearing loss. If the follow-up evaluation does not take place, the hearing loss is presumed to be recordable.
Q: What can employers do to help make the right determination?
A: Employers should have a good working relationship with the professional supervisor from whom they are seeking guidance. Ask if the physician or audiologist who reviews your audiometric test results is certified by the Council for Accreditation in Hearing Conservation (CAOHC). While this additional level of training is not required, it does help the employer differentiate and find the best-qualified assistance.
Q: Finally, why is work-relatedness determination important?
A: Prevention of noise-induced hearing loss is the best way to avoid recordable hearing loss. Employers should take advantage of additional information that is available now with the separate column, such as the identification of patterns of hearing loss, which should lead to control of hazards that would prevent noise-induced hearing loss.
Identification of unacceptable noise exposures can lead to noise reduction and prevention. Identification of problems in your hearing conservation program can help prevent future recordable hearing loss cases. If a hearing loss is not work-related, it is important to determine other causes of hearing loss and arrange for necessary treatment.
Theresa Schulz, Ph.D., Lt. Col., USAF (ret.), is hearing conservation manager for Howard Leight/Honeywell Safety Products. Schulz is a past-president and an active member of National Hearing Conservation Association (NHCA) and president of the board for the NHCA Foundation. She also is a board member and past chair of the Council for Accreditation in Occupational Hearing Conservation, a certified member of the American Speech-Language-Hearing Association, a fellow in the American Academy of Audiology (AAA) and a member of the Air Force Audiology Association. Schulz holds a BS in communication disorders and an MA in audiology from the University of Texas at Austin, and a Ph.D. in hearing science from Ohio State University. She served in the U.S. Air Force for more than 20 years as an audiologist. She can be contacted at email@example.com.