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• Standard Number: 1910.95

May 3, 1983

Steven C. White, Ph.D.
Director, Reimbursement Policy Division
American Speech - Language - Hearing Association
10801 Rockville Pike
Rockville, Maryland 20852

Dear Dr. White:

This is in response to your letter of March 16, 1983, to Assistant Secretary Auchter regarding responsibility for determining that a standard threshold shift (STS) is not work-related under the hearing conservation amendment.

As published in the Federal Register on August 21, 1981, the hearing conservation amendment continued the stay pending further comment and evaluation on the requirement that an audiologist, otolaryngologist or qualified physician review audiograms to determine whether an STS is work-related and that work-related STS's be recorded on the Occupational Safety and Health Administration (OSHA) Form 200. Numerous comments, including yours (Exh. 327-154)m were received and reviewed in reaching a decision regarding the determination of work- relatedness. Many commenters described the difficulties in making this determination.

OSHA revoked the requirement for the need to make a positive determination of work-relatedness in part because such a determination is not necessary in order to take steps to protect a worker's hearing. However, it was felt that under certain, perhaps unique, circumstances, a negative determination might avoid costly and inappropriate follow-ups. Several commenters suggested that such a determination is, in fact, a medical diagnosis that legally could be made only by a physician (See Exh. 325-130, and 325-179). This provision will not be excercised very often given the difficulties commenters raised in determining work-relatedness. It was felt that such a finding, if made at all, would most appropriately be made by a physician. Audiologists will continue to play a major role in hearing conservation programs since they are allowed to perform audiometric tests, run the program, evaluate audiograms and review problem audiograms.

I hope this information has helped to clarify OSHA's position on this issue.

Sincerely,



R. Leonard Vance
Director
Health Standards




March 16, 1983

Thorne Auchter
Assistant Secretary
U. S. Department of Labor
200 Constitution Avenue
Washington, D. C. 20010

Re: Occupational Noise Exposure; Hearing Conservation Amendment; Final Rule

Dear Mr. Auchter:

The American Speech-Language-Hearing Association requests a clarification of one of the revised sections of the Hearing Conservation Amendment. Specifically, under Follow-up procedures (g)(8)(F)(ii), it states that:

"Unless a physician determines that the standard threshold shift is not workrelated or aggravated by occupational noise exposure, the employer shall ensure that the following steps are taken when a standard threshold shift occurs:...."

We are perplexed as to the origin of this paragraph since there were no requests for comments regarding Follow-up procedures in the August 21, 1981, Federal Register. As a matter of fact, there were no requests for comments for this section whatsoever.

In January 16, 1981, Hearing Conservation Amendment, paragraph (j)(8)(iv)(d) indicated that the audiologist, otolaryngologist, or qualified physician must record the extistence of the permanent significant threshold shift when it is determined that the shift is work-related. We are well aware that the requirement was revoked but, now, without public comment and without consistency with the remainder of the amendment, the final rule states that only a physician may determine that the standard threshold shift is not work-related or aggravated by occupational noise exposure. Elsewhere in the amendment, one finds that the audiologist as well as the physician reviews problem audiograms (g)(7)(iii) and that the employee is to be referred for an audiological evaluation or otologic examination as appropriate (g)(8)(ii)(C).

We would appreciate an explanation of this change if it was other than inadvertent. We recommend that a technical amendment be made and the following language be substituted:

(g)(8)(F)(ii) Unless an audiologist or physician determines that the standard threshold shift is not work-related or aggravated by occupational noise exposure, the employer shall ensure that the following steps are taken when a standard threshold shift occurs:

I am looking forward to your reply.

Sincerely yours,



Steven C. White, Ph.D.
Director
Reimbursement


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