4 – Eligibility, Significance of Disability and Order of Selection for Services


An individual with a disability under the Rehabilitation Act of 1973 amendments of 1998 means any individual, who has a physical or mental impairment which for such individual constitutes or results in a substantial impediment to employment; who can benefit in terms of employment outcome from vocational rehabilitation (VR) services.

The Order of Selection for Services (OSS)

If a VR agency cannot serve all eligible consumers, they must by law enter into an Order of Selection for Services, under which consumers who are determined to be the most significantly disabled must be served before other eligible consumers.

As an agency moves into an Order of Selection for Services, there is concern about where consumers who are hard of hearing and late deafened fall on the Order of Selection priority list. In recent years, VR agencies have shifted from dependence primarily on medical or audiological criteria to increased reliance on functional limitations for purposes of determining eligibility and order of selection. Consumers who are hard of hearing and late deafened are often mistakenly viewed as “single service” hearing aid cases and excluded because their functional limitations and accompanying service needs are not recognized or addressed. Functional impediments to employment of individuals who are hard of hearing or late deafened can be significant and vocationally debilitating and they may have little correlation to the level of their decibel loss.

Significance of Disability

An individual with a significant disability means an individual who has a severe physical or mental impairment that seriously limits one or more functional capacities, i.e. mobility, communication, self-care, self-direction, interpersonal skills, work tolerance or work skills, in terms of an employment outcome; whose vocational rehabilitation can be expected to require multiple vocational rehabilitation services over an extended period of time; and who has one or more resulting physical or mental disabilities causing substantial functional limitation.

Many times the mandate to serve consumers who are significantly disabled before other eligible consumers is incorrectly interpreted to mean that only persons who are deaf and use sign language qualify as significantly disabled (SD) or most significantly disabled (MSD) under an Order of Selection — this is a misnomer. The functional limitations of each applicant must be accurately identified and considered, instead of automatically assuming individuals who are deaf are more significantly disabled than individuals who are hard of hearing or late deafened.

The importance of looking at the functional limitations of the individual with a hearing loss rather than focusing on the degree or decibel of hearing loss in determining disability and significance of disability becomes clearer if we apply the foregoing definitions to hypothetical consumers.


Ms. A has had an 80 dB hearing loss all of her life, which is considered to be a severe to profound hearing by audiological standards. Ms. A has a master’s degree in rehabilitation counseling, is a certified rehabilitation counselor, and has five years of work experience in her field. She uses two hearing aids, a wide range of hearing assistive technology (HAT), and is assertive about her communication and accommodation needs.

Mr. B has a moderate hearing loss as measured on a recent audiogram. He has a 35 dB loss in one ear and a 65 dB loss in the other. He feels he has acquired this hearing loss over time as an adult but does not know exactly when it started. Mr. B is a sales representative for a local firm and communication is an important part of his job. He knows he is having more difficulty communicating with people, especially on his cell phone, in meetings and in noisy situations but is trying to “get by” although he is exhausted at the end of the day. He complains that traveling for his job has also become a headache because he cannot understand public address systems or communicate in public transportation facilities and has missed connections and announcements. He is reluctant to try hearing aids for a variety of reasons and does not have the slightest idea that assistive listening devices (ALDs) exist. Mr. B is in serious jeopardy of losing his job when his employer insists that he have a medical check-up. His hearing loss is verified by an audiologist who recommends hearing aids. Mr. B does not follow through, continuing to deny that he needs hearing aids or any assistance with his hearing disability. He feels sad most of the time, loses interest in many activities and sleeps a lot when not at work.

Which of these individuals is more significantly limited by the hearing disability?

We have Ms. A, who has a severe degree of hearing loss based on audiological standards. However, with the use of her hearing aids, assistive listening devices and other technology, communication strategies and willingness to let people know about her specific communication requirements, she will generally be able to function more easily and effectively in communication situations than Mr. B. Her awareness and acceptance of the hearing loss and how it impacts on her physical and emotional well-being allows her to cope in most situations. Through her knowledge, attitude and actions, Ms. A finds her severe hearing loss to present a minimal impediment in her career, personal life and community activities.

Mr. B’s level of hearing loss is not deemed to be as severe as Ms. A’s in audiological terms. However, his moderate hearing impairment clearly is causing him a great deal of distress and perhaps the loss of his job as well as future jobs if he does not recognize, adjust to and accommodate his disability. He is disabled not only by his communication difficulties, but also by his inability to cope with the added stresses that accompany hearing disability, resulting in strained interpersonal relationships at work, home and in the community.

At this time, Ms. A is not experiencing functional limitations due to her hearing loss in any areas of major life functions. Ms. A would not be considered significantly disabled.

However, Mr. B is experiencing major life functional limitations with his moderate degree of hearing loss in the areas of:

Services needed to address Mr. B’s functional limitations are:

Other services that may be needed or indicated could be coping skills and support groups; aural rehabilitation; and relaxation training and are discussed later in the Individualized Plan of Employment (IPE) section of this module.

There are many consumers who are hard of hearing similar to Mr. B who would be considered to have a significant disability if, in fact, all of their problems and needs for services were recognized and dealt with by the VR counselor. It is therefore critical that the VR counselor of the consumer who is hard of hearing or late deafened be able to recognize the variety of functional limitations in the categories of major life activities, i.e. communication, interpersonal skills, work tolerance, etc., that impact the consumer’s employability, plus the multiple services over an extended period of time that should be provided to address these limitations.

Functional capacities with examples of symptoms/limitations and possible impact:

Mobility Impaired balance or motor coordination; Unable to hear wake up and safety alarms in public places; Unable to hear public address systems; Unable to converse while walking driving or otherwise moving Unable to travel readily; Difficulty utilizing public accommodations – hotels etc.; Unable to use public transportation unassisted
Communication Difficulty understanding verbal instructions; Difficulty understanding on telephones radios pagers; Difficulty hearing and understanding in 1 – 1 situations & groups Makes mistakes and errors in personal business and at work; Misses important information; Cannot participate effectively in meetings
Self Care Family members or others  make phone calls schedule appts. respond to questions; Difficulty being alerted to environmental sounds such as phone alarm doorbells etc. Cannot conduct personal business independently; Dependent on others to wake up and be aware of surroundings
Self Direction Unable to identify communication problems and solutions Dependent on others to plan initiate organize and carry out goal directed activities
Interpersonal Skills Difficulty understanding & participating in groups Exhibits social isolation & withdrawal; Fails to understand obvious social cues
Work Tolerance Unable to perform job functions related to telephones radios paging etc. Requires accommodations in essential job functions
Work Skills Unable to hear warning sounds and alarms at workplace Cannot safely complete all job tasks without assistance


Information and Referral Services and Wait Lists

For state VR agencies operating under an Order of Selection for Services, some individuals who are determined eligible for services based on their hearing disability will be placed on a wait list due to their determined priority category. The Rehabilitation Act provides that eligible individuals who do not meet the Order of Selection criteria shall have access to an information and referral system adequate to ensure provision of accurate information in appropriate modes of communication to assist them with their employment needs. This may include referrals to other Federal and state programs including other components of the statewide workforce investment system. These may be one-stop career centers, state employment agencies, or local specialized programs that can be utilized in the absence of VR services such as speech and hearing centers and other related community service centers; technology centers and loan programs. Unfortunately, staff in these programs may not recognize, be knowledgeable, of or trained in the unique needs of person who are hard of hearing or late deafened. Further, consumers may be reluctant to use these resources for fear that appropriate accommodations will not be provided and their communication needs not met.

Preventing an Incorrect Eligibility Decision/Order of Selection Determination

If a consumer is found to be ineligible because there are no functional limitations resulting in impediments to work (seldom will this occur), the counselor must be certain that the consumer understands the reason for the ineligibility decision, and that the consumer fully understands appeal rights and procedures.

If the consumer is found to be eligible for services and the state VR agency is currently operating in an Order of Selection for Services (OSS), it is critical that the counselor make an appropriate OSS determination. If the consumer is not currently designated to be served due to the state agency’s OSS priorities, information and referral services must be effectively explained. These situations require that the counselor effectively communicate the situation to the consumer.