Cockpit noise, flight workload, and hearing loss all likely influence U.S. Army pilot performance; however, hearing loss flight waiver decisions are largely based on audiometric evaluation results. Twenty Army helicopter pilots (two hearing level groups) participated in this study. The pilots flew three flights in a full motion-base Black Hawk helicopter simulator, each involving a different headset configuration as well as varying flight workload levels and varying communication signal quality in a counterbalanced ordering. Objective flight performance parameters of heading, altitude, and airspeed deviation and air traffic control (ATC) command readbacks and subjective measures of workload and situation awareness were measured. Results support a conclusion that factors other than hearing thresholds and speech intelligibility in a quiet environment should be considered when evaluating Army helicopter pilots' flight safety with regard to hearing sensitivity. Results also support a recommendation that hearing-impaired pilots use assistive communication technology and not rely on passive-attenuation headsets worn over foam earplugs.