Social Security Disability, SSI, AND HIV

Social Security Disability, SSI, and HIV

Human immunodeficiency virus (HIV) is a retrovirus that causes acquired immunodeficiency syndrome (AIDS). AIDS causes a progressive failure of the body's immune system that enables life endangering opportunistic infections and cancers to flourish.

Most individuals with HIV will eventually get AIDS without antiviral treatment. Most untreated individuals die from cancers or infections associated with a failed immune system.

However, antiviral treatments have dramatically changed the prospects of individuals with HIV infections. Treatment with anti retrovirals has increased the life expectancy of HIV patients even after the progression to AIDS.

For this reason, Social Security has fine-tuned their impairment listing to address the status quo with regard to treatment of HIV infections.

To view the listing: HIV Listing 14.08.

The evaluation of claims involving HIV and/or AIDS

To receive disability benefits from the Social Security Administration on the basis of HIV infection/AIDS, the condition must first be documented. Documentation will serve to establish the diagnosis and existence of the condition as well as to document the progression of the condition and the functional limitations that may exist as a result of the condition.

Documentation may consist of laboratory evidence or medical evidence by any other medically acceptable method that is consistent with current medical knowledge and clinical practice.

A definitive diagnosis of HIV must be documented by one of the following:

1. A serum specimen that contains HIV antibodies documented through screening tests like the ELISA, Western Blot, or immunofluorescence assay.
2. A specimen that contains HIV antigen documented through serum specimen, lymphocyte culture, or cerebrospinal fluid (CFS) specimen.
3. Another test that might be used to document HIV is the highly specific polymerase chance reaction (PCR) test.

Social Security Disability examiners must consider the impact of all diseases or conditions that are manifested by a disability applicant with HIV.

HIV infections are associated with a wide spectrum of opportunistic infections that include but are not limited to bacterial infections, fungal infections, sepsis (bacterial infection of blood), meningitis, pneumonia, other viral infections, and parasitic intestinal infections.

Additionally, HIV infection is associated with malignant tumors or cancers such as carcinoma of the cervix, invasive, FIGO stage II or more; or Kaposi's sarcoma with extensive oral lesions, or involvement of the gastrointestinal tract, lungs, or other viscera organs.

A diagnosis of HIV along with an opportunistic viral or bacterial infection or a malignant neoplasm could potentially allow an individual to meet or equal the criteria of the HIV impairment listing.

In addition to impairments related to the HIV infection, disability examiners must consider the impact of additional impairments unrelated to the HIV infection when making their disability determination. Since Social Security Disability is about functional ability rather than simply the diagnosis of specific impairments, the disabling effects of other conditions must be considered along with the limitations imposed by the HIV infection when making a disability determination.

Disability examiners must also consider the effect of treatment. Medical treatment is considered in terms of how successful the treatment was in improving the signs, symptoms, and lab abnormalities of a collateral disorder or the HIV infection itself or side effects that cause further impairment. Treatment responses vary widely. Therefore, HIV cases are considered on an individual basis along with the effects of treatment that maybe adverse or beneficial to the applicant's ability to function.

Functional Capability

Since eligibility for Disability benefits is focused on functional capability, disability examiners must consider what an individual is able to do despite the limitations of their disabling condition or conditions. This holds true for disability applicants with HIV infections as well. Limitations can result from the impact of the HIV disease process itself on physical and/or mental functioning, or may be due wholly, or in part, to extended or intermittent symptoms such as depression, fatigue, pain, or medication side effects.

Disability examiners consider three areas of functioning when making their medical determination:

1) Activities of daily living.
2) Social functioning.
3) Problems with completing tasks due to deficiencies in concentration, pace, and persistence.

Activities of daily living might include household chores, personal hygiene (bathing, combing hair, brushing teeth, etc.), paying bills, grocery shopping, driving, or even using public transportation. A person who has HIV may not be able to maintain these ordinary activities of daily living due to pain or other symptoms caused by the HIV infection or collateral conditions or treatment side effects.

Social functioning may include but is not limited to appropriate interactions and communication with others. An individual with HIV may not be able to maintain sustained communication or interactions with others due to symptoms of their illness. Severe restrictions in social functioning would cause a marked impairment of their ability to engage in social interactions needed to maintain employment.

Completing tasks timely requires that an individual be able to sustain concentration, pace, and persistence. Concentration, pace, and persistence are necessary to complete tasks commonly found in a work place setting. If an individual with HIV infection suffers from fatigue, depression, pain, or other systems, they may not be able to complete simple routine work tasks even if they are able to do some of their daily activities.

In order to evaluate a person's residual functional capacity, disability examiners use medical record information along with questionnaires completed by the disability applicant and a third person who knows them and is aware of the effects of their disabling conditions.

Qualifying for disability benefits, under either the Social Security Disability or SSI disability program, can be difficult. However, failing to satisfy the criteria of HIV listing 14.08 does not necessarily that a claimant will be denied for disability benefits.

If an individual has HIV infection, they may qualify for disability benefits through a medical vocational allowance if their residual functional capacity has become so restrictive due to the symptoms of their HIV infection or collateral disease processes that it precludes the performance of any of their past work or any kind of other work that their job skills could transfer to.

Work Activity and Filing for Disability

As is the case with all claims, Social Security's definition of disability states that an individual's disabling impairment must either have prevented them from engaging in substantial and gainful work activity for twelve continuous months, or must be expected, based on a review of the available medical evidence, to prevent the performance of substantial and gainful work activity for twelve continuous months. Even if a person has full blown AIDS and they are terminal, their disability claim will still be denied if they are working and earning a substantial and gainful income at the time they file for disability benefits.

What does Social Security consider to be substantial and gainful work activity? This essentially means work that results in earning at least a certain minimum amount per month. The current amount in effect is discussed here: The Social Security SGA limit for earned income.

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