AIDS or HIV

AIDS or HIV and Social Security Disability Benefits

If you have HIV/AIDS and cannot work, you may qualify for disability benefits from the Social Security Administration. Your disability must be expected to last at least a year or end in death, and must be serious enough to prevent you from doing substantial gainful work. The amount of earnings Social Security considers substantial and gainful changes each year. For the current figure, refer to the annual Update (Publication No. 05-10003).

If your child has HIV/AIDS, he or she may be able to get Supplemental Security Income (SSI) if your household income is low enough.

For additional information, see SSA Publication No. 05-10019 February 2005, ICN 454510 [View .pdf]

To assist the Administration in evaluating these claims, Social Security has issued the following guidelines for health professionals in providing medical evidence for individuals with HIV infections. Although these guidelines do not address every possible situation, they should help a medical provider understand the documentation we need to evaluate the disability applicant’s condition.

Many individuals with HIV infection have a condition that prevents them from being able to work. If their impairment(s) meet the duration requirement, they may be found disabled. On the other hand individuals with HIV infection who are asymptomatic, or who have less severe HIV manifestations, may be found not disabled. Therefore, Social Security evaluates each case on an individual basis, and relies on the signs, symptoms, laboratory findings, and other information unique to that person’s case in order to make a decision.

As in all disability claims, Social Security first tries to resolve the issue of disability based on the medical information alone. If the medical information shows either that the individual is clearly disabled, or that the individual is clearly not disabled, Social Security decides the case based on that information. Otherwise, Social Security goes on to consider other factors, such as (in the case of adults) work capacity, age, education, and work background or (in the case of most children) the individual’s ability to function independently, appropriately, and effectively in an age-appropriate manner.

The medical evidence required to evaluate cases involving HIV infection is similar to that required for cases involving other medical conditions. The evidence must be sufficiently complete to permit the DDS medical consultant to make an independent determination about the nature, severity, and probable duration of the individual’s impairment(s). A complete medical report should include medical history, clinical and laboratory findings, diagnosis, prognosis, and a statement about what the individual can still do despite his or her impairments. However, Social Security will accept and evaluate any medical evidence, even if it is not a complete report.

Medical History

The medical history should be thorough, and discuss the onset and duration of the individual’s illness. It is important to describe the full clinical course of the illness to assist in determining when the illness became disabling (the disability “onset”). Establishing the correct disability onset date is important because it may affect when cash benefits and Medicare coverage begin.

Findings, Diagnosis, and Prognosis

A medical report should also describe the standard positive and negative findings of a thorough physical or mental examination. Progress notes that document findings are also helpful.

Copies of laboratory findings, including HIV testing, should also be included, if available. (The DDSs have an appropriate release form for HIV test results.)

A diagnosis and prognosis consistent with the medical data should be included. A diagnosis of HIV infection that is not supported by laboratory test results should be explained.

A Statement About Any Functional Limitations

Finally, a medical report should include a statement of the individual’s ability to do work-related physical and mental activities (described below).

The following outline describes the type of information that is particularly useful to Social Security. The outline lists frequently encountered changes due to HIV infection but it is, by no means, an exhaustive list.

Symptoms

Symptoms may include an individual’s statements about:

1. Low energy, fatigue, weakness
2. Fever, night sweats
3. Weight loss
4. Shortness of breath
5. Persistent cough
6. Persistent diarrhea
7. Depression, anxiety
8. Forgetfulness, loss of concentration, slowness of thought
9. Other symptoms (e.g., headaches, nausea, vomiting)

Signs

Signs may include:

1. Muscle weakness
2. Documented fever or weight loss
3. Dyspnea
4. Neurological deficits
5. Mental abnormalities

Lab Findings

Laboratory findings may include:

1. Positive HIV antibody test (including any confirming test)
2. Depressed T4 (CD4) lymphocyte count; inverted helper/suppressor ratio
3. Abnormal blood counts (e.g., hematocrit)
4. Other markers for HIV infection (e.g., beta-2 microglobulins, detectable
p24 antigen)
5. Radiographic or other imaging abnormalities
6. Pertinent microbiology or pathology reports

Work-Related Physical and Mental Activities

An individual may have limitation(s) in the ability to:

1. Perform physical functions such as walking, standing, sitting, lifting,
pushing, pulling, reaching, carrying, or handling
2. See, hear, and speak
3. Understand, carry out, and remember simple instructions
4. Use judgment
5. Respond appropriately to supervision, co-workers, and usual work
situations
6. Deal with changes in a routine work setting

NOTE: If the medical provider provides specific details about the individual’s abilities and limitations, it will be easier for Social Security to make a sound decision.