HIV, the human immunodeficiency virus, attacks the cells in the human body that fight infections and diseases. If not treated, HIV can develop into a late-stage infection known as AIDS (acquired immunodeficiency syndrome).
Although medication exists that can stop the progression of HIV, no cure exists for HIV/AIDS. A person diagnosed with AIDS may survive for about three years with HIV medication and only about one year without it.
With treatment, a person diagnosed with HIV/AIDS may be able to continue working. However, as it progresses, the disease may significantly limit a person’s ability to perform routine daily activities, including those required to continue working. At this stage, HIV disability benefits can be crucial by providing monthly benefit payments.
This guide from the disability professionals at the Clauson Law Firm explains the Social Security Disability benefits application review process and approval requirements. As you read through the information, remember that you can rely on Clauson Law for advice and skillful representation to fight for you from the application through appeals.
What is HIV/AIDS, and is it a disability?
HIV is a virus that makes a person susceptible to developing other diseases and infections. It accomplishes this by destroying the cells within a person’s immune system that fight against the development of other diseases.
As HIV progresses, white blood cell counts drop to such low levels that a person’s immune system becomes severely damaged, making them susceptible to infections and diseases. This final HIV stage is when the condition progresses to AIDS.
AIDS, acquired immunodeficiency syndrome, is a chronic condition occurring when the human immunodeficiency virus (HIV) damages the immune system so much that it cannot prevent the development of other infections and diseases.
The best way to understand the relationship between HIV and AIDS is that a person must first be infected with HIV to develop AIDS. Treatment of HIV slows its effect on the immune system, so a person may not develop AIDS.
The human immunodeficiency virus spreads through contact with blood or other bodily fluids of an infected person. No cure for HIV or AIDS currently exists, but treatment with an antiretroviral medication can reduce the level of the virus in a person’s body. A person undergoing treatment may live a normal life without the disease by slowing the progression of damage to the immune system and delaying or preventing AIDS.
Symptoms of HIV
In its early stages, HIV generally causes flu-like symptoms, such as:
· Chills
· Fever
· Night sweats
· Sore throat
· Muscle aches
· Swollen lymph nodes
· Rashes
· Mouth ulcers
· Fatigue
Symptoms in the early stages can vary among those with the condition. Some people may have no symptoms, while others may experience symptoms that last for weeks. The only way to know for certain whether you have been infected with HIV is by being tested.
Does SSD pay disability benefits for HIV/AIDS?
The Social Security Administration relies on a definition of disability to evaluate AIDS and HIV SSD claims. According to the definition, a disability requires that a person be unable to do any substantial gainful work activity by reason of a medically determinable physical or mental impairment, or a combination of impairments.
The impairment or impairments must be expected to result in death or have lasted or be expected to last for at least 12 continuous months. By its terms, the definition excludes conditions that result in short-term disability or partial impairment.
To be approved for disability benefits through the Social Security Disability Insurance or Supplemental Security Income programs, an HIV or AIDS disability application must meet the disability standard of the Social Security definition. It must also meet non-medical requirements during the application review process.
Application review process for SSD for HIV/AIDS
The review process begins when an application reaches a local Social Security Administration field office. The claimant must meet non-medical requirements before the application goes to a Disability Determination Services (DDS) office, a state agency that reviews the claim to decide whether it meets the disability standard.
Non-medical criteria for the SSDI program include having a work history at jobs subject to payment of Social Security payroll taxes. The average amount of wages earned becomes part of a formula used to calculate an individual’s monthly SSDI benefits.
Applicants for the SSI program do not need a work history. SSI is a means-based program that provides a federal benefit amount each month to help recipients pay for housing, food, and other
essentials. Instead of a work history, SSI applicants must not exceed income and resource limitations to be approved for the program.
HIV/AIDS and the Social Security listings of impairments
The DDS uses a five-step sequential evaluation process to review applications and determine whether an individual applying for SSD for HIV/AIDS has a disabling medical condition that meets the federal disability standard. Step three of the process reviews medical records to determine whether an applicant’s condition meets or is medically equivalent to a listed impairment.
Section 14.11 of the listings, “Human immunodeficiency virus (HIV) infection,” contains the requirements to meet the HIV listing. Medical records must document one of the following:
· Multicentric, meaning not localized, Castleman disease affecting multiple lymph nodes or organs containing lymphoid tissue, or
· Primary central nervous system lymphoma, or
· Primary effusion lymphoma, or
· Progressive multifocal leukoencephalopathy, or
· Pulmonary Kaposi sarcoma, or
· Absolute CD4 count of 50 cells/mm3 or less, or
· Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, with BMI measurement of less than 18.5; or hemoglobin measurement of less than 8.0 grams per deciliter; or
· Complications of HIV infection with limitation of activities of daily living, or limitations in maintaining social functioning, or limitation completing tasks in a timely manner due to impaired concentration, persistence, or pace.
The last section is based on complications of HIV infection. The complications may involve different systems of the body, but they should be significant and severe to the point of interfering with the ability to do daily activities. Examples include:
· Fever
· Headaches
· Extreme fatigue
· Vomiting, nausea, and other digestive issues
· Pain
Medical documentation must be available to the disability examiner at the DDS as evidence supporting claims seeking SSD for HIV/AIDS.
Medical documentation needed to prove HIV SSD claims
The medical evidence available from treating healthcare professionals should include the following:
· Physical examination with a diagnosis of HIV/AIDS.
· A positive HIV antibody test.
· Lab testing results, especially blood tests and virus cultures.
· Hospital records.
· Physician’s notes and findings.
· Medications and treatments, including notes of the patient’s response to them.
Medical records must not have gaps in treatment or medication administration. Such gaps may result in Social Security denying benefits for failing to adhere to the treatment plan prescribed by doctors.
When you need SSD benefits, rely on our team of disability professionals
The HIV/AIDS disability application process can be overwhelming, but there is no reason to take it on without the help of a disability attorney with decades of Social Security Disability experience. There is too much at stake to not turn to a seasoned disability representative fight for the disability benefits that you need and deserve. Contact Clauson Law for a free consultation and find out how we can make a difference for you.