Social Security Disability Benefits For AIDS Diagnosis
Understand the SSDI qualifications for AIDS, including the necessary medical documentation and level of impairment required to get approval for benefits. Learn about the medical condition, functional limitations, and required treatment for eligibility. Your knowledge can safeguard your rights and interests in this complicated process.
SSDI AIDS Eligibility Guidelines
1. Determine if an individual is working (engaging in substantial gainful activity) according to the SSA definition. Earning more than $1,470 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.
2. Conclude that the AIDS disability must be severe enough to significantly limit one’s ability to perform basic work activities needed to do most jobs. For example:
- Walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling.
- Seeing, hearing and speaking.
- Understanding/carrying out and remembering simple instructions.
- Responding appropriately to supervision, co-workers and usual work situations.
- Dealing with changes in a routine work setting.
3. Declare that the human immunodeficiency virus (HIV) infection is caused by a specific retrovirus and may be characterized by susceptibility to one or more opportunistic diseases, cancers, or other conditions, which are described in medical listing 14.11. Any individual with HIV infection, including one with a diagnosis of acquired immunodeficiency syndrome (AIDS), may be found disabled under this listing if his or her impairment meets any of the criteria in 14.11 or is of equivalent severity to any impairment in 14.11.
MEDICAL LISTING 14.11
Human immunodeficiency virus (HIV) documented by appropriate laboratory and clinical findings and one of the following:
MULTICENTRIC CASTLEMAN DISEASE (MCD)
MCD affects multiple groups of lymph nodes and organs containing lymphoid tissue. This widespread involvement distinguishes MCD from localized (or unicentric) Castleman disease, which affects only a single set of lymph nodes. While not a cancer, MCD is known as a lymphoproliferative disorder. Its clinical presentation and progression is similar to that of lymphoma, and its treatment may include radiation or chemotherapy.
PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL)
PCNSL originates in the brain, spinal cord, meninges, or eye. Imaging tests (for example, MRI) of the brain, while not diagnostic, may show a single lesion or multiple lesions in the white matter of the brain.
PRIMARY EFFUSION LYMPHOMA (PEL)
PEL is also known as body cavity lymphoma.
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)
PML is a progressive neurological degenerative syndrome caused by the John Cunningham (JC) virus in immunosuppressed individuals.
PULMONARY KAPOSI SARCOMA (KAPOSI SARCOMA IN THE LUNG)
Pulmonary Kaposi sarcoma is the most serious form of Kaposi sarcoma (KS). Other internal KS tumors (for example, tumors of the gastrointestinal tract) have a more variable prognosis.
ABSOLUTE CD4 COUNT OF 50 CELLS/MM3 OR LESS
To evaluate your HIV infection, we require one measurement of your absolute CD4 count (also known as CD4 count or CD4+ T-helper lymphocyte count). This measurement must occur within the period we are considering in connection with your application or continuing disability review. If you have more than one measurement of your absolute CD4 count within this period, we will use your lowest absolute CD4 count.
MEASUREMENT OF CD4 AND EITHER BODY MASS INDEX OR HEMOGLOBIN
To evaluate your HIV infection, we require one measurement of your absolute CD4 count or your CD4 percentage, and either a measurement of your body mass index (BMI) or your hemoglobin. These measurements must occur within the period we are considering in connection with your application or continuing disability review. If you have more than one measurement of your CD4 (absolute count or percentage), BMI, or hemoglobin within this period, we will use the lowest of your CD4 (absolute count or percentage), BMI, or hemoglobin. The date of your lowest CD4 (absolute count or percentage) measurement may be different from the date of your lowest BMI or hemoglobin measurement. We calculate your BMI using the formulas in 5.00G2.
Complications of HIV infection requiring at least three hospitalizations within a 12-month period and at least 30 days apart.
Repeated manifestations of HIV infection or other manifestations (including, but not limited to, cardiovascular disease, diarrhea, distal sensory polyneuropathy, glucose intolerance, gynecologic conditions, hepatitis, HIV-associated dementia, immune reconstitution inflammatory syndrome (IRIS), infections (bacterial, fungal, parasitic, or viral), lipodystrophy, malnutrition, muscle weakness, myositis, neurocognitive or other mental limitations, oral hairy leukoplakia, osteoporosis, pancreatitis, peripheral neuropathy
4. Explore the ability of an individual to perform work they have done in the past despite their AIDS disability. If the SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.
5. Review age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine AIDS disability, the SSA enlists medical-vocational rules, which vary according to age. For example, a person with AIDS would warrant a finding of disabled at any age. The inability to meet any of the basic mental demands of work would entitle a claimant to disability benefits. Social Security Rulings 85-15 and SSR 96-9p both describe how an individual must, on a sustained basis, be able to understand, remember and carry out simple instructions; make simple work-related decisions; respond appropriately to supervision, coworkers, usual work situations and to deal with changes in a routine work setting. A substantial loss of ability to meet any one of these basic work related activities would severely limit the potential occupational base for all age groups and justify a finding of disabled. A person who has a medically determinable severe impairment of AIDS and is unable to understand, remember or carry out simple instructions would be found disabled based on his/her mental residual function capacity.
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