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SSDI Assessment

AIDS and Social Security Disability Insurance

  SSDI Guidelines - AIDS Here is an explanation of Social Security's five-step process to determine if an AIDS patient qualifies for SSDI:

1.  Determine if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $1,040 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 14.08. 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 14.08 or is of equivalent severity to any impairment in 14.08.

 
MEDICAL LISTING 14.08: Human Immunodeficiency Virus (HIV) documented by appropriate laboratory and clinical findings and one of the following:

 

Bacterial infections: Mycobacterial infection (e.g., caused by M. avium-intracellulare, M. Kansasii, or M. tuberculosis) at site other than the lungs, skin, or cervical or hilar lymph nodes; or pulmonary tuberculosis resistant to treatment; or Nocardiosis; or Salmonella bacteremia, recurrent non-typhoid; or Syphilis or neurosyphilis; evaluate sequelae under the criteria for the affected body system (e.g., 2.00 Special Senses and Speech, 4.00 Cardiovascular System, 11.00 Neurological); or Multiple or recurrent bacterial infection(s), including pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment three or more times in one year. OR

Fungal infections: Aspergillosis; or Candidiasis, at a site other than the skin, urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or candidiasis involving the esophagus, trachea, bronchi, or lungs; or Coccidioidomycosis, at a site other than the lungs or lymph nodes; or Cryptococcosis, at a site other than the lungs (e.g., cryptococcal meningitis); or Histoplasmosis, at a site other than the lungs or lymph nodes; or Mucormycosis. OR

Protozoan or helminthic infections: Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for one month or longer; or Pneumocystis carinii pneumonia or extrapulmonary pneumocystis carinii infection; or Strongyloidiasis, extra-intestinal; or Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes. OR

Viral infections: Cytomegalovirus disease (documented as described in 14.00B4b) at a site other than the liver, spleen, or lymph nodes; or Herpes simplex virus causing: Mucocutaneous infection (e.g., oral, genital, perianal) lasting for one month or longer; or Infection at a site other than the skin or mucous membranes ( e.g., bronchitis, pneumonitis, esophagitis, or encephalitis); or Disseminated infection; or Herpes zoster, either disseminated or with multidermatomal eruptions that are resistant to treatment; or progressive multifocal leukoencephalopahty; or Hepatitis, as described under the criteria in medical listing 5.05. OR

Malignant neoplasms: Carcinoma of the cervix, invasive, FIGO stage II and beyond; or Kaposi’s sarcoma with: Extensive oral lesions; or involvement of the gastrointestinal tract, lungs, or other visceral organs; or Involvement of the skin or mucous membranes, as described under the criteria in 14.08F; or Lymphoma (e.g., primary lymphoma of the brain, Burkitt’s lymphoma, immunoblastic sarcoma, other non-Hodgkins lymphoma, Hodgkin’s disease); or Squamous cell carcinoma of the anus. OR

Conditions of the skin or mucous membranes (other than described in B2, D2, or D3, above), with extensive fungating or ulcerating lesions not responding to treatment (e.g., dermatological conditions such as eczema or psoriasis, vulvovaginl or other mucosal candida, condyloma cause by human papillomavirus, genital ulcerative disease), or evaluate under the criteria in medical listing 8.00ff. OR

Hematologic abnormalities: Anemia, as described under the criteria in medical listing 7.02; or Granulocytopenia, as described under the criteria in medical listing 7/15; or Thrombocytopenia, as described under the criteria in medical listing 7.06. OR

Neurological abnormalities: HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses; or Other neurological manifestations of HIV infection (e.g., peripheral neuropathy) as described under the criteria in medical listing 11.00ff. OR

HIV wasting syndrome, characterized by involuntary weight loss of 10 percent or more of baseline (or other significant involuntary weight loss, as described in 14.00D.2) and, in the absence of a concurrent illness that could explain the findings, either: Chronic diarrhea with two or more loose stools daily lasting for one month or longer; or Chronic weakness and documented fever greater than 38°C (100.4°F) for the majority of one month or longer. OR

Diarrhea, lasting for one month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding. OR

Cardiomyopathy, as described under the criteria in medical listing 4.00ff or medical listing 11.04. OR

Nephropahty, as described under the criteria in 6.00ff. OR

One or more of the following infections (other than described in A-L, above), resistant to treatment or requiring hospitalization or intravenous treatment three or more times in one year (or evaluate sequelae under the criteria for the affected body system): Sepsis; or Meningitis; or Pneumonia; or Septic Arthritis; or Endocarditis; or Sinusitis documented by appropriate medically acceptable imaging. OR

Repeated (as defined in 14.00D8) manifestations of HIV infections (including those listed in 14.08A-M, but without the requisite findings; e.g., carcinoma of the cervix not meeting the criteria in 14.08E, diarrhea not meeting the criteria in 14.08J, or other manifestations; e.g., oral hairy leukoplakia, myositis) resulting in significant, documented symptoms or signs (e.g., fatigue, fever, malaise, weight loss, pain, night sweats) and one of the following at the marked level (as defined in 14.00D8O: Restriction of activities of daily living; or difficulties in maintaining social functioning; or difficulties in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

 

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, if 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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