Riverside, OC & San Bernardino (949)-645-9366

Disability Benefits for HIV/AIDS

Social Security Disability Attorneys: Riverside, Orange & San Bernardino Counties


On June 5, 1981, federal health officials reported the first cases of a new and fatal disease. Since then, acquired immunodeficiency syndrome, or AIDS, has become one of the deadliest pandemics in history. Today, more than a million people in the United States are living with HIV/AIDS.

In the late 1980s, the no effective therapies were available. But in 1989, NIH researchers made several major discoveries about how the human immunodeficiency virus (HIV) destroys the body's immune system and ultimately leads to full-blown AIDS.

In 1996, NIH-funded scientists discovered a new class of drugs, known as protease inhibitors. When used in combination with other AIDS drugs, these medicines attack HIV in several ways at once, extending the lives of HIV-infected people.

The discovery and development of new drugs have turned HIV infection from a death sentence into a chronic disease for those who have access to, and can tolerate, these powerful medicines.

Today, in the United States, there is less than a 1% chance that a child will become infected by his or her HIV-infected mother if she is taking anti-HIV medicines.

Reference: https://www.nih.gov/about-nih/what-we-do/nih-turning-discovery-into-health/hiv/aids

HIV, or human immunodeficiency virus, is the virus that causes AIDS (Acquired Immunodeficiency Syndrome) and can be transmitted during sexual intercourse; while sharing syringes; or from mother to child during pregnancy, childbirth or breastfeeding. First identified in 1981, HIV is the cause of one of humanity's deadliest and most persistent epidemics. Although significant progress has been made in the fight against new infections and AIDS deaths, the HIV pandemic continues around the world.

HIV attacks the immune system by destroying CD4+ T cells, a type of white blood cell that is vital to fighting off infection. The destruction of these cells can leave people living with untreated HIV vulnerable to life-threatening infections and complications. Today, effective anti-HIV medications allow people living with HIV to lead longer, healthier lives. When taken as prescribed, these daily medications, called antiretroviral therapy, will suppress blood levels of the virus to durably "undetectable," and prevent sexual transmission of HIV. Further, researchers have developed several methods of preventing HIV acquisition, including pre-exposure prophylaxis, or PrEP, post-exposure prophylaxis, or PEP, and voluntary adult medical male circumcision.

Reference: https://www.niaid.nih.gov/diseases-conditions/hivaids

Getting Disability Benefits With HIV/AIDS

Today, HIV/AIDS has gone from once being an un-treatable, uniformly fatal disease to a chronic disorder that can be effectively managed for many years with medication and proper treatment.

The disability resulting from HIV/AIDS depends on the stage of the disease and on the drugs that are required for treatment. If you are applying for Social Security Disability (SSDI) benefits, the Social Security Administration (SSA) has published a complicated set of criteria called "listings" that include clinical and laboratory parameters (e.g., absolute CD4 count of 50 cells/mm3 or less) which, if you meet them, may entitle you to receive disability benefits.

If you do not meet the "listings," you can still qualify for Social Security disability benefits by providing documentation from your doctor of impairments that prohibit you from performing your prior occupation or any other occupation for which you may be suited. If you are applying for long-term disability under an employer-based disability plan (ERISA), there are no "listings" for you to meet. You will need to present medical documentation of impairments that prohibit you from performing your prior occupation or any other occupation for which you may be suited (see below). 

Exertional impairments related to HIV/AIDS may impose disabling limitations that include difficulty with standing/walking, sitting, or lifting/carrying. These limitations should be documented in the medical record with specificity. For example, if because of fatigue, weakness, and debility, you can stand/walk for less than 2 hours out of an 8-hour day, or sit for less than 6 hours, or lift/carry less than 10 pounds, then your work capacity would probably be considered "less than sedentary," and you would probably be entitled to long-term disability benefits under most circumstances.

Non-exertional impairments related to medications can include such symptoms as nausea, vomiting, drowsiness, confusion, cognitive dysfunction, or an inability to concentrate and "stay on task." They must also be documented in the medical record with specificity and may give rise to an entitlement to long-term disability benefits in their own right.

Just having a diagnosis of HIV/AIDS is not enough. In order to qualify for long-term disability benefits, ether through Social Security (SSDI) or an employer-based plan (ERISA), your medical records must state the specific reasons why you are no longer able to perform your prior occupation or any other occupation for which you may be suited.

Medical Documentation

SSA utilizes the term "Impairments" (and resulting "limitations" - why you cannot work) are the essential bits of information that must be clearly and consistently documented throughout your medical history by the treating sources (medical doctors, psychologists, psychiatrists).

SSA additionally utilizes the term "Residual Functional Capacity" (RFC); this is a key concept related to the resulting physical and/or mental impairments from conditions for which the disability claim is based upon and the impact upon ability to work. 

SSA has its own forms that are used for Physical RFC here. These forms can be filled out by the treating source who has the opportunity to examine the patient and understand the limitations which result from his/her condition and thereby document with specificity in the language of SSA disability.

SSA "Blue book" or Listing for HIV can be found here. (See 14.07)

Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.