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HIV and AIDS

How Do I Get Social Security Disability Benefits if I have HIV/AIDS?HIV/AIDS and Disability

HIV infection is a condition caused by the human immunodeficiency virus (HIV). The condition gradually destroys the immune system, which makes it harder for the body to fight infections. If you have HIV/AIDS, contact the experienced social security disability benefits attorneys at Howard Law, PC today.

For you to qualify for Social Security Disability benefits due to human immunodeficiency virus (HIV) infection, you must have documentation of HIV and one of the following:

  1. Bacterial infections:
    1. Mycobacterial infection (for example, caused by M. avium-intracellulare, M. kansasii, or M. tuberculosis) at a site other than the lungs, skin, or cervical or hilar lymph nodes, or pulmonary tuberculosis resistant to treatment; or
    2. Nocardiosis; or
    3. Salmonella bacteremia, recurrent non-typhoid; or
    4. Multiple or recurrent bacterial infections, including pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment three or more times in a 12-month period.
  2. OR

  3. Fungal infections:
    1. Aspergillosis; or
    2. Candidiasis involving the esophagus, trachea, bronchi, or lungs, or at a site other than the skin, urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or
    3. Coccidioidomycosis, at a site other than the lungs or lymph nodes; or
    4. Cryptococcosis, at a site other than the lungs (for example, cryptococcal meningitis); or
    5. Histoplasmosis, at a site other than the lungs or lymph nodes; or
    6. Mucormycosis; or
    7. Pneumocystis pneumonia or extrapulmonary Pneumocystis infection.
  4. OR

  5. Protozoan or helminthic infections:
    1. Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for 1 month or longer; or
    2. Strongyloidiasis, extra-intestinal; or
    3. Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes.
  6. OR

  7. Viral infections:
    1. Cytomegalovirus disease at a site other than the liver, spleen or lymph nodes; or
    2. Herpes simplex virus causing:
      1. Mucocutaneous infection lasting for 1 month or longer; or
      2. Infection at a site other than the skin or mucous membranes (for example, bronchitis, pneumonitis, esophagitis, or encephalitis); or
      3. Disseminated infection; or
    3. Herpes zoster:
      1. Disseminated; or
      2. With multidermatomal eruptions that are resistant to treatment; or
    4. Progressive multifocal leukoencephalopathy.
  8. OR

  9. Malignant neoplasms:
    1. Carcinoma of the cervix, invasive, FIGO stage II and beyond; or
    2. Kaposi's sarcoma with:
      1. Extensive oral lesions; or
      2. Involvement of the gastrointestinal tract, lungs, or other visceral organs; or
    3. Lymphoma (for example, primary lymphoma of the brain, Burkitt's lymphoma, immunoblastic sarcoma, other non-Hodgkin's lymphoma, Hodgkin's disease); or
    4. Squamous cell carcinoma of the anal canal or anal margin.
  10. OR

  11. 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 (for example, dermatological conditions such as eczema or psoriasis, vulvovaginal or other mucosal Candida, condyloma caused by human Papillomavirus, genital ulcerative disease).
  12. OR

  13. HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses.
  14. OR

  15. HIV wasting syndrome, characterized by involuntary weight loss of 10 percent or more of baseline (computed based on pounds, kilograms, or body mass index (BMI)) or other significant involuntary weight loss, and in the absence of a concurrent illness that could explain the findings. With either:
    1. Chronic diarrhea with two or more loose stools daily lasting for 1 month or longer; or
    2. Chronic weakness and documented fever greater than 38* C (100.4* F) for the majority of 1 month or longer.
  16. OR

  17. Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding.
  18. OR

  19. One or more of the following infections (other than described in A-I, above). The infection(s) must either be resistant to treatment or require hospitalization or intravenous treatment three or more times in a 12-month period.
    1. Sepsis; or
    2. Meningitis; or
    3. Pneumonia; or
    4. Septic arthritis; or
    5. Endocarditis; or
    6. Sinusitis documented by appropriate medically acceptable imaging.
  20. OR

  21. Repeated manifestations of HIV infection, but without the requisite findings for those listings (for example, carcinoma of the cervix not meeting the criteria or diarrhea not meeting the criteria), or other manifestations (for example, oral hairy leukoplakia, myositis, pancreatitis, hepatitis, peripheral neuropathy, glucose intolerance, muscle weakness, cognitive or other mental limitation) resulting in significant, documented symptoms or signs (for example, severe fatigue, fever, malaise, involuntary weight loss, pain, night sweats, nausea, vomiting, headaches, or insomnia) and one of the following at the marked level:
    1. Limitation of activities of daily living.
    2. Limitation in maintaining social functioning.
    3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

For more information on HIV and the Social Security Administration guidelines, visit the Social Security Administration website.

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Listing vs. Residual Functional Capacity (RFC): How Does the Social Security Administration Determine Whether I Qualify for Disability Benefits for HIV/AIDS?

Social Security disability benefits may be available for people who suffer from HIV/AIDS. The Social Security Administration must first determine whether your HIV/AIDS is severe enough to meet or equal a listing at Step 3 of the Sequential Evaluation Process. The Social Security Administration will conclude that you are disabled and eligible for disability benefits if it determines that you meet or equal a listing because of your HIV/AIDS.

If the Social Security Administration decides that your HIV/AIDS is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

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How Can I Meet a Listing and Win Social Security Disability Benefits for HIV/AIDS?

The Social Security Administration will determine whether you are disabled at Step 3 of the Sequential Evaluation Process by evaluating whether your HIV/AIDS is severe enough to equal a listing.

The term "listing" refers to a compiled list of common impairments. The Social Security Administration created a set of guidelines called the Listing of Impairments that contains the most common impairments. For each listing of a particular impairment, there is an explanation regarding the degree of severity that the Social Security Administration presumes would prevent a person from performing substantial work.

The Social Security Administration will consider you disabled if your HIV/AIDS is severe enough to meet or equal a listing.

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What is Your Residual Functional Capacity Assessment for HIV/AIDS?

If the Social Security Administration decides that your HIV/AIDS is not severe enough to equal or meet a listing, it must assess the work that you are still capable of doing, in spite of your illness or disease. The work that you are able to do in spite of your illness or disease is called residual functional capacity (RFC). You may qualify for benefits at Step 4 and Step 5 of the Sequential Evaluation Process if you are able to do in spite of your illness or disease.

The Social Security Administration expresses an RFC for physical impairments in terms of whether the Social Security Administration believes you are able to do heavy, medium, light, or sedentary work in spite of your impairments. The lower your RFC, the less the Social Security Administration believes you can do.

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Can Your Doctor's Medical Opinion Help You Qualify for Social Security Disability Benefits for HIV/AIDS?

The role of the Social Security Administration is to conclusively establish whether you are disabled based on your education, work experience, medical evidence, and your age.

The role of your doctor is to provide the Social Security Administration with information concerning the degree of your medical impairment by providing the Social Security Administration medical source statement that describes your capacity for work which is part of your residual functional capacity assessment. Your residual functional capacity is what you can still do despite your limitations.

The Social Security Administration must consider your treating physician's opinion because the Social Security Administration considers it to be controlling when making its decision.

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What is the 5 Step Sequential Evaluation Process?

The Social Security Administration has created a five (5) step sequential process to determine whether an adult claimant is entitled to receive disability benefits. Children have a different test to determine eligibility.

Step 1: Substantial Gainful Activity

The Social Security Administration presumes that if you are working and that you make a certain amount of money that you are engaging in what it determines to be a substantial gainful activity (SGA). The Social Security Administration considers a person to be engaged in a SGA if that person is earning more than a certain amount of money each month (i.e. net of impairment - related work related expenses).

In 2013, the Social Security Administration has determined that a statutorily blind individual is engaged in a SGA if they earn more than $1740.00 per month while a non-blind individual must earn more than $1040.00 per month. Changes in the national average wage index usually affect the aforementioned SGA amounts.

Step 2: Severe Impairment

The Social Security Administration has determined that each claimant must either have a severe impairment or a combination of impairments. The impairment or combination of impairments must drastically limit the claimant's physical or mental ability to do basic work activities without regard to age, work history, or education. For many claimants, the level of proof at this level is minimal; therefore, they usually satisfy the Step 2 requirements and proceed to Step 3.

Step 3: Listing of Impairments

The Listing of Impairments details specific impairments that the Social Security Administration considers severe enough to prevent an adult claimant from engaging in a substantial gainful activity and in the case of a minor, the impairment has to be severe enough to cause functional limitations. There is also a durational requirement. The Social Security Administration has determined that the impairment must last for 12 months or long or result in the death of the claimant. If the claimant fails Step 3 because they do not meet or equal a listing then the case will proceed to Step 4.

Step 4: Past Relevant Work

At Step 4, if your condition is severe enough to meet the requirements of Step 2 (Severe Impairment); however, your severe impairment does not meet or equal a listed impairment that is the subject of Step 3 (Listing of Impairments), then the Social Security Administration must decide whether your severe impairment interferes with your ability to do any of the work you previously performed. The Social Security Administration likes to look at the work you performed over the past 15 years prior to the onset of your disability. If the Social Security Administration determines that your impairment does not interfere with work you previously did then you must proceed to Step 5.

Step 5: Ability to Perform Other Work

A majority of disability claims are decided at this level. If you cannot perform work you did in your past, then a determination must be made as to whether you can adjust to different types of work. The determination at this level takes into consideration your education, age, and prior work and is better known as your residual functional capacity.

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