- Christopher Le
Can I get Social Security Disability if I have HIV or AIDS?
Is HIV or AIDs considered a disability?
One way to qualify for social security disability is by meeting SSA's listing requirements for HIV in the Immune System Disorders section of the Blue Book. The Blue Book is SSA's manual, written for doctors with expertise to understand complex medical terminology. Your doctor can help determine if you meet SSA's Blue Book listing requirements to be approved for SSDI benefits. To qualify through the Blue Book, your HIV must be advanced and cause significant and frequent symptoms despite treatment.
The Social Security Administration needs to see through your medical records that you at least have one of the following:
You experience frequent or persistent bacterial, fungal, viral, or parasitic infections
You’ve developed cancer and that the cancer is advanced or terminal
There is fluid collecting on the brain or brain swelling that causes severe disruption in your ability to think or move effectively
You’ve had severe weight loss (HIV-wasting syndrome)
Uncontrolled and persistent diarrhea has required you to have IV fluids and nutrition via a feed tube for a month or longer
You experience other types of infections (sinusitis, encephalitis, sepsis, etc) that require hospitalization, IV therapy, or which are resistant to treatment
Your frequent infections and other complications have severely compromised your activities of daily living , also called ADLs.
If you’re unable to definitively meet the requirements mentioned above, then you’ll have to proceed through additional stages to determine if your eligible for disability benefits.
Qualifying for Social Security Disability for HIV without meeting a Blue Book Listing
For HIV to qualify for benefits without meeting a blue book listing, you must:
Have strong, consistent and concrete medical records
Have a doctor that can provide a strong and persuasive medical opinion letter
Be able to complete “function report forms” or RFC forms that make a compelling argument that you are disabled despite not qualifying through the Blue Book listing requirements
Functional report forms, also known as RFC's are a standard part of SSA's analysis. An RFC looks at your physical and mental limitations caused by your HIV symptoms, complications, and treatments. SSA reviews your activities of daily living or ADLs to determine how limited you are. ADLs include things like grocery shopping, traveling to doctor visits, household chores, preparing food, and staying in touch with friends and family, among others. Severe nausea, weakness, persistent diarrhea, muddled thinking, and other common complications of HIV treatment alone can make it impossible for you to keep up with those daily tasks. For SSA to see how severe your limitations are, your doctor should provide detailed information on the manner in which your HIV and required treatments have affected your daily life.
In addition to reviewing your physical and mental limitations, SSA also looks at your work history, job experience, education, training, and your age to determine if you’re unable to work at all. If awarded benefits through an RFC, it means SSA has determined you cannot work in any job.
Medical Documentation Needed for HIV
SSA must have strong medical evidence regardless of whether you qualify through the Blue Book Listing or through an RFC evaluation. This evidence includes:
Lab reports proving a positive HIV diagnosis
CD4 test results showing immune system compromise and how susceptible you are to opportunistic infections
Hospitalization or emergency room records going back at least one year
Diagnostic reports (like lab work, biopsies, imaging tests, etc) documenting complications of HIV, including infections, cancer, if present, or organ damage
Qualifying for Disability Benefits with AIDs
HIV becomes AIDS when CD4 cell count drops below a specific level. The CD4 cell, also called a T-cell is a white blood cell that is important in your immune system’s ability to fight off illness. Although AIDS is different than HIV, it still falls under the same Blue Book Listing as HIV. For someone with AIDS, section 14.11 G of the Blue Book is most relevant. The criteria is:
Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and one of the following:
BMI measurement of less than 18.5; or
Hemoglobin measurement of less than 8.0 grams per deciliter.
This criteria is important because of the CD4 threshold of 200 cells/mm3. This CD4 count is the same number that differentiates HIV and AIDS. Therefore if you have been diagnosed with AIDS, you will likely be able to qualify if you have a low BMI or hemoglobin measurement. Keep in mind this isnt the only way to qualify. You can still qualify if you meet the HIV listing criteria.