HIV and AIDS can cause debilitating symptoms and lead to other illnesses that severely affect a person’s life and impair his/her ability to work. When a person’s symptoms have progressed to the point that s/he can no longer work, s/he may qualify for Social Security disability for HIV or AIDS.

The Social Security Administration (SSA) sets forth strict criteria that claimants must meet, though, and not all people qualify. For a free case evaluation to determine your eligibility for disability benefits, call one of our disability lawyers in Raleigh at Lunn & Forro, PLLC: 888-966-6566.

Does HIV/AIDS automatically qualify me for benefits?

No. However, HIV/AIDS is one of the conditions the SSA deems potentially disabling if you are able to satisfy the severity criteria. Listing 14.11 provides that to qualify as disabled for HIV/AIDS, you must prove your diagnosis with acceptable documentation (more on that later) and have at least one the following:

  • “Multicentric Castleman disease affecting multiple groups of lymph nodes or organs containing lymphoid tissue,
  • Primary central nervous system lymphoma,
  • Primary effusion lymphoma,
  • Progressive multifocal leukoencephalopathy,
  • Pulmonary Kaposi sarcoma,
  • Absolute CD4 count of 50 cells/mm3 or less,
  • Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and either a BMI measurement of less than 18.5 or a hemoglobin measurement of less than 8.0 grams per deciliter,
  • Complication(s) of HIV infection requiring at least three hospitalizations lasting 48 hours or longer within a 12-month period” (hospitalizations must occur at least 30 days apart),
  • “Repeated manifestations of HIV infection…or other manifestations such as cardiovascular disease, diarrhea, distal sensory polyneuropathy, glucose intolerance, gynecologic conditions, hepatitis, HIV-associated dementia, immune reconstitution inflammatory syndrome (IRIS), infections, lipodystrophy, malnutrition, muscle weakness, myositis, neurocognitive or other mental limitations, osteoporosis, pancreatitis, peripheral neuropathy.”

The manifestations must result in significant, documented symptoms or signs such as fever, headaches, insomnia, involuntary weight loss, malaise, nausea, night sweats, pain, severe fatigue, or vomiting. And you must have at least 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.”

What if I do not meet the criteria for the HIV/AIDS listing?

You may still qualify for benefits even if you do not meet all of the criteria under the listing for HIV/AIDS. To determine whether you qualify, a doctor will examine your medical records and your functional capacity.

Functional capacity is your ability to perform basic, work-related tasks such as communicating, lifting, and standing for long periods. If the examiner determines that given your condition(s), symptoms, and signs, you are not capable of working at your old job and cannot adjust to new work, then the SSA may still grant you benefits.

Will I be eligible for benefits if I am still working?

Possibly. However, it is important to note that you can only make a certain amount depending on which disability benefit you are applying for:

  • Supplemental Security Income: SSI is a benefit for disabled persons with little to no work history and very limited assets and income. To meet the criteria for SSI, your monthly income must not exceed the federal benefit rate (which can change each year). The value of your assets must also be less than $2,000 (for individuals). (There are various sources of income and assets that the SSA excludes, though.)
  • Social Security Disability Income: SSDI is a benefit for disabled workers that have sufficiently paid into the Social Security system via income taxes. To qualify, you must make less than $1,170 a month. You must also have a certain amount of work credits on your record.

How do I prove I qualify for benefits?

To prove you deserve benefits, you must provide evidence that you satisfy the qualification criteria. To prove you satisfy the assets, work credits, or income criterion, you can provide documentation of your work history, your paystubs, and a valuation of your assets.

You can establish your condition with any of the following:

  1. Lab tests, e.g., HIV antibody screening test, HIV nucleic acid detection test, HIV p24 antigen test, or isolation of HIV in viral culture;
  2. A persuasive report from your doctor stating that an appropriate laboratory test confirmed a positive diagnosis of your HIV infection; or
  3. Diagnoses of opportunistic disease that is predictive of a defect in cell-mediated immunity, such as toxoplasmosis of the brain or Pneumocystis pneumonia (PCP).

When applying for benefits, you will need to submit all pertinent records from your medical providers regarding your health condition. You can also send the SSA non-medical evidence, such as letters from your case worker, social worker, therapist, employer, and partner regarding your condition and how it affects your ability to work.

I received a letter denying my benefits for HIV/AIDS. What do I do now?

If you recently received a letter of denial from the SSA, you have the right to appeal your case. It is important to exercise this right because monthly disability benefits can be a lifesaver when you are unable to work.

The first step is to call our office and talk to one of our team members. We will review the facts of your case, determine the reason the SSA denied your claim, and request the SSA reconsider its initial decision. We will help the SSA gather the evidence it needs to reconsider your claim.

Contact Lunn & Forro, PLLC today at 888-966-6566 and schedule a free meeting with a disability lawyer in Raleigh to discuss your case.