Can You Get Disability for HIV/AIDS?

Human immunodeficiency virus (HIV) is a virus that attacks the cells of your body's immune system, causing it to weaken and leaving you vulnerable to other infections and diseases. Left untreated, HIV can develop into acquired immune deficiency syndrome (AIDS), an advanced stage of immunocompromise that can be life-threatening.

Although there is currently no cure, many advancements have been made in the prevention and treatment of HIV/AIDS. Pre-exposure prophylaxis (PrEP) is a medicine that can reduce your chances of getting HIV if you're at a high risk of exposure. If you've already been infected, your doctor might prescribe medicines known as antiretrovirals that can significantly slow the progression of the disease.

Is HIV/AIDS a Disability?

Advances in medical treatment mean that people with HIV/AIDS are living longer and healthier lives. Whether the Social Security Administration (SSA) finds you disabled will depend on the severity of your symptoms and the results of your medical tests. If your symptoms are well controlled with your current medication, it's unlikely that the SSA will find that you're disabled.

But for some people, symptoms from HIV treatment or complications from the disease can prevent them from working full-time. Additionally, about half of people with HIV are over the age of 50, meaning the SSA has special rules that can make it easier for them to qualify for disability benefits.

Qualifying for Disability by Showing That You Meet the Medical Requirements for the HIV/AIDS Listing

The SSA maintains a list of illnesses, conditions, or diseases that the agency considers especially severe (the "Listing of Impairments"). HIV/AIDS is one of these listed impairments, so if your records contain certain medical requirements, Social Security can find you disabled without having to determine whether you can do any work.

When you file for disability based on HIV/AIDS, the SSA will evaluate your application under Listing 14.11 for HIV infection. Getting benefits based on this listing can be pretty complex. First, you'll have to show a diagnosis of HIV, ideally from the results of lab tests that the agency considers medically acceptable. Examples of lab tests include:

• HIV antibody tests. These tests check for antibodies in your blood that indicate an immune response to the virus.
• HIV nucleic acid detection test. For example, a polymerase chain reaction (PCR) test checks for the genetic material (RNA or DNA) of the virus.
• HIV p24 antigen test. This test detects the presence of a protein (p24) that makes up a large part of the virus.
• Isolation of HIV in viral culture. This test uses a sample of your body fluid or tissue and adds it to other cells to see if they become infected with the virus.

Not everybody with HIV has a diagnosis based on the above tests, but having a lab diagnosis is pretty important. Instead of submitting test results, Social Security can allow your doctor to vouch for your diagnosis, but your doctor still has to state that you've had the appropriate test. Or, if you have evidence of another condition that almost only occurs in people with HIV (an "opportunistic disease"), the SSA can take that as proof of an HIV diagnosis.

Once the SSA sees evidence of a diagnosis, the agency will continue with its evaluation under listing 14.11. Essentially, the SSA will be looking for medical documentation of complications from HIV/AIDS, such as certain cancers or greatly reduced white blood cell count. Examples include:

• Multicentric Castleman's disease. This disease affects multiple lymph nodes (part of your immune system) and can cause flu-like symptoms.
• Primary central nervous system lymphoma. This is a type of cancer that forms in the lymph tissue of the brain or spinal cord.
• Primary effusion lymphoma. This is a type of cancer that forms in the part of a blood cell that produces antibodies.
• Progressive multifocal leukoencephalopathy. This is a progressive disease that causes deterioration of cells that protect the nerves in your brain.
• Pulmonary Kaposi sarcoma. This is a type of cancer that forms in the lungs.
• Low CD4 (T-cell) count. CD4 cells are an important part of your immune system. If your CD4 count is too low, you're more vulnerable to infections.

There are additional ways to meet Listing 14.11 even if none of the above apply to you. For example, if you've had multiple lengthy hospitalizations during one year due to complications from HIV, or you're repeatedly getting infections (such as pancreatitis or pneumonia), the SSA can find that you satisfy the requirements of the listing.

Qualifying for Disability by Showing That You Can't Do Any Work

Social Security can still find you disabled even when your medical records don't contain the exact information needed for the agency to find you disabled under Listing 14.11. Many of the common antiretrovirals used to treat HIV/AIDS have side effects that can prevent you from working full-time.

Antiretrovirals work by blocking a protein that infected cells need to put together new virus particles. Common side effects can include:

• abdominal pain, diarrhea, nausea, or vomiting
• numbness, tingling, or burning sensations
• dizziness, headaches, or fatigue
• depression or anxiety, and
• overall weakness or joint pain.

Some side effects can be longer lasting and more damaging, such as a build-up of acid, sugar, or fat in the blood that can lead to kidney or liver damage.

The SSA will review your medical records for evidence that your antiretrovirals cause side effects that interfere with your activities of daily living (ADLs). Any difficulties you have doing your ADLs provide insight into limitations that could prevent you from working. For example, if you can't stand longer than 15 minutes without joint pain, it's unlikely that you'd be able to do a job where you'd be on your feet all day.

Assessing Your Residual Functional Capacity

After reviewing your medical records and your ADLs, Social Security will determine what restrictions you would have in a work environment. This determination is called your residual functional capacity (RFC). A typical RFC for somebody with HIV/AIDS will include physical limitations such as:

• how long you can sit, stand, and walk for
• how much weight you can lift and carry
• how often you can move your arms and hands, and
• how often you can bend, stoop, crouch, crawl, and kneel.

Depending on what additional symptoms—such as depression or fatigue—are documented in your medical records, you might also have mental limitations such as:

• whether you can do skilled, semi-skilled, or unskilled jobs
• how frequently you can work with the general public and your coworkers, and
• how long you can maintain concentration.

How Social Security Uses Your Residual Functional Capacity

The SSA will look at the physical and mental demands of every job you've had in the past five years and use your RFC assessment to determine whether you could do your past work today.

If the agency decides that you can't do your past work, it will then decide if you can do any other work, depending on how old you are.

If you're over the age of 50, Social Security will use a set of rules called the medical-vocational grid to see if you learned any skills from your past work that you could use to do a less demanding job. The agency can find you disabled under the grid if you could physically perform an easier job but don't know how to do it (and can't learn).

If you're under the age of 50, you'll need to show the agency that you can't do any job full-time, even if it's less demanding, because of your limitations. Missing too many days of work, taking extra breaks, or spending too much time "off-task" are examples of limitations that the SSA considers disabling.

What If I Take a "Drug Holiday"?

Structured treatment interruptions, also known as "drug holidays," aren't recommended for patients outside of a clinical trial (a supervised, experimental setting). Social Security wants to see that you're taking all your medications regularly and following your treatment as prescribed, or they might deny you benefits because you didn't follow your doctor's recommendations.

But if you're having serious adverse side effects from your medications and you stop taking them for a short period of time, the SSA likely won't hold it against you—as long as you tell your doctor about the side effects and you both work together to find a more tolerable treatment.

If the SSA thinks your record shows a pattern of not taking your medications properly, though, the agency can deny your claim.

Getting Advance Payments Through SSI

The SSA provides two types of disability benefits: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). If you applied for SSI, you might be eligible for "presumptive disability" payments that can help support you while the agency decides your claim.

Social Security can grant you immediate SSI payments if you've been diagnosed with AIDS or HIV complications. For more information, see our article on presumptive disability.