What Medical Evidence Is Required to Get Disability for AIDS or HIV?

Here's the evidence you'll need to meet the requirements of Social Security's official disability listing for HIV infection.

The simplest way to qualify for disability because of HIV/AIDs is to meet the requirements of Social Security's official disability listing for HIV infection. However, you'll need the proper documentation to prove that you have had a diagnosis of HIV infection and a serious complication or opportunistic disease.

Diagnosis of HIV or AIDs

In order to show that you "meet" Social Security's listing for HIV or AIDS, you must first show through proper medical evidence that you are HIV positive or have AIDS.

There are many ways in which you can show that you have HIV infection, including laboratory tests or other accepted medical tests. Social Security will attempt to get your laboratory results or other medical tests from your doctor or hospital, if you have had them. If you haven't, Social Security may pay for you to have such testing done if no other documentation is available.

The accepted laboratory tests include:

  • HIV antibody tests
  • HIV DNA or RNA detection test
  • HIV p24 antigen test
  • isolation of HIV in viral culture, and
  • other highly specific laboratory tests that are used to diagnosis HIV.

If you do not have evidence of one of the above tests, you may also be able to prove that you are HIV positive through medical records, other laboratory tests, or diagnosis through medical evidence. For example, a diagnosis of an opportunistic disease that is common for those who are HIV positive or have AIDS and has no other cause may be enough to prove you are HIV positive or have AIDS. The opportunistic disease must indicate a defect in cell-mediated immunity (for example, toxoplasmosis of the brain or pneumocystis pneumonia), and you must have laboratory evidence of the infection or disease. For example, to show cancer, you must show biopsy results. For toxoplasmosis of the brain, you could show biopsy results or symptoms such as fever, headache, seizures, lesions seen on brain imaging, and positive serology tests.

It is important to note that CD4 cell tests, which count T-helper lymphocytes in your blood, are not enough to prove you are HIV positive. Those who are HIV positive have lower CD4 cell counts; a lower CD4 cell count generally means a weaker immune system, which leaves the body to be more susceptible to opportunistic infections. However, a lower CD4 cell count is not enough to prove HIV status. Once you have the required documentaion of your HIV infection (discussed above), you can use a low CD4 cell test to establish your eligibility for disability benefits under teh HIV listing (see our article on the HIV/AIDS disability listing).

Medication and Effects of Treatment

If you do not meet the criteria of the HIV-AIDs disability listing, you may still be able to receive disability benefits if the medications you are taking severely affect your ability to function. Two main things Social Security looks at with regards to medications is the effectiveness of the medication at improving your symptoms and the side effects of those medications. Specifically, they will look at any adverse reactions you have, the time and difficulty it takes to follow your treatment plan, the length of your treatment, and the effects of your treatment on your mental functioning.

Common side effects of HIV/AIDS medication include hypersensitivity, diarrhea, abdominal pain, nausea and vomiting, anemia, numbness, tingling, and burning sensations, dizziness, fatigue, difficulty sleeping, headaches, depression, anxiety, general weakness, and joint pain. Some individuals may also suffer from more severe side effects, including a build up of acid, sugar, or fat in their blood, or liver damage.

Lack of concentration is the most common of mental impairments caused by HIV/AIDS medications. Headaches, fatigue, insomnia, and confusion can all contribute to difficulty with concentrating and being able to complete tasks.

It is important for you and your doctor to note the medications you are taking and any difficulties that you are having due to your medication and treatment in your disability application.

For those with HIV/AIDS, structured treatment interruptions, known as “drug holidays,” are commonly prescribed by doctors. Social Security will not view these interruptions as an indication that your impairments have improved or that you are not following your treatment plan.

If you have not received treatment in the past, this will not necessarily ban you from receiving Social Security disability benefits. The agency will look at the severity of your medical condition and the length of time you have been sick. If you recently started a treatment plan, Social Security may need to delay making a decision about your benefits in order to see your level of functioning on the medication. If you are not taking any medications at all, you will likely not be able to meet the listing for HIV, but you may be able to receive disability benefits if your disabilities prevent you from being able to return to any type of work. (For more information, see our section on How Social Security Decides If You Can Work (or Are Disabled).

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