What Medical Evidence Is Needed To Qualify for SSDI for HIV/AIDs

If your claim for Social Security Disability Insurance benefits due to HIV or AIDs has been denied, please contact the Houston disability attorneys at Marc Whitehead & Associates without delay. In many cases, a person’s SSDI benefits claim wasn’t rejected because they don’t qualify for benefits, but simply because they failed to provide the necessary medical evidence to qualify for SSDI for HIV/AIDS based on the Social Security Administration (SSA) criteria. 

HIV (human immunodeficiency virus) is a virus that attacks the cells that help our bodies fight off infections. The disease is characterized by an increased susceptibility to common infections, as well as opportunistic infections, cancers, or other conditions. While there is currently no cure for HIV, there are many treatments available for managing the effects of the disease and preventing the condition from progressing to AIDS (acquired immunodeficiency syndrome), a deadly disease with a 1 – 3 year life expectancy.

Qualifying for SSDI Benefits for HIV/AIDs

To qualify for SSDI benefits, you will have to demonstrate that the severity of your HIV infection is so severe that you are unable to perform work of any kind. The medical evidence needed to qualify for SSDI for HIV/AIDs appears in the SSA’s “Bluebook” of Disabilities, under section 14.11 of the “Immune System Disorders – Adult” listings.  

The SSA will need to examine your medical history to determine if you meet the Blue Book qualifications for an HIV-related disability. To do this they will need the medical reports, such as the results of physical examinations, laboratory findings, appropriate imaging, and tissue biopsy reports that show you have an HIV infection.

A Laboratory Test That Comes Back Positive for HIV/AIDs

The first medical evidence you’ll need to qualify for SSDI for HIV/AIDS is documentation of an infection. This includes a positive diagnosis of HIV/AIDs obtained through one of the following laboratory tests:

• An HIV antibody screening test (for example, enzyme immunoassay, or EIA), confirmed by a supplemental HIV antibody test such as the Western blot (immunoblot), an immunofluorescence assay, or an HIV-1/HIV-2 antibody differentiation immunoassay.
• An HIV nucleic acid (DNA or RNA) detection test (for example, polymerase chain reaction, or PCR).
• An HIV p24 antigen (p24Ag) test.
• Isolation of HIV in viral culture.
• Any other tests that are highly specific for the detection of HIV and that are consistent with the prevailing state of medical knowledge.

Diagnosis of Disorders That Indicate an HIV/AIDs Infection

The SSA may also accept a diagnosis of HIV/AIDs without one of the listed tests if you have an opportunistic disease that is predictive of a defect in cell-mediated immunity and there is no other known cause of diminished resistance to that disease. These disorders can include:

The SSA also considers HIV-related disorders specific to women, such as vulvovaginal candidiasis or pelvic inflammatory disease.

Definitive Documentation of Your HIV Infection

The SSA will also require definitive documentation of the manifestations of your HIV/AIDs infection. This includes positive findings on definitive laboratory tests, such as culture, microscopic examination of biopsied tissue or other material (for example, bronchial washings), serologic tests, or on other generally acceptable definitive tests.

CD4 Measurement

The SSA requires at least one measurement of your absolute CD4 count (also known as a CD4+ T-helper lymphocyte count) or CD4 percentage and either a measurement of your body mass index (BMI) or your hemoglobin.

Complications from Your HIV/AIDs Requiring Hospitalization

To qualify under section 14.11, you must be able to show that you’ve had at least three hospitalizations for complications from an HIV infection within a 12 month period that were at least 30 days apart. Complications can include cancers and other infections, as well as depression, diarrhea, immune reconstitution inflammatory syndrome, and malnutrition.

All three hospitalizations must occur within the period being considered in connection with your application and each hospitalization must have lasted for at least 48 hours (this can include any hours spent in a hospital emergency department immediately before the hospitalization).

Demonstrate How the Effects of Treatment Contribute to Your HIV/AIDs Disability

The SSA will also take into account the effects of any treatments you have been prescribed for your HIV/AIDs. They will consider treatments in terms of effectiveness in improving the signs and symptoms of your HIV, as well as any side effects that may limit your functioning.

Factors the SSA will consider include:

• The duration of your treatment;
• The effects of the medications you take;
• Adverse side effects (including severe fatigue, fever, headaches, high blood pressure, joint swelling, muscle aches, nausea, shortness of breath, or limitations in mental function including cognition, concentration, and mood);
• The intrusiveness and complexity of your treatment ;
• The effect of treatment on your mental functioning;
• Variability of your response to treatment; and
• The interactive and cumulative effects of your treatments

We Are Here To Help You Get the SSDI Benefits You Need

As you can see, qualifying for SSDI benefits requires the submission of some very specific evidence. It’s understandable that a person with little knowledge of the SSA and its process could omit some critical piece of evidence that would cost them their benefits.

Marc Whitehead & Associates have been helping disabled individuals all over the U.S. obtain the SSDI benefits they need, even after their claims had been denied. Let us put our experience to work for you, preparing a claim submission that addresses all the SSA’s requirements.

Call the Social Security disability lawyers at Marc Whitehead & Associates to speak about your claim. In many instances, we handle SSDI cases on a contingency basis, which means there are no upfront costs to you and we only collect our fee after your benefits have been approved.