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AIDS and Social Security Disability Insurance

(continued)

Qualifying for SSDI If You Have a Disability and AIDS

To receive SSDI benefits, you must meet certain criteria showing you have a disability and AIDS. You must be able to provide proof of:

  • Laboratory evidence of HIV infection or at least one AIDS opportunistic infection. (CD4 count alone is not enough evidence of HIV infection.)
  • Symptoms, illness, or HIV treatment side effects. These must be severe enough to result in a marked restriction of functioning in one or more activities related to:
    • Activities of daily living, such as taking public transportation, doing household chores, or paying bills
    • Social functioning, such as the ability to consistently interact and communicate effectively
    • Concentration, persistence, or pace, such as the ability to complete tasks in a timely way

Unfortunately, the legal and medical definitions of disability don’t always match. Plus, what it takes to win benefits claims is often counterintuitive to both the medical profession and to those living with HIV

  • Doctors don’t tend to chart information about functional limitations. But this information is needed to win claims. Also, the words your doctor uses in a medical chart may have a very different legal meaning. To a doctor, the words "HIV stable," may simply mean there’s no change for better or worse. To an adjudicator, however, "stable" may be interpreted to mean a disability does not exist.
  • Many patients minimize symptoms. They emphasize the "good days" when talking to their doctors. Or patients might stop mentioning persistent symptoms.
  • The stigma associated with both HIV and disability may make it hard for patients to pursue the benefits they need.

To prove you have a disability and AIDS, you must consistently report and document symptoms that result in limitations of day-to-day activities.

To be able to do that, you should:

  • Write down symptoms between doctor appointments.
  • Report to the doctor any and all symptoms that result in functional limitations. For example, you might have fatigue severe enough to require naps, or fecal incontinence that makes it difficult to leave the house.
  • Know that you are not burdening your doctor (or the Social Security system) when reporting these kinds of problems.
  • Seek legal advice when applying for Social Security.

Disability and AIDS: Other Resources

  • For more information about federal benefits, call the Social Security Administration at (800) 772-1213 (also known as TELECLAIM).
  • To find AIDS hotlines that may refer you to benefits information, go to http://www.thebody.com/index/hotlines/state.html and click on the state you are looking for.
  • For legal advice, contact your local Legal Aid Society, the Bar Association in the county where you live, or the National Organization of Social Security Claimants’ Representatives at http://www.nosscr.org/.
  • For more information about all types of disability insurance, go to www.ahip.com. This is the web site of America’s Health Insurance Plan, a trade organization. There you can find a "Guide to Disability Income Insurance."

 

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WebMD Medical Reference

Reviewed by David T. Derrer, MD on August 16, 2014
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