5.1. Guide to Social Security Benefits (AIDS) Part 4 -- How Does Social Security Evaluate Your Disability?
Description
This article is from the AIDS FAQ, by Dan Greening with numerous contributions by others.
5.1. Guide to Social Security Benefits (AIDS) Part 4 -- How Does Social Security Evaluate Your Disability?
Social Security works with an agency in each state, usually called a
Disability Determination Service (DDS), to evaluate disability
claims. At the DDS, a disability evaluation specialist and a doctor
follow a step-by-step process that applies to all disability claims,
thus assuring a consistent approach to evaluating disability. First,
the DDS specialists decide whether your impairment is "severe." This
simply means the evidence must show that your disability interferes
with your ability to work. The next step in the process is deciding
whether the disability is included in a list of impairments. This list
describes, for each of the major body systems, impairments that are
considered severe enough to prevent an adult from doing any
substantial work or in the case of children under the age of 18,
impairments that are severe enough to prevent a child from functioning
in a manner similar to other children of the same age. Recently we
published a list of impairments for HIV infections. In this list, we
have included many conditions associated with symptomatic HIV
infection, including some that specifically apply to women and
children with HIV infection (See next two sections). Some of the
HIV-related conditions included in the HIV list of impairments are
shown below. The level of severity that an impairment must meet to be
found disabling are also specified in the regulations.
o Pulmonary tuberculosis resistant to treatment
o Kaposi's sarcoma
o Pneumocystis carinii pneumonia (PCP)
o Carcinoma of the cervix
o Herpes Simplex
o Hodgkin's disease and all lymphomas
o HIV Wasting Syndrome
o Syphilis and Neurosyphilis
o Candidiasis
o Histoplasmosis
Remember: these are just a few examples. You can see a complete list
of HIV-related impairments at any Social Security office. The complete
list will also include the findings necessary for listed impairments
to be considered disabling by Social Security. If you have symptoms of
HIV infection that are not specifically included in (or equal in
severity to) the impairments on our list, then DDS disability
specialists will look at how frequently these conditions occur and how
they affect your ability to function. The DDS team will evaluate how
well you function in three general areas: daily activities; social
functioning; and the ability to complete tasks in a timely manner,
which requires the ability to maintain concentration, persistence, and
pace. If you have "marked limitations" in any one of these functional
areas and repeated manifestations of HIV meeting the criteria in the
listings, you may be found disabled. A marked limitation is one that
seriously interferes with your ability to function independently,
appropriately, and effectively. It does not mean that you must be
confined to bed, hospitalized, or in a nursing home. If the
specialists decide that you are not disabled at this point because you
do not have a condition that exactly matches or is equal in severity
to one on our list, then they will look to see if your condition
prevents you from doing the work you normally do. If it does not, then
we look to see if it prevents you from doing any other type of work
you're suited for, based on your age, education, and experience. If it
does, you may still be found disabled. Remember, at all steps in the
process, your impairment must be documented. Documentation includes
medical records from your doctors, as well as laboratory test results,
X-ray reports, etc. The HIV infection itself--that is, the presence of
the virus--must be documented as well as any HIV-related
manifestations. At all steps in the process it is important that we
have evidence of signs, symptoms, and laboratory findings associated
with HIV infection, as well as information on how well you are able to
function day-to-day. The signs and symptoms may include: repeated
infections; fevers/night sweats; enlarged lymph nodes, liver or
spleen; lower energy or generalized weakness; dyspnea on exertion;
persistent cough; depression/anxiety; headache; anorexia; nausea and
vomiting; and side effects of medication and/or treatment, as well as
how your treatment affects your daily activities.
Evaluation Of HIV Infection In Women
Statistics show that there is an increasing number of women with HIV
diseases. Social Security's guidelines for the immune system recognize
that HIV infection can show up differently in women than in men. In
addition to following the criteria outlined in the previous section,
DDS disability evaluators consider specific criteria for diseases
common in women. These include: vulvovaginal candidiasis (yeast
infection); genital herpes; pelvic inflammatory disease (PDI);
invasive cervical cancer; genital ulcerative disease; and condyloma
(genital warts caused by the human papillomavirus). Again, the level
of severity necessary for these impairments to be considered disabling
is included in the list of impairments.
Evaluation Of HIV Infection In Children
We also have separate listings for children with HIV infection. These
guidelines recognize the fact that the course of the disease in
children can differ from adults. As with adults, some children may not
appear to have the conditions specified in the guidelines, or may have
listed conditions that are not as severe as the guidelines
require. When this happens, a functional assessment is made using
criteria contained in the lists. A child may be disabled if the
HIV-related impairments substantially reduce his/her ability to grow,
develop, or engage in activities similar to children of the same
age. For more information about disability benefits for children, ask
Social Security for a copy of the booklet, Social Security And SSI
Benefits For Children With Disabilities (Publication No. 05- 10026).
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