mandatory national training curriculum exists to ensure that disability examiners and medical consultants interpret listings consistently across states and regions.

Training provides these personnel with the necessary background to accurately determine whether a claim meets or equals a listing. For example, the disability examiner/medical consultant team must be confident in its ability to interpret a listing and apply it to determine that a claimant has a limitation on activities of daily living, maintains social functioning, and completes tasks in a timely manner (the functional criteria in the current 14.08K sublisting). This information can be subjective and is not easily derived from the medical record. If the team is not able to accurately identify these limitations, cases that should be determined at Step 3 may unnecessarily progress to Steps 4 and 5, resulting in inefficiencies. By the same token, an incorrect allowance may be made at Step 3. Training on the technical details of the HIV Infection Listings and the most current advances in HIV medicine are essential to correctly interpreting and applying the Listings. As in continuing medical education, continuing training of medical examiners and disability examiners is also expected to enhance the professionalism and reduce turnover of these key personnel.

As discussed in Chapter 5 and Appendix D, the committee believes assessment of functional capacity is necessary for identifying the severity of a person’s disability. Ideally, an objective predictive measure of HIV-related employment disability would be available to assess whether a claimant would be able to work. Such a measure could be coupled with evidence of a claimant’s medical condition to determine the severity of disability at Step 3.

The current knowledge base about functioning and return to work for people living with HIV/AIDS is limited, though research is likely to expand as they live longer. Areas of needed research include (1) how medical, psychosocial, financial/legal, and vocational factors impact functional limitations, and (2) how well a person’s ability to function is impacted by the fit between the person and his work environment (Conyers and Braveman, 2010). Conclusive research about valid measures of functioning and returning to work could greatly improve the HIV Infection Listings.

Conyers, L., and B. Braveman. 2010. HIV/AIDS and employment. Paper presented at Workshop of the IOM Committee on Social Security HIV Disability Criteria, Irvine, CA.