HIV and Disability: Updating the Social Security Listings

SSA’s HIV disability criteria (i.e., the HIV Infection Listings) have not been substantially updated to reflect these changes. In 2009, SSA asked the Institute of Medicine (IOM) to recommend revisions to the Listings, for which the IOM established the Committee on Social Security HIV Disability Criteria.

The severity of HIV infection and its disabling nature are why SSA originally added HIV to its disability listings. It is the history and progression of medical management that necessitates revision of how SSA considers HIV as an emerging disability, how the Listings reflect the current state of clinical practice, and how they address the specific needs of people living with HIV/AIDS.

SOCIAL SECURITY DISABILITY

SSA pays disability benefits through two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI).

In 2008, more than 12 million people received Social Security disability benefits, and SSA expected to process more than 3.3 million new disability applications claims in fiscal year 2010 (see Table 1-1) (SSA, 2010a).

THE DISABILITY EVALUATION DECISION PROCESS

Definition of Disability

To be eligible for disability benefits under SSDI, a person must be insured for benefits, be younger than full retirement age, have filed an application for benefits, and have a Social Security-defined disability. SSA defines disability as “an inability to engage in any substantial gainful activity¹ by reason of any medically determinable physical or mental impairment(s)² which can be expected to result in death or which has lasted or can be

The term substantial gainful activity (SGA) is used to describe a level of work activity and earnings. Work is “substantial” if it involves doing significant physical or mental activities or a combination of both. For work activity to be substantial, it does not need to be performed on a full-time basis. Work activity performed on a part-time basis may also be substantial gainful activity. “Gainful” work activity is work performed for pay or profit; work of a nature generally performed for pay or profit; or work intended for profit, whether or not a profit is realized. The amount of monthly earnings considered as SGA depends on the nature of the person’s disability. The Social Security Act specifies a higher SGA amount for statutorily blind persons. If a person’s impairment is anything other than blindness, earnings averaging over $1,000 a month (for the year 2010) generally demonstrate SGA. For a statutorily blind person, earnings averaging over $1,640 a month (for the year 2010) generally demonstrate SGA for SSDI.

A medically determinable impairment (MDI) is an impairment that results from anatomical, physiological, or psychological abnormalities which can be shown by medically acceptable clinical and laboratory diagnostic techniques. The MDI must be established by medical evi

Table of Contents

Front Matter R1-R16

Summary 1-14

1 Introduction 15-32

2 Current Concepts in HIV/AIDS 33-44

3 Low CD4 Count as an Indicator of Disability 45-52

4 Imminently Fatal or Severely Disabling HIV-Associated Conditions 53-62

5 HIV-Associated Conditions Without Listings Elsewhere 63-76

6 HIV-Associated Conditions With Listings Elsewhere 77-86

7 Concepts Specific to Children With HIV/AIDS 87-100

8 Maximizing the Utility of the HIV Infection Listings 101-108

Appendix A: Current HIV Infection Listings (14.08 and 114.08) 109-140

Appendix B: Committee Charge 141-156

Appendix C: HIV Background Tables 157-162

Appendix D: Literature Tables 163-184

Appendix E: Committee Member and Staff Biographies 185-192

Index 193-200

SOCIAL SECURITY DISABILITY

THE DISABILITY EVALUATION DECISION PROCESS

Definition of Disability