patients may have a shorter median survival compared with patients who do not receive treatment (Wyen et al., 2004).

Diagnosis of PML includes brain biopsy, MRI with consistent white-matter lesions, and confirmation of the presence of polyomavirus JC (NINDS, 2010). There is no specific treatment for PML. Therapy with cytosine arabinoside, interferon-alfa, and cidofovir has not shown any benefit in the treatment of PML compared to antiretroviral therapy alone (De Luca et al., 2008).

PML is considered under the current 14.08D sublisting. Because of its aggressive nature in HIV-infected patients, it should be included in the HIV Infection Listings as a condition that warrants permanent disability.

PLACE IN THE DETERMINATION PROCESS

The rare conditions described above are generally untreatable and are fatal or extremely disabling. Because of the gravity of these conditions, the committee believes these claimants need to be considered separately from other HIV infection claimants. To expedite their claims, these claimants ought to receive permanent disability on confirmation of diagnosis. Supplemental Security Income applicants may qualify for presumptive disability on presentation at the Social Security Administration (SSA) field offices, which allows for immediate payment of benefits for up to 6 months as the claim goes through the five-step disability determination process.

It is worth noting that in 2007, SSA launched a program called “compassionate allowances” as a way of quickly identifying conditions that should be deemed permanently disabling and providing these claimants with disability benefits. Compassionate allowance cases require minimal objective medical evidence to determine the claimant disabled and eligible to receive benefits. Notably, PML is also one of less than 100 conditions identified by SSA as so serious that claimants receive a compassionate allowance.

Compassionate allowance cases progress through Steps 1 and 2 and either meet or equal the listings in Step 3 (see Figure 1-1). It is important to note that conditions identified as compassionate allowances are typically found in the Listing of Impairments under the appropriate body system. If the condition cannot be verified, the claim will proceed through Steps 4 and 5 of the determination process. The committee believes the conditions identified in this chapter are so severe that SSA may want to consider them as compassionate allowance conditions.

RECOMMENDATION 2. SSA should make disability determination allowances permanent for imminently fatal and/or severely disabling



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