HIV and Disability Updating the Social Security Listings (2010) / Chapter Skim
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Before the availability of potent therapy in 1996, AIDS resulted in death in less than 2 years in most cases, usually as a direct result of one or more opportunistic infections or cancers. Advances in HIV research have led to the widespread availability of potent combination antiretroviral therapy, which has dramatically changed the course of HIV infection, making it a chronic, manageable disease in many people.
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SOCIAL SECURITY DISABILITY EVALUATION PROCESS SSA pays disability benefits through two programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)
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The committee will review the current medical criteria for disability resulting from HIV infection in SSA's List ing of Impairments ("the Listings") and identify areas in which the HIV Infection Listings should be revised and updated based on current medical knowledge and practice.
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FIGURE S-1 S ocial Security Administration five-step sequential evaluation process. at the Listings level proceed to Step 4 and, if necessary, Step 5, which considers a claimant's ability to perform past work and to do other work in the national economy, respectively.
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REVISING THE HIV INFECTION LISTING SSA's Listing of Impairments needs to be highly valid and reliable to efficiently and effectively recognize disabled claimants. The committee developed the following principles on which a new Listing ought to be based: • Reflect current medical practice; • Determine severity fairly; • Use objective evidence, to the extent possible; • Incorporate work-related functioning, to the extent possible; • Be simple and easy to implement; and • Use flexible language to account for changes in the disease and its treatment over time.
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It is comparable to the previous CDC AIDS definition based on opportunistic infections and cancers in its ability to indicate impairment. Although other clinical markers exist, such as HIV plasma viral load, none predict disease stage as well as CD4 count.
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Although much less common than early in the epidemic, these generally untreatable conditions resemble the AIDS-defining infections or cancers that were considered appropriate for disability allowance in the current listing. The committee therefore concludes that claimants with these conditions need to be considered separately from other HIV infection claimants and that these conditions should be specifically included in the HIV Infection Listings as permanent disabilities.
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Having a condition with a current listing elsewhere also provides a path to being deemed disabled in Step 3. HIV-Associated Conditions Without Listings Elsewhere The committee suggests that a Listing be developed that identifies potentially severe HIV-associated conditions currently without listings elsewhere
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The prevalence of these diseases is growing among HIV-infected populations and will likely increase as these populations live longer. HIV infection typically results in an increased risk of developing comorbid conditions and an accelerated rate of progression to a severe or fatal outcome.
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First, the duration of these allowances should follow the durations identified by the other sublistings. However, if it is found in the literature that HIV coinfection causes changes to the disease not effectively captured in other disability listings, SSA may want to consider adding the disease to the HIV Infection Listings.
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Accordingly, a similar listing should be included in the pediatric HIV Infection Listing. Modifications should include the replacement of HIV-associated dementia with the current listing for neurological manifestations of HIV infection (currently 114.08G)
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SSA should monitor these issues and others and consider adding them to the HIV Infection Listings as appropriate. Data can be very informative in making the listings as effective as possible.
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By revising the HIV Infection Listings to better reflect current clinical practice, SSA will be able to more accurately identify those who need Social Security disability benefits. 4 "Acceptable medical sources" are defined by SSA to include licensed physicians, psycholo gists, optometrists, qualified speech-language pathologists, and psychological consultants.
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