Many individuals with HIV/AIDS are able to work and perform normal daily activities for many years after their initial diagnoses. For this reason, a diagnosis of HIV/AIDS alone is usually not sufficient to prevail in a claim for Social Security disability benefits. As with most impairments and diseases, a specific degree of severity is required to be shown before Social Security will conclude that an individual’s HIV has progressed to the point where they are unable to work.
For purposes of proving disability due to HIV in Social Security disability claims, medical evidence and claimant testimony should demonstrate a definitive diagnosis of HIV and the existence of the signs and symptoms indicative of a debilitating condition. To prove a diagnosis of HIV generally, Social Security will review the medical records for positive HIV antibody tests and positive “viral load” tests, among others. Social Security has also stated that it will “accept a diagnosis of HIV infection without definitive laboratory evidence of HIV infection if you have an opportunistic disease that is predictive of a defect in cell-mediated immunity…and there is no other known cause of diminished resistance to that disease…” (Emphasis added).
Of particular interest to the Social Security adjudicators, and to Social Security disability practitioners, is the HIV claimant’s “CD4 tests.” A CD4 test (or “count”) is a laboratory test that will reveal a reduction in the percentage of an HIV patient’s “T-helper lymphocytes” (or “CD4 cells”). These cells help the immune system suppress infections and other hostile infiltrates. Social Security will consider an HIV diagnosis to be definitive when the CD4 count is in the 200s or below. SSA cautions, however, that even a CD4 count in the 200s or below alone “does not document the severity or functional consequences of HIV infection” (emphasis added).
Therefore, to evaluate the severity or functional limitations imposed by HIV infection, SSA will look beyond antibody tests and CD4 counts. Specifically, SSA will review the medical evidence and consider claimant testimony as to certain symptoms indicative of a debilitating immune system disorder. These symptoms typically include severe fatigue, fever, malaise, involuntary weight loss, night sweats, nausea, vomiting, headaches, and insomnia. Other symptoms include persistent cough and diarrhea, depression, forgetfulness, and problems with concentration.
Having found the existence of any of these symptoms, SSA will then ask whether any of the symptoms cause a “marked” limitation in the claimant’s functional abilities. A “marked” limitation is a limitation that manifests itself for at least one-third of an 8-hour workday. These marked limitations should affect the claimant’s ability to perform the normal activities of daily living, to adequately maintain social functioning, or to sustain concentration and pace for meaningful periods of time. Examples of these activities and skills include physical functions such as walking, standing, sitting, lifting, carrying, reaching, and pulling. They also include non-physical skills, such as being able to understand and carry out simple instructions, respond appropriately to co-workers and the general public, and dealing with changes in routine.
In summary, a diagnosis of HIV will need to be demonstrated by accepted medical evidence. However, a diagnosis of HIV alone is not enough to prevail in a claim for disability. Claimants must show that their immune disorder causes marked limitations in the physical and mental capabilities.