Disability Benefits for HIV/AIDS

Human immunodeficiency virus (HIV) is a retrovirus that damages the immune system by destroying white blood cells that help your body fight disease. If the virus destroys enough white blood cells, "opportunistic infections" can develop—illnesses and cancers that take advantage of the weakened immune system. At this stage of the disorder, somebody with HIV is likely to become diagnosed with acquired immune deficiency syndrome, or AIDS.

Symptoms and treatment of these opportunistic infections can significantly restrict the types of activities HIV-positive individuals can perform. When these symptoms become severe enough to prevent you from working full-time for at least one year, you may qualify for Social Security disability benefits.

Is HIV a Disability?

Medical advances over the past few decades have dramatically improved the quality of life and expected longevity of people living with HIV. Some HIV-positive people can remain free of significant symptoms for years and have no issues working or completing their activities of daily living. Social Security is unlikely to approve an application for disability in these cases, because the agency can't award benefits if an HIV infection hasn't progressed far enough to cause serious symptoms or is being successfully treated with medication management.

But there are situations where an applicant infected with HIV without an AIDS diagnosis will be granted benefits if the condition is severe enough. That's because Social Security looks at the applicant's entire medical records and functional limitations, rather than a specific diagnosis, to make a disability determination.

Is AIDS a Disability?

People living with AIDS are more likely to be approved for benefits because the diagnosis signals to Social Security that their HIV infection has progressed to the point where they have functional limitations keeping them from working. The agency can find them automatically disabled under the Blue Book listing for HIV infection, or issue a medical-vocational allowance if no jobs exist that they can perform despite their symptoms.

Qualifying for Disability Under the Listing for HIV

Listed impairments are disorders that Social Security considers especially severe. You can qualify for disability benefits without needing to show that you can't work at all if your condition meets the criteria of listing 14.11 for HIV infection. You'll first need to provide documentation of specific medical test results that support a diagnosis of HIV. Then, you'll need to show evidence of at least one of nine serious complications or comorbidities (other diseases occurring alongside HIV infection) in order to meet the listing requirements.

Medical Evidence Required to Establish HIV Infection

Your HIV-positive diagnosis must be established by certain laboratory tests that Social Security considers medically acceptable. According to the listing, a diagnosis of HIV can be documented with:

• HIV antibody tests
• HIV DNA or RNA detection test
• HIV p24 antigen test
• isolation of HIV in viral culture, or
• other highly specific laboratory tests that are used to diagnose HIV and are consistent with the prevailing state of medical knowledge.

People with HIV often have their white blood cell counts taken—because HIV destroys these cells and a low count can show susceptibility to opportunistic diseases—but a low white blood cell count alone doesn't establish an HIV infection. You can still prove that you're HIV-positive if you haven't taken one of the above blood tests, however, if you have another disorder that is "predictive of a defect in cell-mediated immunity," meaning it almost only occurs in people who have HIV.

HIV Complications Needed to Qualify Automatically for Disability

In addition to providing documentation showing that you are HIV-positive, you'll need evidence showing that you have one of the complications listed below that often affect HIV-positive people (and can lead to an AIDS diagnosis). These include:

• multicentric Castleman disease (a disorder of the lymph nodes or lymphoid tissue)
• specific cancers of the brain, blood, or lungs (primary central nervous system lymphoma, primary effusion lymphoma, and pulmonary Kaposi sarcoma)
• progressive multifocal leukoencephalopathy (a disease that attacks cells that protect the nerves in your brain)
• greatly diminished counts (less than 50 per cubic millimeter, or less than 200 per cubic millimeter with a low blood protein amount and an underweight body mass index) of specific white blood cells known as CD4
• any complications of HIV infection that caused three or more hospitalizations (lasting at least 48 hours and occurring at least 30 days apart) within one year, and
• repeated manifestations (occurring three times per year and lasting for two weeks, on average) of HIV infections causing significant symptoms that result in a marked limitation in daily activities, social functioning, or completing tasks.

The last bullet point functions as a "catch-all" for people who have serious complications from HIV infection but don't otherwise meet the requirements of the listing. Social Security provides an extensive list of conditions that can qualify as a "repeated manifestation," covering various affected body systems ranging from cardiovascular diseases to pancreatitis to osteoporosis. No matter what part of your body is affected, the complication must cause significant symptoms such as:

• fever
• headaches
• fatigue or malaise (a general feeling of illness)
• sleep issues, such as insomnia or night sweats
• digestive problems, such as involuntary weight loss, nausea, or vomiting
• headaches, or
• pain.

These symptoms must rise to the level of causing "marked" limitations in your ability to complete chores, get along with others, or accomplish goals on time. "Marked" means that you're able to perform the activity independently, but only with a lot of help.

Listing 14.11 contains more specific details about how severe the infection or disease must be before automatically qualifies for disability. For instance, for pulmonary Kaposi's sarcoma, Social Security requires microscopic findings of biopsied lymph nodes (or other generally acceptable methods). Consider going over the listing requirements with your doctor to see whether you meet these criteria, and, if so, having your doctor write a medical source statement to that effect.

Qualifying for Disability Through Limited Functional Capacity

Even if you don't meet the requirements of the HIV listing, you can still get disability benefits if your residual functional capacity (RFC) rules out all full-time jobs. Your RFC is a set of restrictions on what you can do, physically and mentally, in a work environment. For example, if you're too fatigued to do a job where you'd have to be on your feet for most of the day, your RFC will limit you to sedentary (sit-down) work. If you can't even do sit-down work—say you'd be absent too many days per month or are unable to focus well enough to finish your job duties—Social Security will consider your RFC to be "incompatible with competitive employment" and approve your disability application.

Applicants 50 years of age and older may win benefits even if they can physically perform sedentary work if they're unable to do their past work and haven't acquired transferable skills to a sit-down job. That's because Social Security doesn't expect you to switch careers or learn a new skill the closer you are to full retirement age.

Any symptoms that are mentioned in your medical records should translate to limitations in your RFC. The more limitations you have in your RFC, the less likely Social Security will be to find that you can do certain jobs. You can also document your symptoms in a diary, with specific reference to the ways in which these symptoms interfere with your daily routine and prevent you from working.

In addition, your doctor's progress notes should describe your symptoms over time, any decline in function, the side effects of medications you're taking. The antiretroviral drugs used to treat HIV and AIDS can have debilitating side effects, such as vomiting, headaches, anemia, peripheral neuropathy, and muscle weakness. Social Security is required to consider how these side effects impact your ability to work, as well as how other impairments combine to affect your functioning.

Can I Get a Disability Living Allowance for HIV?

Social Security doesn't pay benefits based on the kind of medical condition you have. Instead, the size of your disability check depends mostly on the type of disability program you qualify for, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI).

SSDI eligibility is determined by your work history and wage record. The more money you've earned before you stopped working, the larger your SSDI check will be. For 2024, the maximum SSDI benefit you can get is $3,822 per month (increasing to $4,014 in 2025), but the average check is much smaller, at around $1,600.

SSI benefits are provided to disabled people who have limited income and assets, regardless of work history. You can receive up to $943 per month in SSI for 2024 ($967 in 2025), minus any countable income you have for that month. Most states also provide a modest supplemental SSI benefit, with many offering other benefits such as housing aid or an assisted living allowance.

HIV Advance SSI Disability Payments

If you're applying for SSI and have an HIV infection with some severe symptoms, you may qualify for presumptive disability benefits. The presumptive disability program allows you to get immediate SSI disability payments while you wait for a final decision on your disability benefits. If you aren't eligible for presumptive disability but still need financial help to tide you over, you can apply for interim assistance.

Getting Legal Help With Your Application

You don't need a lawyer to file for disability benefits, but it's usually a smart move. Many people who apply for disability based on HIV infection alone—without evidence of a listed opportunistic disease or AIDS—are initially denied benefits, but some of these cases can be won on appeal. An experienced disability attorney can beef up your case by identifying and gathering any missing medical records, handling communications with Social Security, and representing you at a hearing with an administrative law judge.