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If you have HIV / AIDS you may qualify for SSDI / long-term disability benefits.

Appealing for benefits is best done under the guidance of an experienced disability lawyer.

Can I get disability benefits if I am suffering from the effects of HIV / AIDS?

Author: Attorney Lonnie Roach
Updated: 2/26/2024


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If you or someone you know has been diagnosed with HIV/AIDS, you may qualify to receive Social Security Disability (SSDI) benefits or Long Term Disability (LTD) benefits. Call 512-454-4000 to schedule your Free Consultation today.

HIV is listed specifically as an impairment in the SSA’s Blue Book under Section 14.11 and the best way to qualify for SSDI is to satisfy the requirements of that listing. You will need to provide medical evidence that you have tested positive for HIV and also meet the work requirements set out by the administration.


There is no cure currently for HIV or AIDS, but medications can control HIV and prevent complications.

Antiretroviral therapy or ART is a common treatment that combines three or more medications from different drug classes.


ART helps:

  •    keep the immune system strong
  •   reduces the chance of getting infection
  •   reduces the chance of developing treatments resistant to HIV; and
  •   reduces the chance of transmitting HIV to others


Demonstrating that you are following your doctor’s treatment plan is an important part of qualifying for disability benefits.


HIV or AIDS and Qualifying for Disability Benefits.

HIV is listed specifically as an impairment in the Social Security Administration’s Blue Book under Section 14.11 and the easiest way to qualify for Social Security Disability Income is to meet the requirements of that listing.

First, you will need to provide medical evidence that you have tested positive for HIV.


Social Security considers a variety of definitive laboratory tests when evaluating HIV:

  •    HIV antibody screening test
  •   HIV p24 antigen test
  •   HIV nucleic acid detection test
  •   Isolation of IV in viral cultures
  •   Any other tests specific for HIV and consistent with current medical knowledge.


Social Security will try to get results from your laboratory tests and other medical tests from your doctor or hospital, but if no acceptable documentation exists, Social Security may pay for you to have testing done.

You may also prove you are HIV positive through your medical history or a diagnosis of a disease that is common to those who are HIV positive and has no other cause.


There are several diseases and conditions commonly associated with HIV/AIDS, including:

  •    Pneumocystis pneumonia (PCP)
  •   Candidiasis (Thrush)
  •   Tuberculosis (TB)
  •   Cytomegalovirus
  •   Cryptococcal meningitis
  •   Toxoplasmosis


Additionally, an applicant must show evidence of one of the following to qualify:

  1.   Multicentric Castleman disease affecting multiple groups of lymph nodes or organs containing lymphoid tissue
  2. OR

  3.    Primary central nervous system lymphoma – lymphoma that originates in the eye, spinal cord, meninges, or brain
  4. OR

  5.    Primary effusion lymphoma
  6. OR

  7.    Progressive multifocal leukoencephalopathy – a neurological disorder that causes changes in mental function and personality
  8. OR

  9.   Pulmonary Kaposi sarcoma. – a severe lung disorder
  10. OR

  11.   Absolute CD4 count of 50 cells/mm3 or less.
  12. OR

  13.   Absolute CD4 count of less than 200 cells/mm3 or CD4 percentage of less than 14 percent, and one of the following (values do not have to be measured on the same date):
    1.  BMI measurement of less than 18.5; or
    2.  Hemoglobin measurement of less than 8.0 grams per deciliter (g/dL).
  14. OR

  15.   Complication(s) of HIV infection requiring at least three hospitalizations within a 12-month period and at least 30 days apart. Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
  16. OR

  17.   Repeated manifestations of HIV infection such as other mental or physical limitations, infections, or disorders that result in significant signs of HIV as well as limited functions of daily living, limited social functioning, or limitations in concentrating or completing normal tasks.


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SuperLawyers rated Lonnie Roach – highly published lawyer for disability claims in Texas including HIV/AIDS claims.

If you have HIV or AIDS, yet your disability does not match Social Security’s listing, you may still be eligible for Social Security Disability benefits if the effects of medications you are taking severely affect your ability to function.

Social Security will consider the effectiveness of medications you are taking and the side effects of those medications, particularly adverse reactions. They will also look at the time and difficulty it takes to follow treatment, the length of treatment, and how treatment affects your mental functioning, so it is important for your doctor to note any difficulties you are experiencing. Some common side effects of HIV/AIDS medications include abdominal pain, nausea, vomiting, anemia, fatigue, general weakness, anxiety, depression and inability to concentrate.

“Once Social Security determines the limitations caused by your condition, they will employ a vocational expert to assess whether a person with these limitations is employable. Most vocational experts will find a person to be unemployable if their condition or the treatment rendered for the condition causes the person to regularly be absent two or more days a month or be “off-task” 15% or more of the workday.” – Lloyd Bemis Disability Attorney

Structured treatment interruptions called “drug holidays” are often prescribed by doctors for HIV/AIDS patients.

Social Security does not view these breaks as an indication that a patient’s medical condition has improved or that the patient is not following their treatment plan. If you have not had treatment in the past, but recently began treatment, Social Security may delay their determination to see how medications affect your functioning. If you are not taking any medications at all, you will probably not meet the criteria of the listing.


If you are 55 or older or have another medical condition you may get approval.

Social Security follows a set of rules to determine when the agency expects an applicant to learn a new job.

Applicants who are 55 or older often fall under a grid rule, which means they are not expected to learn a new job. For example, a 55-year-old applicant with no transferable skills might be found disabled. If you can’t go back to your old job, and you don’t have the skills to learn a new one, Social Security will likely grant you disability benefits.


You may also be eligible for Social Security Disability benefits if you have another medical condition; for example, diabetes or high blood pressure.

One disorder by itself may not match the requirements of an impairment as stated in Social Security’s Blue Book, but if you have more than one medical condition, Social Security must consider how those health issues combined limit your ability to hold a job and perform necessary daily tasks.


Social Security also has basic financial requirements.

Before you are eligible for Social Security disability benefits, you must satisfy some basic financial requirements.

You must: 1) have a disability that has lasted or is expected to last 12 months; and 2) you must have worked in a job where you paid Social Security taxes long enough and recently enough; and 3) you must not earn more than Substantial Gainful Activity (SGA), which is $1,550 per month in 2024 for nonblind applicants and $2,590 per month for blind applicants.


What if I don’t qualify for SSDI?

If you haven’t worked long enough to earn enough work credits, or if you earn too much income, you may be eligible for disability benefits through another Social Security program, such as Supplemental Security Income (SSI), or from a long-term disability insurance plan through your employer or a privately purchased policy.

SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits, and is financed by general funds of the U.S. Treasury.


I have long-term disability insurance – should I file a claim?

Yes, you should file a claim as soon as you become disabled.

Long-term disability insurance (LTD) is coverage that protects your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company. Policies pay between 50-60% of your salary and benefits continue until you return to work or for the number of years stated in the policy. However, LTD coverage is good only as long as you are employed, so do not quit your job before you file a claim, and be sure to check your policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Additionally, be aware that long-term disability insurance companies can require a claimant to also apply for SSDI.


How do I file for Social Security Disability benefits?

You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.

If your initial application is denied, don’t be discouraged. Approximately 65% of initial applications are denied, but you will have the opportunity to appeal.


There are four steps to the Social Security appeal process:

  1.    File a Request for Reconsideration with the Social Security Administration to completely review the case.
  2.    If you don’t agree with SSA’s response to your Request for Reconsideration, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for the Social Security Administration; they review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney at this point, now is the time to obtain legal counsel. This is a critical point in the process and will raise your chance for success.
  3.    If an ALJ does not grant your claim, you can request that the Appeals Council review your case.
  4.    Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.


Do I need a disability attorney for SSDI?

Qualifying for Social Security Disability benefits is problematic because the requirements of Social Security’s impairment listing are very difficult to decipher.

Your chances for approval are increased significantly if you have an experienced disability attorney who can gather your necessary medical evidence and even write a brief explaining why you qualify. At each potential stage of the process, from the initial application stage, the reconsideration stage and the ALJ hearing stage, an attorney can assist you in completing the detailed forms and questionnaires required by Social Security, collecting and submitting relevant medical evidence, and preparing questionnaires for your doctors. At the ALJ hearing phase an attorney will not only continue to assure that the evidence is complete, but prepare you for questioning by the ALJ, prepare an argument on your behalf and question any doctors or vocational experts selected by the ALJ to testify at the hearing. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Fees charged by disability attorneys are regulated by federal law and are usually 25% of disability backpay you are owed. There are no out-of-pocket costs, and if you don’t win your case, you won’t be charged anything.


Do I need a disability attorney for a long-term disability insurance claim?

Whether you have a long-term disability insurance policy purchased through a private insurance broker or a group policy purchased with your employer, filing a claim for long-term insurance is a complex process.

The wording of LTD policies can be confusing and the laws and regulations which affect the two types of LTD insurance differ in their procedures for filing claims and appeals. An experienced LTD attorney with thorough knowledge of ERISA laws and regulations will avoid mistakes and increase your chance of success. An attorney will act on your behalf, completing your application and filing your claim in a timely manner. They can also negotiate a settlement or file an appeal for you. If it becomes necessary to file suit, an LTD attorney can prepare your case against an insurer. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits. You do not pay an attorney’s fee unless the attorney wins your case.


If you have HIV/AIDS and you are unable to work, you may be eligible for Social Security Disability benefits.

An experienced Social Security Disability attorney can review your case and help you file your claim, saving valuable time and improving your chances of approval.


best social security disability lawyer
Disability benefits are an important source of income for those who are unable to work. If you are not able to work due to accident or illness, you may be eligible for Social Security Disability or Long Term Disability benefits. If you have applied for benefits and been denied, contact the attorneys at Bemis, Roach and Reed for a free consultation. Call 512-454-4000 and get help NOW.


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"Words can not truly express the gratitude that I feel toward Mr. Lonnie Roach and his professional team. I give them an A+++. Very compassionate and prompt. Their priorities are first and foremost helping you succeed at your case. When you feel helpless, feeling like someone is on your side can mean the world to you. Thank you for working for the people."
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Attorney Lonnie RoachAuthor: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.

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