Report at a Glance
HIV and Disability: Updating the Social Security Listings
By the end of 2010, the Social Security Administration (SSA) expects that more than 3.3 million individuals will have applied for disability benefits on the basis that they have a physical or mental impairment that prevents them from engaging in any substantial gainful activity. Given the complex issues involved and the importance of its decisions, SSA’s process for deciding whether applicants (claimants) qualify for disability benefits is both time and resource intensive. As one approach to streamlining the process, SSA uses a screening tool called the Listing of Impairments—known as the Listings—to identify claimants who are so severely impaired that they clearly cannot work at all and thus immediately qualify for benefits. For claimants who do not meet the Listings criteria, SSA requires additional, often extensive, information about vocational capacity and other factors, such as work history, education, and age, to decide on their claims. The Listings screen, therefore, provides many claimants with a rapid decision and saves SSA substantial administrative costs.
SSA currently organizes the Listings under 15 body systems, such as the neurological, musculoskeletal, and immune systems. Because of the key role the Listings play, it is important that they conform to advances in medical treatment and diagnostic methods and also to the changing nature of employment in the United States. Accordingly, SSA revises the Listings periodically. SSA asked the Institute of Medicine (IOM) to provide guidance on updating the Listing covering human immunodeficiency virus (HIV) infection, which can lead progressively to a number of serious medical conditions, including the advanced stage of infection termed acquired immunodeficiency syndrome (AIDS). SSA first began providing disability benefits for people with AIDS in 1983, and the agency adopted the current HIV Infection Listings in 1993.
An IOM committee reviewed the literature related to the diagnosis and treatment of HIV/AIDS and assessed the evidence on the effectiveness of using clinical markers in predicting how varying degrees of infection-induced disability will impact an individual’s ability to function or hold a steady job. It also collected data from SSA and other groups working in the area of HIV/AIDS; visited program adjudicators involved in making decisions about disability claims; and gathered input from a range of other stakeholders, including private advocacy groups and members of the general public. The committee’s report, HIV and Disability: Updating the Social Security Listings, offers a number of findings and recommendations.