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The Social Security Administration (SSA) uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they.
Table of contents
- Human Immunodeficiency Virus (HIV)
- HIV and Disability: Updating the Social Security Listings.
- IN ADDITION TO READING ONLINE, THIS TITLE IS AVAILABLE IN THESE FORMATS:
- Social Security Disability & HIV – [ IMSTILLJOSH ]
- Symptoms and Treatment of HIV
While we do not consider impairments other than manifestations of HIV infection when evaluating whether a claimant's impairment meets listing The purpose of these listings is to quickly identify impairments that we consider severe enough to prevent a person from doing any gainful activity, without the need to evaluate vocational factors. We may still find a person disabled later in our sequential evaluation process even if we find that his or her impairments do not meet or medically equal a listing. Comment: One commenter requested that we add language to note that proposed listing Response: We adopted the comment and have added wording to clarify that the examples given in Comment: A number of commenters noted that HIV infection may also accelerate or interact with impairments in other body systems.
Response: We agree with the comments and have added language to final We have also revised Comment: One commenter requested that we either eliminate our proposed criteria in The commenter believes that we are incentivizing claimants to opt for longer hospital stays or abstain from treatment to prove the severity of their conditions and meet the listing criteria. In our experience, individuals do not opt for unwarranted hospital stays or forgo treatment in order to possibly qualify for disability benefits. The benefit of having a listing that captures more disabled individuals at step 3 of our sequential evaluation process outweighs the concern that particular claimants may attempt to lengthen hospital stays or abstain from treatment to meet the listing.
We believe that a complication s of HIV infection that warrants three hospitalizations of 48 hours or longer, 30 days or more apart, within a 12 month period that we are considering in connection with an application or continuing disability review will prevent a person from engaging in any gainful activity and, therefore, represents listing-level severity. Moreover, we are able to evaluate complications of HIV infection resulting in fewer than three hospitalizations in a consecutive month period using medical equivalence, the other listing criteria for adults, the functional equivalence rules for children, or at other steps in our sequential evaluation process.
For example, the criteria in listing Although some of our listings include criteria for repeated hospitalizations The medical equivalence policy also accommodates claimants' varying level of access to medical care, the preference of some medical providers to reduce the use of emergency department and hospital-level medical interventions, and recent trends in clinical care that emphasize quality of, rather than quantity of, medical treatment. This accommodation accounts for differences in medical care people with similar disorders receive depending on the medical resources available to them.
The medical equivalence policy provides some flexibility in determining whether a claimant is disabled at step 3 of the sequential evaluation process by allowing us to consider whether the claimant's impairment meets the listed criteria exactly or is at least equal in severity and duration to the criteria of any listed impairment. If we are not able to find that a person's impairment due to HIV infection is disabling using our listings, we may still find the person disabled at the final steps of the sequential evaluation process. Finally, the commenter's suggestion that we defer to the treating physician with regard to the medical severity of a person's condition in lieu of hospitalization frequency and duration in this listing means that we would be permitting the physician to determine whether the person is disabled.
Under our rules, the finding of disability is an issue reserved to the Commissioner of Social Security. Comment: One commenter requested that we train adjudicators to evaluate repeated manifestations of HIV infection correctly. Response: We did not make any changes in our final listings as a result of this comment.
We will provide training on the new listings, as we do for all listing updates. We will also conduct a study on the use of the listings after they have been in use for a year, as we do for all listing updates, and issue further training or policy guidance if needed. Comment: One commenter recommended that the introductory text be improved by adding a more significant definition of multicentric Castleman disease MCD , particularly how it is very similar to a lymphoma, although it is not actually a cancer.
Response: We adopted the comment and have provided expanded definitions for MCD in Response: We adopted this comment and have provided text in Comment: One commenter agreed with our revisions to section We provide guidance in current sections This guidance is sufficient to allow adjudicators to evaluate the functional limitations resulting from HIV infection and other immune system disorders. The proposed text would instruct adjudicators to give special consideration to the opinion s of a claimant's primary care provider, in particular, an experienced HIV medical provider.
When we evaluate medical opinions, such as those described by the commenters, we consider several factors. Those factors include the treating relationship between the opining medical source and the claimant, how much the medical source's treatment records support the medical opinion, and the consistency of the medical opinion with the other evidence throughout the record as a whole, including a claimant's self-reporting. Additionally, the finding about whether a claimant is or is not disabled is an issue reserved to the Commissioner.
We do not give any Start Printed Page special significance to the source of a statement on an issue reserved to the Commissioner, even if that source is a medical source who has treated the claimant. Comment: One commenter suggested that we expand the role of evidence of a claimant's functional limitations, as required under Response: We did not adopt the comment because it is outside the scope of this rulemaking.
However, under our rules, we may use evidence from sources other than acceptable medical sources in order to show the severity of a person's impairment and how that impairment affects the individual's ability to function. Other sources of evidence that we may consider include counselors, family members, caregivers, or neighbors. Comment: One commenter disagreed with our proposal to remove diarrhea as a standalone listing current listing While we agree that diarrhea is a manifestation of HIV infection that may result in a marked functional limitation, we do not believe it is best evaluated under a standalone listing.
We agree with the recommendation of the IOM that diarrhea should be evaluated using functional impairment criteria. Comment: Two commenters requested that we revise proposed listing Response: We did not add references to the specific mental disorders listings requested by the commenters, because doing so would appear to restrict the mental disorders we would consider under Instead, we added language to Comment: One commenter asked how we would implement the evaluation of a neurocognitive limitation under proposed Response: We did not make any changes in the final rule based on this comment.
The need for a psychological consultant review depends on the facts in the individual case. The neurocognitive limitations provided as an example under listing We evaluate medical evidence based on the underlying disorder. If the level of limitation is such that we consider the neurocognitive limitation to be a mental impairment on its own, then a psychological consultant or a medical consultant who is a psychiatrist would review the case.
Comment: Numerous commenters disagreed with our proposal to remove the text in current section The commenters were concerned that adjudicators who are unfamiliar with HIV infection may not immediately recognize that certain signs and symptoms are related to HIV infection in women. They believed that retaining the current language would help to instruct adjudicators to acknowledge and take these signs and symptoms into account as manifestations of HIV infection in women when making disability determinations.
Response: We adopted these comments and have placed this guidance in section Additionally, we have added language to Comment: One commenter recommended that we consider including the adolescent population more specifically in the listings. The Part A and Part B listings for adults and children are very similar and closely parallel one another. In addition, under our rules, we may use the criteria in Part A when those criteria give appropriate consideration to the effects of the impairment s in children.
Comment: One commenter suggested that we remove the information in the proposed revisions to 5. We have based our final revisions on recommendations in the IOM report. In the introductory text, we include information that will be useful to our adjudicators when they evaluate impairments in a particular body system. Comorbid disorders, such as HIV infection, do have an impact on chronic viral hepatitis infections, and their presence can affect how we evaluate an impairment under the digestive body system.http://designyourlocket.com/components/60/2936-horoscope-by.php
Human Immunodeficiency Virus (HIV)
Response: We did not adopt these comments. We do not specify a particular period of disability in the medical listings unless we can uniformly expect medical improvement for an impairment in a specific listing such that a person would no longer be disabled for example, listing 6. This is not the case for the impairments in the listings for HIV infection. We will address any new considerations for diary length and CDRs related to HIV infection in our internal policy guidance, as we normally do. Comment: One commenter expressed concern that we do not provide quantitative data to show the validity of any of our proposed listings.
In the NPRM, we provided a list of specific references that we used to inform the changes that we proposed. The listings in this final rule represent impairments that we consider severe enough to prevent a person from engaging in any gainful activity.
HIV and Disability: Updating the Social Security Listings.
Comment: One commenter noted that medications for HIV infection affect people in different ways and may cause a person's other psychological and physical issues to worsen. We take the effects of treatment, including medications for HIV infection, into account when evaluating a case. This guidance is provided in section Specifically, in Comment: One commenter believed that the language in proposed listing Our proposed language is clear and captures the intent of the listing.
The changes that the commenter suggests would alter the meaning of the listing, not clarify it. We will address the concerns with the application of the rule in training for our adjudicators. Comment: One commenter requested that we provide our disability examiners with more training in evaluating a claim involving HIV infection and applying the HIV infection listings.
As we do with all updates to the listings, we will provide our disability examiners with training on the final rule for evaluating HIV infection. We explained that we were not including similar criteria in proposed listing After we published the NPRM, we published a final rule for evaluating mental disorders, which removed In this final rule, we revised paragraph In order to provide consistent guidance, we are also making conforming changes to the listings for hematological disorders in 7.
We will begin to use this final rule on its effective date. We will continue to use the current listings until the date this final rule becomes effective. We will apply the final rule to new applications filed on or after the effective date of this final rule and to claims that are pending on or after the effective date.
This final rule will remain in effect for 3 years after the date it becomes effective, unless we extend the expiration date. We will continue to monitor the rule and may revise it, as needed, before the end of the 3-year period. Under the Act, we have full power and authority to make rules and regulations and to establish necessary and appropriate procedures to carry out such provisions.
Sections a , a 5 , and d 1. We consulted with the Office of Management and Budget OMB and determined that this final rule meets the Start Printed Page criteria for a significant regulatory action under Executive Order , as supplemented by Executive Order Therefore, OMB reviewed it. We certify that this final rule will not have a significant economic impact on a substantial number of small entities because it affects individuals only.
Therefore, the Regulatory Flexibility Act, as amended, does not require us to prepare a regulatory flexibility analysis. These Final Rules do not create any new or affect any existing collections, and therefore, do not require OMB approval under the Paperwork Reduction Act. For the reasons set out in the preamble, we are amending 20 CFR part subpart P as set forth below:. The authority citation for subpart P of part continues to read as follows:.
Authority: Secs. Amend appendix 1 to subpart P of part by:. Revising item 15 of the introductory text before part A;. Revising the last sentence of paragraph 5. Revising paragraph 5. Revising paragraph 7. Revising the last sentence of paragraph 8. Revising paragraph Revising paragraphs Revising the first two sentences of paragraph Removing the first three sentences of paragraph Removing and reserving listing Adding listing Revising the last sentence of paragraph Removing the first two sentences of In addition, detection of the hepatitis B e antigen HBeAg suggests an increased likelihood of progression to cirrhosis, ESLD, and hepatocellular carcinoma.
Treatment usually includes interferon injections, oral antiviral agents, or a combination of both. Common adverse effects of treatment are the same as noted in 5. We evaluate malignant cancerous hematological disorders, such as lymphoma, leukemia, and multiple myeloma, under the appropriate listings in We evaluate primary central nervous system lymphoma associated with HIV infection under What impairments do these listings cover?
We use these listings to evaluate all cancers malignant neoplastic diseases except certain cancers associated with human immunodeficiency virus HIV infection. We use the criteria in We evaluate all other cancers associated with HIV infection, for example, Hodgkin lymphoma or non-pulmonary Kaposi sarcoma, under this body system or under Human immunodeficiency virus HIV infection HIV infection may be characterized by increased susceptibility to common infections as well as opportunistic infections, cancers, or other conditions listed in How do we document and evaluate HIV infection?
Any individual with HIV infection, including one with a diagnosis of acquired immune deficiency syndrome AIDS , may be found disabled under Definitive documentation of HIV infection. We may document a diagnosis of HIV infection by positive findings on one or more of the following definitive laboratory tests:. We will make every reasonable effort to obtain the results of your laboratory testing.
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Other acceptable documentation of HIV infection. We may also document HIV infection without definitive laboratory evidence. Definitive documentation of manifestations of HIV infection. We may document manifestations of HIV infection by positive findings on definitive laboratory tests, such as culture, microscopic examination of biopsied tissue or other material for example, bronchial washings , serologic tests, or on other generally acceptable definitive tests consistent with the prevailing state of medical knowledge and clinical practice.
Other acceptable documentation of manifestations of HIV infection. We may also document manifestations of HIV infection without definitive laboratory evidence. To be persuasive, this report must state that you had the appropriate definitive laboratory test s for diagnosing your manifestation of HIV infection and provide the results. For example, many conditions are now commonly diagnosed based on some or all of the following: Medical history, clinical manifestations, laboratory findings including appropriate medically acceptable imaging , and treatment responses.
Multicentric Castleman disease MCD, This widespread involvement distinguishes MCD from localized or unicentric Castleman disease, which affects only a single set of lymph nodes. While not a cancer, MCD is known as a lymphoproliferative disorder. Its clinical presentation and progression is similar to that of lymphoma, and its treatment may include radiation or chemotherapy.
We require characteristic findings on microscopic examination of the biopsied lymph nodes or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis. Localized or unicentric Castleman disease does not meet or medically equal the criterion in Imaging tests for example, MRI of the brain, while not diagnostic, may show a single lesion or multiple lesions in the white matter of the brain.
We require characteristic findings on microscopic examination of the cerebral spinal fluid or of the biopsied brain tissue, or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis. Primary effusion lymphoma PEL, We require characteristic findings on microscopic examination of the effusion fluid or of the biopsied tissue from the affected internal organ, or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.
Progressive multifocal leukoencephalopathy PML, Clinical findings of PML include clumsiness, progressive weakness, and visual and speech changes.
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Personality and cognitive changes may also occur. We require appropriate clinical findings, characteristic white matter lesions on MRI, and a positive PCR test for the JC virus in the cerebrospinal fluid to establish the diagnosis. We also accept a positive brain biopsy for JC virus or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.
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Pulmonary Kaposi sarcoma Kaposi sarcoma in the lung, Other internal KS tumors for example, tumors of the gastrointestinal tract have a more variable prognosis. We require characteristic findings on microscopic examination of the induced sputum, bronchoalveolar lavage washings, or of the biopsied transbronchial tissue, or by other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis. CD4 measurement To evaluate your HIV infection under This measurement must occur within the period we are considering in connection with your application or continuing disability review.
If you have more than one measurement of your absolute CD4 count within this period, we will use your lowest absolute CD4 count. Measurement of CD4 and either body mass index or hemoglobin These measurements must occur within the period we are considering in connection with your application or continuing disability review. If you have more than one measurement of your CD4 absolute count or percentage , BMI, or hemoglobin within this period, we will use the lowest of your CD4 absolute count or percentage , BMI, or hemoglobin. The date of your lowest CD4 absolute count or percentage measurement may be different from the date of your lowest BMI or hemoglobin measurement.
We calculate your BMI using the formulas in 5. Complications of HIV infection requiring hospitalization Complications of HIV infection may include infections common or opportunistic , cancers, and other conditions. Examples of complications that may result in hospitalization include: Depression; diarrhea; immune reconstitution inflammatory syndrome; malnutrition; and PCP and other severe infections.
Under The hospitalizations may be for the same complication or different complications of HIV infection and are not limited to the examples of complications that may result in Start Printed Page hospitalization listed in All three hospitalizations must occur within the period we are considering in connection with your application or continuing disability review. Each hospitalization must last at least 48 hours, including hours in a hospital emergency department immediately before the hospitalization.
Social Security Disability & HIV – [ IMSTILLJOSH ]
Most women with severe immunosuppression secondary to HIV infection exhibit the typical opportunistic infections and other conditions, such as PCP, Candida esophagitis, wasting syndrome, cryptococcosis, and toxoplasmosis. However, HIV infection may have different manifestations in women than in men. Adjudicators must carefully scrutinize the medical evidence and be alert to the variety of medical conditions specific to, or common in, women with HIV infection that may affect their ability to function in the workplace.
Additional considerations for evaluating HIV infection in women. Many of these manifestations for example, vulvovaginal candidiasis or pelvic inflammatory disease occur in women with or without HIV infection, but can be more severe or resistant to treatment, or occur more frequently in a woman whose immune system is suppressed.
Therefore, when evaluating the claim of a woman with HIV infection, it is important to consider gynecologic and other problems specific to women, including any associated symptoms for example, pelvic pain , in assessing the severity of the impairment and resulting functional limitations. We may evaluate manifestations of HIV infection in women under HAD is an advanced neurocognitive disorder, characterized by a significant decline in cognitive functioning. We evaluate HAD under How do we use the functional criteria in these listings? The following listings in this body system include standards for evaluating the functional limitations resulting from immune system disorders: Marked limitation means that the signs and symptoms of your immune system disorder interfere seriously with your ability to function.
Individuals with immune system disorders, including HIV infection, may manifest signs or symptoms of a mental impairment or of another physical impairment. For example, HIV infection may accelerate the onset of conditions such as diabetes or affect the course of or treatment options for diseases such as cardiovascular disease or hepatitis. We may evaluate these impairments under the affected body system. With documentation as described in Multicentric not localized or unicentric Castleman disease affecting multiple groups of lymph nodes or organs containing lymphoid tissue see Hemoglobin measurement of less than 8.
Complication s of HIV infection requiring at least three hospitalizations within a month period and at least 30 days apart see Repeated as defined in Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. Common adverse effects of treatment are the same as noted in We evaluate malignant cancerous hematological disorders, such as lymphoma, Start Printed Page leukemia, and multiple myeloma, under the appropriate listings in Any child with HIV infection, including one with a diagnosis of acquired immune deficiency syndrome AIDS , may be found disabled under We require appropriate clinical findings, characteristic white matter lesions on MRI, and a positive PCR test for the JC virus in the cerebrospinal fluid to Start Printed Page establish the diagnosis.
We require characteristic findings on microscopic examination of the induced sputum, bronchoalveolar lavage washings, or of the biopsied transbronchial tissue, or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis. These measurements absolute CD4 count or CD4 percentage must occur within the period we are considering in connection with your application or continuing disability review.
If you have more than one CD4 measurement within this period, we will use your lowest absolute CD4 count or your lowest CD4 percentage. The hospitalizations may be for the same complication or different complications of HIV infection and are not limited to the examples of complications that may result in hospitalization listed in Neurological manifestations specific to children The methods of identifying and evaluating neurological manifestations may vary depending on a child's age.
For example, in an infant, impaired brain growth can be documented by a decrease in the growth rate of the head. Neurological manifestations may present in the loss of acquired developmental milestones developmental regression in infants and young children or, in the loss of acquired intellectual abilities in school-age children and adolescents.
A child may demonstrate loss of intellectual abilities by a decrease in IQ scores, by forgetting information previously learned, by inability to learn new information, or by a sudden onset of a new learning disability. When infants and young children present with serious developmental delays without regression , we evaluate the child's impairment s under To evaluate growth failure due to HIV immune suppression, we require documentation of the laboratory values described in The dates of laboratory findings may be different from the dates of growth measurements.
We calculate BMI using the formulas in How do we consider the impact of your immune system disorder on your functioning? We will consider all relevant information in your case record to determine the full impact of your immune system disorder, including HIV infection, on your ability to function. Functional limitation may result from the impact of the disease process itself on your mental functioning, physical functioning, or both your mental and physical functioning.
Symptoms and Treatment of HIV
This could result from persistent or intermittent symptoms, such as depression, diarrhea, severe fatigue, or pain, resulting in a limitation of your ability to acquire information, to concentrate, to persevere at a task, to interact with others, to move about, or to cope with stress. You may also have limitations because of your treatment and its side effects see Important factors we will consider when we evaluate your functioning include, but are not limited to: Your symptoms see Children with immune system disorders, including HIV infection, may manifest signs or symptoms of a mental impairment or of another physical impairment.
Loss of previously acquired developmental milestones or intellectual ability including the sudden onset of a new learning disability , documented on two examinations at least 60 days apart; or. Progressive motor dysfunction affecting gait and station or fine and gross motor skills, Start Printed Page documented on two examinations at least 60 days apart; or. New Book. Shipped from UK. Established seller since Seller Inventory CA Book Description Natl Academy Pr, Condition: Brand New. In Stock. Book Description NAP.
Seller Inventory BD Ships with Tracking Number! Buy with confidence, excellent customer service!. Seller Inventory n. Publisher: National Academies Press , This specific ISBN edition is currently not available. View all copies of this ISBN edition:. Synopsis The Social Security Administration SSA uses a screening tool called the Listing of Impairments to identify claimants who are so severely impaired that they cannot work at all and thus qualify for disability benefits.
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