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Author Topic: When is one "disabled"?  (Read 5140 times)

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Offline vegaslocal39

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  • Posts: 50
When is one "disabled"?
« on: May 07, 2007, 10:38:32 PM »
I'm curious about the point at which one becomes eligible to receive disability payments.

Personally, I'm fairly healthy and I wouldn't want to quit working unless I was ill.  But how does one know when they have crossed that line from being abled to being disabled?

If you are ill, but can still drag yourself into work, does that mean that you are not disabled?  If you become disabled, but then get better, do you end your claim for disability?

Does anyone know at what point the social security admin will allow one to claim disability?  Are the requirements different if you have a private disability policy?

I know it's a huge subject and I've asked a lot of questions.  If you can tell me what your experience has been, I'd appreciate it.

Offline Pilot

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Re: When is one "disabled"?
« Reply #1 on: May 08, 2007, 12:07:52 AM »
Well speaking from family experience...dont get your hopes up about social security disability.  When my Mom fell ill with lung cancer and was confined to her bed on an oxygen tank, social security, determined that she was not  to ill to work.  We had to threaten them in court before she was suddenly too ill to work any longer.
She received two payments before she passed away. It amazes me that we work and pay into a system that does its level best to keep from paying honestly disabled people and I know many who receive benefits that are more able to work than I am.

So in reality, you have the convince the social security doctors that you are disabled according to their own set of guidelines and dont count on the fact that you dragged yourself into the place on a gurney hooked up to oxygen.

Pilot  (who drags his happy ass into work everyday and plays joyfully with two chemicals that are known to cause cancer)   ;D

Offline bear60

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Re: When is one "disabled"?
« Reply #2 on: May 08, 2007, 08:08:04 AM »
It used to be a simple AIDS classification......if you were classified as having AIDS you were eligible to apply for disability.  I guess that changed.  However, it is something to think about.
Poz Bear Type in Philadelphia

Offline vegaslocal39

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Re: When is one "disabled"?
« Reply #3 on: May 08, 2007, 09:54:37 AM »
So, it doesn't sound like there is a clear-cut definition.

I was asking because there is good chance I will get laid off this summer.  My CD-4 numbers have been declining in the last few months although I'm still undectable.

I'm worried about being able to afford Cobra on unemployment.  I have a private disability policy through my employer that would pay me 2/3 of my salary until retirement age.  I don't want to attempt to claim disability, unless I qualify....and if all it takes to qualify is a number, then it might be a consideration.  But if it comes down to a subjective opinion then I'm sure I would not qualify.

Does anyone out there have a any recent experience applying for disability either through social security or through a private policy?  Even if I don't qualify, I'm sure the information could help someone out there.

Offline Robert

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Re: When is one "disabled"?
« Reply #4 on: May 08, 2007, 11:05:16 AM »
Private disability is completely different from SS. Since they are the ones shelling out the money, they make their own rules and guidelines.  I think it's best you get ahold of someone in Human Resources and ask them for the name of the company that covers disability then talk to them directly or read their brochure. 

It's already May.  Summer will be  here in no time.  I wouldn't put it off much longer.  Good luck.


Dan J.

  • Guest
Re: When is one "disabled"?
« Reply #5 on: May 08, 2007, 11:17:58 AM »
AIDS and Social Security Disability Insurance (SSDI)
Here is an explanation of Social Security's five-step process to determine if an AIDS patient qualifies for Social Security Disability Insurance:

STEP ONE simply determines if an individual is "working (engaging in substantial gainful activity)" according to the SSA definition. Earning more than $860 a month as an employee is enough to be disqualified from receiving Social Security disability benefits.

STEP TWO implies that the AIDS disability must be severe enough to significantly limit oneís ability to perform basic work activities needed to do most jobs. For example:

walking, standing, sitting, lifting, pushing, pulling, reaching, carrying or handling
seeing, hearing and speaking
understanding/carrying out and remembering simple instructions use of judgment
responding appropriately to supervision, co-workers and usual work situations
dealing with changes in a routine work setting
STEP THREE states that human immunodeficiency virus (HIV) infection is caused by a specific retrovirus and may be characterized by susceptibility to one or more opportunistic diseases, cancers, or other conditions, which are described in medical listing 14.08. Any individual with HIV infection, including one with a diagnosis of acquired immunodeficiency syndrome (AIDS), may be found disabled under this listing if his or her impairment meets any of the criteria in 14.08 or is of equivalent severity to any impairment in 14.08.

MEDICAL LISTING 14.08: Human Immunodeficiency Virus (HIV) documented by appropriate laboratory and clinical findings and one of the following:

Bacterial infections: Mycobacterial infection (e.g., caused by M. avium-intracellulare, M. Kansasii, or M. tuberculosis) at site other than the lungs, skin, or cervical or hilar lymph nodes; or pulmonary tuberculosis resistant to treatment; or Nocardiosis; or Salmonella bacteremia, recurrent non-typhoid; or Syphilis or neurosyphilis ? evaluate sequelae under the criteria for the affected body system (e.g., 2.00 Special Senses and Speech, 4.00 Cardiovascular System, 11.00 Neurological); or Multiple or recurrent bacterial infection(s), including pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment 3 or more times in 1 year. OR

Fungal infections: Aspergillosis; or Candidiasis, at a site other than the skin, urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or candidiasis involving the esophagus, trachea, bronchi, or lungs; or Coccidioidomycosis, at a site other than the lungs or lymph nodes; or Cryptococcosis, at a site other than the lungs (e.g., cryptococcal meningitis); or Histoplasmosis, at a site other than the lungs or lymph nodes; or Mucormycosis. OR

Protozoan or helminthic infections: Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for 1 month or longer; or Pneumocystis carinii pneumonia or extrapulmonary pneumocystis carinii infection; or Strongyloidiasis, extra-intestinal; or Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes. OR

Viral infections: Cytomegalovirus disease (documented as described in 14.00B4b) at a site other than the liver, spleen, or lymph nodes; or Herpes simplex virus causing: Mucocutaneous infection (e.g., oral, genital, perianal) lasting for 1 month or longer; or Infection at a site other than the skin or mucous membranes ( e.g., bronchitis, pneumonitis, esophagitis, or encephalitis); or Disseminated infection; or Herpes zoster, either disseminated or with multidermatomal eruptions that are resistant to treatment; or progressive multifocal leukoencephalopahty; or Hepatitis, as described under the criteria in medical listing 5.05. OR

Malignant neoplasms: Carcinoma of the cervix, invasive, FIGO stage II and beyond; or Kaposiís sarcoma with: Extensive oral lesions; or involvement of the gastrointestinal tract, lungs, or other visceral organs; or Involvement of the skin or mucous membranes, as described under the criteria in 14.08F; or Lymphoma (e.g., primary lymphoma of the brain, Burkittís lymphoma, immunoblastic sarcoma, other non-Hodgkins lymphoma, Hodgkinís disease); or Squamous cell carcinoma of the anus. OR

Conditions of the skin or mucous membranes (other than described in B2, D2, or D3, above), with extensive fungating or ulcerating lesions not responding to treatment (e.g., dermatological conditions such as eczema or psoriasis, vulvovaginl or other mucosal candida, condyloma cause by human papillomavirus, genital ulcerative disease), or evaluate under the criteria in medical listing 8.00ff. OR

Hematologic abnormalities: Anemia, as described under the criteria in medical listing 7.02; or Granulocytopenia, as described under the criteria in medical listing 7/15; or Thrombocytopenia, as described under the criteria in medical listing 7.06. OR

Neurological abnormalities: HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses; or Other neurological manifestations of HIV infection (e.g., peripheral neuropathy) as described under the criteria in medical listing 11.00ff. OR

HIV wasting syndrome, characterized by involuntary weight loss of 10 percent or more of baseline (or other significant involuntary weight loss, as described in 14.00D.2) and, in the absence of a concurrent illness that could explain the findings , either: Chronic diarrhea with two or more loose stools daily lasting for 1 month or longer; or Chronic weakness and documented fever greater than 38įC (100.4įF) for the majority of 1 month or longer. OR

Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding. OR

Cardiomyopathy, as described under the criteria in medical listing 4.00ff or medical listing 11.04. OR

Nephropahty, as described under the criteria in 6.00ff. OR

One or more of the following infections (other than described in A-L, above), resistant to treatment or requiring hospitalization or intravenous treatment 3 or more times in 1 year (or evaluate sequelae under the criteria for the affected body system): Sepsis; or Meningitis; or Pneumonia; or Septic Arthritis; or Endocarditis; or Sinusitis documented by appropriate medically acceptable imaging. OR

Repeated (as defined in 14.00D8) manifestations of HIV infections (including those listed in 14.08A-M, but without the requisite findings; e.g., carcinoma of the cervix not meeting the criteria in 14.08E, diarrhea not meeting the criteria in 14.08J, or other manifestations; e.g., oral hairy leukoplakia, myositis) resulting in significant, documented symptoms or signs (e.g., fatigue, fever, malaise, weight loss, pain, night sweats) and one of the following at the marked level (as defined in 14.00D8O: Restriction of activities of daily living; or difficulties in maintaining social functioning; or difficulties in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

STEP FOUR explores the ability of an individual to perform work they have done in the past despite their AIDS disability. If SSA finds that a person can do his past work, benefits are denied. If the person cannot, then the process proceeds to the fifth and final step.

STEP FIVE looks at age, education, work experience and physical/mental condition to determine what other work, if any, the person can perform. To determine AIDS disability, SSA enlists vocational rules, which vary according to age.

For example, if a person with AIDS would warrant a finding of disabled at any age. The inability to meet any of the basic mental demands of work would entitle a claimant to disability benefits.

Social Security Rulings 85-15 and SSR 96-9p both describe how an individual must, on a sustained basis, be able to understand, remember and carry out simple instructions; make simple work-related decisions; respond appropriately to supervision, coworkers, usual work situations and to deal with changes in a routine work setting.

A substantial loss of ability to meet any one of these basic work related activities would severely limit the potential occupational base for all age groups and justify a finding of disabled. A person who has a medically determinable severe impairment of AIDS and is unable to understand, remember or carry out simple instructions would be found disabled based on his/her mental residual function capacity.



Hope this helps.

Dan J.

Offline Lisa

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Re: When is one "disabled"?
« Reply #6 on: May 08, 2007, 11:23:35 AM »
If you are at the cusp of considering the application process, you should probably go ahead and begin. It is exceptionally difficult to navigate the government red tape involved.
At this very moment, I am living in abject poverty. All of my resources have been tapped out, and I am in danger of having a few things shut off.
I have been in the disability application process for four years, and will likely still be awaiting an Administrative Law Judge hearing until the end of this year. I had to seek a private attorney who does disability(and will get 25% of the recovery) who said I absolutely have a meritorious case, but the district I live in has a back log of two years before you can get before the judge.
The Social Security Disability office WILL always deny your initial, and second appeals, unless it is done for you by a social worker or other official beause you are near death.
Prepare yourself, as the process is long, humiliating, and demeaning, unless you have enough private funds to allow you utilities, and groceries for four or five years.   ....but I'm a little bitter......maybe you won't have it as difficult.
Were I you, I would begin the process now.
No Fear  No Shame  No Stigma
Happiness is not getting what you want, but wanting what you have.

Offline AlanBama

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Re: When is one "disabled"?
« Reply #7 on: May 08, 2007, 11:24:10 AM »
Personally, I'm fairly healthy and I wouldn't want to quit working unless I was ill. 

This is a good decision.   Believe me, disability is nothing to strive for.
"Remember my sentimental friend that a heart is not judged by how much you love, but by how much you are loved by others." - The Wizard of Oz

Offline BT65

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Re: When is one "disabled"?
« Reply #8 on: May 08, 2007, 11:58:43 AM »
Let me tell you what I do when having problems with government agencies.  I get ahold of someone in the government (senator, governor etc.).  You'll find, especially around election times, that they are more than willing to help.  This is how I managed to get my SSDI rolling in '95.  I got ahold of my senator, who called the disability office every week, then they approved me.  I've also had help from the government on a few other things.  Believe me, it works!
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline antibody

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  • "every man thinks his burden is the heaviest"
Re: When is one "disabled"?
« Reply #9 on: May 08, 2007, 03:49:22 PM »
i am on state disability which my funds have run out and i am not ready to go back to work. this sucks. i am much better but not quite ready to take stress. i know i should have got a case worker but never thought they had any help for me. i have a doctors appointment friday maybe he can do something to get me ssi, he put me on disability for depression and chronic pain syndrome. i don't know whats going to happen, it's only tuesday now so i can't stress about it now. if friday comes and he says go back to work i will have to find a job. i already got my last state disabilty check and the moneys running out soon.
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Offline SirPrize

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Re: When is one "disabled"?
« Reply #10 on: May 08, 2007, 04:38:46 PM »
Aside from the information you've already received, I would add; IF you are planning to pursue a claim for disability, you will do yourself a favor by starting to keep a daily diary of your physical and mental symptoms.  Include everything no matter how insignificant you may think it is, e.g., overslept due to nightly muscle/joint pain waking me intermittently, OR was short with coworkers today from lack of sleep, OR queasy stomach this a.m.

Give your physician(s) a copy of the diary each visit so that you can discuss any problems, s/he can update your file, and document any prescribed  therapies/medicines.  You will need this AND more when dealing with the Social Security Administration.  Employer sponsored and privately owned disability policies tend to be more forgiving and will most likely rely solely on your physicians statement but rest assured, you will still be required to apply through the SSA.
Due to current economic conditions, the light at the end of the tunnel has been temporarily turned off!

Offline Miss Philicia

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Re: When is one "disabled"?
« Reply #11 on: May 08, 2007, 05:00:51 PM »
Yes, I agree with SirPrize.  In my link to Per Larson up above one of the articles linked at the bottom of that page is his article on keeping a daily diary and how it will vastly help in any disability appeal.  It is ALL about documentation -- you know these folks are paper pushers and the more paper they have the happier they will be.  Larson covers this in detail so read his article.
"Iíve slept with enough men to know that Iím not gay"

Offline Moffie65

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Re: When is one "disabled"?
« Reply #12 on: May 08, 2007, 05:30:06 PM »
Of all the things in life I miss the most, is the ability to hold down a job and go to work daily.  I REALLY MISS THAT ONE.

I have been "officially" disabled since 1995, and haven't had one review since then.  It took only a few months for me to get approved, and unlike Lisa above, my case sailed through and started shortly after approval.  Unfortunately this is probably not going to happen to anyone at this time, due to much of the bullshit out of the Pharmaceutical industry that has tagged HIV a "Chronic Managable Illness", and to think "WE" allowed this to happen. 

The Bible contains 6 admonishments to homosexuals,
and 362 to heterosexuals.
This doesn't mean that God doesn't love heterosexuals,
It's just that they need more supervision.
Lynn Lavne

Offline Miss Philicia

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Re: When is one "disabled"?
« Reply #13 on: May 08, 2007, 05:39:35 PM »
Yeah, and if they took you off of it Moffie good luck in explaining away that 12 year hole in your employment history :)  I'm in the same position as you, though not for that long a period of time but fully half of it.
"Iíve slept with enough men to know that Iím not gay"

Offline pozniceguy

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Re: When is one "disabled"?
« Reply #14 on: May 08, 2007, 05:51:41 PM »
When I was first diagnosed  Jan 1994, I had many of the issues stated above  PCP , neuropathy, diarrhea, chronic ear infection.., MAC, and because of medications at the time I  needed Transfusions every two weeks......My first contact with Social Security I was told  there is no case for Disability with AIDS.....( total lie).. there was in fact a very specific exception..It took one year and a very helpful person at a different Social Security office to clear a case in less than a month and get me a years worth of back payments....
Recommendation ,, find a Social Security Office that isn't overwhelmed  ( usually in/ near small towns)  go personally with all the documentation you can get and persevere.......after about two years they convert you to Social Security as long as your status hasn't changed.

Like Tim  ..I have never had a review or a further question...just get checks every month...
I also agree  with the above  , don't do it until you really have to....be prepared.. but once they refuse you  , you start the goat rope of trying to prove them wrong....they have the power to string you along for a long time....I was given that advice and changed the Office I was talking with to another "friendlier" office...then got quick action...

remember the good times...honor the past but don't live there
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Offline Miss Philicia

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Re: When is one "disabled"?
« Reply #15 on: May 08, 2007, 05:55:27 PM »
I've heard all of this about the variability of individual offices, but I'll add I think it also has a lot to with each state as that is who runs those offices.  I did it all in NY and they have a mechanism in place to speed up HIV disability cases, I guess because of the amount and the political pressure applied years ago by the gay community.  I don't know what states you live in when you applied... I know Moffie lives in the SW of the US.  Oh, I see you're in Texas pozniceguy.  Nuf said! :)
"Iíve slept with enough men to know that Iím not gay"

Offline BT65

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Re: When is one "disabled"?
« Reply #16 on: May 08, 2007, 09:01:30 PM »
good luck in explaining away that 12 year hole in your employment history :)

That's the thing I'm going to have to deal with when I graduate.  Having that hole in employment, since being on disability myself since 1995.  But I'm only going to work as much as disability allows (which I think currently is $865/mo) because I can't afford to lose Medicare Part D prescription coverage.
I've never killed anyone, but I frequently get satisfaction reading the obituary notices.-Clarence Darrow

Offline vegaslocal39

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Re: When is one "disabled"?
« Reply #17 on: May 09, 2007, 10:08:17 AM »
You have all been very helpful.  Thank your for sharing your experiences.

Offline RapidRod

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Re: When is one "disabled"?
« Reply #18 on: May 09, 2007, 10:15:48 AM »
vegaslocal39, think real hard before appling for SSI. It's no money, of course you can live but nothing like how you live today. It's a bitch.

Dan J.

  • Guest
Re: When is one "disabled"?
« Reply #19 on: May 09, 2007, 10:17:12 AM »
That's the thing I'm going to have to deal with when I graduate.  Having that hole in employment, since being on disability myself since 1995.  But I'm only going to work as much as disability allows (which I think currently is $865/mo) because I can't afford to lose Medicare Part D prescription coverage.

That is what I do. I work just enough to keep the checks coming so I won't loose my Medicare Part D coverage.
The best way to go about going back to work and still drawing your soc sec chk is going thru the Ticket To Work Program. http://www.yourtickettowork.com/program_info  You will have a 9 month trial work period that you can earn any anount (no limits) and still draw your full check & have your Medicare Part D coverage.  Also if you get sick again you can be fast tracked back on soc sec disability... All the info is available thru the link I gave.

Offline brooklynpoz

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Re: When is one "disabled"?
« Reply #20 on: May 12, 2007, 05:58:33 AM »
I applied for SSDI and was denied, then I hired Binder & Binder, after that, I was aprroved in only 4 months.
They were excellent.
Diagnosed, Monday,  8/9/2004, 1ST year was ruff , now I am well adjusted .
Current Med's ; Kaletra & Truvada
Undetecable,<48 ,  531 tcells, 21%
Keeping the faith, that they will get a cure in our lifetime.

Offline mudman8

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Re: When is one "disabled"?
« Reply #21 on: May 13, 2007, 05:50:24 PM »
I finally was feeling really bad even tho on AZT, Dr said I had 80 Tcells and put  me on the new cocktail, I had Pneumpcystus and KS starting, those 3 things put me on SSDI. Now I"m doing fine and no one has ever questioned my Status.

I have a friend now that had private insurance and he's been getting payments for years, and now at 62 is having to switch to SS and is having to prove he can't work. Dr is very supportive, but  he has to do lots of tests still to show his poor medical conition.

I've been told by a benefits counselor that I can't make over $600 and I only receive $685, Just enough for rent and a bill or two. If i make more than $800 they drop me like a rock.

Life is analog

Offline RapidRod

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Re: When is one "disabled"?
« Reply #22 on: May 13, 2007, 10:42:23 PM »
Step 3, was what disabled me for SSI approval.

Offline northernguy

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Re: When is one "disabled"?
« Reply #23 on: May 14, 2007, 01:28:56 AM »
I think you need to heed Moffie's first sentence, that one can actually miss work. 

There's a lot of social interaction that goes with a job that you might miss.  While cautioning me about leaving a job with disability insurance, my own doc said he has seen many patients who have left the workforce at a young age without realizing what that will mean in terms of reduced income, lack of social contact, and even lack of purpose.
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Offline david25luvit

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Re: When is one "disabled"?
« Reply #24 on: May 14, 2007, 04:00:30 AM »
Hey V...

            No! There's no clear cut answer to your questions.  When it comes to SSI they make it as difficult as possible and I should know.
            It took me three years to get David's and he died within a year of receiving it...it took only two years for me but then I had two
            things going for me....actually three if you consider Hurricane Katrina.  Contracting SJS and a good attorney.  Generally speaking they
            seem to deny most at first.  It's my opinion that it takes a good attorney that stays on top of your case to get your disability...or one
            foot in the grave.

            And like you I've seen some people get it right away and then the next day see them unload furniture off a truck.  If I could stand up
            for longer than thirty minutes and could get up off the ground when I fall without assistance I'd rather be working....God knows I'd make
            a lot more money.  I don't know how some people do it....it took two and a half years to get Medicare after I was approved for disability
            and after they take out Part B....I don't know how anybody could live on what's left.  I can't imagine living on what I make from disability..
            I'm one of the lucky ones who got a settlement from a certain drug maker.

            Hope this helps..........
In Memory of
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I miss him terribly..........


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