Social Security Disability and SSI claimants need to be aware of the Social Security Administration’s recent announcement regarding claims involving drug or alcohol addiction (DAA). The SSA recently published SSR 13-2p that:
explains our policies for how we consider whether “drug addiction and alcoholism” (DAA) is a contributing factor material to our determination of disability in disability claims and continuing disability reviews.
Sections 223(d)(2)(C) and 1614(a)(3)(J) of the Social Security Act (Act) provide that a claimant “shall not be considered to be disabled * * * if alcoholism or drug addiction would * * * be a contributing factor material to the Commissioner’s determination that the individual is disabled.” The key factor in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether the claimant would still be found disabled if she stopped using drugs or alcohol.
DAA is not material to the determination that the claimant is under a disability if the claimant would still meet the definition of disability if she was not using drugs or alcohol. If DAA is not material, the claimant is disabled.
DAA is material to the determination of disability if the claimant would not meet the definition of disability if she were not using drugs or alcohol. If DAA is material, the claimant is not disabled.
The SSA will make a DAA determination when:
There is medical evidence from an acceptable medical source establishing that a claimant has a Substance Use Disorder, and
- They find that the claimant is disabled considering all impairments, including the DAA.
- They do not make a determination regarding materiality if a claimant has a history of DAA that is not relevant to the period under consideration.
If the claimant has another physical or mental impairment(s) that results in disability and DAA is not causing or does not affect the other impairment(s) to the point where the other impairment(s) could be found nondisabling in the absence of DAA, DAA is not material to the determination of disability. The claim should be allowed. There are three basic scenarios:
- The claimant has a disabling impairment independent of DAA; for example, a degenerative neurological disease, a hereditary kidney disease that requires chronic dialysis, or intellectual disability (mental retardation) since birth. See 20 CFR 404.1535(b)(2)(ii) and 416.935(b)(2)(ii).
- The claimant acquired a separate disabling impairment(s) while using a substance(s). One example is the claimant has quadriplegia because of an accident while driving under the influence of alcohol. A second example is the claimant acquired listing-level human immunodeficiency virus (HIV) infection from sharing a needle for intravenous drug use. In each example, the claimant acquired the impairment because of an activity related to substance use, but the Substance Use Disorder did not medically cause or exacerbate the impairment.
- The claimant’s DAA medically caused the other disabling impairment(s) but the other impairment(s) is irreversible or could not improve to the point of nondisability in the absence of DAA. Examples of such impairments could include peripheral neuropathy, permanent encephalopathy, cirrhosis of the liver, Substance-Induced Persisting Dementia, and Substance-Induced Persisting Amnestic Disorder that result from long-term alcohol or drug use.
This Social Security Ruling is effective March 22, 2013.
If you need more information about a Social Security Disability/SSI matter, personal injury matter (car wreck, boating accident, slip and fall, etc.), EEOICPA claim, long or short-term disability, VA disability, Railroad Retirement Board disability, or a workers compensation matter, please contact the Law Offices of Tony Farmer and John Dreiser for a free case evaluation. We can be reached at (865) 584-1211 or (800) 806-4611, through Facebook, or through our website. Our office handles claims throughout East Tennessee, including Knoxville, Chattanooga, Kingsport, Bristol, Johnson City, Morristown, Maryville, Rogersville, Dandridge, Tazewell, New Tazewell, Jefferson City, Strawberry Plains, Sevierville, Gatlinburg, Loudon, Kingston, Halls, Maynardville, Crossville, Cookeville, Jamestown, Sweetwater, Lenoir City, Athens, Oak Ridge, Clinton, LaFollette, Lake City, Jacksboro, Bean Station, Cosby, Newport, White Pine, Mosheim, Wartburg, Sunbright, Pigeon Forge, and Deer Lodge.
- John Dreiser to Present on Complex Social Security Law Issues (farmerdreiser.wordpress.com)