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When Drugs or Alcohol Can Prevent You From Receiving Disability Benefits

When Drugs or Alcohol Can Prevent You From Receiving Disability Benefits
When your disabilities might disappear if you quit drinking or taking drugs, Social Security may refuse you disability compensation.

Many disability applicants ("claimants") have one of two common misconceptions about how the Social Security Administration (SSA) regards drug and alcohol abuse:
- You can get disability based only on a drug or alcohol addiction diagnosis, or 
- You can never get disability if you have a history of substance abuse or alcoholism;

In actuality, the SSA can grant disability payments to applicants who are presently abusing drugs or alcohol, but only if the agency concludes that the claimant is incapacitated despite the addiction.

SSR 13-2p: How Social Security Handles Drug and Alcohol Addiction Cases
SSRs are regulations issued by Social Security that advise claims examiners and administrative law judges on how to decide disability claims. SSR 13-2p is the agency's decision on how to analyse claims containing evidence of drug addiction or alcoholism (DAA).

If the Social Security Administration (SSA) considers that DAA is "a contributing factor material to the determination of disability," it has the discretion to deny a disability claim. Material demonstrates that substance abuse is so central to your claim that the agency is unsure if you would be disabled if you stopped using drugs or alcohol.

SSR 13-2p explains the Social Security Administration's approach for determining when DAA is material. The DAA procedure consists of six questions.

Do you have a history of drug or alcohol abuse?
The SSA will review your medical records to look for signs of drug or alcohol abuse. The use of illegal street drugs such as methamphetamine, cocaine, and heroin is a red signal, but the agency will also look for signs of prescription drug addiction, such as requesting opioid (such as Vicodin) refills too quickly.

Because Social Security is unconcerned with the occasional or responsible use of alcohol or recreational drugs, a glass of wine with dinner will not cause any issues. However, if you indulge in excessive drinking on a regular basis to the point that your doctor has diagnosed you with a drug use issue, the SSA would most likely consider this to be proof of drug usage.

Are your other Medical Issues Incapacitating?
To decide whether your impairments are debilitating, Social Security will consider all of your physical and mental limitations, including those caused by DAA, and will use the sequential evaluation method. If you would not be deemed handicapped even if you were not using drugs or alcohol, the government will refuse your claim without considering whether DAA is relevant.

Is Drug and Alcohol Addiction the Only Impairment the SSA Considers for Disability?
The SSA no longer awards disability benefits solely on the basis of drug abuse. (The government used to allow claims based on addiction, but a 1996 legislation prohibits them from doing so any more.) Later, the SSA would find petitioners incapable under the list of impairments for substance abuse, but this practise was abolished in 2017.

There is currently no other option for Social Security to award compensation based purely on drug and alcohol addiction. You must show that you have another medical condition that prevents you from working.

Are your impairments incapacitating on their own or as a result of DAA?
If Social Security concludes that you have debilitating impairments, the agency will then assess whether they are disabling on their own or just because of how they interact with your substance usage.

The problem arises most commonly when a claimant alleges impairment due to a mental health illness, because even minor drug and alcohol usage can increase symptoms of despair and anxiety. In these situations, it's critical to create a period of abstinence so that the SSA can see your mental health baseline without the consequences of substance misuse.

Is the DAA causing or exacerbating the Impairments?
Many bodily issues remain whether or not the claimant abuses drugs or alcohol. Even if the medical condition was caused by drug usage, Social Security is unlikely to decide that DAA is substantial in many situations. As an example:

- Conditions that exist independently of substance abuse, such as a degenerative neurological disease (such as Parkinson's), 
- A hereditary kidney disease requiring chronic dialysis, or 
- A developmental disability from birth; 
- Conditions that were acquired while using drugs or alcohol, such as quadriplegia from driving under the influence or HIV/AIDS from sharing needles; and - - Conditions that were caused by long-term DAA but are irreversible, such as certain types of liver disease.

Would you be able to return to work if you stopped drinking or doing drugs?
The most difficult aspect of assessing if DAA is relevant is determining whether a claimant would be incapacitated if drugs or alcohol were not present. Based on the data in the medical records, Social Security claims examiners and administrative law judges must make an informed assumption.

Since the DAA affects job performance in areas such as memory, mood, and focus in much the same manner as mental disorders do, the agency may have difficulty distinguishing which restrictions are caused by the mental condition and which by DAA.

Claimants who have recently quit using drugs or alcohol, as well as those with mental health difficulties, may be caught off guard at this stage. For claimants who are newly clean and sober, Social Security may not have enough information about how they are coping without the use of substances to determine if they may return to work.

Obtaining a Medical Opinion on DAA
DAA claims are seldom granted at the first stage. It might be difficult for the claims examiner to evaluate whether the impairment would exist in the absence of drug and alcohol addiction, especially when the claim covers both DAA and mental problems. However, obtaining your physicians to produce a medical source statement in support of your disability claim can considerably boost your chances of acceptance as early as possible. 

Social Security cherishes the opinions of regular doctors and mental health practitioners, so getting a statement from your treating doctor stating that you have a continuous debilitating disease that would exist without DAA can be very useful in winning your case. If you believe your doctor would write a supportive letter,

Legal Representation Can Be Beneficial
Claimants with a history of drug or alcohol misuse face an uphill struggle in practice. 

Your Disability examiners and judges are aware of harmful misconceptions about the disability programme and may be hesitant to contribute to them. Consider hiring a disability attorney to assist you with your claim. As long as you are honest with your legal representation, doctor's statements and the SSA, you may demonstrate to Social Security that your difficulty with DAA does not imply that you are not handicapped.

For more legal help, you can consult our expert disability attorneys at The Law Office of Irene Ruzin

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Monday, 17 June 2024