The claimant’s use of alcohol and/or illegal (or “street”) drugs is one of the single greatest problems in getting claims approved. Why is it such an issue?
Drugs and alcohol are a problem because the Social Security Administration may deny benefits where it finds such use is a “material contributing factor” to the disability.
Standard of Review
First, Social Security must determine whether there is “medical evidence of Drug Addiction and/or Alcoholism (“DAA”).”
“Medical evidence of DAA” means that the evidence is from an acceptable medical source; and is sufficient and appropriate to establish that the individual has a medically determinable substance use disorder.
If there is medical evidence of DAA, the SSA must then determine whether the DAA is material to the claimant’s disability. DAA is material only when the evidence establishes that the individual has medically determinable DAA as described, and would not be disabled if he or she stopped using drugs or alcohol.
According to the guidelines, the key factor Social Security must consider when making a material determination is whether it would still find the individual disabled if he/she stopped using drugs or alcohol. In doing this, SSA must decide which of the current physical and mental limitations would remain if the individual stopped using drugs or alcohol; and whether any or all of these remaining limitations would still be disabling.
Examples of When DAA Is Material
The following are some examples of when DAA is material.
1. The only impairment is a substance use disorder.
2. The individual’s other impairment(s) is by itself not disabling; e.g., a hearing impairment that is “not severe.”
3. The individual’s other impairment(s) is exacerbated by DAA and the evidence documents that, after a drug-free period of 1 month, the other impairment(s) is by itself not disabling.
If the evidence in file is sufficient and consistent to establish that the individual is disabled but does not establish that the individual has DAA, then no additional development of the DAA is required, and SSA should make a disability determination based on the evidence in file.
For additional information, visit the following pages on Social Security’s website:
The “Reality” of DAA
Now I have to tell what I believe to be the “reality” of DAA in disability claims. Many Judges are very hesitant to award benefits to claimants with a drug and/or alcohol history. Even if the use of drugs and alcohol is not “material” to the claimant’s disability, many (if not most) Judges will not award benefits to individuals where the Judge believes the claimant will use government benefits to consume illegal drugs or alcohol.