Why Is My Attorney So Concerned About Drugs Or Alcohol Abuse In My Social Security Disability Claim?

Your attorney is concerned because a claimant’s use of alcohol and/or illegal (or “street”) drugs is one of the single greatest problems in getting claims approved. Drugs and alcohol are a problem because the Social Security Administration may deny Social Security Disability benefits if it finds that your use of drugs and alcohol use contributes to your disability.

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.

Is Alcohol or Drug Use Contributing To Your Impairment?

Whether drug or alcohol use will affect a claimant’s eligibility for disability benefits hinges on whether such use contributes to the claimant’s disabling medical condition. If a claimant’s drug or alcohol abuse is deemed a material contributing factor to a medical impairment, that claimant will not win disability benefits.

Materiality is determined by asking this question: “Is the medical condition for which the claimant alleges disability exacerbated (made worse)—or even caused—by alcohol or drug use?” If the answer is yes, the claimant’s drug or alcohol use may be considered material to the alleged impairment, and the claimant may be found ineligible to receive disability benefits. This evaluation is called a drug and alcohol abuse (DAA) determination.

Examples of When DAA Is Material

The following are some examples of when DAA is material to an impairment.

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. DAA exacerbates the individual’s impairments 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 on 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: Adjudicating a Claim Involving Drug Addiction or Alcoholism (DAA) and Drug Addiction and Alcoholism.

Will Impairment Improve Without Alcohol or Drugs?

The SSA will then ask, “If the applicant quits drinking or using drugs, will the applicant’s medical condition improve?” For example, if a claimant has seizures, and the records show substance abuse, a claims examiner or judge (depending on the level the claim is at) will question what role the claimant’s use of substances plays.

If an SSA medical consultant is of the opinion that the claimant’s seizure condition would medically improve if the substance use or abuse stopped, then the substance use or abuse is material to the seizure condition. As a result, the SSA could not award benefits for a seizure disorder.

If, however, the medical consultant concludes that the claimant’s frequency of seizures would continue regardless of whether the alcohol or drug use were to stop, such use would be immaterial (or irrelevant) to the claim.

What If the DAA Caused the Disability/Impairment?

It doesn’t matter whether past alcohol or drug abuse caused the medical condition.
Here’s another example. A claimant applies for Social Security disability based on liver dysfunction and alcoholic hepatitis. The claimant has a history of alcohol abuse, some of it pretty recent.

Will the alcohol abuse harm the claimant’s disability case? It doesn’t matter whether the alcohol abuse caused the liver damage. The answer depends on whether it is currently material or immaterial to the claimant’s disabling medical condition.

What matters is whether the disabling condition would disappear if the claimant stopped drinking. If the claimant’s liver damage is so pronounced that ceasing alcohol use completely would make no difference to the claimant’s medical condition, then alcohol abuse would be immaterial, or irrelevant, to the case.

If, however, ceasing the use of alcohol would cause medical improvement, alcohol abuse would be material to the disability case, and the SSA would deny the claim.

It’s Difficult For Applicants with Mental Conditions To Prove Immateriality

Claimants whose disabling conditions are psychiatric or emotional (for example, depression or anxiety) will have a harder time proving that their alcohol or drug use is not a contributing factor to their mental impairment. Most psychologists and psychiatrists believe that even moderate alcohol use contributes to depression.

Claimants for Social Security disability who have a history of alcohol or drug abuse but who are not currently using substances should carefully review their medical records before they file for disability. Often, medical doctors and mental health professionals will state “suspected use” in their treatment notes, and these indications, proven or otherwise, can have a damaging effect on a disability claim.

Representative Payees

If you win your claim for disability, but the SSA believes you are still abusing alcohol or drugs, the SSA will require that you have a representative payee and will refer you to a substance abuse treatment program. The SSA will send your disability check to the representative payee, who doles out money to you and paying bills for you, and preventing you from spending money on your addiction. The representative payee can be a trusted friend, family member, or organization.

The “Reality” of Drug or Alcohol Abuse In Social Security Disability Claims

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.