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If you are worried that your use of drugs or alcohol will affect your ability to win your Social Security disability case, you will want to read this. First let’s start by defining our terms. The Social Security Administration, (“SSA”), refers to this as drug and alcohol abuse. (“DDA”). DDA refers to substance use disorders as per the Diagnostic and Statistical Manual of mental Disorders published by the American Psychiatric Association. (“DSM”). Substance use disorders are diagnosed in part by the presence of abusive use of alcohol, illegal drugs, prescription medications and toxic substances.
Per the DSM, substance use disorders involve: taking a substance in larger amounts or for a longer period of time then you are supposed to; not managing to cut down or stop using even though you want to; spending a lot of time getting, using or recovering from use of the substance: cravings and urges to use the substance; not managing to do what you should in life because of the substance use; continuing to use the substance even when it causes problems in relationships; giving up important social, occupational or recreational activities because of substance use; using substances repeatedly even when it puts you in danger; continuing to use even when you know you have a physical or psychological problem that could have been caused or made worse by the substance; needing more of a substance to get the effect you want; developing withdrawal symptoms which can be relieved by taking more of the substance. The severity of the substance use disorder depends on how many symptoms are identified. According to SSA, a specific medical diagnosis of substance abuse disorder is not required if there is sufficient medical evidence of drug or alcohol use in the record.
SSA looks for evidence regarding the existence of DAA in the form of treatment for a substance use disorder, or evidence of emergency department admissions due to substance abuse. There must be objective medical evidence, such as signs, symptoms, laboratory findings from an acceptable medical source to support a finding of DAA. Evidence that simply shows that a claimant uses drugs or alcohol is not by itself sufficient to establish the existence of a substance use disorder. For example, self-reported drug or alcohol use, an arrest for driving under the Influence, or a third-party report, would not be sufficient evidence of DAA alone.
In order to prove disability and be entitled to Social Security Disability Benefits, you must meet the definition of “disability” under the SSA’s rules and regulations. There is a five step process or analysis that the SSA uses to evaluate each claim and determine if you are disabled. In general, to meet the definition of disability you must be unable to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.
SSA looks at whether DAA is a contributing factor that is material (or a key factor) to the determination of disability. What does it mean to be “material” to the determination of disability? If you would still meet SSA’s definition of disability even if you stop using drugs or alcohol then DAA is not material; and you will be found disabled. In other words, if a claimant would not be disabled absent his alcoholism, alcoholism is a contributing factor material to the finding of disability, and benefits would be denied. Once a claimant shows that he or she would still be found disabled even if drug or alcohol use stopped; the focus turns to whether the remaining impairments are disabling.
When does SSA determine whether DAA is material or not? This determination will only be made if there is medical evidence from an acceptable medical source establishing that a claimant has a substance use disorder and you are disabled considering all impairments, including DAA. This determination does not get made if there is a history of DAA not relevant to the period of disability under consideration. You, as the claimant, have the burden of proving disability. Therefore, you have the burden of establishing that you would still be disabled even if you were not using drugs or alcohol. SSA will look at how the DAA causes or affects your other medically determinable impairments, and see if the other impairments are disabling by themselves. If your other physical or mental impairments are sufficiently severe to establish disability by themselves, (in other words they prevent basic work activities), then you will be found disabled.
It can be difficult to prove the disabling effects of other impairments in the absence of DAA, since the record, as it exists, includes the DAA. SSA may consider medical opinions about the effects of the remaining medical conditions and their limitations in absence of DAA. SSA also has to consider whether if the DAA is removed, the remaining impairments would improve to the point that there may no longer be a disability. DAA can cause or exacerbate the effects of physical impairments. Usually, the best evidence for determining whether a physical impairment would improve to the point of no disability is to look at a period of abstinence from DAA. The period of abstinence should be long enough to allow the acute effects of drug or alcohol use to abate. If the other impairments are mental disorders, it should be documented what medical findings and impairment related limitations remain after the DAA is removed.
The period for which you are claiming disability should not start until the earliest date on which the evidence shows that you became disabled due to a medically determinable impairment and that DAA was not material.
If you believe that you have mental and or physical impairments that are preventing you from working, applying for social security disability is likely the right choice for you. The existence of an alcohol or drug use disorder on top of your physical and or mental impairments presents an added challenge and complexity to your claim that will need to be addressed. At the LaBovick Law Group we provide free consultations where we will review the facts of your case to determine if this is the right program for you. Call us today at (561) 625-8400 for your free evaluation.