Eligibility to Collect Social Security Disability (“SSD”) Benefits:

Under the Social Security Act, you are disabled (and thus eligible for SSD) if you are unable to work due to a physical or mental impairment which has lasted, or can be expected to last, for at least 12 months. You will be considered disabled if your impairments are so severe that you cannot perform your usual work AND cannot perform other work given your age, education and work experience.

Not only must you be disabled to qualify for benefits, you must have paid into the Social Security system for the required period. Generally, you must have worked at least five out of the ten years before the disability began. During this period, you and your employer must have paid required social security taxes.

How Substance Abuse Impacts an SSD Claim:

20 CFR 416.0935 addresses how the Social Security Administration (“SSA”) determines whether substance abuse is “a contributing factor material to the determination of disability.” If SSA finds that a claimant is disabled but there is evidence of substance abuse, it must determine whether it is a contributing factor material to the determination of disability.

The key factor is whether SSA would still find a claimant disabled if he stopped using drugs or alcohol. If SSA determines that the remaining limitations are disabling, the claimant will be deemed disabled independent of the substance abuse. In other words, the drug addiction or alcohol abuse is not a contributing factor material to the determination of disability.

Policy Interpretation Ruling:

In March 2013, SSA issued SSR 13-2p, a policy interpretation ruling regarding evaluating cases involving drug addiction and alcoholism (“DAA”). SSA makes a DAA determination only when it has medical evidence from an acceptable medical source establishing that a claimant has a substance abuse disorder and it finds the Claimant is disabled considering all impairments, including the DAA.

Notably, SSA does not decide materiality if a Claimant has a history of DAA that is not relevant to the period under consideration. However, a Claimant bears the burden of proving disability throughout SSA’s sequential evaluation process.

DAA Evaluation Process:

The DAA Evaluation Process has a series of six steps. However, the adjudicator may go through them in any order.

Step 1–Does Claimant have DAA? If NO, there is no DAA materiality determination. If YES, go to step 2.

Step 2–Is Claimant disabled considering all impairments, including DAA? If NO, there is no DAA materiality determination because the claim is denied. If YES, go to step 3.

Step 3–Is DAA the only impairment? If YES, DAA is material and the claim is denied. If NO, go to step 4.

Step 4–Is the other impairment(s) disabling by itself while Claimant is dependent upon or abusing drugs or alcohol? If NO, DAA is material and the claim is denied. If YES, go to step 5.

Step 5–Does the DAA cause or affect Claimant’s medically determinable impairment(s)? If NO, DAA is not material. If YES, but the other impairment(s) are irreversible or could not improve to the point of non-disability, DAA is not material. If YES and DAA could be material, go to step 6.

Step 6–Would the other impairment(s) improve to the point of non-disability in the absence of DAA? If YES, DAA is material and the claim is denied. If NO, DAA is not material.

Conclusion:

Claims for SSD benefits can be long and frustrating. DAA issues may add another layer to an already complicated and confusing process. However, DAA issues must be properly evaluated by SSA to determine whether they are material to the period at issue. Thus, Claimants with DAA issues may still be awarded SSD benefits. If you or someone you love has DAA issues, we urge you/them to stop using drugs and alcohol and seek professional treatment.

Helpful Websites:

https://www.ssa.gov/OP_Home/cfr20/404/404-1535.htm

https://www.ssa.gov/OP_Home/rulings/di/01/SSR2013-02-di-01.html