Monday, February 25, 2013

New Social Security Ruling on Drug Addiction and Alcoholism

Sometimes it can be difficult for a claimant that has had problems with drugs or alcohol to obtain Social Security Disability benefits. As a general rule, if a claimant’s condition would improve if he or she stops using drugs or alcohol, the SSA would deny the claim.
Over the past few years there has been considerable controversy as to how Social Security Disability cases dealing with drugs or alcohol should be evaluated. This past week, the Social Security Administration issued new ruling on how to evaluate these cases. See SSR 13-2p, on "Evaluating Cases Involving Drug Addication and Alcoholism (DAA)." 78 Fed. Reg. 11939 (Feb. 20, 2013). This SSR is effective on March 22, 2013.

SSR 13-2p will replace the 1996 EM-96-200, which has been repeatedly extended over the years. The ruling issued last week states that "This SSR obsoletes EM 96-200."; moreover, it rescinds and replaces SSR 82-60.
In my practice, I often worry that the mere occasional use of these substances by claimants could negatively affect their cases. Fortunately, the new ruling clarifies that mere occasional use is not sufficient to deny benefits and it clarifies in order for the SSA to consider the use of drugs and/or alcohol in a case, the claimant must have a "medically determinable addiction" to alcohol or drugs. Specifically, the new ruling states that "A claimant’s occasional maladaptive use or a history of occasional prior maladaptive use of alcohol or illegal drugs does not establish that the claimant has a medically determinable" addiction.
The Ruling gives a step by step analysis to determine whether a claimant is disabled if the Claimant has struggled with addiction. Below is a decisional outline explaining SSA’s DAA evaluation process:
1. Does the claimant have DAA?

a. No—No DAA materiality determination necessary.

b. Yes—Go to step 2.

2. Is the claimant disabled considering all impairments, including DAA?

a. No—Do not determine DAA materiality. (Denial.)

b. Yes—Go to step 3.

3. Is DAA the only impairment?

a. Yes—DAA material. (Denial.)

b. No—Go to step 4.

4. Is the other impairment(s) disabling by itself while the claimant is dependent upon or abusing drugs or alcohol?

a. No—DAA material. (Denial.)

b. Yes—Go to step 5.

5. Does the DAA cause or affect the claimant’s medically determinable impairment(s)?

a. No—DAA not material. (Allowance.)

b. Yes, but the other impairment(s) is irreversible or could not improve to the point of nondisability—DAA not material. (Allowance.)

c. Yes, and DAA could be material—Go to step 6.

6. Would the other impairment(s) improve to the point of nondisability in the absence of DAA?

a. Yes—DAA material. (Denial.)

b. No—DAA not material (Allowance.)

For the complete text of SSR 13-2p visit: