Recently, the Social Security Administration (SSA) issued a new ruling, Social Security Ruling (SSR) 13-2p concerning how it will evaluate social security disability cases involving drug addiction and alcoholism (DAA). Ruling 13-2p is quite lengthy, overlapping, sometimes unclear, and heavy on detail. It represents bureaucracy at its finest.
For those applying for social security disability, and who have or recently used or abused alcohol or drugs, whether legally prescribed or not, you need to be familiar with this Ruling. At the heart of the Ruling, is a discussion of materiality as it relates to your DAA usage or recent past usage.
That is, if the SSA finds that your DAA is material to your disability claim, then you might not be approved for disability benefits. If your DAA usage is not material then the DAA is essentially irrelevant to whether you are disabled or not.
In such cases, when your DAA is not material, then the SSA will look at all of your other conditions and these will either establish your disability or not – wholly apart from your DAA usage. The real fun of this Ruling comes in weeding through how, when, and by whom the materiality decision is made. While it is impossible to summarize the entire multi-page Ruling here, the following are some basic concepts.
First, perhaps the most fundamental is that the SSA must look at whether there is sufficient evidence of DAA. If not, then the DAA cannot be material to your case and, thus no further consideration is given to the DAA issue.
Role of DDA
Second, if SSA finds that DAA is an issue, then SSA must look at your entire situation, that is they must look at all of your physical and mental conditions, including the DAA. If, after considering all of that, you would not meet SSA’s test of disability, then you are denied benefits. In such a situation, the DAA makes no difference.
If, however, you meet the test of disability when considering all of your conditions, including the DAA, then SSA must, in essence re-evaluate your claim a second time, but this time focusing on what role the DAA plays in your disabling condition. Of course, if DAA is your only disabling condition, then you are denied benefits because the DAA is material to your case.
Third, SSA looks to see whether all of your other (non-DAA) conditions are disabling all by themselves, even while you are dependent upon or abusing drugs or alcohol. If they are not, then the DAA is material and no benefits are awarded. If the other conditions are disabling on their own then the SAA moves to the next step.
Causes of Impairments
Fourth, SSA asks whether the DAA causes or affects your other impairments. If your DAA has no effect on the other impairments, then the DAA is not material and SSA will grant benefits. On the other hand, if your DAA either causes or affects your other impairments, then SSA moves on to the final step.
One important note here is that if the DAA causes a condition that is irreversible or could not improve to the point of non-disability in the absence of the DAA, then benefits may be allowed. For example if the DAA resulted in an irreversible condition that was deemed disabling such as cirrhosis of the liver, permanent encephalopathy, peripheral neuropathy, etc., a disability will likely result.
Possibility of Improvement
Fifth, if SAA finds that the DAA causes or affects your other impairments, then SAA needs to determine whether the other impairments would improve to the point of making you not disabled if there were no drugs and/or alcohol abuse.
Simply stated, if there was no DAA, would you still be disabled? If you would be, then you will be approved for benefits. On the other hand if removing DAA from the picture makes you otherwise not-disabled (i.e., able to engage in full time work activity), then you will not be found disabled.
Accompanying this analysis are Ruling provisions about who can make the DAA determination, what constitutes DAA, how much abstinence is enough, how much usage is enough, what opinion evidence is allowed, etc.
My recommendation is that if you are facing a social security disability claim in Pennsylvania, and if drug and alcohol abuse is or may be part of your claim, you should seek legal counsel as soon as possible. The Pennsylvania social security disability lawyers at Trinity Law are ready to assist you now. Contact us today for help.