Social Security attorney Jeffrey Scholnick explains the six steps that are taken when evaluating disability benefits cases in which drug addiction or alcoholism is involved.
When examining the process for receiving Social Security disability benefits, there are numerous factors that administrators consider before granting or denying benefits to an applicant. Throughout the past two decades, there has been one area of concern in the application process that has sparked significant controversy and confusion – drug and/or alcohol abuse.
There is a common misconception that disability benefits can be granted to an applicant based solely on the diagnosis of drug addiction or alcoholism (DAA). Yet, another common misconception is that a person with a history of substance abuse is automatically ineligible for such benefits and will never be approved. In general, an individual who was or is addicted to drugs or alcohol may be approved for disability benefits, but only if Social Security determines that the individual would still be disabled if he or she was not still using drugs or alcohol.
However, because cases that involve DAA are often extremely complex and unique, the Social Security Administration (SSA) addresses the six questions below, known as the DAA Evaluation Process, to determine the appropriate course of action for each DAA case presented before officials.
- Does the applicant legitimately have DAA? If the applicant cannot produce a record of past or current substance abuse, no further DAA determination is required. However, if the applicant or his or her attorney proves that there is a history of abusing illegal substances, such as cocaine and heroin, or prescription drugs, such as opioids, depressants, and stimulants, then the case will most likely proceed to step two.
- Do the applicant’s impairments, including DAA, qualify him or her as “disabled?” Social Security defines a disability as “the inability to engage in any substantial gainful activity (SGA) by reason of a 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.” If the applicant’s disability does not meet these standards, then the case will likely be denied. Otherwise, the case will proceed to step three.
- Is DAA the sole impairment? If drug addiction or alcoholism is the applicant’s only impairment, the case will be likely denied as benefits are not granted solely on such diagnosis. If one or more additional impairments are present, then the case will proceed to step four.
- Are the non-DAA impairments disabling by themselves or is DAA the cause? The SSA must determine if the non-DAA impairments are disabling exclusively or if they are the root of the disability. The claim will probably be denied if additional impairments are not severe enough to the point of disability by themselves or if the applicant would not be disabled but for DAA. Otherwise, the case would proceed to step five.
- Does DAA cause or effect the applicant’s medically determinable impairment? An applicant will have a greater chance of being approved for benefits if the SSA concludes that an additional impairment is disabling even in the absence of DAA. The DAA is immaterial, so the case would likely proceed to step six.
- Would the other impairment improve to the point of non-disability in the absence of DAA? In order to prevent automatic ineligibility, the SSA must be able to determine that the other impairment would not be affected if DAA becomes absent. Determining whether or not DAA is a triggering factor in cases involving mental impairments have been historically difficult to prove. As a result, a medical professional, such as the applicant’s psychiatrist or psychologist, must document any effects that occur or would occur if DAA was not present. If it is found that the impairment would improve and would not preclude the applicant’s ability to work without DAA, then the case would likely be denied.
Remember, every applicant’s case is different, regardless of whether the same addiction is applicable. Seeking guidance from a social security attorney is advantageous for these cases as they will have a thorough understanding of the laws governing Social Security disability benefits, as well as the best practices to increases the likelihood of approval for your specific disability case.
For more information on drug and/or alcohol abuse and its impact on Social Security disability benefits, contact Maryland Social Security attorney Jeffrey Scholnick today.