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How Social Security looks at alcohol or drug use when applying for SSI or disability?

What are the standards used to evaluate drug and alcohol abuse in a Social Security or SSI disability setting? If an ALJ (Administrative Law Judge) determines a claimant is not disabled based upon drug and alcohol abuse ("DAA"), the ALJ must go through the normal five-step sequential evaluation process, find them either disabled or not disabled, and then make a specific finding that drug abuse or alcoholism is material to the claimant's disability. Susan O'Malley discusses substance abuse and its effect upon your disability application The standard for materiality is whether the claimant would still be disabled if s/he did not abuse drugs or alcohol. If the ALJ finds that the claimant's DAA is material to her disability, then he goes through the five-step sequential evaluation process again to determine what her RFC would be without the DAA. If, after going through the sequential evaluation process without the functional impairments caused by the DAA, the ALJ finds that the claimant would not be disabled, then they are not disabled. Put differently, if the ALJ finds that but for the claimant's DAA, they would not be disabled, they are not disabled under the below cited law. Basically if the ALJ makes a finding that the DAA is material to the claimant's disability more likely than not there will be a decision of no disability a loss unless you have very compelling evidence that she would be disabled regardless of the DAA.

LAW:  42 U.S.C. § 423(d)(2)(C):An individual shall not be considered to be disabled for purposes of this sub chapter if alcoholism or drug addiction would (but for this sub paragraph) be a contributing factor material to the Commissioner's determination that the individual is disabled.

SSR 82-60: "the principles underlying the adjudication of disability claims from drug addicts or alcoholics are the same as those underlying the adjudication of claims from other any individual.""Drug addicts or alcoholics cannot be considered "disabled" on the basis of that diagnosis alone; on the other hand, a diagnosis of drug addiction or alcoholism should not have an effect on a disability evaluation that is adverse to the applicant." "Where the definition of disability is met in a title XVI claim, and there is evidence of drug addiction or alcoholism, a determination must also be made as to whether the drug addiction or alcoholism was a factor material to the finding of disability for purposes of applying the treatment and representative payee provisions. In making this decision the key issue is whether the individual would continue to meet the definition of disability even if drug and/or alcohol use were to stop. If he or she would still meet the definition, drug addiction or alcoholism is not material to the finding of disability and the treatment and representative payee provisions do not apply. The drug addiction and alcoholism requirements are imposed only where (1) the individual's impairment(s) is found disabling and drug addiction and/or alcoholism is a contributing factor material to the determination of disability, and (2) the same impairment(s) would no longer be found disabling if the individual's drug addiction or alcoholism were eliminated, as, for example, through rehabilitation treatment"

See also, 20 C.F.R. § 416.935 - How we determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability. (a) General. If we find that you are disabled and have medical evidence of your drug addiction or alcoholism, we must determine whether your drug addiction or alcoholism is a contributing factor material to the determination of disability, unless we find that you are eligible for benefits because of your age or blindness.(b) Process we will follow when we have medical evidence of your drug addiction or alcoholism. (1) The key factor we will examine in determining whether drug addiction or alcoholism is a contributing factor material to the determination of disability is whether we would still find you disabled if you stopped using drugs or alcohol.(2) In making this determination, we will evaluate which of your current physical and mental limitations, upon which we based our current disability determination, would remain if you stopped using drugs or alcohol and then determine whether any or all of your remaining limitations would be disabling.(i) If we determine that your remaining limitations would not be disabling, we will find that your drug addiction or alcoholism is a contributing factor material to the determination of disability.(ii) If we determine that your remaining limitations are disabling, you are disabled independent of your drug addiction or alcoholism and we will find that your drug addiction or alcoholism is not a contributing factor material to the determination of disability.

CASE Law

In other words, if, and only if, an ALJ finds a claimant disabled under the five-step disability inquiry, should the ALJ evaluate whether the claimant would still be disabled if he or she stopped using drugs or alcohol. Bustamante v. Massanari, 262 F.3d 949, 955 (9th Cir.2001).

In social security disability case, ALJ was required to make disability determination based on the five-step sequential evaluation without segregating out any effects that may have been due to claimant's substance abuse, and only upon finding that claimant was disabled, was ALJ to evaluate claimant's disability in accordance with regulation detailing how Commissioner was to evaluate if substance abuse is material in determining disability. Welch v. Barnhart, E.D.Mo.2005, 355 F.Supp.2d 1008

Claimant's drug and alcohol abuse did not preclude a grant of social security disability benefits, where his severe schizophrenia was independently disabling. Johnson v. Astrue, 2007, 493 F.Supp.2d 652.

Claimant's drug and alcohol abuse did not preclude a grant of social security disability benefits, where his severe schizophrenia was independently disabling. Johnson v. Astrue, 2007, 493 F.Supp.2d 652.

On Treatment (or lack thereof):

Evidence that Social Security claimant was told by treating physician that her psychological status was probable reason for some of her blackouts and that best way to treat them was for her to continue in drug treatment and stop smoking marijuana did not indicate that claimant would not suffer from psychological impairments if she stopped using drugs or alcohol, and was therefore insufficient to support finding that claimant's drug addiction was contributing factor material to determination of disability, as required for her addiction to serve as grounds for partial denial of benefits. 20 C.F.R. §§ 404.1535(b)(1), 416.935(b)(1). Boehm v. Chater, S.D.Iowa1997, 969 F.Supp. 31

Administrative law judge's (ALJ) determination that claimant's depression was related to his abuse of alcohol, and thus did not support claim for supplemental security income (SSI) benefits, was supported by examining physician's report that claimant had "depressive symptoms which may be related to past alcohol use," where claimant failed to prove that he would continue to suffer from depression if he quit drinking. Social Security Act, §§ 223(d)(2)(C), 1614(a)(3)(J), as amended, 42 U.S.C.A. §§ 423(d)(2)(C), 1382c(a)(3)(J); 20 C.F.R. §§ 404.1508, 416.935(b)(1). Austin v. Massanari, W.D.La.2001, 162 F.Supp.2d 517

If the process for determining whether a social security disability claimant's substance use disorders are a contributing factor material to the determination of disability proves indeterminate, an award of benefits must follow. Social Security Act, § 203(d)(2)(C), 42 U.S.C.A. § 423(d)(2)(C); 20 C.F.R § 404.1535. Brueggemann v. Barnhart, C.A.8 (Mo.)2003, 348 F.3d 689  [TIE GOES TO THE CLAIMANT]

If you have any questions regarding whether you or a close friend or family member is disabled, feel free to call Amos Waranch for his excellent research for this post.

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