How Substance Abuse Could Affect a Claim

The Social Security Administration (SSA) can deny a claim for disability benefits if they believe that substance use is a contributing factor material to the applicant’s disability.

SSA issued a Policy Interpretation Ruling on February 20, 2013 to help clarify SSA’s role in evaluating cases involving drug addiction and alcoholism (DAA).[i]  SSA will first determine whether the claimant has a DAA, such as marijuana abuse. Next, SSA will consider whether the claimant is disabled considering all of the alleged impairments, including substance abuse. When SSA finds that substance abuse is one of the impairments, the evaluation becomes whether the applicant would still be disabled if he or she stopped abusing that substance.[ii]

Importantly, at the initial application level, it’s important to be cautious about information relayed that may not be relevant or necessary to a disability claim. While an applicant must be truthful in his or her application, we have found that oftentimes applicants will include substance abuse as a “disability” on their application when such use may have only been in the past and may not be material to their disability. In fact, even if DAA actually caused the medical condition or disability, it doesn’t automatically follow that such use is material to the disability. For example, alcoholic hepatitis or liver failure can be caused or worsened by alcohol use. However, SSA must first go through the above evaluation to determine essentially whether the individual would still be disabled if he or she were to altogether stop abusing alcohol; and, if the answer is “yes” that the individual would still be disabled, then alcohol abuse is not considered “material” to the individual’s disability, and he or she still may be eligible to receive disability benefits.

Furthermore, we have found that when the individual’s disability includes mental or psychiatric conditions, he or she may have a more difficult time showing that substance abuse is not a contributing factor material to their disability. This is the case because DAA can come in the form of stimulants and depressants – causing individuals to exhibit many of the same symptoms that are manifested by individuals with mental or psychiatric disabilities like depression, anxiety, or bipolar disorder to name a few. Nevertheless, even with ongoing use, doctors and mental health specialists can sometimes discern whether an individual’s DAA is material. Our attorneys draft both Physical and Mental Residual Functional Capacity Questionnaires for our client’s treating physicians and specialists to complete that can help SSA understand not only the claimant’s limitations, but also whether DAA is material to his or her disability. These Questionnaires become additional evidence that can help result in a favorable outcome for our clients. To talk with one of our Social Security Disability attorneys, and schedule a free consultation, call us at (888) 678-5839.

[i] See SSR 13-2p. This Ruling rescinds and replaces SSR 82-60 “Titles II and XVI: Evaluation of Drug Addiction and Alcoholism.”

[ii] In other words, SSA will determine whether DAA is “material” to the finding of disability in that case. 20 CFR 404.1535 and 416.935.

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