The Possible Effect of Drug or Alcohol Abuse on a Disability Claim

Whenever a claim for Social Security Benefits under Title II or Title XVI is being evaluated, the Administrative Law Judge must be aware of possible “DAA” materiality on the claim. DAA stands for drug and alcohol abuse. Prior to 1996, a claimant could receive benefits based upon “DAA” (Drug Addiction or Alcoholism) with the conditions that benefits would be paid to a “representative payee” who would manage the funds, that the claimant enter a mandatory treatment program, and that their benefits would be limited to threes.


In 1996, however, Congress enacted the “Contract with America Advancement Act of 1996”, Public Law 104-121. Section 105 provides that "an individual shall not be considered to be disabled ... if alcoholism or drug addiction would ... be a contributing factor material to the Commissioner's determination that the individual is disabled."


The Social Security Administration has acknowledged that there are no exact criteria for when drug addiction and alcoholism are present. However, some courts have concluded that an actual diagnosis of a substance abuse disorder is not required, only that there is some evidence to support a finding of DAA.


The key factor Judges look to in determining whether drug addiction or alcoholism is a contributing factor material to the disability is whether the claimant would still be disabled if he or she stopped using drugs or alcohol. In making that determination, the Judge evaluates whether the claimant’s current physical or mental impairments would remain if the claimant stopped using drugs or alcohol and whether any of the remaining conditions would be disabling. If the impairments would still remain and would be disabling, then the DAA is not a contributing factor.


In order to be a contributing factor to the disability, however, the claimant must be currently abusing drugs or alcohol. The law does not apply to claimants who have stopped using drugs or alcohol. The Social Security Administration considers a one-month period of abstinence to be a sufficient period of time to observe whether the absence of drugs or alcohol has affected the claimant’s condition.


Credibility is always of major importance in disability cases, but it is especially important when a claimant states that the disability is independent of the drug or alcohol abuse. Judges often give great weight to the opinions of the claimant’s treating physicians in their determinations. Thus it is very important for claimants to be truthful about their drug or alcohol abuse. If a doctor feels that their patient is not being truthful, that opinion may appear in their treatment notes. And Judges will review those notes before the hearing. If a Judge suspects that the claimant has not been truthful in the past, the chances of being awarded disability benefits will be severely damaged.

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Disability Benefits and the Diabetes Listing

Disability Benefits and the Diabetes Listing

by Rachel Slocombe

It is important to have a disability attorney handle your claim for disability benefits because disability attorneys understand the way claims are analyzed by a judge. Claims are decided per a five-step sequential analysis. One way a claimant can win disability benefits is on the third step of the analysis. At this step, the claimant’s disability is compared to Social Security’s listing of impairments. If the claimant’s condition rises to the level of severity described in the listings, the claimant will win. Disability attorneys work with the listings on a daily basis and understand what is necessary in order to satisfy them.

In order to be found eligible for disability benefits per Social Security’s listing for diabetes (9.08), an adult claimant must establish:

A. Neuropathy demonstrated by significant and persistent disorganization of motor function in two extremities resulting in sustained disturbance of gross and dexterous movements, or gait and station (see 11.00C); or
B. Acidosis occurring at least on the average of once every 2 months documented by appropriate blood chemical tests (pH or pC02 or bicarbonate levels); or
C. Retinitis proliferans; evaluate the visual impairment under the criteria in 2.02, 2.03, or 2.04.

Neuropathy
Neuropathy is considered disabling if it causes severe and lasting limitations in the use of the hands, arms, legs or feet. The listing uses the language “persistent disorganization of motor function.” This can be attributed to paralysis, tremor, ataxia, sensory disturbances, or any other involuntary movements. Whether or not the interference is enough to satisfy the requirements of the listing depends on the degree to which the impairment interferes with the claimant’s ability to ambulate effectively or use his/her fingers, hands and arms. Also, according to the language of the listing, two extremities must be involved.

Acidosis
The claimant must suffer from acidosis on average at least every two months, and this acidosis must be established by the chemical tests described in the listing. It is also important to note that if a claimant suffering from acidosis is not following a prescribed course of treatment in order to regulate his/her diabetes, he/she will have difficulty satisfying the listing. Well controlled diabetes is not a disabling condition, therefore, a claimant must at least try to regulate his or her condition through medical treatment. If the condition cannot be regulated in such a way despite a claimant’s best efforts to treat the condition, then the condition may rise to the level described in the listing.

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