Social Security is prohibited by law from awarding disability benefits to claimants for whom drug and/or alcohol abuse (DAA) is a material factor in their disability.
In order to make the determination of materiality, Social Security promulgated an administrative ruling, known as SSR 13-2p.
This ruling sets forth in painstaking detail the circumstances in which a determination of materiality is made.
However, I will attempt to explain this determination in the simplest possible terms, although there are many nuances I will not cover in this post.
In order to find DAA material, the person must first be found “disabled.” (If a person is found “not disabled”, then there is no need to determine whether or not DAA is material).
Then a determination is made whether or not the person would remain disabled in the absence of substance abuse.
If the answer is “no”, then DAA is material. This results in a denial of the claim.
If the answer is “yes”, then DAA is not material. A favorable decision is made.
In determining presence of substance abuse, social security looks at a wide variety of medical and non-medical evidence.
Oftentimes with substance abuse, there are behavioral health issues as well. It is sometimes necessary for social security examiners to purchase a Consultative Exam from a specialist in order to sort out the DAA issues.
In determining whether or not substance abuse is material, periods of abstinence are illuminating. If a claimant has a lengthy period of abstinence in which his functioning is still extremely low, this may tend to show that disability persists even in the absence of DAA.
These are difficult issues. It is important for claimants to seek treatment for substance abuse and to stay clean when pursuing a disability case, although that sounds preachy and is easier said than done. But substances abuse can really muddy the waters in disability cases, as evidenced by the complexity of the rules regarding determining whether or not DAA is “material.”
Because Social Security’s rules and regulations are difficult to navigate, it is often best to consult with an experienced attorney when pursuing a disability case.
This material should not be construed as legal advice for any particular fact situation, but is intended for general informational purposes only. For advice specific to any individual situation, an experienced attorney should be contacted.