How Does Drug and Alcohol Use Affect a Disability Claim?

Sometimes the Social Security Administration (SSA) can use the fact that you drink or use drugs as a reason to ignore your disabling symptoms and limitations and deny your claim. In other cases, however, it is possible to get disability benefits even if you drink or use drugs.

Whether drug or alcohol use will affect your eligibility for disability benefits hinges on whether it contributes to your disabling medical condition. If your drug or alcohol abuse is deemed a material contributing factor to a medical impairment, you will not be awarded disability benefits based on that impairment. Materiality is determined by asking these questions: Is the medical condition for which the claimant alleges disability exacerbated – or caused – by alcohol or drug use? Would the medical condition improve enough not to be disabling if the claimant stopped using drugs or alcohol? If the answer to these questions is yes, your drug or alcohol use will be considered material to the alleged impairment, and you may be found ineligible to receive disability benefits.

For example, if a claimant has seizures, and the records indicate substance abuse, a claims examiner or judge (depending on the level the claim is at) will question what role is played by the claimant’s use of substances. If the SSA thinks that a claimant’s seizure condition would medically improve if the substance use came to an end, then the substance use would be labeled as material to the seizure condition. As a result, the claimant could not be awarded benefits on the basis of seizure disorder. If, however, the conclusion was made that the claimant’s frequency of seizures would continue regardless of whether or not the alcohol or drug use was discontinued, such use would be considered immaterial.

It does not matter whether past alcohol or drug abuse caused the medical condition. Another example: a claimant applies for Social Security disability based on liver dysfunction and alcoholic hepatitis. The claimant has a history of alcohol abuse, some of it recent. Will the alcohol abuse harm the claimant’s disability case? It depends on whether or not it is currently material to his condition. It doesn’t matter whether the alcohol abuse caused the liver damage in the first place. What matters is whether the disabling condition would disappear if the claimant stopped drinking. If the claimant’s liver damage is so pronounced that ceasing alcohol use completely would make no difference to the claimant’s medical condition, then alcohol abuse would be considered immaterial, or irrelevant, to the case. If, however, ceasing the use of alcohol would result in medical improvement, alcohol abuse would be deemed material to the disability case, and the claim would be denied.

This evaluation process is called a drug and alcohol abuse (DAA) determination. Of course, if the claimant has another medical condition, one that’s severely debilitating and completely unrelated to the one caused by or exacerbated by drugs or alcohol, he or she could get disability benefits based on that condition, regardless of drug or alcohol use.

Claimants whose disabling conditions are psychiatric or emotional in nature (for example, depression or anxiety) will have a harder time proving that their alcohol or drug use is not a contributing factor to their mental impairment. Most psychologists and psychiatrists believe that even moderate alcohol use contributes to depression.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

See: https://www.ssa.gov/OP_Home/cfr20/416/416-0935.htm ; https://www.ssa.gov/OP_Home/rulings/di/01/SSR2013-02-di-01.html

By: Joyce Trudeau of Premier Disability Services, LLC^®

February is American Heart Month

Heart disease is the leading cause of death in the United States. Fortunately, it is largely preventable (see links below for heart health tips). If you suffer from a heart condition, you may be eligible for Social Security Disability benefits. Certain impairments are considered severe enough by themselves to warrant a finding of disability based solely on your condition. These are Social Security’s “Adult Listings” for disability. The most common Listings for heart conditions are:

• Aneurysm of the Aorta or Major Branches. Regardless of the cause, you will be considered disabled if appropriate medical imaging confirms an aneurysm of the aorta or any major branch.
• Chronic heart failure. To qualify for disability benefits, your condition must have systolic or diastolic heart failure. Additionally, your heart conditions must fall within given parameters while it is stable. Additionally, you must meet one of the following conditions: Poor performance on an exercise tolerance test, two or more occurrences of heart failure within one year (must have fluid retention and require hospitalization), or symptoms which would limit your ability to work and which would suggest that an exercise test would present a danger to you.
• Chronic Venous Insufficiency. You will be considered disabled if you have an obstruction and meet one or more of the following: brawny edema which involves 2/3 or more of your leg from the knee to the ankle or 1/3 from your ankle to your hip OR persistent or recurrent ulcerations which fail to heal after being treated for three months.
• Heart Transplant. You will automatically be considered disabled for at least one year after a heart transplant.
• Ischemic Heart Disease. To qualify for disability benefits, you must meet one or more of the following: Coronary artery disease (this requires an angiography, medical imaging, and either an exercise test or medical documentation showing why an exercise test would be too dangerous to your health), three distinct ischemic episodes, with each of them needing revascularization (or in which revascularization is not possible), or an exercise test which shows that you fall within the SSA’s guidelines for complete disability.
• Peripheral Artery Disease (PAD). Must be shown by medical imaging and fall within the SSA’s guidelines for your blood pressure.
• Recurrent Arrhythmia. To qualify for disability benefits based on recurring arrhythmias, the medical evidence must show that the condition is not reversible and that it results in near-syncope or syncope.
• Symptomatic Congenital Heart Disease. For symptomatic congenital heart disease, the SSA considers evidence from medical imaging or a heart catheter. They will look to see whether your hematocrit levels and O2 saturation meet with their criteria. You may also qualify if you have right to left shunting or if your systolic pressure is significantly elevated (70% of systemic or higher)

Even if your heart condition does not meet one of the Listings above, you may still qualify for disability benefits if your impairments have – or are expected to – put you out of work for one year or longer. The Social Security Administration will consider whether your conditions prevent you from returning to your past work or any other work available in the regional or national economy.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

Adult Listings for cardiovascular impairments: https://www.ssa.gov/disability/professionals/bluebook/4.00-Cardiovascular-Adult.htm

Tips for heart health: https://www.webmd.com/a-to-z-guides/prevention-15/heart-healthy/12-tips-for-better-heart-health ; https://www.healthline.com/health/healthy-heart-tips ; https://www.heartfoundation.org.au/your-heart/keep-your-heart-healthy ; https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-healthy-diet/art-20047702 ; https://www.health.harvard.edu/healthbeat/10-small-steps-for-better-heart-health

By: Joyce Trudeau of Premier Disability Services, LLC^®

How Can I Speed up my Disability Claim?

There are certain situations which require the Social Security Administration (SSA) to make fast disability decisions. The process of applying for and getting Social Security disability is lengthy, and it can take up to two years – or longer – to get a final decision. Fortunately, there are a few types of claims called “critical cases” that the Social Security Administration will process quickly.

• Dire Need: If a claimant does not have the resources to get food, medicine, or shelter, the SSA will treat the claim as a critical case. The SSA will not immediately label the file of every claimant who alleges financial hardship as a “dire need” case because it would prevent them from being able to help the most serious cases. Therefore, if you request that your claim be treated as a “dire need” case, you should provide the SSA with as much evidence as possible to support your statements.
• Personal or Public Safety: If there is evidence that a claimant is suicidal or homicidal, the SSA will expedite the claim. This evidence may come from the claimant, treating physicians, family and friends, law enforcement, or SSA employees. If it is determined that a claimant is a threat to either him or herself or to others, the SSA will contact the appropriate authorities immediately to ensure everyone’s safety.
• Terminal Illness: The SSA will also expedite claims based on a terminal illness. The SSA calls these claims “TERI” cases. Because of the sensitive nature of TERI cases, the SSA will never mark or note the case as “terminal” in the file. The SSA may identify a claim as terminal based on doctors’ statements, certain diagnoses, if the claimant has an ongoing need for life support, is on a transplant wait-list, has been in a coma longer than 30 days, has certain cancers or cancer that has metastasized, is at stage IV, recurs after treatment, or is inoperable. Other terminal conditions may also qualify as a TERI case.
• Military Service Personnel: The SSA will expedite disability claims filed by military service personnel for injuries or illnesses that developed on or after October 1, 2001. The claimant does not need to be a current service member, but the disability must have begun while the claimant was on active duty.
• Compassionate Allowances: Some medical conditions may qualify for what the SSA calls a “compassionate allowance” (CAL). CAL conditions are so severe that they are almost always immediately approved under the SSA’s Listing of Impairments. The SSA requires minimal objective medical evidence for some CAL conditions and will sometimes grant approval based on a diagnosis alone. This makes it easier to approve these claims quickly, sometimes in as little as ten days. There are currently over 100 CAL conditions currently recognized by the SSA, including pancreatic cancer, ALS, and malignant multiple sclerosis.

If you or someone you know is unable to work due to a medical condition, please contact us for a free evaluation of your claim!

By: Joyce Trudeau of Premier Disability Services, LLC^®