Drugs, Alcohol and Benefits Claims

I AM AN ALCOHOLIC. ISN'T THAT AN ILLNESS? SO WHY CAN'T I GET SSI?

Hardly a week goes by that we do not hear this when we tell a person that we cannot represent him or her because there is no way we can win. We realize that most people who want to apply for Social Security benefits do not understand this. Right now, you are probably wondering - Why not? After all I am disabled. Unfortunately, most people just assume that we do not know what we are doing and decide to go elsewhere for help. But the law was not passed just to deny people disability benefits because of alcohol and/or drug addiction or abuse. In a nutshell, the law states that if SSA determines that a claimant is disabled but that drug abuse or alcoholism (DA&A) is a contributing factor material to a claimant's disability determination, the claimant cannot be found disabled and receive benefits.

This is not just difficult for a claimant to accept. It is also very difficult for an attorney who has looked at all the evidence and listened to the claimant's story, and based on this, as well as how SSA must go about in deciding whether the individual is disabled, legal definitions, and the processes and considerations SSA must go through in making a materiality determination before deciding that the individual's claim cannot (in the attorney's opinion) be decided favorably. As attorneys, we often become a target of the individual's wrath upon hearing this news, as if we were the ones who made this law.

Put into simple terms, this means that the disability would not be there if the person did not abuse alcohol and/or drugs, and if the claimant stopped drinking alcohol or abusing illegal drugs, he/she would no longer be disabled. In other words, alcohol and or drug abuse is something that can be eliminated if you would just said "No to drugs and alcohol." The fact that there are organizations such as AA or NA that will help people stay clean and help them to acknowledge their problem and provide them with the necessary support to rid themselves of their addictions. While that may be a simplification of the problem, the law does not account for how difficult it may be or how long it may take. The disability process looks at only whether a person is disabled. Everything else is a secondary issue.

For example, when a claimant admits to alcoholism or drug addiction, and one or both these are the only impairments the claimant has, and the medical evidence supports this, it is a simple decision for SSA. The claimant is not going to be receiving disability benefits or medical coverage. When there other impairments exist and the claimant's DA&A problem is a factor, then the decision making gets more complicated. Most people seeking disability have either physical or mental impairments in addition to drug or alcohol abuse or addiction. In fact, many people do not follow a doctor's advice and self-medicate with drugs or alcohol because they feel it tends to ease pain or calm their minds.

When I said most people have other physical or mental problems in addition to their drug and alcohol, I am saying that even if you do abuse drugs or alcohol, you could still be found to be disabled and receive benefits. In some cases, the very idea that SSA could find that if you stopped drinking or using drugs you would no longer be disabled is just silly. Let us say that you have a severe back impairment, involving multiple surgeries before you were finally diagnosed with failed back syndrome.

The law says that SSA must first determine whether your condition is disabling before considering whether the abuse or addiction to drugs or alcohol is a contributing factor material to a claimant's disability determination. This means we would be glad to take your case because the hardest part of the case is proving that your back condition is disabling. And we are confident that modern medicine is proof enough to get past the drug and alcohol issue.

On the other hand, if you have only mental impairments, you are probably going to lose your case. This is because the principles of modern psychiatric practice will not allow your doctor to give a valid diagnosis of a specific mental condition if you are always under the influence of drugs and/or alcohol. And most psychiatrists and psychologists would consider your primary problem to be addiction related. They would have to be able to examine you after a period of sobriety of over a month before they could reach an opinion as to what your diagnosis would be. It is no surprise when a person can stay clean for a number of months and your doctor can evaluate your mental condition both in a clean state, and when you were under the influence of drugs or alcohol, that there is most often a great improvement after a period of sobriety. Even though I said you would probably lose a disability case such as this, some cases can still be won based on the doctor's opinion that whether or not you can stay clean, your mental condition is still disabling. These cases are quite difficult, and they demand that you have had a long-standing relationship with your doctor. This gives SSA the ability to verify how consistent your doctor is in evaluating your mental condition.

At this point, if you remember or understand anything I have said, please remember this — the key word is material. It is not enough for SSA to determine that a person's drug and/or alcohol abuse is a contributing factor to your disability, it must be a contributing factor material in the person's disability determination. For instance, if a person has cirrhosis of the liver, it could be easily determined that drugs and/or alcohol abuse is a contributing factor material in determining that you are disabled. But SSA could not find you disabled or pay you benefits because if you were to stop drinking alcohol and/or stop abusing drugs, your liver condition would probably stabilize. However, if your liver was no longer functioning and your doctor gave you maybe one more year before you died unless you got a liver transplant, it would not matter if you were drinking a quart of whiskey every day. This is because, even though your alcoholism is a contributing factor to your now useless liver, it is no longer material in your disability determination. So why is this? It is because your liver disease has passed the point of no return, and whether you continued to drink or stopped immediately you are going to die because you just cannot live without a liver.

The intent of this article is to simplify what the law and SSA's rules say about denying disability benefits to people who abuse drugs and/or alcohol to the point where it is a contributing factor material to a disability determination. I am sure I have oversimplified it is some cases, and did not get detailed enough in others. Contact the Law Offices of Ed Goldner & Associates for advice that addresses your specific situation.