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a.
AR 98-4(6) must be considered when an adjudicator is deciding a subsequent disability
claim with an unadjudicated period arising under the same title of the Act as a prior
disability claim and there was a decision by an ALJ or the AC on the prior disability
claim that has become final. DAA redeterminations under Public Law (P.L.) 104-121
and SSI childhood disability redeterminations under P.L. 104-193 are considered subsequent
claims (and not continuing disability determinations) for purposes of AR 98-4(6).
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b.
See DI 52705.010B.1.b. for a description of the findings to which the requirements for adopting findings
applies under the AR in adjudicating subsequent SSI childhood disability claims, including
SSI childhood disability redeterminations under P.L. 104-193.
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c.
Under AR 98-4(6), the same rules and procedures apply to DAA cases as to any other
cases. However, when it is determined that an individual with DAA (including a child
under supplemental security income (SSI)) is disabled considering the effects of DAA,
a second determination must be made whether DAA is material to the finding of disability.
(See DI 90070.050 and 20 CFR 404.1535 and 416.935 of the regulations.)
Adjudicators must use a two-part process:
First, they must follow the sequential evaluation process, considering all of a claimant's
impairments, including DAA, to determine whether the claimant is disabled.
Second, if the claimant is found disabled under the first part of the process, adjudicators
must again follow the sequential evaluation process, but without considering the effects of the DAA, to determine whether the claimant would be found
disabled if he/she were no longer using drugs or alcohol.
If the individual would not be found disabled under the second part of the process,
DAA is material to the determination of disability. If the individual would be found
disabled, DAA is not material. Thus, when there is a prior final decision in which:
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•
The ALJ or the AC made findings required at steps in the sequential evaluation process
and found that an individual with DAA is disabled, considering the effects of the
DAA, and
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•
The ALJ or the AC made separate findings following the steps of sequential evaluation
by considering the individual's condition without considering the effects of the DAA
to decide whether DAA was material to the determination of disability,
Then adjudicators must consider the findings from both parts of the two-part DAA process
when adjudicating a DAA case (applying the same two-part process) under the requirements
of AR 98-4(6).
A conclusion that DAA "is material" or "is not material" is not a finding that is
required at a step in the sequential evaluation process provided under 20 CFR 404.1520,
416.920 or 416.924 for purposes of AR 98-4(6). Rather, it is a conclusion that results
from the two-part process described above. When an ALJ or the AC has stated a conclusion
in the prior decision that DAA was material, or that DAA was not material to the determination
of disability, but has not set out findings showing how this conclusion was reached
under the second part of the process, there will be no findings that are relevant
to the decision whether an individual's DAA is material to the determination of disability.
However, adjudicators must still consider whether to adopt findings from the ALJ's
or AC's determination about whether the individual is disabled under the first part
of the DAA process.
EXAMPLE 1: A claimant with alcohol dependence and a back condition was found disabled by an
ALJ in the prior decision. The ALJ found that the claimant was not working and had
a combination of impairments that was "severe", but that no impairment(s) met or equaled
any listing. Based on an RFC assessment and a finding about the demands of the claimant's
past relevant work, the ALJ found that the claimant could not do past relevant work.
The ALJ found that the claimant was disabled at step 5 of the sequential evaluation
process based on the finding of RFC and on the ALJ's findings about the claimant's
age, education, and work experience. The ALJ then applied the second part of the DAA
process and made a finding that, if the claimant were no longer using alcohol, the
only impairment would be the back impairment, which would be "not severe" at step
2 of sequential evaluation. Therefore, the ALJ decided that DAA was material to the
determination of disability.
If there is no new and material evidence, the DDS must adopt the findings required
at steps 1 through 5 of the sequential evaluation process which were made by the ALJ,
and which resulted in the ALJ's prior decision that the claimant was disabled considering
both the DAA and the back impairment. The ALJ also made a finding required at a step
in the sequential evaluation process (step 2 of sequential evaluation) that the claimant
would not have a "severe" impairment if the effects of alcohol dependence were not
considered. If, assuming that there is no new and material evidence about that finding,
the DDS must also adopt it. The conclusion resulting from the finding--that DAA was
material to the determination of disability--is not a finding required at a step in
the sequential evaluation process and the DDS is not required to adopt it, although
in this case the DDS will conclude that DAA is material based on the findings it is
required to adopt.
EXAMPLE 2: Given the same facts as in Example 1, an ALJ made the same findings at steps 1 through
5 of the sequential evaluation process that resulted in the conclusion by the ALJ
that the claimant was disabled considering the DAA and the back impairment. However,
instead of making additional findings about the claimant's impairment if the effects
of DAA were not considered, the ALJ stated only "DAA material" in the decision.
In this case, and assuming that there is no new and material evidence, the DDS must
still adopt the findings required at steps 1 through 5 of the sequential evaluation
process that were made by the ALJ and that resulted in the ALJ's prior decision that
the claimant was disabled considering both the DAA and the back impairment. However,
the ALJ's decision did not include findings for the determination whether DAA was
material in the second part of the DAA process. Therefore, there are no findings for
the DDS to adopt regarding the second part of the DAA process. Again, the conclusion that DAA was material to the determination of disability is not a finding required
at a step in the sequential evaluation process provided under 20 CFR 404.1520, 416.920
or 416.924, and the DDS is not required to adopt it.
NOTE: In the examples above, it is important to remember that a finding described in DI 52705.010B.1.a. or DI 52705.010B.1.b, as appropriate, which is contained in a final ALJ or AC decision on a prior claim
will not be adopted if either: (1) there is new and material evidence relating to
the finding; or (2) there has been a change in the law, regulations or rulings affecting
the finding or the method for arriving at the finding.