DAA can cause or exacerbate the effects of a physical impairment(s). In some cases,
the impairment(s), and its effects, may resolve or improve in the absence of DAA.
We expect some physical impairments, such as alcoholic hepatitis or alcoholic cardiomyopathy,
to improve with abstinence. The DE may consider medical opinions from treating and
non-treating sources about the likely effects that abstinence may have on the physical
impairment(s). Usually, evidence from a period of abstinence is the best evidence
for determining whether a physical impairment(s) would improve to the point of non-disability.
The period of abstinence should be relevant to the period we are considering in case
(See SSR 13-2p, Question 6 b). This evidence need not always come from an acceptable medical source. We note these
sources in DI 22505.001.
If we are evaluating whether an individual's work-related functioning would improve,
we may rely on evidence from other medical sources, such as physician assistants or
nurse practitioners, and other sources, such as family members, who are familiar with
how the individual has functioned during a period of abstinence. (See SSR 13-2p, Question 6)
The MC/PC may use his or her knowledge and expertise to project improvement of a physical
impairment(s). Such improvement includes the changes that would occur in the symptoms,
signs, and laboratory findings for the substance use disorder if DAA were to stop.
(See SSR 13-2p, 6 c iii)
The MC/PC may not be able to project whether there would be more than minor changes
in the symptoms, signs, and laboratory findings for the physical impairment(s) if
DAA were to stop.
The MC/PC could conclude that there would be MI in the substance use disorder, but
no MI in the physical impairment(s).
The MC/PC should include in his or her findings an assessment of the changes that
would occur for the substance use disorder if DAA were to stop.
If the MC/PC is unable to determine whether there would be any, minor, or more than
minor changes in the impairment severity if DAA were to stop, he or she may advise
the DE to use the current CDR assessment of physical impairment(s) to determine that