TN 1 (09-14)

DI 90070.050 Adjudicating a Claim Involving Drug Addiction or Alcoholism (DAA)

Citations: Public Law 104-121;

Section 223(d)(2)(C) and 1614(a)(3)(J)
of the Social Security Act, as amended;

20 CFR 404.1512, 404.1513, 404.1520,404.1520a, 404.1520b, 404.1535, 404.1560, and 416.912, 416.913, 416.920, 416.920a, 416.920b, 416.935, 416.960

SSR 13-2p

A. Determining disability in a DAA claim

We do not consider a claimant disabled if drug addiction or alcoholism (DAA) is a contributing factor material to the determination that the claimant is disabled. For more information on the definition of DAA, see Section 105 of Public Law 104-121 and Sections 223(d)(2)(C) and 1614(a)(3)(J) of the Social Security Act (42 U.S.C. §§ 423(d)(2)(C) and 1382c(a)(3)(J).

B. Definition of DAA

We define DAA as the following:

  1. DAA is a substance use disorder(s) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. Exceptions to DAA are nicotine use disorder and caffeine-induced disorder.

  2. A claimant has DAA when he or she has a medically determinable substance use disorder(s) documented by objective medical evidence from an acceptable medical source. (For more information on medically determinable impairments, see DI 24501.020 and DI 25205.005).

  3. Certain substance-induced disorders are included under DAA because they may be long lasting or permanent. The disorders are:

    • Substance-induced persisting dementia;

    • Substance-induced persisting amnestic disorder;

    • Alcohol-induced neurocognitive disorder;

    • Inhalant-induced neurocognitive disorder;

    • Sedative-hypnotic, or anxiolytic-induced disorder; and

    • Hallucinogen persisting perception disorder.

NOTE: Do not make a materiality determination if there is no objective medical evidence from an acceptable medical source documenting the existence of a substance use disorder.

C. Materiality in the DAA Evaluation Process

1. When to make a DAA materiality determination

Only make a DAA materiality determination when:

  • An acceptable medical source establishes that a claimant is diagnosed with a substance use disorder, using evidence in the file. (For more information on acceptable medical sources and medical evidence, see DI 22505.003A and DI 25205.005); and

  • The adjudicator determines the claimant meets our definition of disability considering all impairments, including DAA.

NOTE: We do not make a determination regarding materiality if a claimant has a history of DAA that is not relevant to the period under consideration.

2. Use the Sequential Evaluation Process a second time to make a DAA materiality determination

Apply the sequential evaluation process a second time to determine whether the claimant would continue to meet our definition of disability if he or she were not using drugs or alcohol.

NOTE: We follow the same rules for evaluating evidence in DAA claims that we use to follow other types of claims. (For additional information on evaluating evidence, see DI 24503.000.)

3. DAA is material

We find that DAA is material to the determination of disability if the claimant would not meet our definition of disability if he or she were not using drugs or alcohol. If DAA is material, we find that the claimant is not disabled.

Scenarios when DAA is material

DAA is material in the following situations:

  1. The claimant’s only severe impairment is a substance use disorder.

  2. The claimant's other impairment(s) is not severe by itself. Examples are osteoarthritis of the hip with minimal changes on imaging and an allegation of an anxiety disorder that is not severe.

  3. The claimant’s other impairment(s) may be severe but is not disabling by itself. For example, the claimant may have a back impairment that does not meet or medically equal a listing and does not prevent the claimant from performing past relevant work.

4. DAA is not material

We find that DAA is not material to the disability determination if the claimant would still meet our definition of disability if he or she was not using drugs or alcohol. If DAA is not material, we find that the claimant is disabled.

Scenarios when DAA is not material

DAA is not material when the claimant has a disabling impairment independent of DAA. The following list provides examples of other disabling impairments that the claimant may have that could be disabling on its own:

  1. a degenerative neurological disease;

  2. a hereditary neurological disease;

  3. kidney disease that requires chronic dialysis,

  4. an intellectual disability;

  5. a listing-level diagnosis of schizophrenia;

  6. The claimant acquired a separate disabling impairment(s) while use using substance(s). For example, the claimant has:

    • quadriplegia because of an accident while driving under the influence of alcohol; or

    • listing-level human immunodeficiency virus (HIV) from sharing a needle for intravenous drug use; and

  7. The claimant’s DAA medically caused the other disabling impairment(s) but the resulting impairment(s) is irreversible or could not improve to the point of nondisability. For example:

    • peripheral neuropathy,

    • permanent encephalopathy,

    • cirrhosis of the liver, and

    • substance-induced persisting dementia and substance-induced persisting amnestic disorder that develop from long-term alcohol or drug use.

5. The claimant’s burden of proof

The claimant has the burden of proving disability throughout the sequential evaluation process. As in all disability determinations and decisions, our burden is limited to producing evidence that work the claimant can do exists in the national economy at step 5 of the sequential evaluation process. For more information on the claimant’s burden of proof, see 20 CFR 404.1512, 404.1560, 416.912, and 416.960 and SSR 13-2p, Question 8. The claimant continues to have the burden of proving of disability throughout the DAA materiality analysis, when we apply the steps of the sequential evaluation a second time to determine whether the claimant would be disabled if he or she were not using drugs or alcohol.

6. Documenting materiality

We must provide sufficient information in a determination or decision so that a subsequent reviewer can understand the reasons for the following findings whenever DAA materiality is an issue:

  • The claimant has DAA.

  • The claimant is disabled at step 3 or step 5 of the sequential evaluation process considering all of his or her impairments, including DAA.

  • If the claimant is still disabled at step 3 or 5 of the sequential evaluation process in the absence of DAA, or the finding that the claimant would not be disabled at step 2, 4, or 5 of the sequential evaluation process in the absence of DAA.

NOTE: A single statement by an adjudicator that DAA is or is not material to the determination of disability is not sufficient. For documenting materiality, see Question 14 in DI 90070.041B. Adjudicators must provide explanations in their determinations or decisions, or on other appropriate documents, such as residual functional capacity assessment forms.

D. Six-step DAA Evaluation process

The following chart summarizes the steps in the DAA Evaluation process to decide whether DAA is material:

Step

Evaluation

1. Does the claimant have DAA?

  1. No—No DAA materiality determination necessary.

  2. Yes—Go to step 2.

2. Is the claimant disabled considering all impairments, including DAA?

  1. No—Do not determine DAA materiality (Denial).

  2. Yes—Go to step 3.

3. Is DAA the only impairment?

  1. Yes—DAA material (Denial).

  2. No —Go to step 4.

4. Is the other impairment(s) disabling by itself while the claimant is dependent upon or abusing drugs or alcohol?

  1. No—DAA material (Denial).

  2. Yes—Go to step 5.

5. Does the DAA cause or affect the claimant’s medically determinable impairment(s)?

  1. No—DAA not material (Allowance.)

  2. Yes, but the other impairment(s) is irreversible or could not improve to the point of nondisability—DAA not material (Allowance.)

  3. Yes, and DAA could be material—Go to step 6.

6. Would the other impairment(s) improve to the point of nondisability in the absence of DAA?

  1. Yes–DAA material (Denial).

  2. No–DAA not material (Allowance).

NOTE: For a more detailed explanation of applying the six-step DAA Evaluation Process see DI 90070.041.


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