Effective Dates: 08/25/2022 - Present Previous | Next

TN 12 (08-22)

DI 28005.035 Drug Addiction or Alcoholism (DAA) in a Title II or Adult Title XVI Continuing Disability Review (CDR) - Overview of the CDR Sequential Evaluation Process for Considering DAA

A. Overview - DAA condition in CDRs

1. Definition of DAA condition

When an individual has a medically determinable substance use disorder and DAA is not material, they will be found to have a “DAA condition,” see DI 90070.060. For claims filed on or after July 1, 1996, Public Law (P.L. 104-121) contains special treatment referral provisions for individuals with a DAA condition who are determined to be incapable of managing their benefits.

2. General development of cases with DAA involvement

Follow the general disability case development guides in DI 28030.020. Do not undertake further development on the issue of materiality if you can make a favorable disability determination regarding other impairments and you can make a reasonable inference that additional evidence on the impact of DAA would not result in a finding that DAA is material.

3. Medical improvement (MI) involving DAA

For the definition of MI, and when to find MI under the DAA material CDR evaluation process, see DI 28010.055.

B. Introduction to the DAA CDR sequential evaluation process

We do not consider an individual disabled if DAA is a contributing factor to the determination that the individual is disabled. The definition of DAA can be found in DI 90070.050B.

There are two scenarios we consider DAA involvement:

Such scenarios may be involved in Title II CDRs or in adult Title XVI CDRs. When DAA is involved in those categories of CDR, there is a 7-step DAA CDR sequential evaluation process to follow AFTER following the 8-step CDR sequential evaluation process in DI 28005.010.

We consider the additional steps in the DAA sequential evaluation process displayed in the chart in DI 28005.040 if the following criteria are both met:

  • •

    There is medical evidence of DAA in the CDR, and

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    The 8-step Title II or adult Title XVI CDR sequential evaluation process yields a finding that disability continues, THEN

Follow the additional 7-step process outlined in DI 28005.040. Step 1 of the chart in DI 28005.040 represents the conclusions reached in applying the CDR sequential evaluation process shown in DI 28005.010.

For a detailed discussion of the 7 steps, see DI 28005.045.

C. Skipping evaluation steps with DAA involvement

After you have determined that disability continues under DI 28005.010, follow the DAA material CDR evaluation process in the order shown. However, you may skip an evaluation process step(s) if doing so would not affect the finding that DAA is or is not material; i.e., it would not affect the outcome of the CDR.

1. When to skip evaluation steps

We may skip CDR evaluation steps at several points in the process.

  • •

    No medical improvement (MI) - If there is medical evidence of a substance use disorder but the substance use disorder currently imposes no limitations and does not impact the other impairment(s), find no MI at step 3. Find that DAA is not material and disability continues.

  • •

    Other impairment(s) meets/equals - If there is medical evidence of a substance use disorder, but a listing would still be met or equaled if the substance use stopped (e.g., listing 1.20A or 13.13B), skip step 3 and find no MI related to the ability to work at step 4. Find that DAA is not material and disability continues. The step skipped does not affect the outcome.

  • •

    DAA only - If there is medical evidence of a substance use disorder, and it is the only impairment, find MI at step 3 and skip to step 5 (severe impairment(s)). If the individual were to stop using drugs/alcohol, the substance use disorder would no longer exist and there would be no direct effects or residuals. Find that there would be no severe impairment, DAA is material, and disability ceases. The step skipped does not affect the outcome.

2. When not to skip steps

If there would be MI related to the ability to work if DAA stopped and the individual would not be able to do other work (step 7), do not skip the past relevant work step (step 6). This could affect the DAA material finding and thus the CDR outcome. Obtain any additional evidence needed to determine whether the individual would retain the ability to do past relevant work. If so, find that DAA is material and disability ceases.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0428005035
DI 28005.035 - Drug Addiction or Alcoholism (DAA) in a Title II or Adult Title XVI Continuing Disability Review (CDR) - Overview of the CDR Sequential Evaluation Process for Considering DAA - 08/25/2022
Batch run: 04/02/2024
Rev:08/25/2022