Effective Dates: 05/31/2023 - Present Previous | Next

TN 17 (05-23)

DI 28005.050 Drug Addiction or Alcoholism (DAA) In a Title XVI Child Continuing Disability Review (CDR) Case - Step-by-Step Discussion of the 7-Step DAA Material CDR Sequential Evaluation Process

A. Introduction to the DAA step-by-step evaluation process for Title XVI CDR cases

We cannot consider a Title XVI child to be disabled if drug addiction or alcoholism (DAA) is a contributing factor material to the determination that they continue to be disabled.

Decide whether disability continues by following the CDR evaluation process outlined in DI 28005.025. Consider all the evidence, including any evidence of DAA. If disability continues after evaluating all impairments by following the Title XVI CDR sequential evaluation process outlined in DI 28005.025, follow the additional steps outlined below to evaluate if DAA is material to the Title XVI child CDR determination.

If DAA may be material, but the evaluation through the CDR sequential evaluation process outlined in DI 28005.025 resulted in a finding of “not disabled” (and a continuance is not supported), it is not necessary to evaluate the additional DAA steps below.

B. Procedure to determine if DAA is material to the Title XVI child CDR determination

Follow the steps described in the chart to determine if DAA is material in a Title XVI child CDR case:

Steps to Determine DAA Material for Child CDR

If Yes

If No

1. Decide whether disability continues considering all the evidence, including any evidence of DAA.

Follow the CDR evaluation process outlined in DI 28005.025.

If the child is still disabled, go to Step 2.

If the child is no longer disabled, find that disability has ceased. No materiality determination is needed.

 

 

2. Decide whether there is medical evidence of DAA.

For the policy related to medical evidence of DAA, see DI 90070.050C.

If there is medical evidence of DAA, go to Step 3.

 

If there is no medical evidence of DAA, find that disability continues. No materiality determination is needed.

 

3. Decide whether medical improvement (MI) would occur if the child stopped using drugs or alcohol.

For the policy on MI if the child stopped using drugs or alcohol, see DI 28010.055.

If MI would occur, go to Step 4.

 

If MI would not occur, find that DAA is not material and disability continues.

NOTE: If a Group I exception applies, go to Step 5.

For the policy on Group I exceptions, see DI 28020.001 and DI 28020.250 - DI 28020.365.)

4. Decide whether the impairment(s) present at the comparison point decision (CPD) would still meet or equal the severity of the listed impairment that it met or equaled at the time of the most recent decision if the child stopped using drugs or alcohol.

NOTE: The application of this step depends on whether the CPD was before January 2, 2001, or on or after January 2, 2001. To apply this step, see DI 28005.021.

 

If yes, find that DAA is not material and disability continues.

NOTE: If a Group I exception applies, go to Step 5. To obtain additional instructions on Group I exceptions, see DI 28020.001 and DI 28020.250 - DI 28020.375.

 

 

 

If no, go to Step 5.

 

5. Decide whether the child's current impairment(s) would be severe if they stopped using drugs or alcohol.

If the impairment(s) is severe, go to Step 6.

If the impairment(s) would not be severe, find that DAA is material and disability ceases.

6. Decide whether the current impairment(s) would meet or medically equal a listed impairment if the child stopped using drugs or alcohol.

 

If yes, find that DAA is not material and disability continues.

 

If no, go to Step 7.

 

7. Decide whether the current impairment(s) would functionally equal the listings if the child stopped using drugs or alcohol.

 

If yes, find that DAA is not material and that disability continues.

 

If no, find that DAA is material and disability ceases.

 

C. Summary exhibit for making a DAA materiality determination

The exhibit below summarizes the steps for making a DAA materiality determination in a Title XVI child CDR case:

 

GRAPHIC

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DI 28005.050 - Drug Addiction or Alcoholism (DAA) In a Title XVI Child Continuing Disability Review (CDR) Case - Step-by-Step Discussion of the 7-Step DAA Material CDR Sequential Evaluation Process - 05/31/2023
Batch run: 05/31/2023
Rev:05/31/2023