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 adjudicator may consider statements from medical 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 the case; see
SSR 13-2p, Question 6 b. This evidence may come from an acceptable medical source (AMS) or a non-acceptable
medical source; see DI 22505.003. If we are evaluating whether an individual's work-related functioning would improve,
we may rely on evidence from other non-acceptable medical sources, such as licensed
mental health counselors, 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 their 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)
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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.
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For purposes of evaluating the effect of DAA on a finding about whether there has
been MI in the physical impairment, only those impairments from the time of the CPD
are relevant.
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The MC/PC could conclude that there would be MI in the substance use disorder, but
no MI in the physical impairment(s).
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The MC/PC should include in their 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, they may advise the
adjudicator to use the current CDR assessment of physical impairment(s) to determine
that disability continues.