Substance Use and Social Security Disability Claims

I’ve just finished the first-pass, rough draft of a book that comes out in November, 2016 called Consulting on Social Security Disability Claims for Psychologists and Psychiatrists: How You Can Help Make Disability Decisions. In case you didn’t know, I actually have three publications coming out at the same time this Thanksgiving, 2016. The Social Security disability book as well as two others (if you’re curious check out the Psychology.news home page for the details). One of them of course is related to my work on medical records file reviews for private disability insurance companies and independent medical examinations which you can learn more about at http://www.reviewsandIMEs.com. Truthfully, you don’t have to worry about my health because I have a ton of presentations and other things that I’ve written over the years that I have just never gotten in to finished book form. I’ve now given myself a deadline to do it.

Today I wanted to give you another installment in the “going-under-the-hood” of Social Security disability series for this blog. You might have seen that back in January I wrote about what Social Security views as abilities needed for any job in this first “going under the hood” of Social Security disability post. This post is snippets of things I’ve written for the book. Fun fact, I actually drafted the majority of the recommendations for the National Association of Disability Examiners (NADE) to the Social Security Administration on SSA’s approach to substance use. I won’t go in to detail on that here though.

Social Security policy (POMS 90070.050) doesn’t allow us to “grant” peoples’ claims for reasons primarily related to substance use. Based on policy, the “KEY FACTOR TO CONSIDER” is whether we would still find the individual disabled if he/she stopped using substances. In doing this we decide:

• Which physical & mental limitations would remain if the individual stopped using drugs

• Whether any of these remaining limitations would still be disabling.

When evaluating substance use for Social Security disability claims our main goal is to consider the extent to which it has a material impact on their functioning. If we’re deciding that substance use is “material,” typically that means that the claimant will likely not receive benefits.

When we’re thinking of “materiality,” we’ve generally already decided that we believe the person has “marked” functional limitations. Basically, they have limitations which would be sufficient to qualify them for benefits and we want to know whether the substance use is what is creating that level of severity. We’re deciding between marked limitations and marked limitations that would improve in the absence of substance use; either way we’re still talking about marked severity right now.

Are these decisions inconsequential? I saw a case once where an individual was originally granted because of chronic depression (and they also had long-standing alcohol problems). Originally we granted the claimant based on depression since the impact of depression vs. alcohol couldn’t be reliably determined. Their benefits were discontinued by a different consultant when they came up for review; that consultant determined that substance use was material and that they would improve if they stopped using the alcohol. The claimant was then denied at their next initial claim filing with another DAA material finding, noting that they would improve if they stopped using alcohol. The claimant had “markedly” severe limitations that were expected to improve with abstinence. Unfortunately, we’ll never know for sure if the materiality decision was correct; the claimant took their own life prior to the completion of their reconsideration case.

These are not easy cases. Persons with any type of disability experience substance abuse at rates 2 to 4 times the general population. Substance abuse prevalence rates approach or exceed 50% for persons with TBI, spinal cord injuries, or mental illness according to hhs.gov; the odds are pretty good we’ll see plenty of cases involving substance use. In reality, sometimes we’ll know that substance use is material, however many times the world will never know. In the cases where we just don’t know, the tie goes to the runner. We cannot decide that substance use is material if we don’t have sufficient evidence to make that decision.