If you were to poll Social Security Disability attorneys about the most difficult issues they face in their cases, substance use/abuse would definitely be near the top of the list, if not in the number one spot. People with disabilities are more likely than others to have co-morbid substance abuse disorders, and a case with a substance-related issue can create challenges to proving a disability claim, even when presenting it to the most open-minded and compassionate decision maker.
Substance Abuse and Physical Disabilities
When Social Security considers a case involving a substance use disorder, it will consider whether the disorder is material to the disability. Social Security Ruling (SSR) 13-2p generally provides that if the substance use does not cause the disability, it should not be considered material and should not prevent someone from being awarded disability.
In a case involving primarily physical impairments, this rule is pretty straightforward and judges usually apply it correctly. They understand that if a person is unable to work because of history of spinal problems, the fact that the person may sometimes drink excessively is not material and should not preclude an award of disability.
Nonetheless, substance use can certainly complicate a case like this. It may cause someone to miss necessary medical appointments or could be viewed as a lack of compliance with a pain management regimen. But in general, judges understand that if someone is disabled physically, incidental substance use shouldn’t preclude disability benefits. This is true even if substance use caused the disability, either suddenly (like an alcohol-related accident) or insidiously (such as long-term liver damage caused by substance abuse) – if the damage has been done and leaves someone incapable of working, disability is appropriate.
Substance Abuse and Mental Disabilities
The biggest proof problems come with cases involving primarily mental disabilities with a co-morbid substance use disorder. In every case, the burden of proof is on the claimant – someone seeking disability (along with their attorney) needs to prove that they are disabled in order to get Social Security benefits. However, when evaluating someone’s mental disabilities, ongoing substance abuse can “cloud the clinical picture,” as psychologists say. This means that, in a situation in which substance abuse is frequent and ongoing, it can be hard to tell what kind of functional limitations are caused by the substances and which are caused by the underlying mental disabilities.
It often seems like a “chicken or the egg”-type question. Proving a case like this requires a showing that it is more likely than not that the underlying mental disorders caused the disability. If it’s a total 50/50 toss-up, the claim will be denied.
So, the obvious advice to someone with mental disorders who is using substances and seeking disability is to stop using. Of course, this is much easier said than done. And it may not help much to do so only a short time before a hearing with a Social Security judge, as disability is for chronic impairments that are not expected to resolve in the near future and decision makers want to consider someone’s longitudinal record before reaching a conclusion.
Any History of Substance Abuse Can Complicate Your Claim for Benefits
Even if you know use of substance isn’t related to your disability, any substance use at any time in your life has the potential to negatively affect your case. Decision makers and others involved in the disability evaluation process can be hypervigilant for indicators of it. They may be very concerned with the public perception of the disability program and know it is subject to criticism from skeptics who are opposed to providing income replacement to those who are unable to work and claim that those on disability are lazy and simply prefer to engage in substance use instead of working.
In a case involving a mental impairment, someone seeking disability will usually be sent to a psychologist who will ask them about their psychological history and current symptoms of mental impairments. I have seen reports made which show a diagnosis of a substance use disorder “in sustained remission” after someone described a short period of drug use years and years ago. This could then be flagged by a member of a decision maker’s staff and cause a judge to be reluctant to approve the claim. I have seen records identifying “drug seeking behavior” after a patient merely sought pain medication for legitimate pain. I have then seen a record like this which had apparently been highlighted by a judge or a member of the judge’s staff, as if this were some kind of moral failing which should prevent someone from getting disability. A skilled Social Security attorney can directly address these harmful biases and confront misleading evidence which could lead to an unfair decision in your case.
When someone with co-morbid mental impairments and a substance use disorder is rendered unable to work, it can be very difficult to address the all-important materiality issue, or whether the person would still be disabled in the absence of substance use. So a judge may consult a medical expert, usually a psychologist, on this issue. The problem is that this question can often be difficult for the psychologist, too. What I’ve seen is that psychologists usually take the easy way out and, when confronted with a case of a claimant who can’t work with both underlying mental impairment and a substance use disorder, usually just tell the judge that the substance is material and is the primary factor in making the individual unable to work, knowing that this will lead to a denial of the claim. These experts are paid to consult with the Social Security Administration and are understandably timid about taking a controversial position on such a sensitive issue. Again, a skilled Social Security attorney can act to combat the inherent flaws in this arrangement, and can cross-examine a medical expert to expose their logical errors and lack of use of reliable principles and methods.
Our Social Security Attorneys Can Help Your Claim
Even seemingly unimportant substance use in your past can create challenges for your Social Security case, but you are welcome to contact the attorneys at Keller & Keller for a consultation. We can be on your side to address unfairness when it arises.