Why Social Security’s Drug Abuse and Alcoholism (DAA) Ruling 13-2p Violates Federal Law

The Social Security Administration has an interesting problem.  SSA’s Disability Insurance Benefits program, by law, can only evaluate medical conditions with objective medical evidence.  Symptoms alone are not enough.  Instead, medical signs and laboratory findings must prove “medically determinable” physical or mental impairments.  20 C.F.R. § 404.1529.  Social Security’s own rulings drive this same point home:  “No symptom or combination of symptoms can be the basis for a finding of disability…unless there are medical signs and laboratory findings demonstrating the existence of a medically determinable physical or mental impairment.”  Social Security Ruling 96-4p.

What’s the problem?  SSA currently allows itself to evaluate Drug Addiction and Alcoholism (DAA) without the proper objective evidence.  Social Security Ruling 13-2p, issued last year, clarifies its longstanding policy to deny Disability Insurance Benefits (or SSI) if drug addiction or alcoholism (DAA) causes disability.  The statutory term for this is “materiality”.

Social Security Ruling 13-2p states it incorporates objective medical diagnoses for mental health claims.  It cites the recent incarnation of the Diagnostic and Statistical Manual of mental disorders, version 5 (the DSM-5, for short).  But in cases of mental illness, the actual DSM-5 includes psychiatric diagnoses for substance-induced mental illness:

When psychiatrists and mental health professionals objectively diagnose these substance or medication-induced mental disorders above, they also determine the severity of these disorders based on the number of criteria endorsed: 2–3 criteria indicate a mild disorder; 4–5 criteria, a moderate disorder; and 6 or more, a severe disorder.

A severe, DAA-induced mental disorder can be a medically-determinable impairment under 20 C.F.R. 404.1529.  It can only be acceptable medical evidence of “material DAA”, however, when supported by objective medical signs and laboratory findings.  For Social Security claims with this evidence, SSA should determine DAA is medically “material” and ignore the limitations from the underlying mental impairment.

So what if these diagnoses above do not appear in the treating mental health records of a person applying for Social Security Disability?  Here’s the rub.  SSR 13-2p candidly explains that only SSA decides whether substance use disorders “medically cause or exacerbate” impairments.  Treating doctors are out.  What happened to SSA evaluating only objective medical evidence?  It’s gone.  The Ruling’s footnote 19 is stunning.  SSA plays doctor and decides for itself when claimants have substance-induced mental illnesses:

The finding about materiality is an opinion on an issue reserved to the Commissioner under 20 CFR 404.1527(e) and 416.927(e). Therefore, we will not ask a treating source, a CE provider, a medical expert, or any other source for an opinion about whether DAA is material. We will instead ask for medical opinions about the nature, severity, and functional effects of a claimant’s impairment(s).  In cases involving physical impairments, we may ask for medical opinions that project the nature, severity, and functional effects if the claimant were to stop using drugs or alcohol [emphasis added].

Any way you slice it (and I’ve seen it sliced quite thinly), materiality is a medical determination –

not legal.  The DSM-5 clearly identifies mental illness caused by DAA.  Social Security Ruling 13-2p violates the evidentiary requirements set forth in 20 C.F.R. § 404.1529.  Having practiced this area of law for over 20 years, I know of no other instance in which SSA reserves the exclusive right to make medical determinations.  It plays doctor whenever it uses “materiality” to find substance-induced mental disorders that are not diagnosed in the objective medical evidence.  Isn’t this tantamount to manufacturing medical evidence?  Yes.

We cannot pay people for being drug addicts and alcoholics benefits.  But on the same token, SSA can’t re-diagnose others who primarily have psychosis, bipolar, depression, or anxiety disorders whenever DAA shows up.

This is the stuff from which class actions are made.

If you have a Social Security benefits claim, mental illness and DAA issues don’t mix.  Immediately get help to stay totally clean and sober.  You should also hire a Social Security benefits attorney.  Your attorney should ask your mental health professionals in writing:  “Does your patient have a substance-induced mental disorder as recognized by the DSM-V.”  If no, SSA should follow the treating medical evidence – not create it.

Andrew Kinney, Esq.

Hoglund Law Offices

HoglundLaw.com

1/29/14

Andrew Kinney, Esq., is licensed in MN, OH, NY, and WI.  He is an attorney with Hoglund, Chwialkowski & Mrozik, PLLC, based in Roseville, MN.  He began practicing Social Security benefits law in 1992.  He is a founding chair of the Social Security Disability Law Section for the Minnesota State Bar Association.  He is currently an editor of the Social Security Practice Guide, a multi-volume legal guide for Social Security lawyers and advocates.

Written by Hoglund Law

The attorneys of Hoglund law are licensed in Minnesota, Wisconsin and Ohio. Hoglund, Chwialkowski & Mrozik, PLLC is based in Roseville, Minnesota. In addition to handling cases involving bankruptcy & social security, Hoglund, Chwialkowski & Mrozik, PLLC handles faulty drugs and toxic exposure.

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How Chemical Dependency can Destroy your Social Security Benefits Claim

Andrew Kinney
Hoglund Lawyer Andrew Kinney

Chemical dependency (CD) can destroy your Social Security Disability benefits claim.  As an attorney who argues these kinds of claims every week, I’ll explain how this happens.  I’ll also explain how to make Social Security take your benefits claim seriously.

The Law

From my legal perspective, chemical dependency usually takes one of three forms:  Addiction to alcohol, illegal drugs, or prescribed medications.  Most often, I see chemical dependency issues in my clients with depression and anxiety.  It is not always clear which one came first.  My instinct tells me that, in most cases, the mental illness comes first.  Unfortunately, social security does not always care.  In the 1990’s, social security changed the law about how to evaluate chemical dependency.  Before this change, chemical dependency was its own disability.  After this change, chemical dependency became a basis for denial.  In social security’s view, chemical dependency exaggerates symptoms of mental illness and other impairments.  Social Security also attributes chemical dependency with reducing the effectiveness of medication.  This can be true.  But the actual cause and effect is usually unclear.  Experts in this field have confirmed this with me.  Regardless of this truth, people struggling with chemical dependency these days face an uphill battle in their social security claims.

Why Help Yourself?

What can you do about chemical dependency?  The most important thing is to get professional help now if you (or people you know) think you may have a chemical dependency problem.  Addictions of any kind can have a devastating effect on your health.  They can also unwittingly impact those who care about you.  Candor with your doctors and chemical dependency treatment by professionals is often the best way my clients get themselves out of this hole.   The present law, however imprecise and unscientific at times, can blame your disability on your chemical dependency and deny your claim.  Social Security denies legitimate claims by blaming chemical dependency.  I witness it first-hand all the time.

From my legal perspective, my clients who have gone to get professional help for their chemical dependency have strengthened their Social Security claims.  I can usually make stronger arguments in their favor on three basic levels.  First, clients who treat for chemical dependency are more credible.  I can argue that they have tried to help themselves.  Clients who recognize they may have an addiction and try to overcome it are more likely to get the decisionmaker’s ear.  The rationale is this:  It is easier for decisionmakers (or anyone, for that matter) to sympathize with people who are trying to get out of their holes rather than blaming society for them.  Second, clients who treat for chemical dependency generally have better medical records.  With treatment for chemical dependency, I can argue how medical records parse out chemical dependency from the underlying medical problems.  Third, clients who treat for chemical dependency also have stronger claims because they create a stronger platform for their underlying medical problems.  If I have clients who have overcome chemical dependency, I can argue that their medical problems have not changed in the 3 to 6 month window after they have quit.  If erasing chemical dependency does not change the severity of other impairments, it is undeniably logical  that chemical dependency was not “material” to their disability.  But if being clean and sober does make them better, they might be able to work.  In my book, this is the best case scenario.  When possible, working is a better alternative than benefits.  I wish all my clients got better.

What if I am Still Actively Addicted?

There are still some legal arguments if my clients are struggling with active chemical dependency.  In these situations, I look for how their treating providers view the chemical dependency.  Medical records generally rank order diagnoses, starting with the most significant.  Sometimes chemical dependency is not the first, or primary, diagnosis.  In these circumstances, there is an argument that chemical dependency is a secondary condition and therefore is not to blame for how bad the primary condition is.  Note, however, that this argument can be difficult.  Other arguments in this situation are similarly difficult.  For example, there is an argument that substanced-induced mental illnesses have diagnosis codes custom-tailored for “material” (a legal term) chemical dependacy.  A health professional who does not choose these codes arguably has not found chemical dependency material.

Chemical dependency is a very difficult problem.  Not feeling well does not make it any easier to face.  Getting help is a first step to getting out of this deepening hole.  If you have a social security benefits claim, it is important that Social Security focuses on the truth of your underlying medical problems.  Removing the fog of chemical dependency can not only help you, but it can also help your claim for benefits.

If you do not have an attorney helping you with your claim, it is important to get legal advice specific to your situation.  If you want legal advice from one of our lawyers at Hoglund Law Offices, you can reach our offices at 1-800-850-7867.  There is no fee unless you are approved.  If you are approved, our only fees are 25% of your backpayment of benefits.

→ Click Here to Download your Free Hoglund Lawyer’s Guide to Security Security Hearings

Andrew Kinney, Esq.

AMDG

Written by Hoglund Law

The attorneys of Hoglund law are licensed in Minnesota, Wisconsin and Ohio. Hoglund, Chwialkowski & Mrozik, PLLC is based in Roseville, Minnesota. In addition to handling cases involving bankruptcy & social security, Hoglund, Chwialkowski & Mrozik, PLLC handles faulty drugs and toxic exposure.

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