Social Security Ruling, SSR 13-2p.; Titles II and XVI: Evaluating Cases Involving Drug Addiction and Alcoholism (DAA)
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SUMMARY: We are giving notice of SSR 13-2p, in which we explain our policies for how we consider whether "drug addiction and alcoholism" (DAA) is material to our determination of disability in disability claims and continuing disability reviews. This SSR rescinds and replaces SSR 82-60, Titles II and XVI: Evaluation of Drug Addiction and Alcoholism. This SSR obsoletes EM 96-200.
DATES: Effective Date:
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do not require us to publish this SSR, we are doing so in accordance with 20 CFR 402.35(b)(1).
SSRs make available to the public precedential decisions relating to the Federal old-age, survivors, disability, supplemental security income, special veterans benefits, and black lung benefits programs. SSRs may be based on determinations or decisions made at all levels of administrative adjudication, Federal court decisions, Commissioner's decisions, opinions of the
Although SSRs do not have the same force and effect as statutes or regulations, they are binding on all of our components. 20 CFR 402.35(b)(1).
This SSR will be in effect until we publish a notice in the
(Catalog of Federal Domestic Assistance, Program Nos. 96.001 Social Security--
Dated:
Commissioner of
POLICY INTERPRETATION RULING
TITLES II AND XVI: EVALUATING CASES INVOLVING DRUG ADDICTION AND ALCOHOLISM (DAA)
This Social Security Ruling (SSR) rescinds and replaces SSR 82-60: "Titles II and XVI: Evaluation of Drug Addiction and Alcoholism."
PURPOSE: This SSR explains our policies for how we consider whether "drug addiction and alcoholism" (DAA) is a contributing factor material to our determination of disability in disability claims and continuing disability reviews. /1/
FOOTNOTE 1 For simplicity, we refer in this SSR only to initial adult claims for disability benefits under titles II and XVI of the Social Security Act, and to the steps of the sequential evaluation process we use to determine disability in those claims. 20 CFR 404.1520 and 416.920. The policy interpretations in this SSR apply to all other cases in which we must make determinations about disability, including claims of children (that is, people who have not attained age 18) who apply for benefits based on disability under title XVI of the Act, redeterminations of the disability of children who were receiving benefits under title XVI when they attained age 18, and continuing disability reviews of adults and children under titles II and XVI of the Act. 20 CFR 404.1594, 416.924, 416.987, 416.994, and 416.994a. END FOOTNOTE
CITATIONS: Sections 216(i), 223(d), 223(f), 1614(a). and 1614(c) of the Social Security Act, as amended; Regulations No. 4, subpart P, sections 404.1502, 404.1505, 404.1508, 404.1509, 404.1512, 404.1513, 404.1517, 404.1519a, 404.1520, 404.1521, 404.1523, 404.1527, 404.1528, 404.1530, 404.1535, 404.1560, 404.1594, and appendix 1; and Regulations No. 16, subpart I, sections 416.902, 416.905, 416.906, 416.908, 416.909, 416.912, 416.913, 416.917, 416.919a, 416.920, 416.921, 416.923, 416.924, 416.924a, 416.926a, 416.927, 416.928, 416.930, 416.935, 416.960, 416.987, 416.994, and 416.994a.
INTRODUCTION: In this SSR, we consolidate information from a variety of sources to explain our DAA policy. We include information from our regulations, training materials, and question-and-answer (Q&A) responses. We also base the SSR on information we obtained from individual medical and legal experts, the
POLICY INTERPRETATION:
General
a. Sections 223(d)(2)(C) and 1614(a)(3)(J) of the Social Security Act (Act) provide that a claimant "shall not be considered to be disabled * * * if alcoholism or drug addiction would * * * be a contributing factor material to the Commissioner's determination that the individual is disabled." When we adjudicate a claim for disability insurance benefits (DIB), Supplemental Security Income (SSI) payments based on disability, or concurrent disability claims include evidence from acceptable medical sources as defined in 20 CFR 404.1513 and 20 CFR 416.913 establishing that DAA is a medically determinable impairment(s) (MDI) and we determine that a claimant is disabled considering all of the claimant's medically determinable impairments (MDIs), we must then determine whether the claimant would continue to be disabled if he or she stopped using drugs or alcohol; that is, we will determine whether DAA is " material" to the finding that the claimant is disabled. 20 CFR 404.1535 and 416.935. See Question 2 for additional information.
b. The information that follows, presented in question and answer (Q&A) format with illustrative scenarios, provides specific detail and examples to explain our DAA policy. Question 1 specifies the MDIs we consider under our DAA policy. Different Q&As will apply during the adjudication of a specific claim based upon the evidence in that case. All adjudicators must provide sufficient information in their determination or decision that explains the rationale supporting their determination of the materiality of DAA so that a subsequent reviewer considering all of the evidence in the case record is able to understand the basis for the materiality finding and the determination of whether the claimant is disabled. Question 14 specifies what information adjudicators must include in a determination or decision that requires a finding of the materiality of DAA to the determination that the claimant is disabled.
List of Questions
1. How do we define the term "DAA"?
2. What is our DAA policy?
3. When do we make a DAA materiality determination?
4. How do we determine whether a claimant has DAA?
5. How do we determine materiality?
6. What do we do if the claimant's other physical impairment(s) improve to the point of nondisability in the absence of DAA?
7. What do we do if the claimant's co-occurring mental disorder(s) improve in the absence of DAA?
8. What evidence do we need in cases involving DAA?
9. How do we consider periods of abstinence?
10. How do we evaluate a claimant's credibility in cases involving DAA?
11. How do we establish onset in DAA cases?
12. Can failure to follow prescribed treatment be an issue in DAA cases?
13. Who is responsible for determining materiality?
14. What explanations does the determination or decision need to contain?
15. How should adjudicators consider Federal district and circuit court decisions about DAA?
1. How do we define the term "DAA"?
a. Although the terms "drug addiction" and "alcoholism" are medically outdated, we continue to use the terms because they are used in the Act. /2/
FOOTNOTE 2 See sections 223(d)(2)(C) and 1614(a)(3)(J) of the Act. END FOOTNOTE
i. With one exception--nicotine use disorders--we define the term DAA as Substance Use Disorders; that is, Substance Dependence or Substance Abuse as defined in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the
FOOTNOTE 3
FOOTNOTE 4 See DSM-IV-TR p. 197, Criteria for Substance Dependence and p. 199 for Substance Abuse. END FOOTNOTE
ii. There are two Substance-Induced Disorders that we consider under the definition of DAA because they may be long lasting or permanent. Substance-Induced Persisting Dementia and Substance-Induced Persisting Amnestic Disorder last beyond the usual duration of substance intoxication and withdrawal. Substance-Induced Persisting Dementia refers to the development of multiple cognitive deficits that include memory impairment and at least one of the following cognitive disturbances: aphasia, apraxia, agnosia, or a disturbance in executive functioning. To document this condition, there must be evidence from the medical history, physical examination, or laboratory findings showing that the deficits are due to the persisting effects of substance use. Substance-Induced Persisting Amnestic Disorder refers to a combination of multiple memory deficits that significantly impair social or occupational functioning and represent a significant decline from a previous level of functioning. To document this condition, the evidence must establish that the deficits are clearly due to the persisting effects of substance abuse.
--This is a summary of a
Notice of Social Security Ruling (SSR).
Citation: "78 FR 11939"
Document Number: "Docket No. SSA-2012-0006"
Federal Register Page Number: "11939"
"Notices"
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