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Seeing alcohol and drug use or abuse sends up a red flag for disability examiners




 
Imbedded into the social security administration's disability evaluation system is a concept known as DAA materiality, DAA standing for drug and alcohol abuse. What it essentially means is this: if a patient/claimant has a condition (e.g. liver problems, disabling depression, bipolar issues) and it's clear from a reading of the medical records that the condition, subsequent to the discontinued use of alcohol or drugs, would improve to the extent that the condition would no longer have a disabling effect, then the individual's drug or alcohol abuse would be considered material to the case.

Another way of putting it would be: "Hey, you caused your condition and if you stopped using drugs or alcohol, you'd be able to work a job".

Immateriality is, of course, the flip side of the coin. In other words, if a claimant's condition would not improve regardless of whether or not they continued or discontinued their use of substances, the substance use/abuse would be considered "immaterial". Another way of putting it would be: "Your condition exists, it will exist even if you continue to use, and, for all practical purposes, your continued use just doesn't matter, as far as the evaluation of your disability case is concerned".

The issue of materiality versus immateriality is probably a little easier when it comes to evaluating physical allegations, such as liver disease. But apply the concept to mental impairments and things aren't so cut and dry.

Which brings me to Bipolar disorder. In my last post, I voiced my opinion that the social security disability system probably doesn't know it's head from it's @#&bleep*&^ when it comes to rendering disability determinations on the basis of bipolar. However, when the issue of drug and alcohol use or abuse rears its head in a case, it can become even more problematic.

Why is this? Well, as I said before, Disability Determination services examiners aren't exactly well versed in the particulars of bipolar disorder (or any other physical or mental condition, for that matter). What examiners ARE fairly well trained to do is look for kernels of information in a claimant's medical records. And that includes instances of subtance use or abuse.

What happens when a disability examiner finds a mention of usage in a claimant's medical records, such as etoh (alcohol) or cannibis (pot) use/abuse? It sends up a red flag that must be addressed and weighed.

This is fine, of course, because it's completely fair to consider how and to what extent a claimant's condition has been affected by an external substance. The problem with the process here, however, goes back to the fact that disability examiners know little about bipolar disorder. Bipolar individuals who are plagued by thoughts that simply will not stop racing around in their heads may sometimes seek out substances as a means of finding relief and escape.

Fortunately, most disability examiners are familiar with the concept of self-medication. However, will an examiner who is reading an incident (in a claimant's records) of a bipolar episode, with which alcohol use has been associated, be able to discern whether or not the incident was the result of self-medication? Doubtful. Will the DDS psychological consultant who oversees the examiners mental write-ups be able to discern this? Coin toss.

Think about it. Individuals will often be treated by a psychiatrist for years before the psychiatrist GETS the diagnosis right. So, are we supposed to really believe that some DDS psychological consultant---who spends 30 minutes tops glossing over someone's records and an examiner's writeup---can really understand what is happening with a bipolar patient.

Let me say some particularly nasty words about DDS mental consultants. Though many of them are fine and competent individuals, many are also hacks who sought refuge in a state office, rather than devote themselves to the full rigors of practice. I've seen some of them turn down individuals with IQ's in the low fifties. And I've seen many claimants with schizophrenia and bipolar disorder receive E3 durational denials. What's that? This will sound particularly stupid to a long time sufferer of bipolar. It means that the condition is not expected to last at least as long as 12 months (the necessary minimum for social security disability and SSI benefits).

The stupidity of this, of course, is quite amazing. Bipolar is not a durational condition like a broken leg or a sprained wrist. It exacerbates and remisses and tends to slide back and forth on a spectrum between the manic and depressive poles.

So, what's my point in this post? I'm not sure. It would probably be best, certainly, if minor incidents of substance use (e.g. drinking a single can of beer over the weekend) did not receive the attention of social security because this can send up a flag. And considering the shortcomings of the system, you don't want to send up flags. Of course, I am not advocating anything with regard to what information you pass on to your general practitioner, psychologist, or psychiatrist. But just remember: once something makes it into your medical records, it is there to stay.















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Tips, how to apply for disability
Applying for Disability - Rules and Requirements
Disability attorneys and RFC forms
Social Security Disability, long term disability, and offset
Disability applications can be denied for failure to cooperate
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To win Disability benefits, you may have to appeal a denial
Medical conditions for which you can file and apply for disability



Information on the following topics can be found here: Social Security Disability Questions and in these subsections:

Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI


These pages provide answers to basic questions about pursuing disability benefits

What Mental Problems Qualify for Disability?
Disability for a mental condition
Tips for Filing for disability
Financial Help Filing For Disability
Checklist for filing for disability, SSI or SSD
Qualifying for disability benefits, how to qualify for SSD or SSI
Filing a disability application: the steps
Disability award notice, how long it takes to get benefits
How to Apply for Disability - Where do I go?
What makes you eligible to get disability?
How to check my disability claim status?
Can a disability attorney speed up a disability case?
SSI disability Award Letter
How long to get approved for disability?
How to apply for disability benefits
How long does disability back pay take?
What are qualifications for getting disability?
What medical conditions can you file disability for?
Disability Lawyer help questions
Social Security Attorneys, Disability Representatives