News & Information

CCH® UNEMPLOYMENT INSURANCE — 3/15/13

SSR 13-2p issued on evaluating cases involving drug addiction and alcoholism

The Social Security Administration is giving notice of Social Security Ruling (SSR) 13-2p, in which the agency explains its policies concerning how it considers whether “drug addiction and alcoholism” (DAA) is material to its 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. It also obsoletes EM 96-200. The SSR becomes effective on March 22, 2013.

Background

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 the SSA adjudicates a claim for disability insurance benefits, Supplemental Security Income payments based on disability, or concurrent disability claims that 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 and the agency determines that a claimant is disabled considering all of his or her medically determinable impairments (MDIs), the SSA then must determine whether the claimant would continue to be disabled if he or she stopped using drugs or alcohol; that is, it will determine whether DAA is “material” to the finding that the claimant is disabled (20 CFR 404.1535 and 416.935).

The information contained in SSR 13-2p, which is presented in question and answer (Q&A) format with illustrative scenarios, provides specific detail and examples to explain the SSA’s DAA policy. Question 1 specifies the MDIs the agency considers under its 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 to explain the rationale supporting the 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 and answers in the SSR

Following is a list of the questions and answers provided by the SSA in SSR 13-2p:

(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 do the determination or decision need to contain?

(15) How should adjudicators consider federal district and circuit court decisions about DAA?

For further information, contact Cheryl Williams, Office of Disability Programs, Office of Medical Listings Improvement, SSA, 6401 Security Blvd., Baltimore, MD 21235-6401, (410) 965-1020 or TTY 1-800-325-0778 (78 Fed. Reg. 11939, February 20, 2013).