Qualifying for Disability Benefits (SSDI) with Drug Addiction in Pennsylvania

Much like a disease or physical injury, habitual drug use can cause extremely severe damage to the body and mind.  Depending on factors like the type of substance involved, the age and overall health of the user, the frequency of use, and whether the user combines multiple substances, drug addiction has the potential to cause irreversible organ damage, severe medical complications like limb amputations, and even the risk of death.
It is well known that the Social Security Administration grants monthly disability benefits for many different illnesses and injuries — but what about benefits for disabling drug addictions?  Is it possible to qualify for SSI (Supplemental Security Income) or SSDI (Social Security Disability Insurance) if you struggle with substance abuse problems?  In this article, our social security attorneys will examine some of the rules and requirements that you should be aware of if you’re filing a disability claim for substance addiction.
To set up a free and private consultation, call Young, Marr & Associates at (215) 701-6519 in Pennsylvania.

SSA Eligibility Requirements for Disability Benefits

Before we look at the medical requirements associated with drug abuse, it’s important to cover the basic eligibility criteria which apply to all disability applicants with some rare exceptions, such as advanced terminal illness.  Generally speaking:

• Your disability must be severe enough that it prevents you from working, or puts extreme limits on how much work you can perform.

• Your disability must have either already lasted or be expected to last for at least one year, or be expected to result in death.

• If you are performing limited work, you must not be earning more than the income thresholds for SSI and SSDI.  The 2015 income limits are $1,090 per month for SSDI claimants and $733 per month for SSI claimants.  However, not all income is counted toward the SSI limit, so you can be earning more than $733 and still qualify.

Qualifying for Benefits with a Substance Addiction Disorder

While some claims are rejected for technical reasons, such as missing a deadline, most claims are denied on a medical basis.  These medical denials often amount to the claimant’s problem not being deemed severe enough to be truly disabling.
To determine whether a condition is truly disabling when a claim is being reviewed, the SSA relies on a large document called the Listing of Impairments, which is sometimes referred to as “the Blue Book.”  The Listing provides severity standards for many different conditions, and if a claimant can match or equal the standards for his or her issue, he or she will be deemed disabled and may qualify for benefits.  (Note that in some situations, a claimant can still be approved even if his or her condition does not appear in the Listing.)
The Listing places substance addictions into Section 12.00 (Mental Disorders), under Section 12.09 (Substance Addiction Disorders).  Section 12.09 states the following:

[Substance addiction disorders can cause] behavioral changes or physical changes associated with the regular use of substances that affect the central nervous system.  The required level of severity for these disorders is met when the requirements in any of the following (A through I) are satisfied.

In other words, claimants with substance abuse problems aren’t evaluated based on the addiction itself, but on the type and severity of the damage the addiction causes.  For example, if your addiction results in a mental disorder, you would correspondingly be evaluated based on the standards for mental disorders.  This is what is meant when the SSA refers to sections “A through I,” which include the following:

• A — (12.02) Organic Mental Disorders
  • Brain Dysfunction

• B — (12.04) Depressive Syndrome
  • Bipolar Disorder
  • Major Depression

• C — (12.06) Anxiety Disorders
  • Anxiety
  • Obsessive Compulsive Disorder (OCD)
  • Panic Attacks

• D — (12.08) Personality Disorders
  • Borderline Personality Disorder (BPD)

• E — (11.14) Peripheral Neuropathies, i.e. nerve damage
  • Damaged Motor Function

• F — (5.05) Liver Damage
  • Chronic Liver Disease
  • End Stage Liver Disease

• G — (5.00) Gastritis, i.e. inflammation of the stomach lining

• H — (5.08) Pancreatitis
  • Extreme Weight Loss (Digestive Disorder)

• I — (11.02, 11.03) Seizures
  • Epilepsy (Psychomotor, Convulsive, Grand Mal, Petit Mal, Focal)

Can the SSA Deny a Disability Claim Because of Drug Addiction?

While the damage caused by substance addiction can qualify you for disability benefits, there are also situations where your claim could be denied because of drug abuse.  Under DI 90070.050 (Adjudicating a Claim Involving Drug Addiction or Alcoholism), the SSA very clearly states the following:

We do not consider a claimant disabled if drug addiction or alcoholism (DAA) is a contributing factor material to the determination that the claimant is disabled.

The SSA uses a six-step evaluation process to determine whether DAA is “material” to a claim. DAA is not material if the claimant would be considered disabled even if drug addiction was not a factor.  But if DAA is material, meaning the claimant would not be disabled without the drug addiction, the claim will be denied.
Note that the SSA excludes caffeine addiction and nicotine addiction from its definition of DAA, so drinking coffee or smoking cigarettes won’t necessarily rule out your application.

Call Our Philadelphia + Bucks County Disability Lawyers Today

If you or someone you love is struggling with substance abuse, these Pennsylvania resources may be able to help:
Pennsylvania Department of Drug and Alcohol Programs — Find treatment centers by county, or call the Substance Abuse and Mental Health Services Administration (SAMHSA) Resources Hotline at (800) 662-4357.
To set up a free and completely confidential legal consultation with the disability lawyers of Young, Marr & Associates, call our law offices at (215) 701-6519 in Pennsylvania today.