Alcoholism and Drug Addiction
The Social Security Administration (SSA) has outlined the following procedure as to how it determines whether you are entitled to disability benefits (SSDI) if you have, or have had, a drug addiction or alcoholism problem. The central question is whether the alcoholism or drug addiction is a "contributing factor material to the determination of disability."
In general, if the SSA finds that you are disabled and have medical evidence of drug addiction or alcoholism, the SSA then determines whether your drug addiction or alcoholism is a contributing factor material to the determination of disability (unless you are eligible for benefits for some other reason, such as your age or blindness).
The key factor for the SSA is whether it would still consider you disabled if you stopped using drugs or alcohol.
In making this determination, the SSA considers whether your current physical and mental limitations are disabling and would remain disabling if you stopped using drugs or alcohol.
If the SSA determines that your remaining limitations would not be disabling (in the absence of drugs or alcohol), then your drug addiction or alcoholism is a contributing factor material to the determination of disability. On the other hand, if the SSA determines that your remaining limitations are disabling (in the absence of drugs or alcohol), you will be considered disabled independent of your drug addiction or alcoholism, and the SSA will find that your drug addiction or alcoholism is not a contributing factor material to the determination of disability.
Reference: 60 FR 8151, Feb. 10, 1995
Gettng Disability Benefits When There is a History of Alcoholism or Drug Abse
As a practical matter, in order to qualify for long-term disability (LTD) benefits under the Social Security Act (SSDI), you must be "sober." Otherwise, it would be impossible for the SSA to determine how much of your disability is related to on-going alcohol or drug abuse. The SSA does not provide LTD benefits for disability related to on-going drug or alcohol abuse.
While you cannot get LTD benefits under SSDI for alcoholism or drug addiction per se, you may qualify for disability benefits for the damage that alcoholism or drug abuse may have caused to your body while you were drinking or abusing drugs. For example,if you have cirrhosis of the liver (or cancer of the liver) due to alcoholism, but you are sober and no longer drinking, then the disabling symptoms you have from cirrhosis (or cancer), such as chronic fatigue, gastrointestinal bleeding (from esophageal varices), or cognitive dysfunction (related to liver damage), may entitle you to LTD benefits. Similarly, if you have a history of drug abuse (but are now sober) and have heart disease or pulmonary hypertension from prior drug abuse, you would be eligible for LTD benefits based on the disabling symptoms that your cardiac or pulmonary condition is causing.
Long-Term Disability Benefits Related to Alcohol and Drugs are Different for SSDI and ERISA-Plans
In contrast to SSDI, many (but not all) group employer-based disability insurance policies (ERISA) may provide limited coverage for disability related to drug or alcohol use, abuse, addiction, or dependence, usually for a period of 24 months. “Mental' or “nervous” conditions, such as depression, anxiety, bipolar disorder, and others, are usually also limited to 24 months of coverage in ERISA policies.
Therefore, ERISA-plans may pay disability benefits while battling alcohol or drug addiction, as well as for any disabling medical conditions that remain after you become sober. But these plans typically limit disability payments to no more than 24 months.
SSDI is different. Long-term disability benefits based on mental or nervous conditions from the SSA are not limited to 24 months and extend until retirement age. However, SSDI does not provide disability benefits for drug or alcohol use, abuse, addiction, or dependence. You have to be sober in order to qualify for SSDI benefits.
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records.At Law Med that's what we do.