HOW ADDICTION AFFECTS YOUR DISABILITY BENEFITS

The Old Rules

Before 1996, if you had an addiction, you could qualify for Social Security Disability benefits because of that addiction alone. Addiction was seen as a disability in itself. Today, however, the rules have changed, and this is unlikely to have a significant impact on your case.

The Modern Rules

The law now is the "Senior Citizen's Right to Work Act of 1996," and it took a hard line: no more claiming disability just because of drug or alcohol addiction. In effect, the Act says you’re not considered disabled if addiction is a factor in your disability. More plainly, if your disability would still be there without the substance abuse, you’ve got a chance at benefits. But if your addiction is part of what makes you disabled, the Social Security Administration (SSA) will likely turn you down.

The Reality

Presently, if your file includes evidence of drug or alcohol issues, the SSA must determine whether your disability would exist independently of your addiction or if the addiction exacerbates your condition. Note: This evaluation becomes particularly complex with psychological impairments. The SSA will then review periods of abstinence and compare your physical and mental health during those times to when you were using substances. If there are no periods of abstinence, you will need a detailed statement from your physician explaining how your addiction does not contribute to your disability.

The Bottom Line

In the end, the SSA focuses on whether your disability stands on its own, despite any issues with addiction. To this end, your case depends on proving that your disability is serious enough on its own. And so, if you find yourself in a situation like this, it may help to gather your medical records and get a clear statement from your doctor showing how your disability isn’t just caused by your addiction.

APPLYING FOR BENEFITS

Applying for disability benefits can feel like trying to solve a Rubik’s Cube while blindfolded, especially when you’re doing it all alone. But don’t worry. If you’ve ever found yourself lost in a sea of paperwork and regulations, you’re in good company.

To help you cut through the red tape of it all, here’s the five-bullet truth about applying for SSI and/or SSDI in today’s America:

• Severe Condition: Your disability must be serious enough to prevent you from handling a full-time job.

NOTE: You don’t have to be confined to a bed—just unable to sustain a full time position.

• Duration: Your condition should be expected to last at least twelve months.

NOTE: You don’t need to wait a year to apply. In fact, you can start the process as soon as you and your doctor believe the condition won’t immediately improve.

• Work Status: While it’s generally easier to qualify if you’re not working, you can still apply if you’re working and earning below a certain threshold.

NOTE: If you try working despite your disability, be careful—if it lasts more than six months, it could hurt your case. But if you have to stop working early because of your condition, it may actually help by showing you can’t do the job.

• Medical Records: While you can apply without medical records, having them strengthens your case.

NOTE: You don’t need a complete diagnosis or the perfect treatment plan to get started— just get the forms, fill them out, and keep up with your health.

• Non-Medical Factors: Factors like your work history or income level also play a role in determining your eligibility, so be sure to include accurate and complete information in your application.

NOTE: Don’t get bogged down in the details. Focus on filling out your application and let Social Security get back to you with the results.

DEFINING DISABILITY & SUBSTANTIAL GAINFUL ACTIVITY

According to the SSA

The Social Security Administration (SSA) defines disability in precise terms. For SSA purposes, a disability is an inability to engage in substantial gainful activity due to a severe physical or mental impairment. Notably, this impairment must be expected to last for a continuous period of at least 12 months or result in death. Moreover, for individuals aged 55 and older who are blind, the SSA assesses whether they are unable to perform work that is comparable to their previous employment, considering their blindness.

Substantial v. Gainful

The term “substantial gainful activity” refers to work that involves significant physical or mental effort (i.e., substantial activity) and provides a wage or profit (i.e., gainful activity). To this end, if you earn more than $1,550 per month, the SSA will likely consider you as engaging in substantial gainful activity, meaning you are not eligible, by 2024 standards, for disability benefits.

NOTE: For those who are blind, the 2024 threshold is set higher at $2,590 per month.

Implications

So, what’s the bottom line here? What should you really take away? Here it is: Substantial gainful activity can ruin your disability claim. That is, performing physically or mentally demanding duties for pay, even if you never cash a paycheck, may well disqualify you from receiving the benefits you are otherwise entitled to receive.

And so, if you have any doubts about whether your work qualifies as substantial gainful activity, don’t jeopardize your future—consult with a disability attorney who can answer your questions, restore your confidence, and get you on the right track.

WHY YOUR MEDICAL RECORDS MATTER FOR YOUR DISABILITY CLAIM

Getting disability benefits generally comes down to one thing: your medical records. They’re the guts of your claim, the proof you need. Without solid, complete documentation, your shot at benefits drops fast.

Here’s the why and the how of making sure your records back you up:

Medical Records as Evidence

Medical records are the backbone to proving your SSI or SSDI claim. They provide the hard evidence of your health issues and treatments. Without them, your claim has as good a shot as a paper bag in a rainstorm.

If you can’t afford proper care, don’t just accept your fate. Look up free clinics, seek out community resources, or find other ways to get treatment. Because without records, there’s no evidence, and without evidence, there’s no case.

Matching Your Medical Records with Your Health Issues

You can’t rely solely on your medical records to tell your story. Too often, people describe their daily struggles and pain, but their records don’t match up. This can weaken your claim.

To succeed, make sure you and your healthcare providers are on the same page, and that they document all symptoms and limitations thoroughly.

Where To Get Your Medical Records

Your medical provider matters, and so do their qualifications. In fact, the SSA requires documentation from recognized professionals (e.g., licensed physicians, clinical psychologists, medical specialists) who, typically, must have conducted diagnostic tests and provided detailed clinical findings to meet their standards.

Moreover, while all submissions are given some consideration, medical records from those recognized sources are almost always given priority over those that the SSA has yet to designate as “acceptable” (e.g., social workers, chiropractors, naturopaths).

The moral of the story? To get the benefits you deserve, you have to give the SSA what it wants.

SSDI FROM A BIRD’S EYE VIEW

The Application

Applying for Social Security Disability Insurance (SSDI) might seem straightforward at first—just fill out some forms, right?

Don’t be fooled.

For starters, you’ll need to detail your medical condition and work background by completing both the Adult Disability Report and the Work History Report. What’s more, these forms require meticulous attention to detail, as incomplete or incorrect information can lead to serious delays and even outright denials.

The Result

Here’s the tough part: only about 22% of initial SSDI applications get approved.

Why?

Because proving that your medical condition qualifies under SSDI’s strict rules is not so easy and the appeals process for denied applications is not so fast. Moreover, if your application is originally denied, the process becomes more involved.

The Redo

The reconsideration process provides an opportunity for the Social Security Administration (SSA) to re-evaluate their decision, though it’s not available in all states and often yields little change.

Without a successful reconsideration, you can request a hearing to present your case anew. If, however, the hearing also results in a denial, you still have the option of either requesting a review by the Appeals Council or starting a new application.

The End

All in all, succeeding in your SSDI claim requires patience and persistence. Each step must be carefully managed, each box checked, and every piece of evidence corroborated.

Final success is what counts, after all. The end result. Taken on the whole after taking your lumps and still meeting the bell. That’s when you know you’ve won.

THE FIVE STEPS TO GETTING DISABILITY BENEFITS

Prep Before You Step: An Introduction

The disability evaluation process is a structured sequence of five critical steps, where failure at any step—except the third*—leads to a denial of benefits. The process begins with assessing if you can perform Substantial Gainful Activity (SGA), moves through evaluating the severity of your impairment, and requires meeting specific medical criteria outlined in Listings of Impairments. It then considers your Residual Functional Capacity (RFC) and past relevant work to determine if you can still perform prior job functions. Finally, if you cannot return to your past work, the process examines if you can adapt to other available jobs, factoring in age, education, and transferable skills.

Step One: SGA

In this first step, the Social Security Administration (SSA) determines whether you’re engaging in Substantial Gainful Activity by assessing your work earnings and activity level. If your income exceeds a certain threshold, it suggests you’re capable of working and thus not eligible for disability benefits. Only if your work is deemed nonsubstantial will the evaluation proceed to the next step.

Step Two: Severity

In this step, the SSA assesses whether your impairment is severe enough to limit your ability to perform essential work activities. To be successful, your condition must impose significant restrictions on your daily life and work functions. Conversely, if the impairment does not meet this severity threshold, your claim will likely not advance to the next step.

Step Three: The List*

Next, the SSA checks if your impairment matches one of the specific conditions listed in their “Listings of Impairments.” These listings include 14 categories with detailed medical criteria for various impairments. To qualify, your condition must meet the exact requirements outlined for that listing. Otherwise, your claim will proceed to the next evaluation step.

Step Four: Residual Functional Capacity

Here, the SSA evaluates your RFC, which measures what you can physically and mentally do despite your impairments. They then classify your past work—that is, work done in the 15 years before your disability—by its exertion level: sedentary, light, medium, heavy, or very heavy. Significantly, if your RFC shows you cannot reasonably perform any of your previous jobs, your claim will likely advance to the final evaluation step.

Step Five: Stepping Back

Based on your RFC, the SSA determines if you can perform any other type of work besides your past relevant jobs. To do this, the SSA considers your age, education, and transferable skills (that is, any abilities and experiences from your previous work that can be applied to different jobs).

NOTE: If you’re over 55 and restricted to sedentary work, or over 60 and limited to light work, the SSA mandates that vocational adjustments be minimal. In other words, any new job opportunities must involve only minor changes in work settings, tools, and/or processes.