Staff confusion and incompetence seem to be responsible for the wrongful denial of disability insurance to people with substance use disorders in states hit hard by the opioid-involved overdose crisis, found a new report from the Government Accountability Office (GAO).
Social Security Administration (SSA) examiners at Disability Determination Services in Alabama, Kentucky and West Virginia—states that GAO chose to study because of their high rates of opioid-involved overdose and prescriptions—were found to be denying some eligible claimants on the grounds that drug use was exacerbating their other “impairments.”
People who are unable to work because of certain disabilities are entitled to SSA Disability Insurance. Substance use disorder is, alone, an ineligible “impairment.” Claims of disabilities perceived by an examiner to be “unaffected” by a substance use disorder, like “permanent liver damage” as the report illustrates, may be approved. But a claim of depression, for example, combined with a substance disorder might be ruled ineligible on the grounds that the “claimant would not be considered disabled if they stopped using drugs or alcohol.”
The study reviewed only 30 case files from three different offices, so the extent of the issue remains undetermined. However, multiple people reporting mental health issues were denied disability insurance due to their examiner’s conclusion that their “issues would not be disabling in the absence of the claimant’s substance use disorder,” GAO found.
One case highlighted involved benzodiazepine use, while another included prescription opioids, alcohol and marijuana. The examiners, according to the report, seemed to be using their subjective perceptions of how substance use disorders might interact with another disabling medical condition.
Examiners also provided inadequate rationales for their denials, the study found—as well being unsure when to even conduct a Drug Addiction and Alcoholism (DAA) Evaluation to determine whether a claimant’s potential substance use disorder would render them ineligible for Disability Insurance.
“If SSA does not clarify its policies regarding when to conduct a DAA evaluation, as well as ensure that staff document the rationale for these evaluations, staff may not be in compliance with the policies,” warned the GAO study authors. “Further, if SSA does not take action, staff conducting subsequent appeals and quality reviews may not have the information needed to effectively examine prior evaluations of substance use disorders. Thus, the agency may expend resources re-working cases and, in turn, delay benefits to individuals eligible for assistance.”
The denial of Disability Insurance to Southerners with substance use disorders could have harmful consequences for people in a region that has led the country in opioid-involved death rates. West Virginia and Kentucky were among the five states with the highest rates in 2017.
“Further, while our review focused on prescription opioids, any improvements SSA makes to this process could help the agency stay ahead of shifting trends in the broader opioid epidemic,” noted GAO.