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FILE NO. : EM-96-
DATE: AUGUST 30, 1996
AGENCY : Social Security Administration (SSA)
AUTHOR : Dale Cox, 410-965-7532
TO : All RCs/ARCs/PSCs/DDSs/FDDS/DQBs/OHAs/ OCRO/DOCs/ODIO/OIO/DCO/DCS/DCPPEC/
OCC/HCFAROs/OHAROs/OPIR/DCFAM/DCHR/OIG/OLCA/
DKUs/OHACO/OHAFOs/RPAOs.
FROM : SSA, Office of Disability
SUBJECT : EMERGENCY TELETYPE -- Questions and Answers Concerning DAA from the 07/02/96 Teleconference--Medical Adjudicators--ACTION
Regional Offices must ensure that all disability adjudicators including Adjudication Officers (AOs), decision-writers, etc., receive this message.
Refer any questions concerning this teletype or DAA provisions to your respective Regional Office Disability Programs Branch DAA Coordinators.
FO, PC, TBC; DISREGARD THIS TELETYPE
_______________________________________________________
OVERVIEW
At a 07/02/96 teleconference with DDSs and regional offices, we answered various questions about DAA. The answers to those questions are below.
DAA HOTLINE QUESTIONS AND ANSWERS (Q&As)
ISSUE 1: Misclassified Start-Up cases
Background:
Start-up notices were sent to DAA beneficiaries (DAABs) who were on our disability rolls as of March 29, 1996, to advise them that Public Law 104-121 requires us to terminate their disability benefits affective January 1, 1997. If they disagree that the new law applies to them, they may appeal their start-up notices and ask us to make a new disability determination.
The process for handling start-up appeals in the DDSs was outline in Exhibit 1 of Emergency Instruction (EM) 96-76, dated May 31, 1996. This process provides that an appeal can be closed out and a notice sent regarding the reversal of the DAA coding without making a new disability determination if the case was "misclassified" as DAA. The original exhibit, modified slightly to accommodate comments, is not in POMS DI 90070.900, Exhibit 3. A description of the process is in DI 90070.055B.
1. Q. What type of cases can be closed out as "misclassified?"
A. Only cases involving obvious coding errors. Examples of such errors are now provided in DI 90070.055C.
2. Q. Can a case be close out as "misclassified" if the DDS believes that the DAA material guidelines were misapplied; e.g., the DDS would have reached a different conclusion about whether the individual has DAA or whether DAA is a contributing factor material to the determination of disability?
A. No. We added a note to the end of DI 90070.055C to explain that "misclassified" does not mean that you would have reached a different conclusion about DAA.
3. Q. Can we say that a case that was allowed because met listing 5.05A (chronic liver disease with esophageal varices) was "misclassified" as DAA?
A. No, not unless there was an obvious coding error.
4. Q. If a case is not misclassified, can the DDS make a determination that DAA is no longer material to the determination of disability, and change the DAA coding, without developing current medical evidence?
A. Generally, no. The law requires us to make a new (i.e., a current) disability determination on start-up appeal cases. This means that you should follow the guidelines in DI 22505.C01ff. and develop medical evidence of record (MER) for the 12-month period prior to the date of the start-up appeal. However, if the prior claims folder contains medical evidence that falls within the 12-month period, refer to the response to question 5 for a discussion of when additional medical development is unnecessary.
The extent of documentation required to make the new disability determination may vary from case to case. Some cases, such as those with previously established static or progressive impairments for which the individual has received ongoing treatment, may require only minimal contact with the treating source, while others, such as those involving newly alleged impairments, may require more extensive development to support a new disability determination. (See DI 24575.007 and DI T24515.001.)
5. Q. Is it necessary to get current medical evidence if you have the folder, it contains relatively recent development, and it is possible to conclude from that prior development that DAA is not material?
A. No. If you can make a reasonable inference that the additional medical evidence would not result in a finding that DAA is material, then you need not obtain additional evidence, even if there are sources identified who have treated or evaluated the individual for his/her alleged/documented impairment(s) since the date of the "relatively recent development" and within the 12-month period prior to the date of the start-up appeal.
6. Q. If a case is not misclassified, but the individual has an obviously disabling condition (e.g., advanced HIV or quadriplegia), can we simply verify his/her current status with the treating source and dispose of the DAA appeal without making a new disability determination?
A. Where the individual has an obviously disabling impairment, contact with a current medical source to verify the continued severity of the impairment may be all that is necessary. However, the law requires you to make a new disability determination. See the response to question 4.
7. Q. Step 2a in exhibit 1 of EM-96-76 seems to be inappropriate. Why have a second point for determining whether the case was misclassified as DAA once current medical evidence is obtained?
Why not just make the new disability determination?
A. Originally, we were trying to cover all the bases:
A. DDS might determine that a case was misclassified after reviewing the prior folder (step 1 of exhibit 1); or such misclassification might not come to their attention until after they had begun developing for current medical evidence (step 2a), especially if the DDS had opted not to have the prior folders pulled.
B. After discussing this issue during the July 2, 1996, conference call, we simplified the flow chart. The chart that is now in Exhibit 3, of DI 90070.900 provides one screen-out point. It occurs at the beginning of the process, after the available evidence is reviewed and before development for MER is begun. The narrative in DI 90070.055B.2, explains that, if an obvious coding error is detected during the course of development, the adjudicator can return to the prior step to close out the case as "misclassified".
8. Q. How should we handle continuing disability review cases in which DAA is material if the case was never coded as such?
A. We are still developing instructions for handling these types of cases.
ISSUE 2: Developing Start-Up Appeal Cases
Background:
The same case development guidelines that apply to the development of initial disability claims apply to start-up appeal cases (see DI 22500.000ff and DI 25200.000ff.). The guidelines in DI 24515.001ff. and DI T24515.001 regarding the evaluation of medical evidence also apply to the start-up appeal cases.
9. Q. Some individuals who are appealing the start-up notices are currently alleging only physical impairments. If these cases were initial claims, we would not routinely develop for DAA. However, because these are DAA cases, we know that these claimants had a disabling substance use disorder at one time. To what extent (if any) are we obliged to develop the DAA aspects of the case?
A. You should develop each DAA start-up case just as you would an initial disability claim.
* You are obliged to develop DAA in start-up appeal cases anytime there is an allegation or an indication of a current substance use disorder. The fact that an individual had a substance use disorder at some point in the past is not, in and of itself, an indication of current drug\alcohol use.
* You are not obliged to pursue a potential substance use disorder if a favorable disability determination can be made on the basis of another current impairment (s) and you can make a reasonable inference that the additional medical evidence would not result in a finding that DAA is material.
10. Q. Should activities of daily living (ADL) forms be obtained if an individual alleges only physical impairments in a start-up appeal case?
A. If reference to "activities of daily living (ADL) forms" is to those forms that are specifically used to document the impact of a mental impairment on an individual's ability to function and the individual as alleged only physical impairments use of the ADL forms should be considered only if there is an indication of mental impairment elsewhere in the case record (e.g., FO observations on the SSA 3368 or the evidence developed to document the physical impairments).
11. Q. If the individual alleges only physical impairments and there have been no treating sources, should mental consultative examination (CEs) be purchased?
A. Any CEs that are purchased should focus on the alleged or indicated impairment(s). Refer to the response to question 9.
12. Q. If, during the DAA appeal process, the individual is silent regarding substance use, should the FO or DDS pursue this with the recipient?
Example: The claimant was allowed 4 years ago based on DAA, but a back condition was also documented. The only allegation on the new SSA-3368 is a back problem and the only treating source is an orthopedist. The medical evidence form the treating source addresses only the back impairment, and from the evidence submitted, the DDS concludes that it is not serve. Should the DDS deny this case without securing the prior folder and initiating an investigation into the claimant's previous DAA condition? If no, please provide guidance on how the case should be developed.
A. You are not obliged to pursue the issue with the individual unless there is an allegation or indication of current drug/alcohol use. Refer to the response to question 9.
With regard to the question posed in the example, the DDS should determine that the individual is not disabled at step 2 of the sequential evaluation process for initial claims without securing the prior folder or investigating DAA.
13. Q. If the individual reports he/she is no longer using alcohol or makes no allegation regarding current use, and the current medical evidence documents the fact that he/she has alcoholic cirrhosis, should the DDS develop the DAA aspects of the case?
A. No, unless there are indications that the individual is still using alcohol. Even then, you should not undertake further development if you can make a favorable disability determination and you can make a reasonable inference that the additional medical evidence would not result in a finding that DAA is material.
14. Q. It is appropriate for a Disability Hearing Officer (DHO) to question the individual about his/her current drug/alcohol use?
A. It would be appropriate for the DHO to question an individual about his/her current drug\alcohol use as long as the questions are germane to the appeal. For instance , if the reason the case is before the DHO is that the paper review revealed that the current impairments, including the substance use disorder, are disabling, but that DAA is a contributing factor material to the finding of disability, then the line of questioning should focus on uncovering information that will assist the DHO to determine whether the individual would be disabled if his/her drug/alcohol use stopped.
15. Q. Review of the medical literature indicates that many individuals with substance use disorders have co-morbid mental impairments. However, it is often necessary to observe these patients during a substance-free period before assigning a dual diagnosis. In the past, this did not present much of a problem. If there was no MER and the
claimant indicated frequent intoxication, a CE would be obtained. If the CE offered DAA as the only diagnosis and did not mention a possibility of dual diagnosis, a decision would be made based on all of the evidence obtained, and if the individual was found disabled, DAA would be found to be a contributing factor material to the
finding of disability. Now that the determination of "material to the finding" will result in a denial, should additional development
be undertaken specifically aimed at clarifying whether the individual has a secondary diagnosis (i.e., an additional mental impairment) separate from DAA?
A. If the individual did not allege a mental disorder other than DAA and the evidence does not indicate one, do not develop to determine whether another mental disorder exists.
16. Q. Is the individual's right to confidentiality violated if the DDS identifies a MER request as a DAA case in order to expedite the request (i.e., write on it "This is a DAA case, please expedite")?
A. In some cases, such a remark might violate the Public Health Services (PHS) regulations that restrict the use and disclosure of information from certain alcohol and drub abuse patient (ADAP) records. (See DI 90045.001ff)
ISSUE 3: Standard for Start-Up Appeal Cases
Background:
Public Law 104-121 requires us to make a new disability determination if an individual appeals the notice that his/her disability benefits will terminate effective January 1, 1997.
17. Q. Cases involving DAA require two disability determinations. First, we must decide whether all of the individual's impairments, including DAA, are disabling. If they are disabling and we have medical evidence of DAA, then we must decide if the individual would be disabled if he/she stopped using drugs; i.e., we must make the DAA material determination.
In start-up appeal case, should we use the medical improvement review standard (MIRS) to make the first disability determination?
A: No. the law is very specific in this regard. It requires us to make a new disability determination, without applying MIRS. Follow the steps in the sequential evaluation process for initial claims, (i.e., the steps outlined in SS 404.1520 and 416.920 and DI 22001.001ff.) to
decide if the individual is now disabled, and if so, whether DAA is a contributing factor material to that determination.
NOTE: We clarified this when we converted EM-96-76 into POMS (DI 90070.055.B.3.)
ISSUE 4: Need to Develop Whether DAA is Disabling When it is the Only Established or Alleged Impairment.
Background:
Pubic Law 104-121 requires that "An individual shall not be considered to be disabled...if alcoholism or drug addiction would...be a contributing factor material to the...determination that the individual is disabled."
18. Q. If DAA is the only impairment involved in a DAA start-up appeal case, can we skip the second question in exhibit 3 of DI 90070.500 (is the individual now disabled) and just affirm the termination decision because DAA will be material?
A. No. The start-up appeals process described in DI 90070.055B requires that you must first find the individual disabled before you make a material determination. Therefore, you may not proceed directly to the material determination.
19. Q. If DAA is the only allegation on a current initial claim, do you have to develop medical evidence at all?
A. Yes. The standard claims development procedures still apply. You must first have sufficient medical evidence to determine that the individual is disabled before you can make the material determination (DI 90070.050B).
20. Q. How many sources do you need to contact when the only allegation is DAA?
A. As indicated in the previous answer, the standard claims development procedures still apply.
21. Q. What do you do if DAA is the only allegation and there are no treating sources or other medical records?
A. Again, the standard development procedures apply. Where no medical evidence is available, you purchase a CE (see DI 22805.012). The type and number of CEs you request will depend upon the allegations and observations in the particular case.
ISSUE 5: Medical Evidence of DAA
Background:
If an individual is found to be disabled and we have medical evidence of DAA, a material determination must be made. WE define the terms "medical evidence of DAA" and "medically determinable substance use disorders" in DI 900770.050C.
22. Q. What is the correct terminology: substance dependence disorders, substance use disorders, or drug addiction and alcoholism (DAA)?
A. We presently use the terms drug addiction and alcoholism and substance use disorders interchangeably.
* The term "drug addiction and alcoholism" appears in the statute and dates back to the 1972 amendments that created the SSI program. But, it is not standard terminology used by present-day professionals.
* The term "substance use disorders" is the present-day term that SSA has chosen to equate with the statutory term "DAA". The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (the DSM-IV), published by the American Psychiatric Association (APA) in May 1994, uses the term substance use disorders to describe conditions in which an individual's maladaptive pattern of substance use leads to clinically significant impairment or distress. Traditionally, SSA has applied the nomenclature and diagnostic schemes in the APA's manual when describing various mental disorders that individuals may present.
The term "substance dependence disorders" refers to one of two subsets of "substance use disorders" described in the DSM-IV. The other subset is "substance abuse disorders."
23. Q. Can we look at the overall picture presented by the medical and other evidence in file to establish a diagnosis of DAA, or must we use only the criteria in the DSM-IV?
A. This question presents two issues:
* The first involves what is need to establish an impairment. According to our regulations (see SS 404.1508 and 416-908) and impairment must be established by medical evidence consisting of signs, symptoms, and laboratory findings, not just an individual's statement of symptoms.
* The second involves what diagnostic scheme to follow when deciding if the DAA provisions apply. As stated in the response to question 22 above, follow the scheme in the DSM-IV. We believe the diagnostic criteria in the DSM-IV are sufficiently broad to be compatible with other diagnostic schemes. If an individual is diagnosed as having a drug or alcohol disorder under another diagnostic scheme, you must determine if the findings fulfill the DSM-IV criteria for a substance use disorder.
24. Q. What constitutes sufficient and appropriate evidence to establish the existence of a substance use disorder?
A. As indicated in DI 90070.050C., medical evidence
of DAA, i.e., a substance use disorder, will be considered sufficient and appropriate when the evidence shows that the criteria for "substance dependence" or "substance abuse" disorders defined in the DSM-IV are fulfilled.
ISSUE 6: Role of the Consultant/Disability Examiner
Background:
DI 24501.010 defines the medical consultant's (MC's) and psychological consultant's (PC's) role: DI 24501.005 defines the disability examiner's (DE's) role.
25. Q. What are the responsibilities of the DDS MC/PC and the DE in making the material determination?
A. A DAA material determination is required when a finding of disability is made and there is medical evidence of DAA. The roles of the MC/PC/DE in making that determination are the same as those for making the disability determination.
It is the MC/PC's responsibility to project, on the basis of the evidence in file and his/her professional knowledge and judgment, what limitations, if any, would remain if the individual were to stop using drugs/alcohol. This requires eliminating both the direct effects of the drug/alcohol use and its impact on any other impairments, physical or mental. When recording his/her findings, it is never appropriate for the MC/PC to include statements such as "DAA is material" or "if allowed, DAA material."
It is the DE's responsibility to assess the significance of the remaining limitations recorded by the NC/PC; i.e., those limitations, if any, remaining after excluding the effects of DAA. The DE will follow the sequential evaluation process in making this assessment. If at any point in that process the DE determines that the individual retains the capacity to engage in substantial gainful activity (SGA), the DE will conclude that DAA is material to the disability determination.
26. Q. How should the MC/PC record his/her findings regarding the remaining limitations? How should the DE record a finding that DAA is material?
A. We did not mandate a set format in order to allow adjudicators the latitude to use the most effective and least cumbersome means of
documenting the claims folder. But, regardless of the format selected, the explanation must be sufficient to support the conclusions reached.
For instance:
* An MC/PC may opt to complete a second set of medical assessment forms (e.g., PRTF, RFC) to record the remaining limitations, or he/she may prefer to record them on another form (e.g., in the remarks portion of the PRTF/RFC used to record the assessment of all the impairments, including DAA).
* Generally, a DE should use an SSA-4268 to record the rationale for finding that DAA is material. Where the information to support the rationale is summarized elsewhere in the file, it may be referred to on the SSA-4268. If there is an explanation detailing all the elements required by DI 90010.010F.2. for a material determination rationale elsewhere in file, an SSA-4268 need not be completed; reference to the explanation should be made in the remarks section of the SSA-831/832/833.
27. Q. Is it appropriate for an MC/PC to conclude that he/she cannot project what limitations, if any, would remain if drug/alcohol use stopped and let the DE make a determination that DAA is not material?
A. Yes. There will be cases in which the evidence demonstrates multiple impairments, especially cases involving multiple mental impairments, where the MC/PC cannot project what limitations would remain if the individuals stopped using drugs/alcohol. IN such cases, the MC/PC should record his/her findings to that effect. Since a finding that DAA is material will be made only when the evidence establishes that the individual would not be disabled if he/she stopped using drugs/alcohol, the DE will find that DAA is not a contributing factor material to the determination of disability.
ISSUE 7: Making the DAA Material Determination
Background:
In the instructions we issued, we provided three examples of when it would be appropriate to find that DAA is a contributing factor material to the disability
determination.
* The first two examples (when DAA is the only impairment, and when the other impairment(s) is not by itself disabling) are intended to illustrate situations in which you would be able to separate out the effects of drug/alcohol and determine whether the individual would be disabled if such use stopped.
* The third example (when an individual's other impairment(s) is exacerbated by DAA and the evidence documents that, after a drug-free period of 1 month, the other impairment(s) is not disabling) was intended
to illustrate the fact that, in some situations, it may not be possible to separate the effects of drug/alcohol use from the affects of the other impairment(s) until the individual has been abstinent for a length of time sufficient to allow the acute effects of intoxication and withdrawal to abate.
28. Q. The three examples of when DAA is material are obvious examples. Is it fair to tell adjudicators that when they are unable to determine how an individual would be if he/she stopped using drugs/alcohol, then it is appropriate to make a finding that DAA is not material?
A. Yes. See the response to question 26. When the MC/PC cannot project what those limitations would be, then it would be appropriate for the DE to find that DAA is not material to the determination of disability.
29. Q. The most complicated and difficult determinations of materiality will involve individuals with documented substance use disorders and one of more other mental impairments. In many of these instances, it will be very difficult to disentangle the restrictions and limitations imposed by the substance use disorder form those resulting from other mental impairment(s). Can any examples be provided for how to handle the materiality determination in these situations, or can any guidance be provided for the type of information that should be used in trying to assess the impact of each impairment?
A. We know of no research data upon which to reliably predict the expected improvement in a coexisting mental impairment(s) should drug/alcohol use stop. The most useful evidence that might be obtained in such cases is that relating to a period when the individual was not using drugs/alcohol. Of course, when evaluating this type of evidence consideration must be given to the length of the period of abstinence, how recently it occurred, and whether there may have been any increase in the limitations and restrictions imposed by the other mental impairments since the last period of abstinence. When it is not possible to separate the mental restrictions and limitations imposed by DAA and the various other mental disorders shown by the evidence, a finding of "not material" would be appropriate. See the response to question 27.
30. Q. The third example of materiality that was in EM-96-76 dated May 31, 1996, presents an example in which "the evidence documents that after a drug-free period of at least 1 month [emphasis added], the other impairment(s) is not by itself disabling." Is this an example or is it to be used as an adjudicative rule?
A. It was intended only as an examples. The time period of at least 1 month was not intended to imply that drug-free periods of less than 1 month should not be considered when determining whether DAA is material. To clarify this point, we deleted the words "at least" when we placed the example in DI 90070.050D.3.
31. Q. Does the 1-month period of abstinence described in the third example require definitive documentation or can presumptions be made?
A. Documentation of a period of abstinence should provide information as to what, if any, impairment-related limitations remained after the acute effects of intoxication and withdrawal abated. Reasonable inferences may be drawn from such information, but they should never extend to the point that presumptions are substituted for documentation. What matters is whether there is evidence after such a period that any remaining limitations were not disabling, and therefore, a finding could be made that the individual would not be disabled if he/she stopped using drugs/alcohol.
32. Q. We believe that most individuals will not have had a substantial substance-free period. The basic policy regarding the materiality states that DAA is material only when the evidence establishes that the individual would not be disabled if he/she stopped using drugs or alcohol. Are we to conclude that in the absence of documentation of a substance-free period, a finding of that DAA is material generally should not be made?
A. No. The evidence about the individual's other impairment(s) may allow the MC/PC to project what limitations would remain if drug/alcohol use stopped, even in the absence of a period of abstinence.
33. Q. In a start-up appeal case, after determining the limitations that would remain if the individual stopped using drugs/alcohol, should we use the sequential evaluation process that applies to initial claims to make the DAA material determination?
A. Yes. See the response to question 37.
34. Q. If an individual's other impairment(s) does not improve within a month of abstaining from substance use, but is expected to improve significantly within 12 months of sobriety (and would allow the individual to return to work), is DAA material or not material?
A. This type of case would fall under example 2 and there is not time-limit or duration concept associated with this example. As long as the evidence would allow the MC/PC to project the remaining limitations, then the DE should follow the steps in the sequential evaluation process to determine whether the individual would be disabled if he/she stopped using drugs/alcohol.
35. Q. Is there a viable rationale for finding that DAA is material if the claimant is not using drugs\alcohol and is disabled (e.g., the remaining impairment was caused by drug/alcohol use)? If yes, for how long after drug/alcohol use ceases?
A. If the MC/PC can project what limitations would remain, then the concepts behind example 2 apply; and, as stated in the response to question 34, there is not specific time period associated with this example.
If the MC/PC cannot project what limitations would remain and the present remaining limitations are disabling, even if the result of drug/alcohol use, then the concepts in example 3 apply, and you would have to conclude that DAA is not material to the disability determination.
ISSUE 8: Recording the DAA Material Determination
Background:
DI 26515.000ff. provides general guidelines on the preparation of the disability determination/hearing decision rationale. DI 26516.000ff. provides simplified procedures. DI 90010.010F.2. provides guidelines specific to the preparation of DAA material determination rationales; i.e., rationales finding that DAA is a contributing factor material to the determination of disability.
36. Q. When do you need to prepare a DAA material determination rationale?
A. A DAA material determination rationale must be prepared when a finding that DAA is material to the disability determination is made. The rationale is not a specific form; it is the explanation of the basis for the determination. The rationale must reflect the sequential evaluation process followed in concluding that DAA is material.
37. Q. Does sequential evaluation apply to the DAA material decision-making process?
A. Yes. Once a finding has been made that the impairment(s) is disabling, and the medical evidence establishes the presence of a substance use disorder, the decision-maker must follow the sequential evaluation process to determine if the individual would be found disabled if the effects of DAA, including its impact on any other impairments, were discounted.
38. Q. How should the MC/PC complete the PRTF and MRFCA forms in a DAA start-up appeal case?
A. The MC/PC should complete the relevant forms as he/she would for an initial claim. If a mental impairment is established by the medical evidence, he/she should complete a PRTF, unless a favorable disability determination can be made on the basis of a physical impairment(s). See the response to question 26.
39. Q. What forms should be used to record the findings for the DAA material determination?
A. See the response to question 26.
40. Q. What elements should the DAA material rationale contain? Should it address all impairments?
A. The DAA material rationale should address all impairments considered in the disability determination and should describe the current mental/physical limitations upon which the disability determination was based. It should also include a discussion of the findings produced by the sequential evaluation process that was followed in reaching the conclusion that DAA is material. A single statement that DAA is material to the determination of disability is not sufficient, even where a substance use disorder is the only impairment.
41. Q. Does the ALJ need to address substance use disorders al all in his/her decisions with the new legislation? Does the ALJ need to address the "DAA material" process in his/her decisions?
A. Yes to both questions. The new DAA legislation did not change the process under which we have been evaluating cases involving DAA. The effects of DAA must be considered in making the disability decision. If the ALJ finds the individual is disabled and there is medical evidence of DAA, he\she must make a finding that DAA is/is not a contributing factor material to the sequential evaluation process he/she followed in reaching his/her conclusion regarding DAA materiality. The discussion of his/her findings must be sufficient to support his/her conclusion.
42. Q. It is unclear what the DDS should discuss in the personalized decision language section of the personalized decision notice (PDN) after the discussion of the medical findings. Should any discussion of the RFC include both before and after consideration of the effects of DAA?
A. The discussion should be similar to that for current denial notices. Any discussion of RFC should reflect why the individual is not disabled; e.g., because sh/she would be able to do past relevant work if he/she stopped using drugs/alcohol, or because his/her impairment(s) would not be severe if he/she stopped using drugs. You may wish to place the decision paragraph (DI 90070.900 EXHIBIT 14) after the dictated text paragraphs, rather than before.
End