VA Disability and Alcoholism

CCK Law: Our Vital Role in Veterans Law

What is Alcoholism?

 Alcohol use disorder, or alcoholism, is a pattern of alcohol use that involves problems controlling drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, and having withdrawal symptoms when you rapidly decrease or stop drinking.  Alcoholism also includes binge drinking – a pattern of drinking where a male consumes five or more drinks within two hours or a female consumes at least four drinks within two hours.  Symptoms of alcoholism can range from mild to severe and may include the following:

• Being unable to limit the amount of alcohol you drink
• Wanting to cut down on how much you drink or making unsuccessful attempts to do so
• Spending a lot of time drinking, getting alcohol, or recovering from alcohol use
• Feeling a strong craving or urge to drink alcohol
• Failing to fulfill major obligations at work, school, or home due to repeated alcohol use
• Continuing to drink alcohol even though you know it’s causing physical, social, or interpersonal problems
• Giving up or reducing social and work activities/hobbies
• Using alcohol in situations where it is not safe, such as when driving or swimming
• Developing a tolerance to alcohol so you need more to feel its effect, or you have a reduced effect from the same amount
• Experiencing withdrawal symptoms (e.g., nausea, sweating, shaking) when you do not drink, or drinking to avoid these symptoms

Risk factors for alcoholism include depression and other mental health conditions, a history of trauma, family history, and more.

 VA’s Definition of Alcohol Abuse

 In order to understand how the Department of Veterans Affairs adjudicates claims for alcoholism, it is important to first understand how it defines alcohol abuse.  According to VA, alcohol abuse is “the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability or death of the user.”  Importantly, consuming an alcoholic beverage does not constitute alcohol abuse.  Instead, alcohol abuse is constituted by both the length of time that the behavior continues and whether the behavior is done in excess.

Prevalence of Substance Abuse Disorder Among Veterans

 The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 7.1 percent of all U.S. veterans met the criteria for substance use disorder between 2004 and 2006.  The rate of veterans with substance use disorder, such as alcoholism, is disproportionate among time periods served:

• Post-9/11: 7 percent of veterans
• August 1990 – August 2001: 8 percent of veterans
• May 1975 – July 1990: 7 percent of veterans
• August 1964 – April 1975: 7 percent of veterans
• July 1964 or earlier: 7 percent of veterans

Veterans often encounter psychological stress or physiological ailments as a result of their time in service.  Alcoholism can arise due to many factors, including symptoms of post-traumatic stress disorder (PTSD).  According to VA, “getting PTSD increases the risk that veterans will develop a drinking or drug problem.”  Specifically, over 20 percent of veterans with PTSD also have a substance use disorder and nearly 1 out of every 3 veterans seeking substance use disorder treatment also have PTSD.

The percentage of veterans returning from overseas with PTSD is increasing rapidly, yet SAMHSA estimates that only about 50 percent of returning servicemembers in need of mental health treatment actually seek it.  The lack of appropriate treatment may lead to self-medicating with alcohol.

Service Connection for Alcoholism: When Does VA Grant It?

Veterans cannot be directly service-connected for alcoholism; however, they can be service-connected on a secondary basis for conditions that arise from alcoholism, if the alcoholism is due to a service-connected condition.

For example, a veteran is service-connected for PTSD and uses alcohol to cope with their psychological symptoms and sleep disturbances. As a result of this prolonged alcohol use, the veteran develops cirrhosis of the liver. This veteran may be able to receive service-connected compensation for their cirrhosis of the liver on a secondary basis. Here, the veteran’s alcoholism serves as an intermediate step between their service-connected PTSD and cirrhosis.

VA rates cirrhosis of the liver under 38 CFR § 4.114, the Schedule of Ratings for the Digestive System, Diagnostic Code 7312. Veterans can receive ratings at 0, 10, 30, 60, or 100 percent. The rating criteria for each percentage are outlined below:

• 100 percent – “Liver disease with Model for End-Stage Liver Disease score greater than or equal to 15; or with continuous daily debilitating symptoms, generalized weakness and at least one of the following:

• • ascites (fluid in the abdomen), or
  • a history of spontaneous bacterial peritonitis, or
  • hepatic encephalopathy, or
  • variceal hemorrhage, or
  • coagulopathy, or
  • portal gastropathy, or
  • hepatopulmonary or
  • hepatorenal syndrome”

• 60 percent – “Liver disease with Model for End-Stage Liver Disease score greater than 11 but less than 15; or with daily fatigue and at least one episode in the last year of either:

• • variceal hemorrhage, or
  • portal gastropathy, or
  • hepatic encephalopathy”

• 30 percent – “Liver disease with Model for End-Stage Liver Disease score of 10 or 11; or with signs of portal hypertension such as splenomegaly or ascites (fluid in the abdomen) and either weakness, anorexia, abdominal pain, or malaise”

• 10 percent – “Liver disease with Model for End-Stage Liver Disease score greater than 6 but less than 10; or with evidence of either anorexia, weakness, abdominal pain or malaise”

• 0 percent – “Asymptomatic, but with a history of liver disease”

Essentially, alcoholism can potentially be used as a bridge to connect a veteran’s primary service-connected condition to the secondary condition they developed as a result of their alcoholism.

Importantly, veterans can receive disability ratings for alcohol-related conditions as long as the alcoholism was not a product of the veteran’s own “willful misconduct.” VA defines willful misconduct as “an act involving conscious wrongdoing or known prohibited action.” If VA wants to deny benefits based on a veteran’s willful misconduct, it must prove by a “preponderance of evidence” (i.e., more likely than not) that the cause of the veteran’s condition is in line with the definition provided above.

VA Services Available for Alcoholism Treatment

VA offers many services to veterans struggling with substance use.  These services can include treatment options such as medication, therapy, and treatment of co-occurring conditions such as PTSD.  As stated on VA’s website, medication options for these veterans include:

• Medically managed detoxification to stop substance use safely, and services to stabilize
• Drug substitution therapies and medicines to lessen cravings
• Nicotine replacement therapy or medications

Counseling and therapy options include the following:

• Short-term outpatient counseling
• Intensive outpatient treatment
• Marriage and family counseling
• Self-help groups
• Residential care
• Continuing care and relapse prevention
• Programs for veterans with specific needs (e.g., homeless veterans)