Imagine a veteran with service-connected diabetes whose diabetes led to the amputation of his foot. It would seem absurd for the VA to deny his claim. However, many veterans with service-connected mental health issues are routinely denied service-connection to disabilities secondary to substance abuse. Not only has substance abuse been clinically and scientifically seen as a symptom of mental illness for many years, but when the VA rejects these claims, they are breaking their own rules.
Mental illness and substance abuse have been inextricably linked since we’ve been studying mental illness. A high percentage of patients with mental illness also have a substance abuse problem. Many people believe that mental illness causes substance abuse, and others believe that substance abuse causes mental illness. However, studies show that BOTH of these positions are true. Of VA patients with mental illness, around 21 to 35% also have co-occurring substance abuse disorders. While the rate of substance abuse varies from diagnosis to diagnosis (schizophrenia and bipolar disorder have the highest rates), there is an increase in substance abuse with most mental illnesses.
In 2001, the Federal Circuit heard the case of Allen v. Principi, where a veteran with PTSD was fighting for an increased rating for his PTSD, due to the effects of his substance abuse socially and occupationally. The VA responded that substance abuse could NOT be service-connected, either as a primary disability or as secondary to mental illness. However, the court found that the law:
“does not preclude compensation for an alcohol or drug abuse disability secondary to a service-connected disability or use of an alcohol or drug abuse disability as evidence of the increased severity of a service-connected disability.” But cautioned that: “veterans can only recover if they can adequately establish that their alcohol or drug abuse disability is secondary to or is caused by their primary service-connected disorder …where there is clear medical evidence establishing that the alcohol or drug abuse disability is indeed caused by a veteran’s primary service-connected disability, and where the alcohol or drug abuse disability is not due to willful wrongdoing.”
It is the phrase “willful wrongdoing” that is often the problems in these sorts of cases, and it can be difficult to demonstrate to the VA that the substance abuse is not misconduct, but a symptom of the veteran’s mental illness. Typically, the best way to do this is with an independent medical opinion wherein the doctor provides medical research showing the clear connection between substance abuse and mental illness.
There are many disabilities that can be caused by substance abuse, and there can be damage to many parts of the body.
Alcohol and many other drugs of abuse can cause severe liver problems, from cirrhosis, fatty liver disease, alcoholic hepatitis, and even liver cancer.
Alcohol and drug abuse can severely affect the neurological system of the body. Alcohol abuse can lead to Wernicke-Korsakoff disease, the result of thiamine (b1) deficiency that is common with alcoholism. This can result in confusion, memory and cognitive problems, problems walking, and paralysis of the nerves that control eye movement. Chronic alcohol abuse also causes peripheral neuropathy and myopathy, pain in the nerves and muscles. Many drugs of abuse can have serious and profound effects on the brain, from brain damage to strokes, and even coma.
Chronic alcohol abuse is terrible for your cardiovascular system. Drinking can elevate triglycerides in the blood, and cause hypertension, anemia, stroke, cardiomyopathy, arrhythmias, and even sudden cardiac death. Drinking also tends to lead to obesity, which can aggravate cardiac problems further. Many other drugs of abuse, such as stimulants like cocaine and methamphetamines, can cause severe heart problems as well.
Excessive alcohol use can cause cancers in many places, such as the mouth, esophagus, breast and digestive system.
There are many other complications from alcohol and drug abuse, from diabetes to even orthopedic problems caused by intoxication. Infectious diseases, such as HIV or Hepatitis C may be the result of intravenous drug use, and veterans with drug problems have gotten these disabilities service-connected in the past.
It is important for the VA to recognize that alcohol and substance abuse are NOT moral problems in those with mental illness, but are as much a part of the disease process as any other symptom. It is even more important for veterans with substance abuse problems to receive the treatment and care that they need and deserve.