Bipolar SSDI Denial Guide – Texas, Texas Appeals Help

Introduction: Why Bipolar SSDI Denials Matter in Texas

The Social Security Administration (SSA) denies a significant percentage of initial Social Security Disability Insurance (SSDI) applications nationwide. In Texas, the denial rate for first-time claims historically exceeds 60%. Claimants living with bipolar I or bipolar II disorder often face unique challenges because their symptoms fluctuate and medical evidence can be difficult to document. If you received a denial letter in Dallas, Houston, San Antonio, Austin, or any other Texas community, you are not alone—and you still have multiple appeal levels available under federal law.

This comprehensive guide favors protecting the rights of Texas disability claimants while remaining strictly factual and grounded in authority. All citations come directly from the Social Security Act, the Code of Federal Regulations (CFR), Social Security Rulings (SSRs), or published federal court opinions. You will find step-by-step instructions for challenging an SSDI denial, specific deadlines, local resources, and tips tailored to Texans coping with bipolar disorder.

Understanding Your SSDI Rights

What SSDI Provides

SSDI pays monthly cash benefits and automatically qualifies successful claimants for Medicare after 24 months of entitlement. Eligibility depends on:

• Insured status—enough “covered earnings” under the Federal Insurance Contributions Act (FICA).

• Disability—an inability to engage in substantial gainful activity (SGA) for at least 12 continuous months, as defined in 20 CFR §404.1505(a).

• Severe medically determinable impairment—verified by acceptable medical sources (20 CFR §404.1520(a)(4)(ii)).

Bipolar Disorder in the SSA Listings

The SSA evaluates bipolar disorder under Listing 12.04 (Depressive, bipolar, and related disorders). To meet the Listing, you must provide clinical documentation of:

• Manic, hypomanic, or depressive episodes causing marked limitation in at least two of four functional areas (understanding & memory; social interaction; concentration; adaptation), or

• Evidence of the disorder plus a two-year history of ongoing medical treatment with marginal adjustment.

Even if you do not meet the Listing, you may still qualify under a residual functional capacity (RFC) assessment that precludes competitive employment. The RFC analysis must consider the combined effects of your symptoms, side effects of medication (e.g., lithium, atypical antipsychotics), and any comorbid conditions such as anxiety or PTSD.

Your Right to Appeal

Under 20 CFR §404.909, you have 60 days from receipt of a denial notice—plus five additional mailing days—to file a written request for reconsideration. If denied again, the same timeline applies for each subsequent level: request for hearing, Appeals Council review, and federal district court. Missing a deadline usually ends your claim unless you establish “good cause” (20 CFR §404.911). Texas residents file appeals through regional SSA offices and the Office of Hearings Operations (OHO) assigned to the Dallas Region.

Common Reasons SSA Denies SSDI Claims

1. Insufficient Medical Evidence

The SSA must see objective evidence from psychiatrists, psychologists, or other acceptable medical sources. Progress notes should describe:

• Frequency, intensity, and duration of manic/depressive episodes.

• Hospitalizations, suicide attempts, or psychotic features.

• Medication adjustments and side effects that limit functioning.

Many Texans rely on overstretched community mental health centers, resulting in sporadic treatment records. If your file lacks longitudinal evidence, adjudicators may assume your condition is mild or controlled.

2. Continuing to Work Above SGA

For 2024, the SGA threshold for non-blind claimants is $1,550 per month. Earnings above that amount typically trigger a technical denial, regardless of severity of bipolar symptoms.

3. Non-Compliance With Treatment

Refusing prescribed medication can lead to denial unless you prove a legitimate reason—serious side effects, religious objections, or inability to afford treatment (SSR 18-3p).

4. Failure to Cooperate With the DDS Examiner

Disability Determination Services (DDS), run by the Texas Health and Human Services Commission under contract with SSA, may schedule a consultative examination. Missing or refusing the exam frequently results in an adverse decision.

5. Prior Denials Not Addressed

If you simply re-file instead of appealing, the new claim may be dismissed as res judicata (same facts, same parties). An appeal preserves your protective filing date and retroactive benefits.

Federal Legal Protections & Regulations

Key Statutes and Rules

• Social Security Act §223(d) – Defines “disability.”

• 20 CFR §§404.1505–404.1523 – Medical severity and evaluation process.

• 20 CFR §404.909 – Reconsideration rights.

• 20 CFR §404.933 – Hearing before an Administrative Law Judge (ALJ).

• 20 CFR §404.970 – Appeals Council review standards.

How These Rules Protect Texas Claimants

Federal regulations apply uniformly in every state, but Texas claimants benefit from the Fifth Circuit’s jurisprudence. For example, in Aldrich v. Saul, 983 F.3d 107 (5th Cir. 2020), the court remanded because the ALJ failed to properly consider claimant testimony about mental limitations—underscoring the importance of credible symptom statements.

Attorney Representation and Fees

A licensed Texas attorney or qualified non-attorney representative may charge up to 25% of past-due benefits or $7,200 (whichever is less) with SSA approval (20 CFR §404.1730(b), updated maximum effective Nov. 30, 2022). All representatives must comply with the SSA’s Rules of Conduct and, in Texas, attorneys must be active members of the State Bar of Texas.

Steps to Take After an SSDI Denial

1. Read Your Denial Letter Thoroughly

Locate the date on the top right. Mark 65 calendar days out—your absolute deadline. Note specific reasons cited (medical vs. technical) so you can target evidence on appeal.

2. File a Timely Request for Reconsideration

You may submit Form SSA-561, a statement, and any new evidence:

Online via SSA’s Appeal Portal.

• By mail to your local SSA field office.

• In person (call first; many Texas offices require appointments).

Keep proof of submission—print confirmation, certified-mail receipt, or SSA date stamp.

3. Update Medical Records

Request complete records from psychiatrists, psychologists, and hospitals such as UT Southwestern Medical Center (Dallas), The Menninger Clinic (Houston), or University Health (San Antonio). Explain the SSA’s definition of “disability” so providers emphasize functional limitations—not just diagnoses.

4. Secure Third-Party Statements

Under 20 CFR §404.1513(a)(4), evidence from non-medical sources—family, friends, supervisors—can corroborate mood swings, absenteeism, or unsafe behavior during manic phases.

5. Track Medication Side Effects

Mood stabilizers and antipsychotics often cause weight gain, sedation, or tremors. Document every adverse effect and how it interferes with work-related tasks.

6. Prepare for the ALJ Hearing

If reconsideration is denied, request a hearing (20 CFR §404.933). Texas hearings occur by video or in person at OHO offices in Dallas, Fort Worth, Houston (Bissonnet and Downtown), and San Antonio. An independent vocational expert (VE) will testify about jobs you can perform. Cross-examination from your attorney can expose flaws in the VE’s opinion.

7. Appeals Council and Federal Court

The Appeals Council in Falls Church, Virginia, reviews only 15–20% of requests. If they deny, you may file suit in the U.S. District Court for the Northern, Southern, Eastern, or Western District of Texas within 60 days (42 U.S.C. §405(g)). Court review focuses on whether the ALJ decision is supported by “substantial evidence” and follows proper legal standards.

When to Seek Legal Help for SSDI Appeals

Indicators You Need Representation

• You have multiple mental health hospitalizations or suicide attempts.

• Your work record is complex (intermittent earnings, part-time gigs, gig-economy work).

• You struggle to gather records or meet deadlines because of mood instability.

• You need to question a VE or produce a psychological evaluation.

A texas disability attorney can identify methodological errors in an ALJ decision, draft pre-hearing briefs citing Fifth Circuit precedent, and negotiate onset dates to maximize retroactive benefits.

Cost-Benefit Analysis

Because attorney fees are contingent on back pay, there is typically no upfront cost. Given that the average SSDI benefit for a disabled worker in 2023 was $1,489 per month (SSA data), securing even 12 months of retroactive payments can far exceed the representative fee cap.

Local Resources & Next Steps

Key SSA Offices in Texas

• Dallas Downtown SSA – 1301 Young St., Dallas, TX 75202

• Houston Bissonnet SSA – 8989 Lakes at 59, Houston, TX 77074

• San Antonio SSA – 3438 E. S. W. Military Dr., San Antonio, TX 78223

• Austin SSA – 1029 Camino La Costa, Austin, TX 78752

Mental Health Clinics Offering Sliding-Scale Care

• Harris Center for Mental Health & IDD (Houston)

• Metrocare Services (Dallas)

• Integral Care (Austin)

Free and Low-Cost Legal Help

Texas RioGrande Legal Aid Lone Star Legal Aid Disability Rights Texas

Texas Disability Statistics

The U.S. Census Bureau (2022 ACS) reports that approximately 12.6% of Texans under 65 live with a disability. Mood disorders, including bipolar disorder, are among the top five diagnostic categories for SSDI awards in the Dallas SSA Region, according to SSA actuarial publications.

Checklist Before You Appeal

• Calendar the 60-day deadline.

• Request updated treatment notes and lab results.

• Draft a personal statement describing daily limitations.

• Consult a licensed Texas SSDI attorney.

Legal Disclaimer

This article is for informational purposes only and does not constitute legal advice. Laws and regulations change frequently. You should consult a licensed Texas attorney about your specific situation.

If your SSDI claim was denied, call Louis Law Group at 833-657-4812 for a free case evaluation and claim review.