SSDI Denial Appeals Guide – College Station, Texas

Introduction: Why This Guide Matters to College Station Claimants

Receiving a Social Security Disability Insurance (SSDI) denial can be overwhelming, especially if you live in College Station, Texas and rely on those benefits to cover basic living and medical expenses. In 2023, the Social Security Administration (SSA) reported a nationwide initial allowance rate of roughly 36%.* That means most applicants— including many Brazos County residents—must pursue the appeals process to secure the benefits they earned through payroll tax contributions. This guide breaks down your federal rights, the SSA’s multilayered appeals system, and the local resources available in College Station. It slightly favors claimants by emphasizing practical steps you can take to build a stronger case while remaining strictly factual and rooted in authoritative sources.

Understanding Your SSDI Rights

Earning Coverage Through Work Credits

SSDI is an insurance program funded by your Federal Insurance Contributions Act (FICA) taxes. To qualify, you must (1) have paid sufficient FICA taxes to accumulate the required work credits and (2) meet the Social Security Act’s definition of disability found in 42 U.S.C. § 423(d). In most cases, you need 40 work credits, 20 of which were earned in the 10 years preceding disability onset, although younger workers may need fewer credits.

The Five-Step Sequential Evaluation

The SSA decides disability claims using its five-step sequential evaluation contained in 20 C.F.R. §§ 404.1520–404.1569a. The agency asks:

• Are you engaged in substantial gainful activity (SGA)?

• Do you have a severe medically determinable impairment?

• Does your impairment meet or equal a listed impairment in Appendix 1 of 20 C.F.R. Part 404, Subpart P?

• Can you perform your past relevant work?

• Considering age, education, and work experience, can you adjust to any other work in the national economy?

You have a right to a written explanation of how each step was decided. That explanation is your foundation for any appeal.

Common Reasons the SSA Denies SSDI Claims

Medical Insufficiency

The SSA often concludes that evidence does not establish a medically determinable impairment or that the impairment is not severe for at least 12 months, as required by 20 C.F.R. § 404.1509. Submitting complete, longitudinal medical records from local providers such as CHI St. Joseph Health Regional Hospital or the Texas A&M Health Science Center strengthens your file.

Work Credit Deficiency

If you lack sufficient work credits, the SSA will issue a non-medical, technical denial. To verify your credits, create a my Social Security online account.

Noncompliance With Treatment

Under 20 C.F.R. § 404.1530, the SSA may deny claims if you fail to follow prescribed treatment without good cause. Always document valid reasons—such as inability to afford medication—to rebut such findings.

Substantial Gainful Activity

Earning above SGA limits—$1,470 per month for non-blind claimants in 2024—can trigger denial (see current SGA amounts).

Federal Legal Protections & Regulations

Appeal Rights and Deadlines

The appeals process is governed by 20 C.F.R. § 404.900. You have:

• 60 days from receipt of the denial notice (plus 5 mailing days) to request Reconsideration.

• 60 days after a Reconsideration denial to request a Hearing before an Administrative Law Judge (ALJ).

• 60 days after an unfavorable ALJ decision to seek Appeals Council review.

• 60 days after Appeals Council denial to file a civil action in the U.S. District Court for the Southern District of Texas, Houston Division, which has jurisdiction over Brazos County.

Missing these deadlines generally forfeits your claim, although 20 C.F.R. § 404.911 allows extensions for good cause.

Evidence Standards

Under 20 C.F.R. § 404.1512, the claimant bears the burden of providing all relevant evidence in their possession. The SSA’s duty to develop the record is limited but real; federal courts—including the Fifth Circuit in Brock v. Chater, 84 F.3d 726 (5th Cir. 1996)—have vacated denials where ALJs failed to fully and fairly develop the record for unrepresented claimants.

Representative Fees

Attorney fees are capped at the lesser of 25% of past-due benefits or $7,200 by 42 U.S.C. § 406(a) and 20 C.F.R. § 404.1728, unless a federal court awards a higher fee under § 406(b).

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

The SSA’s notice outlines which of the five steps led to denial, the medical evidence considered, and appeal instructions. Highlight any factual errors or missing records.

2. Request Reconsideration (If Your State Requires It)

Texas participates in the Reconsideration level. File SSA-561 Request for Reconsideration online or deliver it to your local SSA field office within 60 days. Attach new evidence—e.g., updated MRI results from St. Joseph Health-College Station Hospital. You may also submit Form SSA-795 statements from former supervisors describing your work limitations.

3. Prepare for the ALJ Hearing

If Reconsideration is denied (the most common outcome), request an ALJ hearing through SSA’s Appeals portal. Hearings are usually held by video in the SSA’s Houston or Austin hearing offices; travel may be required, but telephone options exist. Follow these best practices:

• Organize Exhibits numbered per SSA rules (e.g., Ex. 1F, 2E).

• Request Medical Opinion Forms (Residual Functional Capacity assessments) from treating physicians familiar with your limitations.

• Identify Vocational Expert Issues in advance—e.g., challenge hypothetical questions that do not fully capture your documented restrictions.

4. Appeals Council Review

If the ALJ denies the claim, you may file Form HA-520 to request review. The Appeals Council in Falls Church, Virginia, looks for errors of law, abuse of discretion, and unsupported findings.

5. Federal Court Action

Your final option is filing a civil complaint under 42 U.S.C. § 405(g) in the Southern District of Texas. The suit must be filed against the Commissioner of Social Security. Federal courts can affirm, reverse, or remand the Commissioner’s decision.

When to Seek Legal Help for SSDI Appeals

Complex Medical Evidence

If your impairment involves nuanced medical findings—such as multiple sclerosis, complex regional pain syndrome, or traumatic brain injury—an experienced college station disability attorney can translate technical jargon into vocational terms the SSA understands.

Past Administrative Deadlines

Lawyers can argue good cause for late appeals and help you avoid future lapses.

Need for Expert Cross-Examination

At ALJ hearings, vocational experts (VEs) and medical experts testify. Attorneys licensed by the State Bar of Texas know how to cross-examine these experts effectively, increasing the odds of a favorable decision.

Local Resources & Next Steps

1. College Station SSA Field Office

Address: 2400 Lakeway Dr., Suite A, College Station, TX 77845

Phone: 866-568-6872

Hours: 9 a.m. – 4 p.m., Monday–Friday (check SSA Office Locator for updates)

2. Health Care Providers

• CHI St. Joseph Health Regional Hospital – Comprehensive diagnostic imaging and specialist referrals.

• Texas A&M Family Medicine Residency Clinic – Primary care and continuity visits that document longitudinal treatment.

3. Vocational Rehabilitation

The Texas Workforce Commission’s Vocational Rehabilitation Services office at 2001 Texas Ave. South, College Station, can provide functional capacity evaluations useful in SSDI cases.

4. Legal Aid

Low-income claimants may seek advice from Lone Star Legal Aid, Bryan branch, which occasionally assists with Social Security issues.

Key Takeaways

• You have four consecutive appeal levels; the first deadline is 60 days.

• Federal regulations (20 C.F.R. §§ 404.900–404.999) govern each step.

• Comprehensive medical evidence, accurate work history, and timely filings dramatically increase success rates.

• Local attorneys licensed in Texas and approved as SSA representatives can collect fees only upon winning past-due benefits.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed Texas attorney for advice regarding 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.