SSDI Denial & Appeals Guide – Texas, Texas

Introduction: Facing an SSDI Denial in Texas

Receiving a Social Security Disability Insurance (SSDI) denial letter can feel like the end of the road, but for thousands of Texans each year, it is only the beginning of the appeals process. According to the Social Security Administration (SSA), roughly two-thirds of initial SSDI applications nationwide are denied. Data from SSA Region 6, which covers Texas, shows comparable rates. Fortunately, federal regulations give Texas residents multiple opportunities to challenge an unfavorable decision, and a well-prepared appeal often succeeds. This comprehensive guide explains those rights, outlines the steps unique to claimants in Texas, and highlights local resources—from SSA field offices in Dallas and Houston to medical providers at UT Southwestern and Baylor Scott & White—that can bolster your record. While the information slightly favors protecting claimants, it remains strictly grounded in authoritative sources such as the Code of Federal Regulations (CFR), the Social Security Act, federal case law, and official SSA publications.

Understanding Your SSDI Rights

Who Qualifies for SSDI?

SSDI is a federal insurance program funded by payroll taxes. To qualify, you must:

• Have earned sufficient work credits under 20 CFR 404.130–404.132.

• Be “disabled” under the SSA’s five-step sequential evaluation described in 20 CFR 404.1520.

• Show the onset of disability lasted or is expected to last at least 12 months or result in death.

Key Claimant Protections

The Social Security Act, 42 U.S.C. § 405(b), guarantees every claimant:

• The right to written notice explaining any adverse action.

• The right to request reconsideration, a hearing before an Administrative Law Judge (ALJ), review by the Appeals Council, and judicial review in U.S. District Court.

• The right to appoint representation; Texas attorneys must be licensed by the State Bar of Texas (see Texas Government Code § 81.051).

Importantly, representatives’ fees are capped by 20 CFR 404.1728 and must be approved by SSA, protecting claimants from excessive costs.

Common Reasons SSA Denies SSDI Claims

Understanding why applications fail helps you fix weaknesses on appeal:

• Insufficient Medical Evidence – Medical records may not document functional limitations in detail. Mental health claims such as bipolar disorder often lack longitudinal treatment notes.

• Non-Severe Impairment Determination – At Step 2 of the sequential evaluation, DDS examiners may find your bipolar disorder “non-severe.” Adding evidence of hospitalizations or Global Assessment of Functioning (GAF) scores can rebut this.

• Residual Functional Capacity (RFC) Findings – DDS may conclude you can perform past relevant work or adjust to other work. Work history forms (SSA-3369) and third-party statements can clarify why episodes of mania and depression preclude competitive employment.

• Improper Technical Denial – Claimants sometimes lack enough work credits or continue Substantial Gainful Activity (SGA). In 2024, SGA for non-blind claimants is $1,550/month; exceeding it leads to automatic denial.

• Missed Deadlines – Failing to respond to SSA correspondence or attend a Consultative Examination (CE) can trigger denial under 20 CFR 404.1518.

Federal Legal Protections & Regulations

Statutes and Regulations Every Texan Should Know

• 20 CFR 404.909 – Allows 60 days from receipt of the initial decision to request reconsideration.

• 20 CFR 404.933 – Governs requesting a hearing before an ALJ, again within 60 days of the reconsideration denial.

• 20 CFR 404.970 – Outlines Appeals Council review standards, including “abuse of discretion” by the ALJ.

• Section 205(g) of the Social Security Act – Confers jurisdiction on U.S. District Courts (in Texas, the Northern, Southern, Eastern, and Western Districts) for judicial review.

Each stage preserves due-process protections such as the right to submit new evidence up to five business days before an ALJ hearing (per 20 CFR 405.331), or later with good cause.

Federal Case Law Influencing Texas Claims

Although ALJ decisions are not bound by Fifth Circuit precedent at the administrative level, district court remands guide future determinations. For example, in Singh v. Commissioner, 955 F.3d 779 (5th Cir. 2020), the court emphasized the need for ALJs to properly evaluate medical opinion evidence under the treating-physician rule (pre-2017 claims). Familiarity with such cases can strengthen written arguments.

Steps to Take After an SSDI Denial

1. Confirm Your Deadline

You generally have 60 days plus a 5-day mailing presumption from the date on the notice to request the next level of review. Missing it usually forfeits rights, but SSA may extend for “good cause” under 20 CFR 404.911—for example, hospitalization for bipolar crisis.

2. File a Request for Reconsideration

In Texas, reconsiderations are processed by Disability Determination Services (DDS) in Austin. File online at SSA.gov or submit Form SSA-561, SSA-3441, and SSA-827 to your local field office. Include:

• Updated psychiatric records (therapy notes, medication adjustments).

• Statements from treating psychiatrists following Listing 12.04 criteria.

• Work performance reports or HR documentation, if any.

3. Request an ALJ Hearing

If denied again, request a hearing. Texas hearings are assigned to the Office of Hearings Operations (OHO) in Dallas, Houston, Fort Worth, or San Antonio. While hearings may occur by video, you can object in writing within 30 days to appear in person. During the hearing:

• You may testify about manic and depressive episodes impacting attendance and concentration.

• Present supportive expert opinions or Medical Source Statements.

• Cross-examine SSA’s Vocational Expert (VE) on job erosion for off-task time >15% of the workday.

4. Appeals Council Review

Unfavorable ALJ? File Form HA-520. The Appeals Council, located in Falls Church, Virginia, examines procedural errors, legal mistakes, or “new and material” evidence.

5. Federal Court Action

Finally, you may sue the Commissioner in the appropriate U.S. District Court in Texas within 60 days of Appeals Council denial.

When to Seek Legal Help for SSDI Appeals

Texas law does not require a lawyer for SSA appeals, but representation improves outcomes. A Government Accountability Office (GAO) study found claimants with representatives were nearly three times more likely to win at a hearing. Texas disability attorneys must:

• Be in good standing with the State Bar of Texas.

• Obtain SSA approval of any fee agreement (maximum 25% of back pay or $7,200, whichever is less, under 20 CFR 404.1728(b)).

Legal counsel can subpoena records, prepare briefs citing Fifth Circuit authority, and cross-exam VEs on the impact of bipolar symptoms.

Local Resources & Next Steps

Key SSA Field Offices in Texas

Dallas Downtown SSA Office 1301 Young St., Dallas, TX 75202 Houston SSA Office – Nearest to Medical Center 8989 Lakes at 610 Dr., Houston, TX 77054 Austin SSA Office 1029 Camino La Costa, Austin, TX 78752

Major OHO (Hearing) Locations

Dallas (North Central Expressway), Houston (Sam Houston Pkwy), Fort Worth, and San Antonio OHO handle hearings for surrounding counties. Addresses and phone numbers are listed on SSA.gov.

Mental Health Treatment Facilities

• UT Southwestern Medical Center – Psychiatry (Dallas)

• The Menninger Clinic (affiliated with Baylor College of Medicine, Houston)

• Texas Health Resources Behavioral Health (statewide network)

Free & Low-Cost Legal Aid

Texas RioGrande Legal Aid Lone Star Legal Aid Disability Rights Texas

Authoritative External References

20 CFR 404.909 – Reconsideration SSA Listing 12.04 – Depressive, Bipolar Disorders Social Security Act § 205 SSA Research on Representation Success Rates

Conclusion

An SSDI denial is frustrating, but armed with federal protections, rigorous medical evidence, and knowledge of local Texas resources, you stand a strong chance of success on appeal. Take prompt action, follow each procedural step meticulously, and consider engaging a qualified Texas disability attorney to maximize your odds.

Legal Disclaimer: This guide is for informational purposes only and does not constitute legal advice. Consult a licensed Texas attorney 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.