Attorneys for Social Security: SSDI Rights in Virginia, VA

Introduction: Why SSDI Denials Matter in Virginia

Every year thousands of Virginians apply for Social Security Disability Insurance (SSDI) to keep a roof over their heads and pay for critical medical care after a serious injury or chronic illness forces them out of the workforce. According to the Social Security Administration’s OASDI Beneficiaries by State, 2022 table, approximately 248,000 disabled workers in the Commonwealth of Virginia currently receive SSDI benefits. Yet first-time approval rates remain low nationwide—hovering just above 35 percent. If you recently received a denial letter from the SSA’s Disability Determination Services (DDS) office in Richmond, Roanoke, or Fairfax, you are not alone.

This comprehensive guide explains your legal rights under federal law, the strict appeal deadlines set out in 20 C.F.R. §404.909 and 20 C.F.R. §404.933, and the practical steps you can take—including when to contact a qualified Virginia disability attorney—to protect your SSDI claim. While we slightly favor the claimant’s perspective, every statement is grounded in authoritative sources such as the Social Security Act, the Code of Federal Regulations, and published SSA policy rulings.

Understanding Your SSDI Rights

The Legal Framework

SSDI is governed primarily by Title II of the Social Security Act (42 U.S.C. §401 et seq.) and accompanying regulations in Title 20 of the Code of Federal Regulations (CFR). Key claimant rights include:

• Right to a Written Decision: 42 U.S.C. §405(b) requires the SSA to give written notice with specific reasons for any adverse determination.

• Right to Examine Your File: 20 C.F.R. §404.916 allows you (or your authorized representative) to review and copy evidence used in deciding your claim.

• Right to Representation: Under 42 U.S.C. §406, you may appoint an attorney or qualified non-attorney representative, and reasonable fees are subject to SSA approval.

• Right to Timely Appeal: Federal regulations give you 60 days from the date you receive a denial notice (plus five mailing days) to file the next level of appeal.

Eligibility Basics

To qualify for SSDI you must establish that:

• You worked in covered employment long enough to earn sufficient quarters of coverage (generally 20 of the last 40 quarters for most adults).

• You have a medically determinable physical or mental impairment expected to last at least 12 consecutive months or result in death (20 C.F.R. §404.1509).

• The impairment prevents substantial gainful activity (SGA)—in 2024, generally $1,550 per month for non-blind claimants (indexed annually).

These requirements apply uniformly in all states, but each state’s DDS evaluates the medical evidence. In Virginia, DDS offices operate under contract with the SSA and follow identical federal guidelines, though local medical consultants may weigh regional treatment norms.

Common Reasons SSA Denies SSDI Claims

Technical Denials

Roughly 30 percent of SSDI denials are technical, meaning DDS never evaluated medical severity because the claimant:

• Lacked sufficient quarters of coverage (work credits).

• Earned over the SGA threshold after the alleged onset date.

• Failed to cooperate with information requests or missed consultative exams.

Medical Denials

Most denials arise at Step 4 or 5 of the SSA’s five-step sequential evaluation (20 C.F.R. §404.1520):

• Severity: Impairment is not “severe” enough to limit basic work activities.

• Listings: Claimant’s condition does not meet or equal a Listing in Appendix 1.

• Past Work: DDS believes claimant can still perform past relevant work.

• Other Work: Using age, education, and residual functional capacity (RFC), DDS finds claimant can adjust to other work in the national economy.

Additional Virginia-specific pitfalls include inconsistent treatment records from multiple hospital systems (Sentara, Inova, VCU Health) and gaps in care due to high out-of-pocket costs. An attorney can help track down missing records and obtain treating-physician opinions that address the RFC factors under Social Security Ruling (SSR) 96-8p.

Federal Legal Protections & Regulations You Should Know

Key Regulations Cited in Denial Letters

• 20 C.F.R. §404.900-404.999: Explains the four-level administrative review process.

• 20 C.F.R. §404.1520: Details the five-step sequential evaluation.

• 20 C.F.R. §404.1512: Claimant’s duty to submit evidence known to exist related to disability.

• 20 C.F.R. §404.1545: Definition of Residual Functional Capacity.

Appeal Deadlines Are Strict

Any untimely appeal generally results in forfeiting your right to further administrative review unless you show “good cause” under 20 C.F.R. §404.911. Examples of good cause include serious illness, natural disasters like hurricanes, or SSA mailing errors. Mere misunderstanding rarely qualifies.

Court Precedent Favoring Claimants

The U.S. Court of Appeals for the Fourth Circuit (whose jurisdiction includes Virginia) has issued several notable SSDI decisions, such as Arakas v. Commissioner of Social Security, 983 F.3d 83 (4th Cir. 2020), clarifying that an ALJ must not discount a claimant’s symptoms solely because objective tests cannot measure them precisely. While every case turns on its own facts, Fourth Circuit precedent can be persuasive when appealing beyond the Appeals Council.

Steps to Take After an SSDI Denial

1. Reconsideration (File SSA-561-U2)

You have 60 days to request reconsideration. In Virginia, the DDS will assign a new medical consultant to review your file. About 13–15 percent of claims are approved at this stage nationally. Strengthen your case by:

• Submitting new diagnostic imaging, lab results, or specialist evaluations.

• Addressing specific deficiencies cited in the denial letter.

• Obtaining a personalized Medical Source Statement from your treating doctor tying functional limitations to clinical findings.

2. Administrative Law Judge (ALJ) Hearing

If reconsideration fails, request a hearing (Form HA-501) within 60 days. Hearings for Virginia residents are typically assigned to the following Office of Hearings Operations (OHO) locations:

• Richmond OHO – 400 N. 8th St., Suite 570, Richmond, VA 23219

• Roanoke OHO – 210 Franklin Rd. SW, Suite 515, Roanoke, VA 24011

• Norfolk OHO – 5850 Lake Herbert Dr., Suite 300, Norfolk, VA 23502

During the hearing an ALJ will take testimony from you, vocational experts, and possibly medical experts. You have the right to cross-examine these witnesses and present new evidence up to five business days before the hearing (20 C.F.R. §404.935).

3. Appeals Council Review

You have 60 days after receiving the ALJ’s decision to ask the Appeals Council to review your case. Most requests are denied, but the Council may remand your claim for a new hearing or issue a fully favorable decision if the ALJ error is clear on the record.

4. Federal Court Action

The final administrative stage is filing a civil action in the U.S. District Court for the Eastern or Western District of Virginia within 60 days of the Appeals Council’s denial. You cannot introduce new evidence at this point; the court reviews whether the ALJ’s decision is supported by substantial evidence and in accordance with law.

When to Seek Legal Help for SSDI Appeals

Advantages of Hiring a Virginia Disability Attorney

• Evidence Development: Attorneys understand how to obtain complete medical records and RFC statements that satisfy SSA’s evidentiary rules.

• Cross-Examination Skills: At hearing, a skilled lawyer challenges vocational expert job numbers and hypothetical questions.

• Contingency-Fee Structure: Under 42 U.S.C. §406, fees are generally capped at 25 percent of retroactive benefits or $7,200, whichever is less, absent special approval.

• No Up-Front Cost: Most firms advance costs and only get paid if you win.

Attorney Licensing Rules in Virginia

Attorneys must be licensed by the Supreme Court of Virginia and remain in good standing. Out-of-state lawyers may practice before SSA nationwide, but only a Virginia-licensed attorney can provide related state-law advice (e.g., workers’ compensation offsets under Va. Code §65.2-520).

Local Resources & Next Steps

SSA Field Offices

File appeals online through SSA.gov or in person at your nearest field office. Major Virginia locations include:

• Richmond Field Office – 1834 West Cary St., Richmond, VA 23220; Tel: 866-316-7061

• Fairfax Field Office – 11212 Waples Mill Rd., Fairfax, VA 22030; Tel: 800-772-1213

• Virginia Beach Field Office – 2875 Sabre St., Suite 202, Virginia Beach, VA 23452; Tel: 888-377-5237

Vocational & Medical Support

The state’s Department for Aging and Rehabilitative Services (DARS) offers job-placement and disability rehabilitation services that can also provide helpful documentation for SSDI claims. Major medical networks such as Inova Health System (Northern Virginia) and VCU Health (Richmond) maintain patient portals where you can quickly download records.

Statistics on Virginia Hearing Outcomes

Per the SSA’s 2023 Annual Statistical Report on the Social Security Disability Insurance Program, the average wait for a hearing decision in Virginia was about 10 months, slightly better than the national average of 13 months. Approval rates at the ALJ level in the Richmond OHO were roughly 52 percent in fiscal year 2023, illustrating the importance of persisting past reconsideration.

Conclusion

An SSDI denial in Virginia is not the final word. By understanding your rights under federal law, meeting strict appeal deadlines, and supplying thorough medical evidence, you greatly improve the odds of success. Whether you tackle the process yourself or partner with a seasoned Virginia disability attorney, persistence and preparation are critical.

Disclaimer: This article provides general information only and does not constitute legal advice. Laws and agency policies change frequently. Consult a licensed Virginia attorney for advice specific to your situation.

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