Bipolar SSDI Denial Guide – Texas, Texas

Introduction: Bipolar SSDI Challenges in Texas

Texans living with bipolar disorder face unique hurdles when applying for Social Security Disability Insurance (SSDI). Although the Social Security Administration (SSA) recognizes bipolar disorder as a potentially disabling condition under Listing 12.04 of its Blue Book, nearly two-thirds of first-time SSDI applications in Texas are still denied, according to SSA State Disability Data. A denial is not the end of the road. Federal regulations give every claimant the right to appeal, and many Texans win benefits at later stages. This comprehensive guide explains your rights, the appeals process, and local resources—slightly favoring the claimant’s perspective while staying strictly factual.

Understanding Your SSDI Rights in Texas

What Is SSDI?

SSDI is a federal insurance program funded through payroll taxes. To qualify, you must have sufficient "quarters of coverage" and meet the SSA’s definition of disability—namely, an inability to engage in substantial gainful activity (SGA) for at least 12 months or that is expected to result in death (42 U.S.C. § 423(d)).

Bipolar Disorder Under SSA Regulations

The SSA assesses bipolar disorder under Listing 12.04 Affective Disorders. To meet the Listing, medical evidence must document:

• Part A: Medically documented persistence of depressive or manic syndrome; and

• Part B: Extreme limitation of one—or marked limitation of two—functional areas (understanding; interaction; concentration; adaptation); or

• Part C: Marginal adjustment with minimal capacity to adapt to changes.

Even if you do not meet the Listing, you can still win benefits by proving—through the Five-Step Sequential Evaluation found in 20 C.F.R. § 404.1520—that your functional limitations prevent competitive employment.

Common Reasons SSA Denies Bipolar SSDI Claims

• Insufficient Medical Evidence. Claimants often submit medication lists but lack longitudinal treatment records from psychiatrists or hospitalizations, leading adjudicators to decide there is no severe impairment.

• Gaps in Treatment. Missed appointments or periods without therapy can prompt SSA to question the severity or duration of bipolar symptoms.

• Residual Functional Capacity (RFC) Findings. The SSA’s Disability Determination Services (DDS) may find you can still perform past work or adjust to other work, resulting in a denial at Step 5 of the sequential process.

• Substantial Gainful Activity (SGA). Earning more than the monthly SGA threshold ($1,550 for non-blind individuals in 2024) during the alleged onset period automatically triggers a technical denial under 20 C.F.R. § 404.1571.

• Non-Compliance with Prescribed Treatment. Under 20 C.F.R. § 404.1530, failure to follow treatment without good reason can block benefits.

Federal Legal Protections & Key Regulations

Core Statutes and Regulations

• Social Security Act § 205(g) (42 U.S.C. § 405(g)): Grants claimants the right to judicial review in federal court after exhausting administrative remedies.

• 20 C.F.R. § 404.900: Establishes the four levels of administrative review—Reconsideration, Hearing, Appeals Council, and Federal Court.

• 20 C.F.R. § 404.935: Requires submission of all evidence at least five business days before the hearing, or good cause for late submission.

Deadlines You Cannot Miss

Every appeal deadline is 60 days from the date you receive a denial notice, with a presumed five-day mailing period (20 C.F.R. § 404.901). Missing the deadline usually forfeits your right to appeal unless you can show “good cause.”

Steps to Take After an SSDI Denial

1. Request Reconsideration

In Texas, you must complete Form SSA-561 and submit it to your local field office within 60 days. You can file online through SSA Appeals Process or mail the form to the nearest office (e.g., SSA Dallas Regional Office, 1301 Young St., Suite 500, Dallas, TX 75202).

2. Prepare for the Administrative Law Judge (ALJ) Hearing

If Reconsideration is denied, request a hearing via Form HA-501. In Texas, hearings are typically held at the following Offices of Hearing Operations (OHO):

• Dallas Downtown OHO: 1301 Young St., Room 460, Dallas, TX 75202

• Houston Bissonnet OHO: 6200 Bissonnet St., Suite 100, Houston, TX 77081

Tele-hearings or Microsoft Teams video hearings are also available statewide.

3. Appeals Council Review

Submit Form HA-520 within 60 days. The Appeals Council in Falls Church, Virginia, will review any legal or factual errors made by the ALJ.

4. Federal District Court

If the Appeals Council denies or remands unfavorably, file a civil action in the U.S. District Court for the Northern, Southern, Eastern, or Western District of Texas under 42 U.S.C. § 405(g). The complaint must be filed within 60 days; attorney representation is strongly recommended.

When to Seek Legal Help for SSDI Appeals

While you have the right to self-represent at every stage, statistics from SSA’s Annual Statistical Report show claimants represented by attorneys are nearly twice as likely to win at hearings. In Texas, attorneys may charge no more than 25% of past-due benefits, capped at $7,200 (effective Nov. 30, 2022) per 20 C.F.R. § 404.1720(b)(1). Hiring counsel can help you:

• Gather longitudinal psychiatric records and mental status examination results.

• Obtain a treating psychiatrist’s Medical Source Statement (MSS) that addresses paragraph B functional limitations.

• Cross-examine vocational experts regarding job erosion for people with unpredictable mood cycles.

• Ensure timely filing and compliance with the Five-Day Rule (20 C.F.R. § 404.935).

Local Resources & Next Steps in Texas

Mental Health Facilities and Support Groups

• UT Southwestern Medical Center – Dallas: Offers specialized mood disorders clinics.

• Harris Center for Mental Health and IDD – Houston: Provides sliding-scale psychiatric services and crisis units.

NAMI Texas: Peer-led support groups and education programs for bipolar disorder.

SSA Field Offices

• Austin Field Office: 1029 Camino La Costa, Austin, TX 78752

• San Antonio Field Office: 727 E. Durango Blvd., San Antonio, TX 78206

Free and Low-Cost Legal Aid

• Disability Rights Texas: State Protection & Advocacy agency offering assistance in SSA cases.

• Texas Legal Services Center: May provide representation or referrals for low-income SSDI claimants.

Checklist for Your Appeal File

• Diagnosis of bipolar I or II from a licensed psychiatrist.

• At least 12 months of treatment records, including medication history, therapy notes, and hospitalizations.

• Function reports from you and a third-party describing daily limitations.

• Updated work history report detailing job duties and stressors.

• Medical Source Statement or Mental RFC from treating provider.

Conclusion

SSDI appeals can be daunting, but persistence pays off—especially for Texans living with bipolar disorder. Follow federal deadlines, supplement the record with compelling medical evidence, and consider professional representation to maximize your chance of success.

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