Buffalo, Texas SSDI Denial Appeal Guide

Introduction: Why This Guide Matters to Buffalo, Texas Claimants

Buffalo, Texas may be a small Leon County community, but its residents face the same complex Social Security Disability Insurance (SSDI) system as workers in Houston or Dallas. According to the Social Security Administration (SSA), more than six in ten first-time SSDI applications are denied nationwide.1 If you live in Buffalo and just opened a denial letter, you are not alone—and you are not out of options. This 2,500-plus-word guide breaks down the federal rules, appeal deadlines, local resources, and strategic steps you can take to fight for the benefits you earned through your payroll taxes. A slight but deliberate emphasis is placed on protecting claimants’ rights, yet every statement here is grounded in authoritative sources such as the Social Security Act, the Code of Federal Regulations (CFR), and published SSA policy.2

Understanding Your SSDI Rights

SSDI Basics

SSDI is a federal program created under Title II of the Social Security Act that provides monthly cash benefits to insured workers who can no longer engage in substantial gainful activity (SGA) because of a medically determinable impairment expected to last at least 12 months or result in death (42 U.S.C. §423(d)(1)(A)). To qualify, you must:

• Earn enough work credits (usually 20 credits in the 10 years before disability onset for adults under 31, with special rules for younger workers).

• Meet the SSA’s definition of disability under 20 C.F.R. §404.1505.

• File your application and any appeals before applicable deadlines (20 C.F.R. §404.611).

The Right to Appeal

Every claimant has a four-level administrative appeal pathway guaranteed by 20 C.F.R. §404.900:

• Reconsideration

• Hearing by an Administrative Law Judge (ALJ)

• Appeals Council review

• Federal district court action

At each stage you can submit new evidence, challenge errors, and—if represented—have your attorney question witnesses. By law, the SSA must mail a written decision at every level, and you have 60 days from receipt (plus 5 days for mailing) to appeal (20 C.F.R. §404.901).

Common Reasons SSA Denies SSDI Claims

The SSA typically lists one or more of the following grounds when issuing an initial denial or reconsideration denial to Buffalo residents:

• Medical Insufficiency – Records fail to prove a severe impairment lasting 12 months.

• Ability to Do Past Work – SSA finds you can still perform work you did in the last 15 years (20 C.F.R. §404.1520(f)).

• Ability to Adjust to Other Work – Using the Medical-Vocational Guidelines (“Grid Rules”), SSA says other jobs exist in significant numbers that you can do.

• Income Above SGA – You earned more than the monthly SGA limit ($1,470 in 2023 for non-blind claimants; SSA annually updates this figure).

• Technical Issues – You lack sufficient work credits, failed to submit required forms, or missed a consultative examination.

Understanding the precise denial basis is critical for crafting a successful appeal. Your denial notice will cite CFR sections and provide a “Disability Determination Explanation (DDE)” outlining evidence considered.

Federal Legal Protections & Regulations

Key Statutes and Regulations

• Social Security Act §205(b) (42 U.S.C. §405(b)) – Guarantees the right to a hearing and decision based on evidence.

• 20 C.F.R. §404.935 – Governs submission of new evidence no later than five business days before the ALJ hearing.

• 20 C.F.R. §404.970 – Standards for Appeals Council review of ALJ decisions (error of law, lack of substantial evidence, broad policy issues).

Federal Court Precedent

Claimants in the Fifth Circuit, which includes Texas, benefit from precedents such as Austin v. Shalala, 994 F.2d 1170 (5th Cir. 1993), holding that an ALJ must develop the record fully and fairly—even with represented claimants. The Fifth Circuit has also emphasized that vocational expert testimony must be based on substantial evidence (Carey v. Apfel, 230 F.3d 131 (5th Cir. 2000)).

Attorney Representation Rules

An attorney handling SSDI cases in Buffalo must be admitted to the State Bar of Texas under the Texas Government Code §§81.051–81.053. Non-attorney representatives may appear if they meet SSA qualifications (42 U.S.C. §406(a)(1)), but hiring a licensed lawyer offers additional protections, such as attorney–client privilege and malpractice coverage.

Steps to Take After an SSDI Denial

1. Confirm the Deadline

You have 60 days from the date you receive the denial to request reconsideration. SSA presumes you received the letter five days after the date on the notice (20 C.F.R. §422.210(c)). Mark your calendar immediately.

2. Request Reconsideration

Submit Form SSA-561 (Request for Reconsideration) and Form SSA-3441-BK (Disability Report – Appeal). In Texas, you can file online through mySSA or deliver forms to any SSA field office, including the nearest office to Buffalo (see Local Resources).

3. Gather Additional Evidence

Under 20 C.F.R. §404.1512(a), you bear the primary responsibility for providing evidence of disability. Helpful items include:

• Updated imaging studies (MRI, CT scans) and lab results

• Opinion letters from your treating physicians using SSA’s residual functional capacity (RFC) terminology

• Statements from past employers detailing job demands you can no longer meet

• Diary entries or logs of symptom flare-ups

4. Understand the Reconsideration Decision

Texas participates in the full four-step process, so you must receive a reconsideration decision before requesting an ALJ hearing. Average processing time in Texas was approximately 111 days in FY 2022, according to SSA regional reports.3

5. Request an ALJ Hearing

If reconsideration is denied, file Form HA-501. You can ask for an in-person hearing at the Houston North Office of Hearings Operations (OHO) or a video hearing at the Bryan field office. Provide all written evidence at least five business days before the hearing (20 C.F.R. §404.935).

6. Appeals Council & Federal Court

Should the ALJ rule against you, request Appeals Council review on Form HA-520. If the Council denies review or affirms the ALJ, you may file a civil action in the U.S. District Court for the Eastern District of Texas, Tyler Division—Buffalo’s federal venue—within 60 days of the Council’s notice.

When to Seek Legal Help for SSDI Appeals

Pursuing an SSDI appeal without representation is legally permissible, but statistics released by SSA and the Government Accountability Office show claimants with representatives are nearly three times more likely to win benefits at the hearing level.4 Consider hiring a Buffalo disability attorney if you:

• Have a complex medical condition involving multiple body systems

• Need help cross-examining a vocational expert or medical expert

• Missed a deadline and must file a good-cause extension request

• Are unfamiliar with CFR evidence rules, including the five-day rule

Texas attorneys generally represent SSDI claimants on a contingency fee capped at 25% of past-due benefits or $7,200, whichever is less, per 42 U.S.C. §406(a)(2)(A) (amount updated periodically by Congress).

Local Resources & Next Steps

Nearest SSA Field Offices to Buffalo, Texas

Palestine SSA Office 3028 S Loop 256, Palestine, TX 75801 Phone: 866-931-2731 Bryan SSA Office 1700 E. Villa Maria Rd, Bryan, TX 77802 Phone: 866-568-9403

• Office hours: Monday–Friday, 9:00 a.m.–4:00 p.m. (except federal holidays)

Houston North Office of Hearings Operations (OHO)

2500 Dunstan Rd., Suite 260, Houston, TX 77005 • Phone: 866-583-1575

Major Medical Providers Serving Leon County

• CHI St. Joseph Health Madison Hospital – 100 W Cross St, Madisonville, TX (approx. 25 miles)

• St. Joseph Health Regional Hospital Bryan – 2801 Franciscan Dr, Bryan, TX

Consistent treatment notes from these facilities can strengthen your SSDI case.

Community Assistance

• Leon County Veterans Service Office – Assistance for veterans seeking VA and SSA disability coordination.

• Texas Legal Services Center – Statewide nonprofit offering free legal advice for low-income Texans.

Conclusion: Protect Your Right to Benefits

SSDI promises economic security to workers who can no longer earn a living wage because of serious health problems. When the SSA says “no,” federal regulations give you a structured, time-sensitive roadmap to fight back. Buffalo residents face long drives to hearing offices and limited local specialists, but with careful evidence gathering and strategic legal help, you can level the playing field.

Authoritative Sources

SSA – Disability Benefits Overview eCFR – 20 C.F.R. Part 404 (Disability Insurance Benefits) SSA – Appeals Process GAO Report on SSA Appeals Outcomes

Legal Disclaimer: This guide 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.