Guide to SSDI Denials & Appeals in Virginia, VA

Introduction: Why SSDI Denials Matter to Virginians

If you live anywhere in the Commonwealth of Virginia—whether in Richmond, Norfolk, Roanoke, or the rural counties that blanket the Blue Ridge—you are not alone if the Social Security Administration (SSA) has denied your Social Security Disability Insurance (SSDI) application. According to the most recent SSA data, fewer than one in three initial disability claims are approved nationwide. Virginia’s numbers mirror that trend, which means thousands of disabled workers across the state must navigate an appeals process that can feel overwhelming. This comprehensive guide is written slightly in favor of protecting you, the claimant, but remains firmly grounded in verifiable law, federal regulations, and published SSA procedures. By the end, you will understand why claims for conditions such as depression are often denied at first, what federal protections you hold, and how to move forward effectively—ideally with the help of a qualified Virginia disability attorney.

Understanding Your SSDI Rights

What SSDI Provides

SSDI is a federally administered insurance program funded through the FICA payroll tax. If you have accumulated enough work credits, you are entitled to monthly cash benefits and Medicare eligibility once you satisfy SSA’s definition of disability under 20 C.F.R. §404.1505. For mental health conditions such as major depressive disorder, the statute recognizes disability when symptoms are severe enough to preclude “substantial gainful activity” (SGA) for at least 12 continuous months.

The Five-Step Sequential Evaluation

• Current Work Activity – Are you earning above the SGA limit ($1,470 per month in 2023 for non-blind claimants)?

• Severity – Does your depression significantly limit basic work functions?

• Listed Impairment – Does your condition meet or equal Listing 12.04: Depressive, Bipolar, and Related Disorders in Appendix 1 to Subpart P of Part 404?

• Past Relevant Work – Can you return to any job you held in the last 15 years?

• Other Work – Considering your age, education, and transferable skills, can you perform any work available in significant numbers in the national economy?

These steps apply identically in Virginia because SSDI is governed by federal law. However, your claim will be processed locally by Disability Determination Services (DDS) at 11703 Jefferson Avenue, Suite 105, Newport News, VA 23606. DDS examiners rely on your medical records, consultative examinations (CEs), and vocational data to make an initial decision.

Your Procedural Rights

• To receive a written notice explaining why your claim was denied.

• To review and copy your entire claims file.

• To be represented by an attorney or qualified non-attorney advocate at any stage (20 C.F.R. §404.1705).

• To appeal within strict deadlines (discussed below).

Common Reasons SSA Denies SSDI Claims

Medical Insufficiency

Depression can be episodic and subjective, making objective evidence crucial. SSA may find your file lacks:

• Psychiatric treatment notes from at least the preceding 12 months.

• Global Assessment of Functioning (GAF) scores or Patient Health Questionnaire-9 (PHQ-9) results.

• Consistent medication compliance.

Residual Functional Capacity (RFC) Misjudgment

Examiners routinely conclude that a claimant with depression can perform unskilled, low-stress work. Without countervailing opinion evidence—such as a treating psychiatrist’s statement on absenteeism or diminished pace—DDS may deny your claim at Step 5.

Work Credit Deficiency

SSD eligibility is insurance-based. If you have not worked 5 of the last 10 years, or roughly 20 of the last 40 quarters, your claim may be denied on technical grounds, regardless of disability severity.

Non-Compliance & Substance Use

Failure to follow prescribed treatment (20 C.F.R. §404.1530) or substance abuse that is material to disability (42 U.S.C. §423(d)(2)(C)) are frequent reasons for denial.

Federal Legal Protections & Regulations

Key Statutes and Regulations

• Social Security Act §205(b) – Guarantees the right to a hearing before an Administrative Law Judge (ALJ).

• 20 C.F.R. §404.909 – Sets a 60-day appeal window (plus 5 days for mailing) for each level of review.

• 20 C.F.R. §404.970 – Governs Appeals Council review, allowing consideration of new and material evidence.

• 20 C.F.R. §404.1740 – Establishes standards of conduct for representatives.

Relevant Federal Case Law

The U.S. Court of Appeals for the Fourth Circuit—whose jurisdiction includes Virginia—has issued significant opinions reinforcing claimant protections. In Bird v. Commissioner, SSA, 699 F.3d 337 (4th Cir. 2012), the court held that subsequent VA disability ratings are “evidence that must be considered” by the SSA. Although the facts revolved around a military veteran, the principle applies widely: adjudicators cannot ignore probative third-party disability determinations.

Protection Against Unreasonable Delay

If your claim languishes beyond standard processing times (generally 3–5 months at the Initial level, 12–18 months to an ALJ hearing), you may request an expedited decision for a Dire Need situation under HALLEX I-2-1-40. Examples include imminent foreclosure or life-threatening lack of medical care.

Steps to Take After an SSDI Denial

1. File a Request for Reconsideration (Level 1)

You must submit Form SSA-561 within 60 days of the date on your denial letter. In Virginia, Reconsideration files return to DDS, but a different medical examiner and physician/psychologist team reviews them.

2. Request a Hearing Before an ALJ (Level 2)

If you are denied again, file the HA-501 request. Hearings for Virginians are scheduled at one of the state’s five Offices of Hearings Operations (OHO): Richmond, Norfolk, Charlottesville, Roanoke, and Falls Church (National Hearing Center for video). You can appear in person, by telephone, or by Microsoft Teams video.

3. Appeal to the Appeals Council (Level 3)

Submit Form HA-520. The Appeals Council in Falls Church, VA, reviews your file to decide whether the ALJ committed a legal or factual error. Roughly 20% of requests are granted review.

4. File a Civil Action in U.S. District Court (Level 4)

You have 60 days from the Appeals Council’s denial to sue the Commissioner of Social Security in the U.S. District Court for the Eastern or Western District of Virginia, depending on your county. This is a technical litigation step and almost always requires counsel admitted to the federal bar.

When to Seek Legal Help for SSDI Appeals

You have the right to self-represent, but federal statistics show claimants represented by attorneys at the ALJ level are awarded benefits at significantly higher rates. Virginia lawyers are licensed by the Virginia State Bar and must comply with Rule 1:5 of the Supreme Court of Virginia regarding professional conduct. Under 42 U.S.C. §406(a), attorney fees are contingency-based and capped at the lesser of 25% of past-due benefits or $7,200 (2023 cap), subject to SSA approval.

Consider hiring counsel if:

• Your primary impairment is depression—a condition often denied for subjective reasons.

• You have co-morbid conditions (e.g., anxiety, PTSD) requiring vocational analysis.

• You missed work due to hospitalizations or suicidal ideation, but records are scattered across multiple providers like VCU Health, Sentara, or Carilion Clinic.

• You struggle to follow deadlines due to cognitive symptoms.

Local Resources & Next Steps

Virginia SSA Field Offices

Richmond District Office 1834 West Cary Street, Richmond, VA 23220 Phone: 866-613-3959 Norfolk Field Office 5850 Lake Herbert Dr., Norfolk, VA 23502 Phone: 866-593-2665 Roanoke Field Office 612 S. Jefferson St., Roanoke, VA 24011 Phone: 866-701-1149

Mental Health Clinics Familiar with SSA Requests

• VCU Health Department of Psychiatry – Richmond

• Sentara Norfolk General Hospital Behavioral Health – Norfolk

• Carilion Clinic Psychiatric Medicine – Roanoke

These facilities routinely complete Mental Residual Functional Capacity (MRFC) forms, which can strengthen your appeal.

State & Non-Profit Assistance

Virginia Department of Social Services – emergency energy & food assistance while appeals pend. Virginia Legal Aid Society – limited pro bono representation in disability claims. Virginia Department of Behavioral Health & Developmental Services – community mental health resources.

Federal References for Further Reading

SSA Disability Benefits Overview SSA Appeals Process Electronic Code of Federal Regulations Part 404

Legal Disclaimer

This article is for informational purposes only and does not constitute legal advice. Always consult a licensed Virginia attorney regarding your specific circumstances.

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