SSDI Denial Appeal Guide – Aurora (CO), Texas

Introduction: Why This Guide Matters to Aurora (CO), Texas Claimants

The Social Security Disability Insurance (SSDI) program is a federal lifeline for Texans who can no longer work because of severe medical impairments. Yet the Social Security Administration (SSA) denies most first-time applications nationwide—about 67% in recent years, according to SSA data published in its Annual Statistical Report. If you live in or near Aurora (CO), Texas (ZIP 76078, Wise County) and recently received a denial letter, you are not alone. This comprehensive guide is designed to help you understand your rights, meet every SSA deadline, and maximize your chances of overturning a denial through the appeals process. It slightly favors the claimant’s perspective while relying strictly on authoritative legal sources such as the Social Security Act, the Code of Federal Regulations (CFR), and published SSA policy statements.

Local context also matters. Aurora (CO) is situated roughly 30 miles northwest of Fort Worth and within the service area of two SSA field offices: the Decatur office at 1601 W. US Highway 380, Decatur, TX 76234, and the Fort Worth – West office at 4200 South Freeway, Suite 600, Fort Worth, TX 76115. Most initial SSDI applications and reconsideration requests filed by Aurora residents are routed through these offices and then assigned for medical review to the Texas Disability Determination Services (DDS) in Austin.

Because federal rules set uniform standards for disability, understanding how the SSA evaluates evidence—from work history and earnings records to doctors’ notes and imaging studies—is key. Let’s walk step-by-step through those rules, common denial reasons, and the four-level appeals process so you can move forward confidently.

Understanding Your SSDI Rights

Who Qualifies Under Federal Law?

SSDI benefits are authorized by Title II of the Social Security Act (42 U.S.C. § 401 et seq.) and implemented through 20 C.F.R. Part 404. To qualify, you must:

• Have a “severe” medically determinable impairment expected to last at least 12 months or result in death (20 C.F.R. § 404.1505).

• Be unable to perform “substantial gainful activity” (SGA) because of that impairment. For 2024, SGA is $1,550/month for non-blind claimants and $2,590/month for blind claimants, as posted by SSA.

• Possess sufficient “insured status” based on past payroll contributions (work credits). Most applicants need 20 credits earned in the 10 years preceding disability onset, but younger workers have reduced requirements.

Key Claimant Protections

Federal regulations give you specific procedural rights:

• Notice and Explanation – SSA must provide “written notice of any initial determination” with the reasons for denial (20 C.F.R. § 404.902).

• 60-Day Appeal Window – You have 60 days (plus 5 days presumed mailing time) to appeal any unfavorable decision (20 C.F.R. § 404.909).

• Right to Representation – You may hire an attorney or qualified representative. Representatives must be licensed and in good standing with a state bar, or otherwise authorized per 20 C.F.R. § 404.1705.

• Fee Approval Protection – SSA must approve any representative fee, usually capped at 25% of back pay or $7,200, whichever is less (current cap as of November 2022).

These rights apply equally in Texas, Colorado, or any other state because SSDI is federally administered.

Common Reasons SSA Denies SSDI Claims

The denial letter you received—called a “Notice of Disapproved Claim”—will cite one or more reasons. Below are the most frequent grounds, each tied directly to federal rules.

1. Insufficient Medical Evidence

SSA may state that your medical records do not support a finding of disability severe enough to prevent SGA. Under 20 C.F.R. § 404.1520(c), the agency requires objective evidence (e.g., MRI scans, lab tests) plus longitudinal treatment notes.

2. Ability to Perform Past Relevant Work

If DDS determines you can still do work you performed within the last 15 years, denial will be based on Step 4 of the Five-Step Sequential Evaluation (20 C.F.R. § 404.1520(e)).

3. Ability to Adjust to Other Work

Even if you cannot do former work, SSA may find you able to adjust to other jobs in the national economy (Step 5). Vocational experts rely on the Dictionary of Occupational Titles and Medical-Vocational Guidelines (“Grid Rules”) in Appendix 2 to Subpart P of Part 404.

4. Technical Issues: Insured Status or Earnings

Failure to meet “date last insured” or having earnings above the SGA limit will trigger a technical denial.

5. Non-Cooperation

Missing consultative exams, failing to return SSA forms (Activities of Daily Living, Work History), or ignoring requests for additional evidence will also lead to denial under 20 C.F.R. § 404.1518.

Federal Legal Protections & Regulations

The Five-Step Sequential Evaluation Process

All disability adjudicators—DDS analysts, Administrative Law Judges (ALJs), and the Appeals Council—must follow the same five-step test outlined in 20 C.F.R. § 404.1520:

• SGA Test – Are you working and earning above the SGA limits?

• Severity Test – Is the impairment severe?

• Listings Test – Does the impairment meet or equal a Listing in Appendix 1?

• Past Work Test – Can you perform past relevant work?

• Other Work Test – Can you adjust to other work, considering age, education, and transferable skills?

Understanding how each step applies to your specific medical condition will guide the focus of your appeal.

The Role of Medical Expert and Vocational Testimony

At the hearing level, ALJs often call medical experts (MEs) and vocational experts (VEs). Their testimony must be based on objective evidence and consistent with SSA policy. Cross-examining these experts is one of the most effective ways for an attorney to strengthen your case.

Statute of Limitations for Appeals

You have 60 days from the date you receive a denial to move to the next stage. Missing that deadline usually means you must start a new application, unless you can show “good cause” (e.g., hospitalization) under 20 C.F.R. § 404.911.

Steps to Take After an SSDI Denial

1. File a Timely Request for Reconsideration

For Aurora claimants, the paper form SSA-561 or the online appeals portal must be submitted within 60 days. Attach any new medical evidence, such as updated MRIs from Wise Health System or specialist reports from Texas Health Fort Worth.

2. Prepare for the Administrative Law Judge Hearing

If reconsideration is denied—as it is for roughly 88% of Texas cases—you can request a hearing (Form HA-501). Average wait time for the Fort Worth Office of Hearings Operations (OHO), which covers Wise County, was about 10.5 months in 2023 per SSA public data.

• Develop the Record – Submit a complete treatment history, including physical therapy records from Baylor Scott & White or mental-health notes from MHMR of Tarrant County.

• Draft a Pre-Hearing Brief – Cite specific listings or Grid Rules that apply.

• Line Up Witnesses – Family members or former supervisors can corroborate functional limitations.

3. Appealing to the Appeals Council

If you lose at the hearing, you may file Form HA-520 within 60 days for Appeals Council review in Falls Church, Virginia. The Council may affirm, reverse, or remand.

4. Federal Court Review

Your last level of appeal is filing a civil action in the U.S. District Court for the Northern District of Texas, Fort Worth Division, within 60 days of the Appeals Council denial, under 42 U.S.C. § 405(g). No new evidence is accepted; the judge reviews the administrative record for legal error or lack of substantial evidence.

When to Seek Legal Help for SSDI Appeals

While you may represent yourself at any level, statistics published by the SSA’s Office of the Inspector General show that represented claimants are almost three times more likely to win at the ALJ stage. Here are key moments to consider hiring an aurora (co) disability attorney:

• Complex Medical Conditions – Cases involving both physical and mental impairments often require expert coordination of evidence.

• Vocational Challenges – If you have transferable skills that SSA could use against you, a representative can argue for non-transferability.

• Adverse Consultative Exam – An attorney can cross-examine the CE’s findings and provide rebuttal opinions.

Attorney fees are contingency-based and subject to SSA approval, making representation financially accessible.

Local Resources & Next Steps

SSA Offices Serving Aurora (CO), Texas

Decatur SSA Field Office 1601 W. US Highway 380 Decatur, TX 76234 Phone: 866-613-2847 Fort Worth – West SSA Field Office 4200 South Freeway, Suite 600 Fort Worth, TX 76115 Phone: 888-717-1530

Medical Providers Frequently Cited in Aurora SSDI Files

• Wise Health System, Decatur

• Baylor Scott & White All Saints Medical Center, Fort Worth

• Texas Health Harris Methodist Hospital, Fort Worth

• MHMR of Tarrant County (for mental-health treatment)

Free or Low-Cost Community Help

• Legal Aid of NorthWest Texas – May provide free representation for qualifying low-income residents.

• 211 Texas – Connects callers to disability resources, transportation services, and state benefits counselors.

• Texas Workforce Solutions – Vocational Rehabilitation – Helps disabled workers explore job retraining, which can also produce evidence that no suitable employment exists.

Your Next Steps Checklist

• Mark your 60-day appeal deadline on a calendar the day you receive any SSA notice.

• Request and review your entire electronic folder (e-Folder) through mySSA.gov.

• Obtain updated medical records and a detailed residual functional capacity (RFC) opinion from your treating physician.

• File the correct appeal form online or at the Decatur/Fort Worth SSA office.

• Consult an attorney licensed in Texas who focuses on SSDI appeals.

Authoritative References

SSA Disability Benefits Overview 20 C.F.R. Part 404 – Federal Regulations SSA Appeals Process Portal SSA Office Locator

Legal Disclaimer

This guide provides general information only and does not constitute legal advice. Laws and regulations change. For advice about your specific situation, consult a licensed Texas attorney.

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