SSDI Denial Appeal Guide – Burbank, Texas

Introduction: Why This Guide Matters to Burbank, Texas Claimants

Burbank, Texas may be small, but its residents face the same complex Social Security Disability Insurance (SSDI) rules that apply nationwide. If you live in Burbank or the surrounding San Antonio metropolitan area and can no longer work due to a severe medical condition, an SSDI denial can feel devastating. Take heart—nearly two-thirds of initial SSDI applications are denied nationwide, yet many denials are overturned on appeal. This comprehensive guide explains your federal rights, key appeal deadlines, and local resources so you can challenge a denial effectively. While the information slightly favors claimants, every statement is grounded in authoritative sources from the Social Security Administration (SSA), the Code of Federal Regulations (CFR), the Social Security Act, and published federal case law.

Understanding Your SSDI Rights

What SSDI Provides

SSDI is a federal insurance program funded by payroll taxes. If you qualify, you receive monthly cash benefits and eventual Medicare eligibility. Qualification depends on two core criteria:

• Insured Status. You must have earned sufficient work credits—generally 20 credits in the 40 quarters before disability onset (20 CFR §404.130).

• Disability Standard. You must be unable to engage in any substantial gainful activity (SGA) due to a medically determinable impairment expected to last at least 12 months or result in death (20 CFR §404.1505).

Importantly, SSDI is not needs-based like SSI; household income or assets do not disqualify you as long as you meet the SGA and insured requirements.

Key Rights Every Claimant Should Know

• Right to Written Notice. SSA must send a written decision explaining why your claim was denied (20 CFR §404.904).

• Right to Representation. You may appoint an attorney or qualified non-attorney advocate at any stage (20 CFR §404.1705).

• Right to Appeal. You have four administrative appeal levels before federal court, each with a 60-day filing window (20 CFR §404.909, §404.933, §404.968).

• Right to a Fair Hearing. An impartial Administrative Law Judge (ALJ) must consider new evidence and testimony (Social Security Act §205(b), 42 U.S.C. §405(b)).

• Fee Protection. Attorney fees are capped at 25% of past-due benefits or $7,200, whichever is less, unless a higher fee is approved (42 U.S.C. §406).

Common Reasons SSA Denies SSDI Claims

Understanding why claims fail helps you fix weaknesses on appeal. The most frequent grounds include:

• Insufficient Medical Evidence. Missing diagnostic images, lab results, or specialist opinions often lead SSA to conclude your condition is not severe.

• SGA Earnings. If you earned more than the monthly SGA limit ($1,470 for non-blind claimants in 2023; SSA annually adjusts), SSA presumes you are not disabled.

• Failure to Follow Prescribed Treatment. Without a good reason, noncompliance can sink an otherwise meritorious claim (20 CFR §404.1530).

• Duration Requirement Not Met. Impairments must last or be expected to last 12 months.

• Transferable Skills Determination. SSA may find you can do other work even if you cannot perform your past job, especially for claimants under 50.

In Texas, Disability Determination Services (DDS) in Austin evaluates medical evidence at the initial and reconsideration levels. Strengthening your medical file before appeal is crucial.

Federal Legal Protections & Regulations You Can Invoke

Key Regulations

Two CFR sections are especially valuable for appealing claimants:

• 20 CFR §404.909 – Establishes the right to request reconsideration within 60 days of a denial.

• 20 CFR §404.1520 – Lays out SSA’s five-step sequential evaluation. Demonstrating where the adjudicator erred in this sequence often wins appeals.

Additional authorities you may cite include:

• 20 CFR §404.1512 – SSA’s duty to develop the medical record.

• Social Security Ruling (SSR) 16-3p – Guidance on evaluating pain and other symptoms.

• 42 U.S.C. §405(g) – Judicial review standard for federal court appeals.

Relevant Case Law

• Brewster v. Barnhart, 145 F. App’x 542 (6th Cir. 2005) – Clarifies SSA’s duty to consider combined effect of multiple impairments.

• Higginbotham v. Barnhart, 405 F.3d 332 (5th Cir. 2005) – Fifth Circuit (binding on Texas) notes Appeals Council must consider new evidence submitted after ALJ decision.

Citing controlling Fifth Circuit precedent like Higginbotham can strengthen Burbank claimants’ briefs.

Steps to Take After an SSDI Denial

SSA’s appeals process is sequential. Missing a step or deadline can force you to start over. Below is a level-by-level roadmap.

1. Reconsideration (20 CFR §404.909)

• Deadline: 60 calendar days from receipt of denial notice; SSA presumes you received the letter five days after mailing.

• What Happens: A different DDS examiner reviews your file. No hearing is held, but you may submit additional evidence.

• Tip: Request all records used in the first decision and have your doctors complete detailed Residual Functional Capacity (RFC) assessments.

2. ALJ Hearing (20 CFR §404.933)

• Deadline: 60 days after reconsideration denial.

• Location: San Antonio Office of Hearing Operations (OHO) handles Burbank cases; video hearings are also common.

• The Hearing: You, your representative, and often a vocational expert testify under oath. ALJs can question medical experts.

• Preparation: Craft a hearing brief pinpointing errors in steps 4 and 5 of the sequential evaluation and prepare cross-exam questions for the vocational expert.

3. Appeals Council Review (20 CFR §404.968)

• Deadline: 60 days from ALJ decision.

• Scope: Council may deny review, remand, or issue its own decision. Submit new and material evidence per Higginbotham.

4. Federal District Court (42 U.S.C. §405(g))

• Deadline: 60 days from Appeals Council denial.

• Venue: U.S. District Court for the Western District of Texas, San Antonio Division, has jurisdiction over Burbank cases.

• Standard of Review: The court reviews whether SSA’s decision is supported by substantial evidence and whether correct legal standards were applied.

Statutes of Limitations Snapshot

Appeal LevelDeadline Reconsideration60 days ALJ Hearing60 days Appeals Council60 days Federal Court60 days

Missed the 60-day window? You may request an extension for good cause in writing (20 CFR §404.911).

When to Seek Legal Help for SSDI Appeals

Although you can self-represent, success rates rise sharply with professional representation, especially at the ALJ and federal court stages. A burbank disability attorney or accredited advocate can:

• Obtain and submit tailored medical source statements addressing SSA’s listing criteria.

• Draft persuasive legal briefs citing Fifth Circuit precedent.

• Cross-examine vocational and medical experts effectively.

• Monitor deadlines and file electronic appeals through Appointed Representative Services.

Under 42 U.S.C. §406(a), attorney fees are contingent and payable only from past-due benefits. Texas attorneys must also comply with State Bar of Texas ethical rules, giving you added consumer protection.

Local Resources & Next Steps for Burbank Residents

Social Security Field Offices

Burbank, Texas falls under SSA’s Dallas Region (Region VI). Use SSA’s online office locator or call 800-772-1213 to confirm the closest field office. Many Burbank claimants file paperwork at the San Antonio – South Flores office:

• Address: 3435 S. Flores St., San Antonio, TX 78204

• Phone: 866-593-1925 (field office line)

• Hours: Mon–Fri, 9 a.m.–4 p.m.

(Information verified via SSA office locator on publication date.)

Texas Disability Determination Services (DDS)

Initial and reconsideration decisions come from DDS in Austin:

• Texas DDS, 6101 E. Oltorf St., Austin, TX 78741

• Phone: 512-437-8000

Medical Documentation Sources Near Burbank

Strong medical records are the backbone of any appeal. Burbank residents often rely on:

• University Hospital – San Antonio (Level 1 trauma center)

• Mission Trail Baptist Hospital (specialty rehab services)

• Methodist Healthcare System (network of specialists)

Request complete treatment notes, imaging, and lab results in SSA-acceptable formats.

Veterans & Community Programs

If you are a veteran living in Burbank, the South Texas Veterans Health Care System can provide nexus letters and disability exams helpful for SSDI. Community legal clinics such as Texas RioGrande Legal Aid occasionally assist low-income claimants with appeals.

Authoritative Resources for Further Reading

SSA Appeals Overview 20 C.F.R. §404.909 – Reconsideration Rules 20 C.F.R. §404.1520 – Five-Step Evaluation Social Security Act §205

Conclusion

An SSDI denial is not the end of your claim—often it is the beginning of a structured appeals process designed to protect your rights. By acting within the 60-day deadlines, fortifying your medical evidence, and citing the correct federal regulations, you markedly increase your odds of success. Consider partnering with an experienced burbank disability attorney to navigate SSA’s procedural maze and present the strongest possible case.

Legal Disclaimer

The information in this guide is for educational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed Texas 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.