SSDI Denial Appeal Guide – Des Moines, Texas

Introduction: Why an SSDI Denial Hits Hard in Des Moines, Texas

Receiving a Social Security Disability Insurance (SSDI) denial can feel devastating, especially in smaller Texas communities such as Des Moines. When a decision letter arrives from the Social Security Administration (SSA), it often contains dense legal language and short deadlines. Yet many claimants ultimately win benefits by appealing. According to the SSA’s Annual Statistical Report on the Social Security Disability Insurance Program, approximately 35 percent of initially denied claims are awarded at later appeal levels nationwide. This guide explains, in plain English, how residents of Des Moines, Texas can protect their rights, meet strict federal timelines, and build the strongest possible appeal.

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Understanding Your SSDI Rights

What SSDI Provides

SSDI pays monthly cash benefits and Medicare eligibility to workers who become disabled before full retirement age and have earned sufficient work credits under the Federal Insurance Contributions Act (FICA). Section 223 of the Social Security Act defines “disability” as the inability to engage in substantial gainful activity (SGA) by reason of a medically determinable impairment expected to last at least 12 months or result in death.

The Five-Step Sequential Evaluation

The SSA uses the five-step test codified at 20 C.F.R. § 404.1520 to evaluate every adult claim:

• Are you performing SGA?
• Is your impairment “severe”?
• Does it meet or equal a listed impairment in Appendix 1, Subpart P?
• Can you do past relevant work?
• Can you adjust to other work in the national economy?

Understanding where your case failed in this sequence is the key to reversing a denial.

Your Appeal Rights

• 60-Day Deadline: 20 C.F.R. § 404.909 requires you to request reconsideration within 60 days of receiving the denial (the SSA presumes you received the letter within five days of the date on the notice).
• Evidence Submission: You may present new medical records at each appeal level (20 C.F.R. § 404.935).
• Representation: Claimants may appoint a qualified representative, including licensed Texas attorneys (20 C.F.R. § 404.1705).

Common Reasons SSA Denies SSDI Claims

While every case is unique, SSA statistics and federal case law highlight recurring pitfalls:

1. Insufficient Medical Evidence

The SSA often finds that medical records do not establish severity or duration. Missing objective testing (e.g., MRI, pulmonary function tests) can trigger a Section 404.1520(c) “not severe” denial.

2. Work Exceeds Substantial Gainful Activity

If your earnings after disability onset exceed the monthly SGA limit ($1,470 for non-blind claimants in 2023 per SSA), the application can be denied at Step 1, regardless of health issues.

3. Non-Compliance With Prescribed Treatment

Under 20 C.F.R. § 404.1530, failure to follow prescribed treatment without good cause may result in denial.

4. Residual Functional Capacity (RFC) Misjudged

At Steps 4 and 5, adjudicators often determine that a claimant retains a light or sedentary RFC, relying heavily on consultative examinations. Vocational misclassification leads to frequent appeals.

5. Technical Eligibility Problems

Not enough quarters of coverage or an insured status lapse before disability onset date are purely technical bases for denial. Understanding your Date Last Insured (DLI) is vital.

Federal Legal Protections & Regulations Every Texan Should Know

The Social Security Act & Due Process

Section 205(b) of the Social Security Act guarantees a hearing before an impartial Administrative Law Judge (ALJ) after reconsideration. The U.S. Supreme Court affirmed this due-process right in Richardson v. Perales, 402 U.S. 389 (1971).

Key Regulations Cited in Appeals

• 20 C.F.R. § 404.900 – Lays out the four-step administrative review process: initial, reconsideration, ALJ hearing, Appeals Council.
• 20 C.F.R. § 404.1527 – Treating physician rule (for claims filed before March 27, 2017) and how SSA weighs medical opinions.
• 20 C.F.R. § 404.1520c – New supportability and consistency factors for medical opinions (claims filed on/after March 27, 2017).
• 42 U.S.C. § 405(g) – Judicial review in U.S. District Court after exhausting administrative remedies.

Statute of Limitations for Federal Court

You must file a civil action within 60 days after receiving the Appeals Council’s denial (42 U.S.C. § 405(g)). The clock mirrors earlier appeal deadlines.

Attorney Licensing in Texas

Only attorneys licensed by the State Bar of Texas and in good standing may provide legal advice on Texas law. Under Tex. Gov’t Code § 81.102, unauthorized practice of law is prohibited. Representatives before the SSA must also comply with 20 C.F.R. § 404.1705.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Thoroughly

The notice explains the medical, vocational, and technical reasons for denial. Identify the exact step in the sequential evaluation where your case faltered.

2. Calendar Your Deadlines

• Add 5 days to the letter date (mailing presumption).
• Count 60 days—this is your cutoff to file the next appeal.

3. Request Reconsideration

Complete Form SSA-561 and form SSA-3441 (Disability Report – Appeal). Submit online or mail to the SSA field office serving Des Moines (see local office information below).

4. Update Medical Evidence

Gather treatment notes, imaging, and specialist opinions dated after your original filing. Under 20 C.F.R. § 404.1510, evidence must be from accepted medical sources.

5. Consider Opinion Letters

Detailed functional capacity questionnaires from treating physicians often sway adjudicators. Ensure doctors reference objective findings and limitations (e.g., need for unscheduled breaks, absenteeism).

6. Prepare for a Potential ALJ Hearing

If reconsideration is denied, request a hearing via Form HA-501. ALJ hearings are de novo, allowing you to testify, cross-examine vocational experts, and submit new evidence.

7. Maintain Consistency

Provide consistent statements to your doctors, the SSA, and on any work-activity reports (SSA-820/821). Inconsistencies can undermine credibility findings (SSR 16-3p).

When to Seek Legal Help for SSDI Appeals

Advantages of Representation

• Evidence Development: Experienced attorneys know which diagnostic tests fill record gaps.
• Vocational Cross-Examination: An attorney can challenge the vocational expert’s job numbers and transferable skills assumptions.
• No Up-Front Fees: Under 42 U.S.C. § 406(a), fees are contingency-based and capped at 25 percent of past-due benefits (currently $7,200 maximum without special petition).

Signs You May Need Counsel

• You face complex medical listings (e.g., mental disorders, autoimmune conditions) requiring specialized evidence.
• Your DLI has expired or is about to expire, necessitating proof of disability in the past.
• You must appear at an ALJ hearing where expert testimony is expected.

Local Resources & Next Steps in Des Moines, Texas

Nearest SSA Field Office

Amarillo Social Security Field Office 7145 IH-40 West, Suite 300 Amarillo, TX 79106 Phone: 1-866-690-5278 (TTY 1-806-356-6519) Hours: 9:00 a.m.–4:00 p.m., Monday–Friday except federal holidays. According to the SSA Field Office Locator, this office currently services ZIP codes in the Des Moines area.### Texas Health Care Providers Familiar With Disability Documentation

• BSA Hospital, Amarillo – Specialists frequently complete SSA functional assessments.
• Texas Tech University Health Sciences Center (Amarillo Campus) – Offers neurology, orthopedic, and mental-health services accepted by many claimants.

Community Assistance

• Texas Workforce Commission – Vocational Rehabilitation Services: Can supply work-restriction reports helpful in Step 5 assessments.
• Panhandle Independent Living Center: Provides advocacy training and peer counseling.

Stay Informed With Authoritative Sources

Bookmark these official resources:

SSA Disability Appeal PortalElectronic Code of Federal Regulations – Part 404Social Security Act § 205(b)SSA Office Locator

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change. Consult a licensed Texas attorney regarding 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.