SSDI Denial & Appeal Guide for Burbank, Texas Claimants

Introduction: Why This Guide Matters to Burbank, Texas Residents

The Social Security Disability Insurance (SSDI) program is a lifeline for many Texans whose medical conditions prevent them from working full-time. Yet the Social Security Administration (SSA) denies roughly two-thirds of initial SSDI applications nationwide, according to data published in the SSA’s Annual Statistical Report on the Social Security Disability Insurance Program. If you live in the Burbank neighborhood of San Antonio—or any part of Bexar County—an SSDI denial can threaten your financial stability and your family’s well-being. Fortunately, federal law gives you several opportunities to appeal. This comprehensive guide explains why claims are denied, outlines each stage of the appeals process, highlights key federal regulations, and spotlights local resources available to claimants in Burbank, Texas. While the information favors the rights of disability claimants, it remains strictly factual and grounded in authoritative sources.

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Understanding Your SSDI Rights

1. What SSDI Provides

SSDI is a federal insurance program funded by payroll taxes under Title II of the Social Security Act. It pays monthly cash benefits and, after 24 qualifying months, automatically enrolls beneficiaries in Medicare. Coverage is not means-tested; eligibility turns on work credits and medical disability.

2. Key Eligibility Requirements

• Work Credits: Most workers need 40 credits, 20 of which were earned in the last 10 years (20 CFR §404.130).

• Severe Medically Determinable Impairment (MDI): The condition must last—or be expected to last—at least 12 months or result in death (20 CFR §404.1505).

• Inability to Perform Substantial Gainful Activity (SGA): In 2024, SGA is generally $1,550 per month for non-blind claimants (SSA Program Operations Manual System).

3. Procedural Due-Process Rights

Section 205(b) of the Social Security Act guarantees every claimant a written notice of denial and the right to a de novo hearing before an Administrative Law Judge (ALJ). The SSA is also required to explain the evidence it relied on and inform you of your right to representation.

4. Representation Rights

You may appoint a representative, including a licensed Texas attorney. Federal regulations governing representatives appear in 20 CFR §404.1700-§404.1799. Attorney fees are generally capped at 25% of past-due benefits or $7,200, whichever is lower, per 42 U.S.C. §406(a).

Common Reasons SSA Denies SSDI Claims

Understanding why claims fail can help you strengthen your appeal. Below are the most frequently cited reasons, all documented in SSA publications and federal decisions:

Insufficient Medical Evidence

  - Missing objective tests (e.g., MRIs, lab results)

  - Lack of longitudinal treatment records

  - No opinion from a treating specialist addressing work-related limitations

• Earnings Above SGA If you earned over the SGA threshold during the alleged disability period, the SSA may conclude you can perform competitive work.

• Failure to Follow Prescribed Treatment 20 CFR §404.1530 allows the SSA to deny benefits if you do not follow treatment that could restore your ability to work—unless you have a valid excuse (e.g., unaffordable costs).

• Disability Not Expected to Last 12 Months Short-term impairments typically do not satisfy 20 CFR §404.1505.

• Non-Severe Classification at Step Two Under the five-step evaluation in 20 CFR §404.1520, the SSA can stop its analysis if it deems your impairment “non-severe.” This is often disputed at appeal.

Federal Legal Protections & Regulations Every Claimant Should Know

1. The Five-Step Sequential Evaluation (20 CFR §404.1520)

The SSA analyzes every adult claim through this framework:

• Step 1: Are you engaging in SGA?

• Step 2: Do you have a severe impairment?

• Step 3: Does your condition meet or equal a Listing in Appendix 1?

• Step 4: Can you return to Past Relevant Work (PRW)?

• Step 5: Considering age, education, and Residual Functional Capacity (RFC), can you adjust to other work?

2. Time Limits for Appeals

• Reconsideration: File within 60 days of the denial date, plus 5 days for mailing (20 CFR §404.909).

• ALJ Hearing: Request within 60 days after reconsideration denial (20 CFR §404.933).

• Appeals Council: 60-day limit following an ALJ’s unfavorable decision (20 CFR §404.968).

• Federal Court: Within 60 days of the Appeals Council’s notice (42 U.S.C. §405(g)).

3. Evidentiary Standards

The SSA must base its decision on “substantial evidence,” defined by the U.S. Supreme Court in Biestek v. Berryhill, 587 U.S. ___ (2019), as “more than a mere scintilla.”

4. Equal Access to Justice Act (EAJA)

If you prevail in federal court and the government’s position was not “substantially justified,” EAJA (28 U.S.C. §2412) may allow recovery of attorney fees, making federal litigation financially feasible for claimants.

5. Confidentiality & Privacy

Your disability file is protected under the Privacy Act of 1974. The SSA may disclose records only with written consent or under specific statutory exceptions.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

Identify the medical and vocational reasons cited. This will guide your evidence-gathering strategy.

2. File for Reconsideration

You must submit SSA-561 and SSA-3441 online or by mail. Missing the 60-day deadline usually forces you to restart the entire application—losing months of back pay—unless you have “good cause” per 20 CFR §404.911.

3. Strengthen the Medical Record

• Obtain updated diagnostic imaging.

• Ask treating physicians for narrative letters detailing functional limitations.

• Follow all prescribed treatments unless financially impossible; document cost barriers.

4. Request an ALJ Hearing

Most favorable decisions occur at the hearing level. You may appear by video from the San Antonio Office of Hearing Operations (OHO) located at 727 E César E. Chávez Blvd., San Antonio, TX 78206.

5. Prepare for Vocational Testimony

At Step 5, the ALJ often questions a Vocational Expert (VE). Consider submitting written interrogatories to challenge hypotheticals that do not reflect your actual limitations.

6. Appeals Council Review

The Appeals Council in Falls Church, Virginia, reviews ALJ decisions for legal or factual error. It can remand, reverse, or deny review.

7. Federal District Court

Texas claimants file in the U.S. District Court for the Western District of Texas, San Antonio Division. Judicial review is limited to the administrative record, but it is an independent Article III review.

When to Seek Legal Help for SSDI Appeals

Texas attorney-client relationships are regulated by the State Bar of Texas Rules of Professional Conduct. Because attorney fees in SSDI cases are contingency-based and capped by federal law, most reputable firms offer free consultations. Consider hiring a burbank disability attorney if:

• You have a complex medical history (multiple impairments, mental health issues).

• Your past work involved skilled trades and transferable skills disputes are likely.

• You’ve missed deadlines and need to argue “good cause.”

• The ALJ decision contains legal errors such as ignoring treating-physician rules (20 CFR §404.1520c).

Federal studies show represented claimants are statistically more likely to succeed at the hearing level. A qualified lawyer can also cross-examine VEs and ensure the record is complete for possible federal court review.

Local Resources & Next Steps for Burbank Residents

1. Nearest Social Security Field Offices

• San Antonio Downtown SSA Office: 727 E César E. Chávez Blvd., San Antonio, TX 78206. Phone: 866-593-1927.

• San Antonio West SSA Office: 411 Richland Hills Dr., San Antonio, TX 78245. Phone: 866-613-2875.

2. Local Medical Facilities Familiar to SSA Examiners

• University Health – Bexar County Hospital System

• Methodist Hospital – South Texas Medical Center

• South Texas Veterans Health Care System (for veteran claimants)

3. Vocational & Rehabilitation Resources

• Texas Workforce Solutions – Vocational Rehabilitation Services

• Goodwill San Antonio – Job training for disabled adults

4. Pro Bono & Low-Cost Legal Aid

• San Antonio Legal Services Association (SALSA)

• Texas RioGrande Legal Aid (TRLA)

5. Staying Organized

Maintain a binder with chronological medical records, SSA correspondence, and contact logs. This organization proves invaluable when deadlines loom.

Authoritative External Resources

SSA Official Appeals Process Electronic Code of Federal Regulations – 20 CFR Part 404 42 U.S.C. §405 – Judicial Review Provision State Bar of Texas Lawyer Directory

Conclusion

SSDI appeals may feel daunting, but the law gives you multiple bites at the apple. By acting quickly, gathering robust medical evidence, and considering professional representation, Burbank, Texas residents can significantly improve their chances of securing the disability benefits they have already paid for through FICA taxes.

Legal Disclaimer: This guide is for informational purposes only and does not constitute legal advice. For advice specific to your circumstances, 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.