SSDI Denial Appeal Guide – Nevada, Nevada

Introduction: Why a Nevada-Specific SSDI Guide Matters

If you live in Nevada and your Social Security Disability Insurance (SSDI) claim was denied, you are far from alone. According to the Social Security Administration’s (SSA) most recent Annual Statistical Report on the Social Security Disability Insurance Program, roughly one in three initial SSDI applications nationwide are approved; the rest are denied and must enter the appeals process. In Nevada, the approval rate follows the national trend, leaving thousands of Nevadans—many from Las Vegas, Reno, Henderson, and rural communities—searching for answers. This comprehensive guide explains what an SSDI denial means, why it happens, how to appeal under federal rules, and what local resources exist to help you protect your rights. Although we slightly favor the claimant’s perspective, every statement below is grounded in authoritative law, regulation, or published data.

Understanding Your SSDI Rights

The Legal Definition of Disability

Under Section 223(d) of the Social Security Act, you are considered “disabled” if you cannot engage in any substantial gainful activity because of “a medically determinable physical or mental impairment” that is expected to result in death or last at least 12 continuous months. The SSA applies this definition using the five-step sequential evaluation found at 20 C.F.R. § 404.1520.

Your Right to a Fair Administrative Process

The SSA must review every application following the procedures in 20 C.F.R. § 404.900 et seq.. These regulations guarantee you the right to:

• Written notice explaining why your claim was denied;

• Timely appeal through up to four review levels—Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and federal court action;

• Representation by a qualified disability attorney or advocate (your representative is usually paid only if you win back benefits);

• Access to your claims file so you can see the evidence SSA relied on.

Important Deadlines

You generally have 60 days from the date you receive an unfavorable decision (the SSA presumes you receive it five days after the notice date) to request the next appeal level. Missing this deadline almost always ends your case unless you show “good cause.”

Common Reasons SSA Denies SSDI Claims

Understanding why applications fail can help you shore up your evidence before you appeal.

Insufficient Medical Evidence. Many claims lack up-to-date diagnostic tests, imaging, or treatment notes. The SSA needs objective proof that your impairments are severe and meet or equal a Listing of Impairments criteria or prevent you from sustaining work.

• Residual Functional Capacity (RFC) Misunderstandings. The Disability Determination Services (DDS) examiner may decide that you can still perform past work or adjust to new work. This RFC analysis often hinges on subtle vocational factors such as age, education, and transferable skills.

• Earned Too Much During the Alleged Disability Period. If your earnings exceeded substantial gainful activity (SGA) thresholds—$1,470 per month in 2023 for non-blind claimants—your application will be denied.

• Non-medical Ineligibility. SSDI is an insurance program. If you have not worked and paid Social Security taxes for enough “quarters of coverage” or your insured status expired, the SSA must deny the claim.

• Failure to Cooperate. Missing consultative examinations, ignoring SSA requests for forms, or giving incomplete information can also trigger a denial.

Federal Legal Protections & Key Regulations

Major Regulations Every Nevada Claimant Should Know

• 20 C.F.R. § 404.1505: Defines disability for SSDI purposes.

• 20 C.F.R. § 404.1512: Your burden to provide medical and other evidence.

• 20 C.F.R. § 404.929–404.961: Reconsideration and ALJ hearing procedures.

• 42 U.S.C. § 405(g): Right to file a lawsuit in U.S. District Court after exhausting administrative remedies.

How Federal Courts View SSDI Appeals

When Nevada claimants exhaust all SSA administrative steps, they may pursue relief in the U.S. District Court for the District of Nevada. Judges review whether the SSA’s decision was supported by “substantial evidence” and applied the correct legal standards. Successful federal-court appeals often hinge on errors such as:

• Ignoring treating physician opinions without proper explanation;

• Mishandling a claimant’s subjective symptom testimony;

• Failing to consider combined effects of multiple impairments.

Although fewer than 3% of claims reach this stage, a well-prepared record from the earlier levels can make or break the outcome.

Steps to Take After an SSDI Denial

1. Request Reconsideration (Level 1)

File SSA Form SSA-561 within 60 days. You can submit online through your mySSA account or by mail to your local Nevada field office. This is a paper review by a different DDS examiner.

2. Prepare for an ALJ Hearing (Level 2)

• Submit Form HA-501 and a statement of the issues.

• Request your complete file (known as the “eFolder”) to identify missing gaps.

• Gather updated medical records, especially imaging results, specialist opinions, and functional capacity evaluations, and submit them at least five business days before the hearing per 20 C.F.R. § 404.935.

• Consider expert testimony. Nevada claimants frequently benefit from vocational or medical experts who can counter SSA’s vocational experts (VEs).

• Expect the Las Vegas Hearing Office or the Reno Hearing Office to schedule your video or in-person hearing. Average Nevada wait time is around 9–11 months, per SSA Hearing Office data.

3. Appeals Council Review (Level 3)

Still denied? File Form HA-520. The Appeals Council in Falls Church, Virginia, reviews legal and factual errors. You may submit new evidence if it relates to the relevant period.

4. Federal Court Lawsuit (Level 4)

File a civil action in the U.S. District Court for the District of Nevada within 60 days of the Appeals Council denial. A Nevada-licensed attorney must sign the complaint and serve the U.S. Attorney’s Office, SSA’s Office of General Counsel, and the local SSA office.

When to Seek Legal Help for SSDI Appeals

Although you can pursue each appeal level pro se (without representation), statistics consistently show higher success rates for represented claimants. Studies cited by the Government Accountability Office (GAO-18-37) revealed that representation at the ALJ level more than doubled the likelihood of approval. Nevada attorneys must be admitted to the State Bar of Nevada and, for federal cases, to the U.S. District Court for the District of Nevada.

Fee Rules

Under 20 C.F.R. § 404.1728, attorney fees are typically capped at the lesser of 25% of past-due benefits or $7,200 (2024 cap) unless approved under a fee petition. You pay nothing upfront; fees are contingent on winning.

Signs You Should Hire Counsel

• You have multiple or complex medical impairments.

• Your past work was skilled or semi-skilled, making vocational issues critical.

• You cannot easily collect medical records or afford consultative testing.

• You already lost at Reconsideration and face an ALJ hearing.

Local Resources & Next Steps

Nevada SSA Field Offices

• Las Vegas (Buffalo): 1250 S. Buffalo Dr., Suite 150, Las Vegas, NV 89117

• Las Vegas (Simmons): 4340 Simmons St., Las Vegas, NV 89032

• Reno: 1170 Harvard Way, Reno, NV 89502

• Elko: 350 W. Silver St., Suite 100, Elko, NV 89801

You can locate additional offices through the SSA’s Field Office Locator.

Disability Determination Services (DDS) for Nevada

Initial and reconsideration decisions are made by Nevada Disability Adjudication Services, 1170 Harvard Way, Reno, NV 89502.

State & Community Assistance

• Nevada Disability Advocacy & Law Center (NDALC) – Provides free or low-cost advocacy (especially for low-income claimants).

• Nevada 2-1-1 – Connects you to community health clinics that may offer low-cost diagnostic tests.

• University Medical Center (UMC) Las Vegas and Renown Regional Medical Center – Two of the largest providers in the state, helpful for comprehensive medical evaluations.

Nevada Disability Statistics

The SSA’s 2022 OASDI Beneficiaries by State report shows approximately 66,551 disabled workers receiving benefits in Nevada, highlighting how many residents rely on the program and why persistence after a denial pays off.

Legal Disclaimer

This article provides general information for Nevada residents about SSDI denials and appeals. It is not legal advice. Laws and regulations change, and every case is unique. Consult a licensed Nevada 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.

SSA – Official Appeals Process

Electronic Code of Federal Regulations – Part 404

Social Security Act § 223 – Definition of Disability

GAO Report on SSDI Representation Outcomes