SSDI Denial Appeal Guide – Plano, Texas Residents

Introduction: Why Plano Claimants Need a Focused SSDI Denial Appeal Guide

Plano, Texas has grown into a major employment hub in Collin County, with corporate campuses lining the Dallas North Tollway and State Highway 121. Yet not every resident can remain in Plano’s active workforce. According to the U.S. Census Bureau’s latest American Community Survey, approximately 5.2 percent of Plano’s 288,000 residents live with a disability that limits substantial gainful activity (SGA). When a medical condition keeps you from working at any of the jobs you performed in the last 15 years, federal Social Security Disability Insurance (SSDI) benefits are meant to replace part of your lost income.

Unfortunately, the Social Security Administration (SSA) denies roughly two-thirds of initial SSDI applications nationwide. Claimants in Plano are no exception, even when they have paid sufficient FICA taxes and supplied medical records from reputable local providers such as Baylor Scott & White – Plano or Medical City Plano. This step-by-step guide—grounded in authoritative federal regulations and statutes—explains what to do immediately after receiving a denial letter, the deadlines that govern appeals, and when to contact a Plano disability attorney to protect your rights.

Understanding Your SSDI Rights

1. The Statutory Framework

Your right to disability benefits stems from the Social Security Act §205(b), codified at 42 U.S.C. §405(b). The statute guarantees you:

• Written notice of any adverse decision.

• An opportunity for a de novo reconsideration by the SSA.

• The right to a hearing before an Administrative Law Judge (ALJ).

• Further administrative review by the Appeals Council.

• The option to file a civil action in U.S. District Court.

2. Key Federal Regulations

The Act is implemented through the Code of Federal Regulations (CFR). Two provisions Plano claimants should know:

• 20 CFR §404.909 – Sets the 60-day deadline (plus 5 days for mailing) to request reconsideration after an initial denial.

• 20 CFR §404.967 – Establishes your right to request Appeals Council review within 60 days of an unfavorable ALJ decision.

These rules are mandatory. Missing a deadline without “good cause” usually forfeits the appeal, forcing a new claim and lost retroactive benefits.

Common Reasons SSA Denies SSDI Claims

Being proactive begins with understanding why denials occur. SSA’s written notice must specify the reason, but the following are the most frequent grounds:

• Medical Insufficiency – The medical evidence fails to show an impairment expected to last 12 months or result in death (see 20 CFR §404.1509).

• Residual Functional Capacity (RFC) Findings – State agency medical consultants conclude you can still perform past relevant work or adjust to other work.

• Technical Earnings Requirements – Insufficient work credits in the date last insured (DLI) period.

• Failure to Cooperate – Missing Consultative Examinations (CEs) or ignoring SSA requests for additional records.

• Substantial Gainful Activity – Earnings above the annual SGA threshold (e.g., $1,470 per month in 2023 for non-blind claimants) demonstrate ability to work.

Plano claimants often treat an SSA denial as final. It is not. The appeals process exists precisely because many denials are reversed once detailed evidence and legal arguments are submitted.

Federal Legal Protections & Regulations

1. The Five-Step Sequential Evaluation

Under 20 CFR §404.1520, SSA decision-makers apply a five-step analysis:

• Step 1 – SGA: Are you working above SGA levels?

• Step 2 – Severity: Does a medically determinable impairment significantly limit basic work activities?

• Step 3 – Listings: Does the impairment meet or equal a listing in Appendix 1?

• Step 4 – Past Work: Can you perform any prior job held in the last 15 years?

• Step 5 – Other Work: Considering age, education, and RFC, can you adjust to other work in the national economy?

If the answer is “no” at any step after Step 3, benefits must be awarded. Many denials incorrectly evaluate Steps 4 and 5, an area where experienced SSDI appeals counsel adds value.

2. Evidence Standards

The burden of proof falls on the claimant through Step 4 and shifts to SSA only at Step 5. Evidence must be “objective medical evidence” from acceptable medical sources (20 CFR §404.1502). Plano claimants frequently treat notes from nurse practitioners or physical therapists as enough; while helpful, SSA gives greater weight to M.D. or D.O. opinions.

3. Right to Representation

Section 206 of the Social Security Act (42 U.S.C. §406) allows claimants to appoint an attorney or qualified non-attorney. Representative fees are capped (currently $7,200 or 25 percent of back pay, whichever is lower) and must be approved by SSA.

Steps to Take After an SSDI Denial

1. Mark the Calendar Immediately

You have 60 days from the date you receive the denial to file a written Request for Reconsideration (SSA-561). SSA presumes you received the notice five days after the date printed on the letter (20 CFR §404.901).

2. Order and Review Your Electronic Folder

Use your my Social Security account or visit the Plano SSA office (address below) to obtain a copy of all Exhibits. Reviewing the Disability Determination Explanation pinpoints why DDS physicians rejected your claim.

3. Strengthen Medical Evidence

• Request updated MRI, CT, or EMG studies from Baylor Scott & White – Plano or other treating facilities.

• Ask your treating physician to complete SSA Form RFC-RFC (Residual Functional Capacity) statements.

• Document side effects of medications and frequency of symptom-related absences.

4. File the Reconsideration

Submit SSA-561, SSA-3441, and SSA-827. Always use certified mail or submit online for timestamped confirmation.

5. Prepare for an ALJ Hearing

If reconsideration is denied (common), request a hearing within 60 days under 20 CFR §404.933. Plano hearings are currently assigned to the Dallas North Office of Hearings Operations (OHO). Average wait times fluctuate—currently about 9–11 months—so filing promptly preserves retroactive benefits.

6. Appeals Council and Federal Court

An unfavorable ALJ decision can be appealed to the Appeals Council in Falls Church, Virginia, then to the U.S. District Court for the Eastern District of Texas (Sherman Division). Federal courts apply the “substantial evidence” standard but often remand when ALJs ignore treating-physician opinions or vocational evidence.

When to Seek Legal Help for SSDI Appeals

While self-representation is allowed, complex medical-vocational issues, cross-examination of vocational experts, and procedural pitfalls often warrant professional assistance. Consider hiring a Plano disability attorney if:

• The denial cites the Medical-Vocational Guidelines (“Grid Rules”).

• You are over age 50, where favorable Grid rules may apply.

• Your condition involves multiple impairments (e.g., diabetes plus neuropathy).

• You have prior workers’ compensation or VA disability ratings that must be harmonized with SSA rules.

• You cannot collect or organize extensive medical evidence.

Texas attorneys must be licensed by the State Bar of Texas and comply with the Texas Disciplinary Rules of Professional Conduct. Always verify licensure and ask for a written fee agreement approved by SSA.

Local Resources & Next Steps

1. Plano SSA Field Office

Address: 1100 E. Park Blvd., Suite 100, Plano, TX 75074

Phone: 1-866-931-2731

Hours: Monday–Friday, 9 a.m.–4 p.m. Bring a government ID and your denial letter when requesting your claims file or submitting appeal paperwork.

2. Medical Providers Familiar with SSDI Forms

• Baylor Scott & White Medical Center – Plano (Orthopedics, Neurology)

• Medical City Plano (Cardiology, Oncology)

• Texas Health Presbyterian Hospital Plano (Rheumatology, Pulmonology)

Ask treating physicians to reference specific functional limitations (e.g., lift/carry limits, need to elevate legs) rather than broad diagnoses.

3. Vocational Rehabilitation & Support

The Texas Workforce Commission’s Vocational Rehabilitation Services has a Plano office on 805 E. Park Blvd., Suite 124. While SSA may use its own vocational experts, rehab records showing failed work attempts can corroborate disability.

4. Community Legal Clinics

Legal Aid of NorthWest Texas (LANWT) sometimes assists low-income SSDI claimants. Call 888-529-5277 or visit their McKinney regional office, which serves Collin County.

Authoritative References

SSA – The Appeals Process 20 CFR §404.909 – Request for Reconsideration 42 U.S.C. §405 – Social Security Act §205 20 CFR §404.967 – Appeals Council Review

Conclusion

A denial from SSA is frustrating, but not the end of your pursuit of Social Security Disability benefits. By acting within strict federal deadlines, bolstering medical evidence, and—when appropriate—engaging an experienced advocate, Plano claimants can dramatically improve the odds of success. Stay organized, know your rights, and use every level of review Congress has provided.

Legal Disclaimer: This guide is for informational purposes only and does not constitute legal advice. No attorney-client relationship is formed. Laws and regulations change; consult a licensed Texas attorney regarding your specific circumstances.

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