SSDI Denial Appeal Guide – Tacoma, Texas Claimants

Introduction: Why Tacoma, Texas Claimants Need a Localized SSDI Denial Guide

If you live in or near the small unincorporated community of Tacoma, Texas—about 20 miles southeast of Longview in Harrison County—you already know that quality medical care and government services can feel far away. When the Social Security Administration (SSA) denies your application for Social Security Disability Insurance (SSDI), that distance can seem even greater. According to the SSA’s most recent Annual Statistical Report on the Social Security Disability Insurance Program, more than 60% of initial SSDI applications are denied nationwide. Texas residents fare similarly, which means many disabled workers in rural East Texas must navigate a multilayered federal appeals system to secure the benefits they earned through payroll taxes.

This comprehensive, evidence-based guide walks Tacoma, Texas claimants through:

• The legal rights you hold under the Social Security Act and federal regulations

• The most common reasons claims are denied

• Exact appeal deadlines and procedures set out in 20 C.F.R. §404.909 and §404.933

• Local resources—from nearby SSA field offices to physicians who routinely supply objective medical evidence

• When and why engaging a Texas-licensed disability attorney can increase your odds of success

Throughout, we cite only authoritative sources such as the SSA, the Code of Federal Regulations (CFR), and published federal court opinions. While the tone slightly favors claimants, the information is strictly factual so you can make informed decisions at every stage of the SSDI appeals process.

Understanding Your SSDI Rights

How SSDI Differs From Other Programs

SSDI is a federal insurance program funded by FICA payroll taxes. If you accumulated sufficient quarters of coverage and can no longer perform substantial gainful activity (SGA) because of a medically determinable impairment expected to last at least 12 months or result in death, you have a right to apply. SSI, by contrast, is means-tested.

Your rights are grounded in Title II of the Social Security Act (42 U.S.C. §401 et seq.) and further detailed in the CFR. Important claimant protections include:

• Notice and opportunity to be heard – The SSA must issue a written decision explaining the reasons for denial (20 C.F.R. §404.904).

• Four-level administrative review process – Reconsideration, hearing, Appeals Council, and federal court (20 C.F.R. Part 404, Subpart J).

• Representation rights – You may appoint an attorney or qualified representative at any stage (20 C.F.R. §404.1705).

• Statutory attorney’s-fee cap – Fees for administrative representation are generally limited to 25% of past-due benefits or $7,200 (2024 cap), whichever is less, per 42 U.S.C. §406(a).

Key Deadlines You Cannot Miss

The SSA imposes firm deadlines that, if missed, usually terminate your claim unless you can show good cause:

• Request for Reconsideration: 60 days after you receive the denial (20 C.F.R. §404.909).

• Request for Hearing: 60 days after a reconsideration denial (20 C.F.R. §404.933).

• Appeals Council Review: 60 days after receipt of the Administrative Law Judge (ALJ) decision (20 C.F.R. §404.968).

• Federal District Court: 60 days after Appeals Council notice (42 U.S.C. §405(g)).

For Tacoma claimants, mail delays can eat into that time. The SSA presumes you receive a notice five days after the date on the letter, so mark your calendar immediately.

Common Reasons SSA Denies SSDI Claims

Medical Evidence Issues

Under 20 C.F.R. §404.1520(a)(4), the SSA follows a five-step sequential evaluation. Most denials occur in Steps 3–5 because:

• Insufficient objective findings – SSA places heavy weight on MRI results, nerve conduction studies, or pulmonary function tests.

• Treating-source gaps – Sporadic treatment raises questions about the severity of impairments.

• Non-compliance with therapy – Failing to follow prescribed treatment without good reason can trigger denial (20 C.F.R. §404.1530).

Work and Earnings Problems

If your earnings exceed the SGA level ($1,550 per month for non-blind claimants in 2024), the SSA will deny at Step 1. Some Tacoma area residents take short-term contract or oil-field jobs, unaware that sporadic high earnings can sink a claim.

Technical & Non-Medical Denials

• Insufficient quarters of coverage – Common among younger or seasonal workers.

• Status outside the insured period – The Date Last Insured (DLI) may have expired; you must prove disability existed before that date.

• Previous denials not appealed timely—The SSA often re-opens only within four years in limited situations (20 C.F.R. §404.988).

Procedural Errors

Missing forms, unsigned releases, or failing to respond to SSA correspondence can result in a failure-to-cooperate denial. In rural areas like Tacoma, spotty internet and postal service make prompt follow-up critical.

Federal Legal Protections & Regulations

The Social Security Act

42 U.S.C. §405(b) mandates that the Commissioner of Social Security provide due-process hearings. The statute also vests federal district courts with jurisdiction to review final SSA decisions (§405(g)).

Key Regulations Every Claimant Should Know

• 20 C.F.R. §404.1504 – Explains how SSA evaluates other governmental disability decisions (e.g., VA ratings).

• 20 C.F.R. §404.1527 & §404.1520c – Weighing medical opinions for claims filed before and after March 27, 2017.

• 20 C.F.R. §404.1545 – Residual Functional Capacity (RFC) assessment.

• 20 C.F.R. §404.1569a – Vocational grid rules critical at Step 5.

Relevant Federal Court Precedent

The U.S. Court of Appeals for the Fifth Circuit, whose jurisdiction includes Texas, has repeatedly reinforced claimant rights:

• Audler v. Astrue, 501 F.3d 446 (5th Cir. 2007) – Reversal where ALJ failed to discuss Step 3 listings adequately.

• Newton v. Apfel, 209 F.3d 448 (5th Cir. 2000) – ALJ must conduct a detailed analysis before rejecting a treating physician’s opinion.

Knowing these holdings empowers claimants and their attorneys to spot reversible errors early.

Steps to Take After an SSDI Denial

1. Read the Denial Letter Carefully

The SSA will specify whether the denial is medical or technical. The code at the bottom (e.g., “RFC1” or “SGA2”) hints at the rationale.

2. File a Timely Request for Reconsideration

Use Form SSA-561 and submit it online via SSA’s appeal portal. Mailed forms should be sent certified to the regional processing center in Dallas: Social Security Administration, Disability Determination Services, P.O. Box 140934, Dallas, TX 75214.

3. Bolster Your Medical Evidence

• Schedule follow-ups at CHRISTUS Good Shepherd Medical Center – Longview and request updated imaging.

• Ask treating physicians to complete Residual Functional Capacity (RFC) forms consistent with 20 C.F.R. §404.1545.

• Document medication side effects, mental health symptoms, and emergency visits.

4. Prepare for the Administrative Law Judge Hearing

Only about 15% of Texas claims are reversed at the reconsideration stage. The ALJ hearing is therefore pivotal. Tips:

• Review the exhibit file – Request your electronic folder (e-FOLDER) on CD.

• Draft a pre-hearing brief – Highlight listing-level impairments, vocational grid rules, and any Fifth Circuit case law.

• Line up witnesses – Coworkers, family, or supervisors who can attest to functional limitations.

• Practice direct testimony – Clear, consistent descriptions of pain and limitations carry weight.

5. Appeals Council and Federal Court Review

If the ALJ denies your claim, you have two remaining administrative options:

• Appeals Council – Located in Falls Church, VA. Provide new and material evidence per 20 C.F.R. §404.970.

• Federal District Court – For Tacoma residents, suits are filed in the U.S. District Court for the Eastern District of Texas, Marshall Division. The court reviews the administrative record for substantial evidence errors.

When to Seek Legal Help for SSDI Appeals

Why Representation Matters

Nationwide, SSA data show that represented claimants are nearly three times more likely to win benefits at the hearing level. Representation is especially important for rural residents who face transportation barriers and limited broadband.

Choosing a Texas-Licensed Attorney

Under the Texas Disciplinary Rules of Professional Conduct, attorneys must be licensed by the State Bar of Texas and in good standing to practice law or hold themselves out as lawyers in the state. Confirm licensure at the Bar’s website before signing a Form SSA-1696.

Attorney Fee Framework

As noted, 42 U.S.C. §406(a) caps fees at 25% of past-due benefits or $7,200. No fee is owed if you do not win back benefits, making legal help economically feasible for most claimants.

Local Resources & Next Steps

Nearest SSA Field Offices for Tacoma, Texas Residents

• Longview SSA Office: 611 Clinic Dr., Longview, TX 75605 (approx. 22 miles)

• Marshall SSA Office (satellite): 611 East End Blvd S., Marshall, TX 75670 (Check SSA locator for hours)

Use the online SSA Field Office Locator to verify addresses and hours.

Medical Providers Familiar With SSA Forms

• CHRISTUS Good Shepherd Medical Center – Longview

• UT Health East Texas – Pittsburg

• East Texas Community Health Services – Marshall

Ask these facilities’ medical-records departments to label chart notes with ICD-10 codes and functional limitations to align with SSA criteria.

Low-Cost & Pro Bono Legal Aid

• Lone Star Legal Aid – Longview Office: 211 East Tyler St., Longview, TX 75601

• Texas RioGrande Legal Aid – Statewide disability rights unit

• East Texas Legal Clinic – Quarterly intake clinics in Harrison County

Transportation Assistance

Harrison County Rural Transit (“TRAX”) offers low-cost rides to the Longview SSA office for eligible residents. Call 1-800-590-3371 to schedule 48 hours in advance.

Authoritative External References

SSA – Official Appeals Information 20 C.F.R. §404.909 – Reconsideration Requests SSA Annual Statistical Report on the SSDI Program SSA Field Office Locator

Legal Disclaimer

The information provided in this guide is for educational purposes only and does not constitute legal advice. Laws and regulations change frequently. For advice about your specific situation, 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.