SSDI Denial & Appeal Guide – Texas, Texas

Introduction: Why a Texas-Specific SSDI Guide Matters

Texas workers pay billions of dollars every year into the Social Security Disability Insurance (SSDI) system, yet thousands of disabled Texans see their initial claims denied. According to Social Security Administration (SSA) data, roughly 65–70 % of first-time SSDI applications filed out of the Dallas Regional Office—which oversees the entire state—are refused.* Denials can feel overwhelming, especially when medical bills, mortgage payments, and family obligations pile up. Fortunately, federal law and SSA regulations give every Texas claimant clear rights to challenge an unfavorable decision. This 2,500-plus-word guide explains, in plain English, how to protect those rights, meet crucial deadlines, and increase the odds of approval, all while rooting the discussion in Texas-specific facts, offices, and resources.### Quick Facts Texans Must Know

• 60-Day Appeal Deadline: Per Social Security Act § 205(b) (42 U.S.C. § 405(b)), you have only 60 days from receipt of a denial letter to file an appeal.
• Four Appeal Levels: Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and federal court (20 C.F.R. §§ 404.907–404.981).
• Local Oversight: The Dallas Regional Office (1301 Young St., Dallas, TX 75202) manages disability operations for all 11 Texas hearing offices and 65 field offices.

1. Understanding Your SSDI Rights in Texas

SSDI is an earned benefit—not a welfare program. If you worked and paid FICA taxes long enough to meet the “insured status” test under 20 C.F.R. § 404.130, you have a federally protected right to monthly disability payments once you satisfy the medical criteria in 20 C.F.R. § 404.1505. Those criteria boil down to proving:

• You have a medically determinable impairment expected to last at least 12 months or result in death; and
• The impairment prevents substantial gainful activity (SGA) as defined by 20 C.F.R. § 404.1571.

Texas claimants also benefit from clear due-process safeguards. SSA must explain its reasons in writing, allow you to review your file, submit new evidence, and receive a fair hearing before an ALJ who did not participate in the prior decision. These protections stem from both the Social Security Act and landmark Supreme Court opinions such as Goldberg v. Kelly, 397 U.S. 254 (1970).

2. Common Reasons SSA Denies Texas SSDI Claims

• Lack of Recent Medical Evidence. SSA physicians often discount hospital records from Houston’s Texas Medical Center or Dallas’ Baylor U. Medical Center if they are older than 90 days.
• Earnings Above SGA. In 2024, monthly earnings over $1,550 generally bar benefits. Oil-field contractors in Midland/Odessa frequently trigger this rule.
• Non-Severe Finding. Claims for chronic pain or PTSD can be labeled “non-severe” if mental-health notes from the VA North Texas Health Care System are missing GAF scores or functional limitations.
• Failure to Follow Prescribed Treatment. 20 C.F.R. § 404.1530 lets SSA deny if you skip doctor-ordered therapy—common when specialist co-pays at UT Southwestern are unaffordable.
• Inadequate Work Credits. Many gig-economy drivers in Austin earn income reported on 1099s but do not pay self-employment taxes, leaving them without the 20/40 quarters of coverage rule.

3. Key Federal Regulations & Protections

• 20 C.F.R. § 404.1520: Five-step evaluation framework SSA must follow.
• 20 C.F.R. § 404.1740: Regulates attorney conduct and fee caps (25 % of back pay, maximum $7,200).
• 20 C.F.R. § 404.968: Appeals Council review rights.
• 42 U.S.C. § 405(g): Grants Texas claimants the right to sue in U.S. District Court (e.g., Southern District of Texas) if dissatisfied with final agency action.

Because these rules are federal, they apply uniformly across the Lone Star State—from El Paso to Beaumont—despite Texas’ unique workforce demographics.

4. Five Steps to Take Immediately After a Denial

Step 1: Mark Your Calendar

You have 60 days plus a presumed 5 days for mailing (20 C.F.R. § 404.901) to request Reconsideration. Missing the deadline usually forces you to restart with a new application.

Step 2: Request Reconsideration Online or at Your Local SSA Field Office

File online using SSA’s iAppeals portal or at offices such as:

• Houston Downtown: 1919 Smith St., Ste. 500, Houston, TX 77002
• San Antonio West: 411 Richland Hills Dr., San Antonio, TX 78245

Step 3: Submit Updated Evidence

Gather new diagnostics from Texas facilities like MD Anderson Cancer Center, Dell Seton Medical Center, or the VA Houston. SSA’s Program Operations Manual System (POMS DI 25501.090) stresses “current” records.

Step 4: Track Your File

Use a mySSA account or call Dallas Regional Office Disability Program Branch (214-767-9401) to confirm receipt.

Step 5: Prepare for an ALJ Hearing

If Reconsideration fails (it often does), you have 60 days to request a hearing. Houston, Dallas, Fort Worth, Austin, San Antonio, and Harlingen host Texas’ hearing centers. Median wait times range from 6–11 months, so early preparation is critical.

5. When to Seek a Texas Disability Attorney

While you may self-represent, statistics published by SSA’s Office of Hearings Operations show that represented claimants win approximately 20 percentage points more often than unrepresented parties. Consider hiring counsel if:

• You need help cross-examining Vocational Experts.
• Your case involves complex impairments (e.g., oil-field traumatic brain injury plus PTSD).
• You have a prior workers’ compensation settlement that must be offset under 20 C.F.R. § 404.408.

Texas attorneys must be licensed by the State Bar of Texas and admitted to practice before SSA under 20 C.F.R. § 404.1705. Fee agreements are capped at 25 % of past-due benefits, up to $7,200, and must be approved by SSA.

6. Local Resources & Next Steps

Free or Low-Cost Help

Disability Rights Texas (DRTx): Statewide protection and advocacy for SSDI claimants (Disability Rights Texas).- Texas Legal Services Center: Offers virtual advice clinics on SSDI appeals.

• 211 Texas: Connects you to transportation or medication assistance during the wait for hearings.

Vocational & Medical Documentation

Obtain functional capacity evaluations from accredited centers such as TIRR Memorial Hermann (Houston) or Texas NeuroRehab Center (Austin) to quantify limitations.

Stay Engaged with SSA

Regularly check your mySSA inbox, keep address changes current, and reply promptly to any requests from the Texas Disability Determination Services (DDS) in Austin (4405 N. Lamar Blvd., Austin, TX 78756).

Authoritative References

SSA – Official Appeals ProcessElectronic Code of Federal Regulations – 20 C.F.R. Part 404Social Security Act – Full TextSSA Appeals Council Resources 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.