SSDI Denial Appeal Guide—Marathon, Texas Claimants

Introduction: Living With Disability in Marathon, Texas

Marathon, Texas may be a small West Texas community, but its residents face the same bureaucratic hurdles as applicants in Houston or Dallas when it comes to Social Security Disability Insurance (SSDI). Because there is no Social Security field office inside Marathon itself, local claimants typically interact with the Alpine Social Security Office at 1104 N. 5th St., Alpine, TX 79830, approximately 30 miles west on U.S. Route 90. If an SSDI claim is denied, hearings are generally scheduled through the El Paso Office of Hearing Operations (OHO), according to the Social Security Administration’s official hearing office jurisdiction list.

This comprehensive, evidence-based guide explains why SSDI denials occur, the exact federal rules that control appeals, and the local resources Marathon residents can use to protect their right to benefits. Although the information below slightly favors claimants—as Congress intended when it created a “non-adversarial” benefits system—every statement is grounded in authoritative legal sources such as the Social Security Act, the Code of Federal Regulations (CFR), and published SSA policy.

Understanding Your SSDI Rights

What Is SSDI?

SSDI is a federally funded insurance program administered by the Social Security Administration (42 U.S.C. § 401 et seq.). It provides a monthly cash benefit to workers who:

• Have earned sufficient quarters of coverage (work credits) as defined in 20 CFR 404.130 and 404.140.

• Are unable to engage in substantial gainful activity (SGA) for at least 12 continuous months or are expected to die from their impairment, per 20 CFR 404.1505(a).

Your Fundamental Rights Under Federal Law

• Right to Notice: SSA must provide written notice of any unfavorable determination, including an explanation of the evidence used (20 CFR 404.904).

• Right to Representation: You may appoint an attorney or qualified non-attorney representative at any stage (20 CFR 404.1700–1715).

• Right to a Four-Level Administrative Appeal: Reconsideration, Administrative Law Judge (ALJ) hearing, Appeals Council review, and federal court, as codified in 20 CFR 404.900(a).

• Right to Timely Payment: If you ultimately win, SSA must pay retroactive benefits back to the established onset date, subject to the five-month waiting period (20 CFR 404.621).

Common Reasons SSA Denies SSDI Claims

Insufficient Medical Evidence

The five-step sequential evaluation in **20 CFR 404.1520** requires objective clinical findings, laboratory results, and physician opinions. Marathon claimants often rely on Big Bend Regional Medical Center in Alpine or University Medical Center of El Paso; gaps in treatment records from these providers can lead to denials.

Failure to Follow Prescribed Treatment

Under **20 CFR 404.1530**, SSA may deny benefits if a claimant does not follow medical advice without good cause.

Earnings Above Substantial Gainful Activity (SGA)

Monthly earnings that exceed the SGA amount ($1,470 for non-blind individuals in 2023, per SSA annual update) automatically preclude benefits at step 1 of the evaluation.

Insufficient Work Credits

Workers under age 24 need six credits in the three years before disability; older workers need more, under **20 CFR 404.130(b) & (c)**.

Non-Severe Impairment Determination

If the impairment does not significantly limit basic work activities for 12 months (**20 CFR 404.1522**), SSA will issue a technical denial.

Understanding the specific citation SSA used in its denial letter is critical. Each denial paragraph references the regulation applied, so keep the letter in a safe place.

Federal Legal Protections & Regulations

The Statutory Framework

The Social Security Act (42 U.S.C. §§ 401–433) authorizes disability insurance and vests the Commissioner of Social Security with rule-making power. These rules appear in 20 CFR Part 404, Subparts J through P.

Key Regulations Every Marathon Claimant Should Know

• 20 CFR 404.909 – Sets a 60-day deadline (plus 5 mailing days) to file a Request for Reconsideration after receiving a denial.

• 20 CFR 404.933 – Governs filing for an ALJ hearing; the same 60-day rule applies after an unfavorable reconsideration.

• 20 CFR 404.970 – Describes when the Appeals Council will grant review, such as abuse of discretion by the ALJ or broad policy issues.

• 20 CFR 404.981 – Makes Appeals Council denial the final decision of SSA, which is then reviewable in federal court.

• 28 U.S.C. § 2401(b) – Federal claimants generally have six years to bring civil actions against the United States, but SSDI court actions must be filed within 60 days of Appeals Council denial under 42 U.S.C. § 405(g).

Why These Rules Matter

Missing a single deadline can forfeit months—or even years—of back benefits. However, SSA may extend deadlines upon a showing of “good cause,” defined in 20 CFR 404.911. Examples include hospitalization or lost mail. Always submit documentation supporting any delay.

Steps to Take After an SSDI Denial

1. Read the Notice Carefully

Locate the “Explanation of Determination” section. Identify whether the denial was technical (e.g., insufficient credits) or medical (e.g., ability to do past work). This dictates your evidence strategy for appeal.

2. Mark Your Calendar

You generally have 65 days (60 days + 5 mailing days) from the date on the denial letter to submit Form SSA-561 Request for Reconsideration. File by certified mail or in person at the Alpine office and keep proof of filing.

3. Collect Additional Evidence

• Request updated imaging and lab reports from Big Bend Regional Medical Center or your specialist in Odessa or Midland.

• Obtain a Medical Source Statement (residual functional capacity form) from your treating physician.

• Keep a daily symptom diary; subjective evidence can bolster credibility under SSR 16-3p.

4. Consider Representation

Statistics published by SSA show that represented claimants have higher approval rates at the ALJ level. Texas attorneys must be licensed by the Supreme Court of Texas and in good standing with the State Bar. They may charge a statutory fee capped at 25% of past-due benefits or $7,200, whichever is less, pursuant to 42 U.S.C. § 406(a)(2)(A).

5. Prepare for Each Appeal Level

• Reconsideration – A different examiner reviews your file. In Texas, this is a paper review; no in-person meeting is required.

• ALJ Hearing – Typically held by video from the Alpine office or in person at the El Paso OHO. You may present witnesses and cross-examine vocational experts.

• Appeals Council – Submit written argument pointing to ALJ errors, new and material evidence, or policy conflicts.

• Federal District Court – Western District of Texas (Midland-Odessa or El Paso Division) has venue over Brewster County claims.

When to Seek Legal Help for SSDI Appeals

You are allowed to represent yourself, but professional assistance can be vital when:

• Complex medical conditions (e.g., combined orthopedic and mental impairments) require coordination of multiple expert opinions.

• The ALJ plans to call a vocational expert—cross-examination skills are critical.

• You missed a deadline and need to establish good cause.

• Past relevant work is classified as “light” or “sedentary,” adding nuance to step 5 of the sequential evaluation.

A marathon disability attorney can also request subpoenas for hostile physicians, draft pre-hearing briefs, and ensure compliance with 20 CFR 404.1740 ethical rules.

Local Resources & Next Steps

Social Security Offices Serving Marathon

Alpine SSA Field Office 1104 N. 5th St., Alpine, TX 79830 Phone: 888-366-6149 Hours: Mon–Fri 9 a.m.–4 p.m. El Paso OHO Street Address: Room 460, Room 460, 700 E. San Antonio Ave., El Paso, TX 79901 This is where ALJ hearings are usually scheduled for Brewster County residents.

Medical & Vocational Evidence Sources

• Big Bend Regional Medical Center – Alpine, TX

• Permian Basin Community Centers – Tele-psychiatry services for mental health records

• Workforce Solutions Borderplex – May provide subsidized employment documentation relevant to SGA analysis

Free or Low-Cost Assistance

• Legal Aid of NorthWest Texas (branch covers Brewster County) – May accept disability appeals for low-income clients.

• Texas RioGrande Legal Aid – Offers veterans’ disability clinics that sometimes cover SSDI issues.

• SSA Ticket to Work Helpline – 866-968-7842; can clarify work incentive rules if you attempt a trial work period.

Practical Timeline

• Denial Received – Day 0

• File Reconsideration – By Day 65

• Reconsideration Decision – Average 3–6 months

• Request ALJ Hearing – Within 65 days of second denial

• ALJ Hearing Wait – 8–12 months (El Paso OHO average, per SSA public data)

• Appeals Council – 6–12 months

• Federal Court – 9–18 months

Authoritative References

SSA – Steps of the Disability Appeal Process Electronic Code of Federal Regulations – 20 CFR Part 404 SSA HALLEX – ALJ Hearing Procedures SSA Substantial Gainful Activity (SGA) Amounts

Legal Disclaimer

The information provided herein is for educational purposes only and does not constitute legal advice. Laws and regulations change frequently. Consult a licensed Texas attorney for guidance on 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.