SSDI Denial Appeals Guide for Spokane, Texas

Introduction: Why This Guide Matters to Spokane, Texas Claimants

The Social Security Disability Insurance (SSDI) program is a federal lifeline for disabled workers who have paid into the Social Security system. Yet the Social Security Administration (SSA) denies the majority of initial SSDI applications nationwide. If you live in Spokane, Texas—a small unincorporated community in Oldham County—denial can be especially stressful. The nearest Social Security field office is more than an hour away in Amarillo, and access to specialized medical providers may require traveling even farther. This guide explains your rights, outlines the federal SSDI appeals process, and lists local resources so you can fight a denial with confidence.

All information below is based on authoritative legal sources, including the Social Security Act, the Code of Federal Regulations (CFR), and published SSA materials. Where statistics or procedures are mentioned, we cite the official source.

Understanding Your SSDI Rights

What SSDI Provides

SSDI pays monthly cash benefits to qualified workers who can no longer engage in substantial gainful activity (SGA) because of a medically determinable impairment expected to last at least 12 months or result in death (42 U.S.C. § 423(d)). Benefits also extend to certain family members.

Your Right to Appeal

Federal law guarantees four levels of administrative review if the SSA denies your claim (20 C.F.R. § 404.900):

• Reconsideration

• Administrative Law Judge (ALJ) hearing

• Appeals Council review

• Federal district court action

You have 60 days from the date you receive a written denial (plus an assumed five mailing days) to request the next appeal step (20 C.F.R. § 404.909(a)(1)). Missing this deadline usually means starting over with a new application.

Key Procedural Protections

• Evidence Rules: The SSA must consider all relevant medical and vocational evidence (20 C.F.R. § 404.1512).

• Burden of Proof: You must show inability to perform past relevant work; at step five of the sequential evaluation, the burden shifts to the SSA to show other work exists in significant numbers (20 C.F.R. § 404.1520).

• Representation: You have the right to appoint a representative (attorney or qualified non-attorney) at any stage (42 U.S.C. § 406).

Common Reasons SSA Denies SSDI Claims

1. Lack of Sufficient Medical Evidence

SSA decisions hinge on objective evidence—lab results, imaging, specialist reports, and treatment notes. In rural areas near Spokane, Texas, claimants may see family practitioners who keep shorter notes or lack advanced diagnostic tools.

2. Substantial Gainful Activity (SGA) Earnings

If you earn more than the monthly SGA limit ($1,470 for non-blind individuals in 2023, according to SSA), you are presumed not disabled.

3. Failure to Follow Prescribed Treatment

Under 20 C.F.R. § 404.1530, the SSA may deny benefits if you do not follow treatment that could restore your ability to work—unless you have a “good reason,” such as cost or contraindications.

4. Duration Requirement

The impairment must last—or be expected to last—at least 12 months. Acute injuries that improve quickly often trigger denials.

5. Vocational Determination

At steps four and five of the sequential evaluation, vocational experts (VEs) may testify that a claimant can still perform past work or other jobs. In many rural Texas cases, the VE is unfamiliar with local labor markets, and claimants fail to rebut the testimony.

Federal Legal Protections & Regulations

The Social Security Act

Title II of the Social Security Act (42 U.S.C. §§ 401–434) establishes SSDI. Section 205(b) guarantees due-process hearings before benefits are denied or terminated.

The Code of Federal Regulations (CFR)

Key SSDI appeal regulations include:

• 20 C.F.R. § 404.900 – Four levels of administrative review.

• 20 C.F.R. §§ 404.1510–404.1523 – The sequential evaluation process.

• 20 C.F.R. § 404.982 – Judicial review in federal court.

Applicable Federal Court Precedents

The U.S. Court of Appeals for the Fifth Circuit (which covers Texas) has issued several claimant-friendly decisions, such as Aspinwall v. SSA, 430 F. App’x 322 (5th Cir. 2011) (remanding when ALJ failed to explain weight given to treating physician). While each case is unique, these precedents reinforce your right to a logical explanation of evidence.

Steps to Take After an SSDI Denial

1. Read the Notice of Determination Carefully

The denial letter explains the medical and vocational basis of the decision. Mark the 60-day appeal deadline.

2. File a Timely Request for Reconsideration

Use SSA Form 561 or file online through SSA’s Appeal Portal. In Texas, you can also deliver paperwork to any field office before close of business on the 60th day.

3. Strengthen Medical Evidence

• Schedule follow-ups with specialists in Amarillo or Lubbock.

• Request RFC (Residual Functional Capacity) assessments from treating doctors.

• Gather imaging studies or lab work that document progression.

4. Prepare for the ALJ Hearing

If Reconsideration is denied (common in Texas), request an ALJ hearing online or via Form 501. Hearings for Oldham County residents are typically assigned to the Amarillo Hearing Office. You have the right to appear by video or in person.

5. Appeal to the Appeals Council

If the ALJ rules against you, you may request Appeals Council review within 60 days. The Council can remand, reverse, or deny review.

6. File a Federal Court Action

The final step is a civil complaint in the U.S. District Court for the Northern District of Texas, Amarillo Division. You must file within 60 days of the Appeals Council decision (20 C.F.R. § 404.981).

When to Seek Legal Help for SSDI Appeals

Attorney Fee Rules

Under 42 U.S.C. § 406(a), fees are contingency-based and capped at 25% of retroactive benefits, not to exceed $7,200 unless approved by the court. Attorneys must be licensed and in good standing with the State Bar of Texas.

Advantages of Representation

• Collecting missing medical records.

• Cross-examining vocational and medical experts.

• Drafting legal briefs that cite binding Fifth Circuit case law.

• Handling federal court filings if necessary.

When DIY May Suffice

If your denial is based solely on missing paperwork that you can quickly supply, you may not need counsel for Reconsideration. However, most claimants benefit from professional help, especially at the ALJ hearing stage.

Local Resources & Next Steps

Nearest SSA Field Office

Amarillo Social Security Office

4750 Canyon Drive

Amarillo, TX 79109

Hours: Mon–Fri 9 a.m.–4 p.m. (verify current hours on SSA website)

Area Hospitals & Specialists

• BSA Hospital, Amarillo – Full-service facility with neurology and cardiology departments.

• Northwest Texas Hospital, Amarillo – Level III trauma center with orthopedic and mental health services.

Legal Aid & Advocacy

Legal Aid of Northwest Texas – May provide free assistance for low-income claimants.

• Texas Rural Legal Aid – Check eligibility for disability appeals support.

Staying Organized

• Create a binder with all SSA notices, medical records, and correspondence.

• Keep a symptom diary to present at hearings.

• Use certified mail when submitting paper forms.

Conclusion

A denial is not the end of your SSDI journey. By knowing the federal timelines, gathering stronger evidence, and leveraging local and legal resources, Spokane, Texas residents can turn a denial into an approval. Act quickly, document everything, and consider professional representation when the stakes are high.

Legal Disclaimer: This guide is for informational purposes only and does not constitute legal advice. Consult a licensed Texas 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.

Additional Resources:

SSA: How to Appeal a Decision

20 C.F.R. § 404.900 – Administrative Review Process

SSA Office Locator

Texas Courts: Handbook for Pro Se Litigants