SSDI Denial Appeals Guide for Spokane, Texas Claimants

Introduction: Why a Spokane, Texas–Focused SSDI Guide Matters

Spokane, Texas is a small unincorporated community in Archer County, roughly 30 miles southwest of Wichita Falls. Although the population is modest, residents face the same challenges that urban Texans do when a serious medical condition prevents substantial gainful activity. If you live in or around Spokane and your Social Security Disability Insurance (SSDI) application was denied, you are not alone. According to the Social Security Administration Annual Statistical Report on the Disability Insurance Program, fewer than 40 percent of initial SSDI claims are approved nationwide each year. For rural claimants, logistical barriers—distance to the nearest Social Security office, fewer specialty physicians, and limited broadband for online services—can compound the stress of an appeal.

This guide provides Spokane, Texas claimants with an evidence-based road map for overturning an SSDI denial. It draws only from authoritative federal sources such as the Social Security Act (42 U.S.C. §401 et seq.), the Code of Federal Regulations (20 C.F.R. Parts 404 and 416), official SSA publications, and published federal court decisions from the Fifth Circuit. While the guide slightly favors claimant protections, every statement is grounded in verifiable law or data.

Understanding Your SSDI Rights

The Insurance You Paid For

SSDI is funded by FICA payroll taxes. If you earned sufficient quarters of coverage—also called “work credits”—you are insured under Title II of the Social Security Act. That insurance entitles you to monthly benefits when a medically determinable impairment prevents you from engaging in substantial gainful activity (SGA) for at least 12 months or is expected to result in death, per 20 C.F.R. §404.1505.

Key Legal Rights for Spokane Claimants

• Notice and Explanation: SSA must send a written notice explaining why your claim was denied, outlining your appeal rights. See 20 C.F.R. §404.904.

Four-Level Administrative Review: Under 20 C.F.R. §404.900, you have a statutory right to pursue reconsideration, a hearing, Appeals Council review, and federal court review in that order.

• Representation: You may appoint an attorney or qualified non-attorney representative. Pursuant to 20 C.F.R. §§404.1705–404.1745, representative fees are subject to SSA approval, capping the usual contingent fee at 25 percent of past-due benefits (maximum $7,200 as of November 2022).

• Timely Appeal: You generally have 60 days from the date you receive a denial notice (plus a presumed 5-day mailing period) to file the next level of appeal. See Social Security Act §205(b), 42 U.S.C. §405(b).

Texas Attorney Licensing Rules

If you hire a lawyer, that attorney must be licensed by the State Bar of Texas under Texas Government Code §81.051. Always verify bar status at the State Bar of Texas website or by calling (800) 204-2222.

Common Reasons SSA Denies SSDI Claims

1. Insufficient Medical Evidence

The most frequent denial basis is a lack of objective medical findings that establish a severe impairment. SSA adjudicators rely on the Listing of Impairments (20 C.F.R. Part 404, Subpart P, Appendix 1) and the Medical-Vocational Guidelines. If your file lacks recent MRIs, laboratory tests, or specialist notes, the agency may decide your condition is not severe.

2. Ability to Perform Past Relevant Work

Under 20 C.F.R. §404.1520(f), SSA denies claims if it concludes you can still perform jobs you have held within the past 15 years. Vocational analysts use your Residual Functional Capacity (RFC) to make this determination.

3. Ability to Perform Other Work

If SSA believes you can perform other work in the national economy, your claim will be denied at Step 5 of the sequential evaluation. This often hinges on transferable skills and age categories set forth in 20 C.F.R. Part 404, Subpart P, Appendix 2.

4. Non-Medical Technical Denials

• Insufficient Work Credits

• Earnings Above SGA (>$1,550 per month for non-blind claimants in 2024)

• Failure to Cooperate (missed consultative exam, incomplete forms)

5. Adverse Credibility Findings

Adjudicators may discount subjective pain testimony if it is inconsistent with medical records. However, the Fifth Circuit requires the agency to provide “specific reasons” supported by substantial evidence (Falco v. Shalala, 27 F.3d 160, 163–64 (5th Cir. 1994)).

Federal Legal Protections & Regulations Every Spokane Claimant Should Know

Social Security Act §223

This section sets forth the definition of disability for Title II benefits: “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment…” (Social Security Act §223).

Due Process Under the Fifth Amendment

Because SSDI benefits are a property interest, you are constitutionally entitled to notice and a meaningful opportunity to be heard. This principle was affirmed in Mathews v. Eldridge, 424 U.S. 319 (1976).

20 C.F.R. §§404.1501 – 404.1599: Medical Evaluation Rules

• §404.1509: Duration requirement – impairment must last or be expected to last 12 months.

• §404.1512: Responsibility to submit evidence – SSA will develop evidence but you bear the primary burden.

• §404.1545: Residual Functional Capacity – assessment of what you can still do physically and mentally.

Federal Statute of Limitations for Court Review

You must file a civil action in U.S. District Court within 60 days after the Appeals Council denial. See Social Security Act §205(g), 42 U.S.C. §405(g).

Steps to Take After an SSDI Denial

Step 1: Read the Denial Notice Carefully

The notice lists the medical and non-medical rationales for denial and provides the deadline for requesting reconsideration. Note the date on the upper right-hand corner; deadlines are strict.

Step 2: File a Request for Reconsideration (Within 60 Days)

• Complete SSA-561 (Request for Reconsideration).

• Submit form SSA-3441 (Disability Report – Appeal) with updated medical information.

• Attach any new medical evidence, such as treatment notes from United Regional Health Care System in Wichita Falls or imaging done at Hendrick Medical Center in Abilene.

You can file online via SSA’s secure portal or mail forms to the Wichita Falls Social Security office (address below). Keep proof of mailing.

Step 3: Prepare for a Hearing Before an Administrative Law Judge (ALJ)

If reconsideration is denied—common in Texas—request a hearing using form HA-501. The hearing office serving Archer County is the Fort Worth Office of Hearings Operations (OHO), located at 819 Taylor Street, Room 7-C19, Fort Worth, TX 76102.

Best practices:

• Obtain a medical source statement from your treating physician describing functional limitations.

• Request your file (exhibit list) from SSA at least 10 days before the hearing.

• Prepare written pre-hearing brief citing Listings or vocational grid rules.

• Ensure your representative is ready to cross-examine the vocational expert (VE).

Step 4: Appeals Council Review

If the ALJ rules against you, file form HA-520 within 60 days. You can submit new evidence if it relates to the period before the ALJ decision and if there is a reasonable probability it would change the outcome (20 C.F.R. §404.970).

Step 5: Federal Court Litigation

The final step is a civil action in the U.S. District Court for the Northern District of Texas, Wichita Falls Division. The lawsuit names the Commissioner of Social Security as defendant and seeks remand or reversal under 42 U.S.C. §405(g). Court filing fee is currently $402 (subject to change), but you may file an application to proceed in forma pauperis if you cannot afford it.

When to Seek Legal Help for SSDI Appeals

Complex Cases

Hire counsel if your case involves:

• Multiple impairments requiring medical-expert testimony.

• Past relevant work with disputed transferable skills.

• Prior workers’ compensation or Veterans Affairs disability ratings.

• Adverse credibility findings needing Fifth Circuit case law rebuttal.

Costs and Fee Regulation

Attorney fees are contingency-based, typically 25 percent of past-due benefits, capped at $7,200 unless a fee petition is filed per 20 C.F.R. §404.1725. No fee is owed if benefits are not recovered.

Advantages of Representation

• Evidence gathering—subpoena hospital records from United Regional or local orthopedists in Wichita Falls.

• Legal briefing—argue Listings 1.17 (major joint dysfunction) or 12.04 (depressive disorders).

• Hearing advocacy—cross-examine VEs to eliminate jobs inconsistent with your RFC.

• Expedited communication—SSA offices often prioritize inquiries from accredited representatives.

Local Resources & Next Steps

Nearest Social Security Field Office for Spokane Residents

Wichita Falls Social Security Office

4309 Old Jacksboro Hwy

Wichita Falls, TX 76302

Phone: (866) 964-0996

Hours: Mon, Tue, Thu, Fri 9 a.m.–4 p.m.; Wed 9 a.m.–12 p.m.

Area Hearing Office

Fort Worth Office of Hearings Operations (OHO)

819 Taylor St., Room 7-C19

Fort Worth, TX 76102

Phone: (866) 406-1838

Medical Providers Familiar with Disability Documentation

• United Regional Health Care System, Wichita Falls – comprehensive imaging and neurology.

• Hendrick Medical Center, Abilene – orthopedic and cardiology specialties.

• Rural Health Clinics in Archer City for primary-care documentation.

Free or Low-Cost Legal Assistance

• Legal Aid of NorthWest Texas – Wichita Falls Branch (940) 723-5542

• Texas RioGrande Legal Aid (TRLA) – statewide intake (888) 988-9996

• State Bar of Texas Lawyer Referral Service – (800) 252-9690

Stay Informed

SSA regularly updates benefit amounts, SGA thresholds, and grid rules. Bookmark the official SSA appeal page: SSA Appeals Process.

Authoritative References Used in This Guide

SSA – How to Appeal a Decision 20 C.F.R. §404.900 – Administrative Review Process 20 C.F.R. §404.1505 – Basic Definition of Disability Social Security Act §223

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws and regulations change, and individual facts matter. Consult a licensed Texas attorney for advice specific to your case.

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