SSDI Lawyers Near Me: Lexington, Texas Denial Appeal Guide

Introduction: Why This SSDI Denial Appeal Guide Matters to Lexington, Texas Residents

Nestled in Lee County, Lexington, Texas may be best known for Friday-night football and Saturday-morning brisket, but its hardworking residents are not immune to life-altering injuries and chronic illnesses. When a serious medical condition prevents you from working, Social Security Disability Insurance (SSDI) benefits can keep the lights on and the mortgage current. Yet, according to the Social Security Administration’s (SSA) own Annual Statistical Report on the Social Security Disability Insurance Program, roughly two-thirds of initial SSDI applications nationwide are denied. Lexington claimants face the same uphill battle, which is why understanding the appeals process, local resources, and your federal rights is essential. This comprehensive guide—written with a slight preference for protecting claimants—explains every stage of a Social Security disability denial appeal, cites controlling federal regulations, and points you toward qualified Lexington disability attorneys when you need extra firepower.

Understanding Your SSDI Rights

1. What SSDI Is—and Is Not

SSDI is a federal insurance program funded by payroll taxes under Title II of the Social Security Act. If you have earned enough work credits and meet the SSA’s strict definition of disability, you are entitled to monthly cash benefits and Medicare eligibility after a 24-month waiting period. SSDI differs from Supplemental Security Income (SSI), which is a need-based program for low-income individuals.

2. The Statutory Definition of Disability

Under 42 U.S.C. §423(d) and 20 C.F.R. §404.1505, you must prove that you have a medically determinable impairment expected to last at least 12 months (or result in death) and that you cannot engage in substantial gainful activity (SGA). For 2024, SGA is generally $1,550 per month for non-blind claimants.

3. Procedural Due Process

Section 205(b) of the Social Security Act guarantees every claimant written notice of an adverse decision and an opportunity for a hearing before an impartial decision-maker. These rights are mirrored in 20 C.F.R. §404.900, which outlines the four-step administrative review process discussed later in this guide.

4. The Right to Representation

You may appoint an attorney or non-attorney representative at any point in your claim. Representative fees are capped by 42 U.S.C. §406(a)(2)(A)—currently 25% of past-due benefits or $7,200, whichever is less, unless a federal judge approves a larger amount.

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied helps you fix the problem before or during an appeal. Below are the most frequent denial rationales cited by Disability Determination Services (DDS) examiners serving Lexington claimants:

• Insufficient medical evidence. MRI scans, bloodwork, or specialist notes may be missing, outdated, or contradictory.

• Ability to perform past relevant work. 20 C.F.R. §404.1520(e) permits denial if the SSA believes you can still perform any job you worked in the last 15 years.

• Failure to meet or equal a Listing. The “Blue Book” Listings of Impairments establish per-se disability criteria. If your medical file does not fit neatly into a Listing, DDS may conclude you are not disabled.

• Earnings above SGA. If payroll records show you earned more than SGA after your alleged onset date, expect a technical denial.

• Non-compliance with treatment. Missing appointments or refusing prescribed therapy can lead to an adverse inference under 20 C.F.R. §404.1530.

• Failure to cooperate. Ignoring requests for additional evidence or consultative examinations stops your claim in its tracks.

Lexington claimants should also know that Texas DDS examiners rely heavily on electronic medical records from regional providers such as Baylor Scott & White Medical Center – Taylor and St. Joseph Health Regional Hospital in Bryan. If your specialists are outside that network, proactively submit complete records to avoid gaps.

Federal Legal Protections & Key Regulations

1. Four Levels of Administrative Review

The SSA’s mandatory review sequence is codified at 20 C.F.R. §404.900. You must proceed in order:

• Reconsideration (20 C.F.R. §404.907): A different DDS examiner reviews your file. Deadline: 60 days from the date you receive the denial notice (five extra days are presumed for mailing).

• Administrative Law Judge (ALJ) Hearing (20 C.F.R. §404.929): You, your representative, and vocational or medical experts testify under oath. Deadline: 60 days after a reconsideration denial.

• Appeals Council Review (20 C.F.R. §404.967): The Council in Falls Church, Virginia may affirm, reverse, remand, or dismiss your case. Deadline: 60 days after the ALJ decision.

• Federal District Court (42 U.S.C. §405(g)): You may sue the Commissioner of Social Security in the U.S. District Court for the Western District of Texas (Austin Division covers Lexington). Deadline: 60 days after Appeals Council denial.

2. Evidence Rules at Each Stage

• Reconsideration: You may submit new medical records, residual functional capacity (RFC) forms, or witness statements.

• ALJ Hearing: 20 C.F.R. §404.935 requires that you submit new evidence 5 business days before the hearing, unless you show good cause.

• Appeals Council: Only evidence that is new, material, and relates to the period on or before the ALJ decision will be considered (20 C.F.R. §404.970).

3. The Treating Physician Rule (post-2017)

For claims filed after March 27, 2017, ALJs no longer give “controlling weight” to treating doctors but must analyze supportability and consistency under 20 C.F.R. §404.1520c. Well-documented Lexington-area treatment notes still carry significant persuasive value.

4. Attorney Regulations in Texas

Texas attorneys must be licensed by the State Bar of Texas and abide by the Texas Disciplinary Rules of Professional Conduct. While board certification in “Social Security Disability Law” is not yet offered in Texas, many disability lawyers seek national accreditation through the National Board of Trial Advocacy. Always verify a lawyer’s status at TexasBar.com.

Steps to Take After an SSDI Denial

Step 1: Read the Denial Letter Carefully

The SSA’s written notice lists the evidence considered, the medical and vocational rationale, and the deadline for appeal. Mark that 60-day clock immediately.

Step 2: File Form SSA-561 Request for Reconsideration

You can submit the form online at SSA Appeal Portal or mail it to the SSA. Include a detailed statement explaining why the decision is wrong and attach any missing records.

Step 3: Strengthen Your Medical File

Schedule follow-ups with local providers—such as Lee County Family Medicine in Giddings or Ascension Seton in Bastrop—to obtain updated imaging, lab results, or specialist referrals. Ask each provider to complete an RFC questionnaire describing specific limitations on lifting, sitting, and concentration.

Step 4: Track and Submit Non-Medical Evidence

Collect third-party statements from former supervisors at Lexington ISD, attendance records showing frequent absences, or caregiver diaries documenting flare-ups. Non-medical evidence is authorized under 20 C.F.R. §404.1513(a)(4).

Step 5: Prepare for the ALJ Hearing

If reconsideration fails (and nationally only about 13% succeed), request a hearing via Form HA-501. The Austin Hearing Office currently handles most Lexington cases; average wait times hover around 9–11 months. Use that time wisely:

• Mock testimony: Practice answering functional questions without exaggeration.

• Vocational analysis: Identify how limitations erode the occupational base at each exertional level.

• Expert opinions: Secure a narrative report from your treating orthopedic surgeon or psychiatrist.

Step 6: Appeals Council and Federal Court

Should the ALJ rule against you, the Appeals Council will review written arguments. If that fails, file a civil action at the Austin Division of the Western District of Texas. The filing fee is $402, but a motion to proceed in forma pauperis can waive it if you meet income limits.

When to Seek Legal Help for SSDI Appeals

1. Complex Medical Profiles

Multiple impairments—such as degenerative disc disease plus severe depression—require skillful presentation of combined effects under SSR 19-2p (obesity) and similar rulings. A Lexington disability attorney can coordinate coherent RFC evidence.

2. Prior Denials or Closed Periods

If you have been denied before or awarded a short “closed-period” decision, legal counsel can reopen prior applications under 20 C.F.R. §404.988.

3. Adverse Vocational Expert (VE) Testimony

At an ALJ hearing, the VE may cite jobs such as addresser or document preparer that, in reality, no longer exist in significant numbers. A knowledgeable lawyer will cross-examine the VE using the Occupational Outlook Handbook or recent federal court precedents.

4. Contingency-Based Fees

Because attorney fees are contingency-based and capped by statute, you owe nothing unless you win. This levels the playing field for Lexington claimants with limited income.

Local Resources & Next Steps

1. Nearest Social Security Field Offices

• Temple Office: 511 N 3rd St, Temple, TX 76501. Phone: 866-593-0933. Approximately 48 miles from Lexington via US-77 and TX-36.

• Bryan Office: 2020 E William J. Bryan Pkwy, Bryan, TX 77803. Phone: 866-568-9428. Roughly 55 miles southeast via TX-21.

2. Medical Providers Familiar with SSDI Forms

• Baylor Scott & White Clinic – Taylor

• St. Joseph Health Regional Hospital – Bryan

• Ascension Seton – Bastrop

3. Vocational Rehabilitation

The Texas Workforce Solutions – Vocational Rehabilitation Services office in Bastrop (located at 53 TX-150 Loop) can supply functional assessments useful in disability claims.

4. Community Legal Aid

Lone Star Legal Aid’s Bryan office (2001 E. 29th Street, Suite 175) offers limited SSDI assistance to low-income residents in Lee County.

5. Tracking Your Case Online

Create a my Social Security account at ssa.gov/myaccount to download denial notices, upload evidence, and monitor appeal status.

Authoritative References

SSA – How to Appeal a Decision 20 C.F.R. §404.900 – Administrative Review Process SSA Blue Book Listings of Impairments Social Security Act §205(b) – Hearings and Review

Legal Disclaimer

This guide provides general information for Lexington, Texas residents. It does not constitute legal advice. Consult a licensed Texas attorney for advice about your specific SSDI claim.

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