SSDI Lawyers Near You: Sioux Falls, Texas Denial Appeal Guide

Introduction: Why This Guide Matters to Sioux Falls, Texas Claimants

If you live in Sioux Falls, Texas and your application for Social Security Disability Insurance (SSDI) was denied, you are far from alone. In recent fiscal years, the Social Security Administration (SSA) rejected roughly two-thirds of initial SSDI applications nationwide. Fortunately, denials are not the final word. Federal law gives every claimant the right to challenge an adverse decision through a four-level administrative review process and, if necessary, federal court. This comprehensive guide explains each step, cites controlling federal regulations, and spotlights local resources so you can pursue the benefits you have earned.

Throughout this article we will slightly favor the interests of claimants—because experience shows that well-prepared applications and appeals supported by solid medical evidence are essential to leveling the playing field against the SSA. Every statement below is grounded in authoritative sources such as the Social Security Act, the Code of Federal Regulations (CFR), official SSA policy guidance, and published federal court opinions.

Understanding Your SSDI Rights

Statutory Foundation

SSDI is authorized under Title II of the Social Security Act, 42 U.S.C. §§ 401–433. If you have earned sufficient “covered” work credits and a severe impairment prevents you from substantial gainful activity (SGA) for at least 12 months, you may qualify for cash benefits and Medicare eligibility. Two federal regulations are central:

• 20 C.F.R. § 404.1505 – Defines disability for SSDI purposes.
• 20 C.F.R. § 404.900 – Establishes the four-step administrative review process for appealing denials.

Key Rights for Claimants

• Written Notice and Reasoning – SSA must send a written denial that explains the evidence considered and the specific reasons for the decision. 20 C.F.R. § 404.1503.
• Timely Appeal – You generally have 60 days plus 5 mailing days to request each level of appeal. Missing a deadline can bar review unless “good cause” is shown.
• Access to Your File – You may examine and copy the complete claims file, including medical and vocational assessments.
• Representation – You may appoint an attorney or qualified non-attorney representative. All fee agreements or petitions must be approved by SSA under 20 C.F.R. § 404.1720.
• Continued Benefits in Some Cases – If appealing a termination rather than an initial denial, you can request continuation of benefits under specific circumstances (20 C.F.R. § 404.1597a).

Common Reasons SSA Denies SSDI Claims

Understanding why claims are denied is critical for crafting a successful appeal. Frequent grounds include:

1. Insufficient Medical Evidence

The SSA must see objective evidence—lab results, imaging, treatment notes—showing a medically determinable impairment. A diagnosis alone is not enough.

2. Ability to Perform Past Work

At Step 4 of the sequential evaluation, adjudicators decide you can still perform your “past relevant work” as actually or generally performed.

3. Capacity for Other Work

At Step 5, vocational experts may testify that you can adjust to other jobs present in significant numbers, leading to denial.

4. Technical Issues

• Insufficient Work Credits – You generally need 20 credits in the 40 quarters before disability onset (age rules vary).
• Substantial Gainful Activity (SGA) – Earnings above the SGA threshold (e.g., $1,470/month in 2023 for non-blind claimants) can cause denial.

5. Non-Compliance With Treatment

Failure to follow prescribed treatment without good cause may support a finding of “not disabled” under 20 C.F.R. § 404.1530.

Federal Legal Protections & Regulations

Sequential Evaluation Process

SSA uses a five-step test codified at 20 C.F.R. §§ 404.1520 & 416.920. Each step is mandatory and sequential:

• Engagement in SGA?
• Severe impairment? Meets or equals a Listing in Listing of Impairments – Part 404, Subpart P, App. 1?- Past relevant work?
• Other work in the national economy?

Burden of Proof

The claimant bears the burden at Steps 1-4. The burden shifts to the Commissioner of Social Security at Step 5 to show other work exists.

Federal Court Review

Adverse Appeals Council decisions may be challenged in the U.S. District Court for the Northern District of Texas (42 U.S.C. § 405(g)). The court reviews whether substantial evidence supports the Commissioner’s findings and whether correct legal standards were applied. Published cases such as Audler v. Astrue, 501 F.3d 446 (5th Cir. 2007) illustrate how procedural errors can result in remand.

Steps to Take After an SSDI Denial

1. Request Reconsideration (Level 1)

You have 60 days to file Form SSA-561 and submit new medical evidence. In Texas, reconsiderations are processed by Disability Determination Services (DDS) in Austin.

2. Request an Administrative Law Judge (ALJ) Hearing (Level 2)

If denied again, file Form HA-501 within 60 days. Hearings are usually held by video from the SSA hearing office in Dallas or Fort Worth, but you can request an in-person hearing. The ALJ will take sworn testimony from you, vocational experts, and—if necessary—medical experts.

3. Appeals Council Review (Level 3)

The Appeals Council in Falls Church, Virginia, may grant, deny, or dismiss your request. You may submit written arguments and additional evidence that is new, material, and relates to the period on or before the ALJ’s decision (20 C.F.R. § 404.970).

4. Federal Court (Level 4)

File a civil action within 60 days of the Appeals Council denial. You must serve the complaint on the SSA’s Office of the General Counsel (Region VI, Dallas) and the U.S. Attorney for the Northern District of Texas.

Practical Documentation Tips

• Obtain treating-source statements that identify functional limitations (e.g., sitting, standing, lifting limits) rather than conclusory “disabled” opinions.
• Keep a symptom diary to corroborate testimony about pain or fatigue.
• Follow all prescribed treatments and document side effects.
• Secure vocational assessments if you are over age 50 and your past work was physically demanding.

When to Seek Legal Help for SSDI Appeals

While you may self-represent, statistics published by SSA show that represented claimants win at a significantly higher rate, especially at the ALJ hearing level. A sioux falls disability attorney licensed in Texas can:

• Analyze prior denials and build medical-vocational arguments aligned with SSR 96-8p and SSR 16-3p.
• Cross-examine vocational experts about job numbers and transferable skills.
• Ensure correct use of the Medical-Vocational Guidelines (20 C.F.R. Pt 404, Subpt P, App. 2).
• Negotiate on-the-record (OTR) decisions, potentially avoiding a hearing.

Texas attorneys must be licensed by the State Bar of Texas and in good standing. Under 42 U.S.C. § 406(b), fees are generally limited to 25% of past-due benefits and must be approved by SSA or the federal court.

Local Resources & Next Steps

Which SSA Office Serves Sioux Falls, Texas?

The SSA field-office locator shows that ZIP codes in northern Texas near the unincorporated Sioux Falls area are served by the Wichita Falls Social Security Office:

• Address: 4312 Call Field Road, Wichita Falls, TX 76308
• Office Hours: Monday–Friday, 9:00 a.m.–4:00 p.m.
• Toll-Free SSA Line: 1-800-772-1213

Before visiting, schedule an appointment by phone to reduce wait times.

Regional Medical Facilities

• United Regional Health Care System – Comprehensive hospital in Wichita Falls for imaging, lab work, and specialist referrals.
• North Texas State Hospital–Vernon Campus – For claimants with serious mental health conditions requiring inpatient or outpatient documentation.

Community Assistance

• Texas Health and Human Services Commission (HHSC) offices can help with Medicaid or SNAP while you await SSDI.
• Legal Aid of NorthWest Texas offers limited representation in disability matters for low-income residents (eligibility required).

Helpful SSA Publications

Your Right to Question the Decision Made on Your ClaimDisability Benefits – SSA Publication 05-10029Official SSA Appeals Portal

Conclusion

An initial denial does not define the outcome of your SSDI journey. By understanding federal rules, meeting every deadline, and assembling persuasive medical and vocational evidence, Sioux Falls, Texas residents can dramatically improve their odds of success. Whether you are gathering new treatment records for reconsideration or preparing to cross-examine a vocational expert at an ALJ hearing, knowledge—and, often, experienced legal counsel—remains your strongest asset.

Legal Disclaimer: This article is for informational purposes only and does not constitute legal advice. 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.