SSI & SSDI Guide: Texas, Texas Denials & Appeals

SSI & SSDI in Texas, Texas: A Practical Guide to Denials and Appeals

If you live in Texas, Texas and your Social Security Disability Insurance (SSDI) claim was denied, you are not alone—and you likely still have options. Many initial SSDI applications are denied because the Social Security Administration (SSA) needs more specific medical evidence, finds that an applicant is working above the substantial gainful activity (SGA) level, or decides that the medical impairment is not severe enough under the federal standards. The good news is that federal law provides a multi-step appeals process with firm timelines and clear rights for you, the claimant.

This guide explains how SSDI and Supplemental Security Income (SSI) decisions are made, the most common reasons for denials, and how to appeal—step by step—under federal rules. Although this article slightly favors claimants by emphasizing practical strategies to build a strong record, every statement is grounded in authoritative sources such as the Social Security Act and the Code of Federal Regulations (CFR). Where appropriate, we also note how the process works on the ground in Texas, including tips for finding your local SSA office and preparing for hearings typically scheduled at SSA hearing offices within the state.

Important context for Texas residents: SSA disability claims are filed and processed under the same federal rules nationwide, but your case is medically developed by Texas Disability Determination Services (DDS) at the initial and reconsideration levels, and administrative law judge (ALJ) hearings are scheduled by Texas hearing offices of the SSA’s Office of Hearings Operations. Your treating providers in Texas—primary care, specialists, hospitals, and clinics—are essential sources of longitudinal medical records that can demonstrate how your impairments limit your functioning over time. Ensuring that those records are complete and promptly submitted can make a real difference in the outcome of your appeal.

Throughout this guide, we cite controlling federal regulations and statutes that apply to SSDI appeals, including the 60-day appeal deadlines at each step and your right to seek review in federal court. We also provide direct links to the official SSA appeals page, the eCFR for Title II (SSDI) regulations, the Social Security Act’s judicial review provision, and the SSA field office locator so you can get reliable, up-to-date information straight from the source.

Who this guide is for

• Texans whose SSDI claim was denied at the initial or reconsideration level.
• Claimants preparing for an ALJ hearing or Appeals Council review in Texas.
• Applicants with both SSDI and SSI claims who want to understand overlapping appeal rules (SSI is Title XVI; SSDI is Title II).
• Family members or caregivers helping a Texas claimant navigate the process.

For searchers looking for the phrase “SSDI denial appeal texas texas,” this page provides a comprehensive, fact-based overview designed to help you safeguard your rights and meet your deadlines.

Understanding Your SSDI Rights

SSDI is a federal insurance program for workers who have paid FICA taxes and become disabled under the Social Security Act’s strict definition of disability. SSI is a separate, needs-based program for people with limited income and resources. Although both programs use the same medical standard for disability, the technical rules differ: SSDI requires you to be “insured” by sufficient work credits and to prove disability before your date last insured (DLI), while SSI uses financial eligibility rules that are separate from insured status.

What “disability” means under federal law

Under the Social Security Act, disability means the inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment expected to last at least 12 months or result in death. See Social Security Act § 223(d)(1)(A), 42 U.S.C. § 423(d)(1)(A). SSA evaluates disability through a five-step sequential process for SSDI claims. The five-step evaluation is codified for Title II in 20 C.F.R. § 404.1520. Key points include:

• Step 1: Are you working at the substantial gainful activity (SGA) level? If yes, you are generally not disabled.
• Step 2: Do you have a severe medically determinable impairment (or combination of impairments)?
• Step 3: Does your impairment meet or medically equal a listed impairment?
• Step 4: Can you perform your past relevant work based on your residual functional capacity (RFC)?
• Step 5: Can you adjust to other work that exists in significant numbers in the national economy, considering your RFC, age, education, and work experience?

Your right to submit evidence is broad. SSA’s evidence rules for SSDI are at 20 C.F.R. § 404.1512 (what evidence is needed) and related sections. SSA may schedule a consultative examination (CE) if the existing medical records are insufficient. See 20 C.F.R. § 404.1519a et seq.

SSDI vs. SSI: different technical rules, similar medical standard

While the medical standard for disability is essentially aligned across SSDI (Title II) and SSI (Title XVI), the technical criteria differ:

• SSDI (Title II): You must have sufficient work credits and be insured through your date last insured. See 20 C.F.R. §§ 404.130–404.133.
• SSI (Title XVI): Eligibility is based on limited income and resources; separate procedural rules apply in Part 416. The appeals framework mirrors Title II (initial, reconsideration, ALJ, Appeals Council, federal court).

Because many Texas claimants file for both SSDI and SSI, a single unfavorable determination may affect both claims. The appeal steps and deadlines are similar, but SSDI technical denials (for example, insufficient insured status) require different evidence than SSI denials (for example, income/resources in excess of SSI limits).

Common Reasons SSA Denies SSDI Claims

Understanding why SSA denies claims helps you respond effectively on appeal. Here are frequent denial categories that affect Texas claimants:

1) Substantial Gainful Activity (SGA)

If you are working and your average earnings are above the SGA threshold, SSA generally finds you not disabled at Step 1. The SGA concept and related rules are at 20 C.F.R. §§ 404.1571–404.1576. SGA amounts are adjusted periodically by SSA; always consult SSA’s current table for the exact dollar amounts for the year you applied or were allegedly disabled.

2) No severe impairment or duration less than 12 months

SSA can deny at Step 2 if the medical evidence does not show a “severe” impairment that significantly limits basic work activities or if the impairment is not expected to last 12 months. See 20 C.F.R. § 404.1520(a)(4)(ii) and (c).

3) Does not meet or equal a Listing

At Step 3, SSA checks whether your impairment meets or equals the criteria of a listed impairment. Failing to meet a Listing is not the end of the claim—SSA must still assess RFC and move to Steps 4 and 5—but many denials occur because the evidence does not satisfy the precise medical findings in the Listings.

4) RFC supports past work or other work

SSA often denies at Step 4 or 5 based on the residual functional capacity (RFC) assessment, concluding you can perform your past relevant work or adjust to other work. RFC determinations draw from objective medical findings, medical opinions, and your symptom statements. See 20 C.F.R. §§ 404.1545, 404.1529, and related provisions.

5) Insured status or Date Last Insured (DLI)

For SSDI, you must prove disability on or before your DLI. If SSA finds your DLI has expired and there is insufficient evidence proving disability before that date, a technical denial results. See 20 C.F.R. §§ 404.130–404.131.

6) Insufficient medical evidence or treatment gaps

SSA may deny if the file lacks longitudinal treatment records, diagnostic testing, or functional assessments showing work-related limitations. Missed consultative examinations (CEs) can also lead to denials if SSA cannot make a determination without the exam. See 20 C.F.R. § 404.1518 (failure to cooperate) and § 404.1519a (when CEs are purchased).

7) Noncompliance with prescribed treatment (limited circumstances)

In certain situations, failure to follow prescribed treatment that would restore the ability to work can result in an unfavorable decision. See 20 C.F.R. § 404.1530. SSA must consider acceptable reasons for noncompliance.

8) Adverse credibility or inconsistency findings

SSA evaluates the consistency of your statements with the medical and other evidence. Subjective symptoms alone cannot establish disability. See 20 C.F.R. § 404.1529. Providing accurate, detailed function reports and statements from treating sources helps mitigate this risk.

Federal Legal Protections & Regulations

SSDI appeals are governed by federal regulations and the Social Security Act. The process is uniform across all states, including Texas, Texas.

Core regulations to know

• Appeals framework: 20 C.F.R. § 404.900 outlines the administrative review process: initial determination, reconsideration, hearing before an ALJ, Appeals Council review, and federal court.
• Reconsideration deadline: 20 C.F.R. § 404.909 generally provides 60 days from receipt of the notice to request reconsideration.
• ALJ hearing request: 20 C.F.R. § 404.933 provides 60 days from receipt to request a hearing after an unfavorable reconsideration.
• Appeals Council review: 20 C.F.R. §§ 404.967–404.968 cover the right to request review and the 60-day deadline.
• Federal court review: Under Social Security Act § 205(g), 42 U.S.C. § 405(g), you may file a civil action in federal district court within 60 days after receiving the Appeals Council’s final decision.
• Mailing presumption: SSA presumes you receive notices 5 days after the date on the notice, unless you show otherwise. See 20 C.F.R. § 404.901.
• Good cause for late filing: 20 C.F.R. § 404.911 addresses good cause factors SSA considers if your appeal is late.
• Evidence: 20 C.F.R. § 404.1512 describes your duty to submit evidence, including all known medical evidence and related materials.
• Five-step evaluation: 20 C.F.R. § 404.1520 codifies the sequential evaluation for disability.

Statutes of limitations for SSDI appeals

• Reconsideration: 60 days from the date you receive the initial denial notice to request reconsideration (20 C.F.R. § 404.909). SSA presumes you received it 5 days after the notice date (20 C.F.R. § 404.901).
• ALJ Hearing: 60 days from the date you receive the reconsideration denial to request a hearing (20 C.F.R. § 404.933).
• Appeals Council: 60 days from receipt of the ALJ decision to request review (20 C.F.R. § 404.968).
• Federal District Court: 60 days from receipt of the Appeals Council decision to file a civil action (42 U.S.C. § 405(g)).

If you miss a deadline, you can ask SSA to accept a late appeal for “good cause” under 20 C.F.R. § 404.911. Always assume the 60-day clock is running and submit as early as possible to avoid timeliness disputes.

Where to find official rules and appeal options

SSA: How to Appeal a Disability DecisioneCFR: 20 C.F.R. Part 404 (Title II—SSDI)Social Security Act § 205 (42 U.S.C. § 405)SSA Office Locator (Find Your Local Texas Office)State Bar of Texas Lawyer Referral & Information Service

Steps to Take After an SSDI Denial

Appealing promptly and methodically gives you the best chance of success. The steps below align with the federal regulations cited above and apply to Texas residents.

Step 1: Read the denial notice carefully

Identify whether your denial is for technical reasons (for example, insufficient insured status) or medical reasons (for example, SSA found that you can still perform other work). The notice should specify what evidence was considered and the basis for the decision. Mark your 60-day appeal deadline on your calendar, remembering the five-day mailing presumption unless you can show earlier or later receipt.

Step 2: Request reconsideration (most initial denials)

Most initial SSDI denials in Texas proceed to “reconsideration.” Submit your appeal online through SSA’s official portal or by filing Form SSA-561 (Request for Reconsideration). You should also complete the Disability Report—Appeal (SSA-3441) and update medical releases (SSA-827). Cite any new diagnoses, treatment records, imaging, lab results, or provider opinions since the initial decision and identify all additional sources of treatment.

Tip for Texas claimants: If you have treatment at multiple facilities across Texas (for example, hospitalizations in Houston and specialist care in Dallas), list them all with accurate addresses and dates so Texas DDS can request complete records. Provide your own copies of recent records if you can obtain them faster, but do not withhold any known evidence.

Step 3: Prepare for a consultative examination (if scheduled)

If Texas DDS schedules a consultative examination (CE), attend as scheduled and give accurate, consistent histories. A missed CE without good cause can lead to an unfavorable determination when SSA cannot evaluate your claim without the exam. See 20 C.F.R. § 404.1518. After the CE, request copies of the report and verify that it accurately reflects your symptoms and limitations.

Step 4: Request a hearing before an ALJ if reconsideration is denied

If the reconsideration decision is unfavorable, request an ALJ hearing within 60 days (20 C.F.R. § 404.933). File the Request for Hearing (HA-501) online when possible to document timeliness. The hearing may be in person, by video, or by telephone, depending on SSA scheduling and your preferences. At this stage, many Texas claimants benefit from representation because ALJ hearings involve testimony, vocational expert evidence, and detailed RFC analysis.

Preparation checklist for ALJ hearings:

• Update the record: Submit all medical evidence at least 5 business days before the hearing in line with SSA’s evidence submission rule (see 20 C.F.R. § 404.935).
• Medical opinions: Obtain treating source statements addressing specific work-related limitations (sitting/standing tolerance, lifting, off-task time, absence frequency, need for unscheduled breaks, postural and manipulative limits, mental pace/persistence).
• Function evidence: Provide third-party statements (family, coworkers) describing your day-to-day limitations.
• Vocational prep: Be ready to explain why you cannot perform past work and how your limitations erode the occupational base at different exertional levels.

Step 5: Appeals Council review

If the ALJ denies your claim, you may request Appeals Council review within 60 days (20 C.F.R. § 404.968). The Appeals Council looks for legal error, abuse of discretion, unsupported findings, or new and material evidence relating to the period on or before the ALJ decision. Use Form HA-520 (Request for Review of Hearing Decision/Order). If you submit new evidence, explain why it was not earlier available and how it is material.

Step 6: Federal court

If the Appeals Council denies review or issues an unfavorable decision, you may file a civil action in the U.S. District Court with jurisdiction over your Texas residence within 60 days of receiving the Appeals Council’s notice. See Social Security Act § 205(g), 42 U.S.C. § 405(g). Federal court review focuses on whether SSA’s decision is supported by substantial evidence and whether the correct legal standards were applied.

Keep deadlines and evidence synchronized

At each step—reconsideration, ALJ hearing, Appeals Council, and federal court—deadlines are strict. If something beyond your control causes delay (for example, hospitalization, natural disaster, or inability to obtain records timely), request “good cause” for late filing under 20 C.F.R. § 404.911 and provide documentation.

How to Strengthen Your SSDI Appeal Record

The SSA’s decision must be supported by substantial evidence. You can improve your record by being proactive, specific, and consistent.

• Document longitudinal treatment: Regularly follow up with treating providers in Texas and keep copies of progress notes, imaging, and labs. SSA weighs longitudinal evidence heavily.
• Clarify functional limits: Ask providers to translate clinical findings into work-related limitations (for example, maximum standing/walking in an 8-hour day; likely absences per month).
• List all providers and facilities: Include primary care, specialists, hospitals, emergency visits, therapy, pain management, and mental health providers across Texas.
• Explain symptom variability: Describe good and bad days, flare-ups, and how often you need to rest or lie down.
• Address activities of daily living: Provide accurate function reports that align with your medical records.
• Prepare for vocational testimony: Understand how transferable skills and RFC limits affect hypothetical jobs at the hearing.

When to Seek Legal Help for SSDI Appeals

While many claimants successfully file appeals on their own, representation can be helpful—especially at the ALJ hearing stage—because the issues often involve technical RFC analysis, vocational testimony, and detailed medical opinion evidence. Under federal law, both attorneys and qualified non-attorney representatives may represent you before SSA. See 20 C.F.R. § 404.1705 (who may be a representative). SSA must approve fees, and most representatives work on a contingency basis with fees authorized under the Social Security Act and regulations (see 42 U.S.C. § 406(a) and 20 C.F.R. § 404.1720).

Texas-specific licensing note: If you choose an attorney, ensure the lawyer is licensed and in good standing with the State Bar of Texas to provide legal advice under Texas law. For federal court litigation of an SSDI case in Texas, the attorney must also be admitted to the bar of the appropriate U.S. District Court.

Practical indicators you may benefit from a representative:

• Complex medical profiles (multiple impairments, rare conditions, or significant mental health components).
• Adverse vocational findings at prior levels (for example, SSA found you can perform other work despite serious limitations).
• Past work that is difficult to classify or explain (composite jobs, self-employment, heavy physical jobs with variable demands).
• Questions about how to meet deadlines, submit evidence, examine witnesses, or develop medical opinions.

Local Resources & Next Steps for Texas, Texas Claimants

Find your local SSA office in Texas

Use the official SSA Office Locator to identify your nearest field office for in-person or phone assistance. You can request reconsideration, hearing, or Appeals Council forms, report address changes, or check claim status. Bring a government-issued ID if you visit in person and call ahead to confirm hours and appointment policies.

SSA Office Locator (Texas)### Appeal and forms quick-reference

• Reconsideration: File within 60 days (20 C.F.R. § 404.909). Use SSA-561 and SSA-3441; update SSA-827 releases.
• ALJ Hearing: File within 60 days (20 C.F.R. § 404.933). Use HA-501.
• Appeals Council: File within 60 days (20 C.F.R. § 404.968). Use HA-520.
• Federal Court: File within 60 days under Social Security Act § 205(g), 42 U.S.C. § 405(g).

Texas-focused preparation tips

• Consolidate medical records from multiple Texas providers. If you have care in different cities (for example, Houston and San Antonio), submit all records to avoid gaps.
• If you live far from a hearing site, ask SSA about video or telephone hearing options, which may reduce travel burden.
• For language accommodation or disability access at Texas hearing sites, alert SSA as soon as you receive the Notice of Hearing so arrangements can be made.

Legal assistance in Texas

If you need a texas disability attorney or a referral, the State Bar of Texas operates a Lawyer Referral and Information Service. Always confirm any attorney’s State Bar standing and relevant experience with SSDI appeals.

State Bar of Texas Lawyer Referral & Information Service## Frequently Asked Questions for Texas SSDI Appeals

Is the appeals process different in Texas?

No. SSDI appeals follow uniform federal rules nationwide. Your case will be processed by Texas DDS at the initial and reconsideration levels, and any hearing will be scheduled by an SSA hearing office serving your area.

How long do SSDI appeals take in Texas?

Timeframes vary based on SSA workload and case complexity. Because processing times change, rely on your SSA notices and the SSA website for current estimates. Respond to requests quickly to avoid delays.

Can I submit new evidence after my initial denial?

Yes. You are encouraged to submit new, material evidence at reconsideration, at least 5 business days before your hearing, and in line with Appeals Council rules. The earlier the better.

What if I missed my appeal deadline?

Request an extension and explain “good cause” under 20 C.F.R. § 404.911, with proof such as hospitalization or other circumstances beyond your control. There is no guarantee, but SSA must consider your reasons.

Do I have to stop working completely to win SSDI?

Not necessarily, but earnings at or above SGA generally lead to a Step 1 denial. Some limited work below SGA may be consistent with disability if the rest of the evidence supports inability to sustain full-time competitive employment.

Key Takeaways for Texas, Texas Claimants

• Appeal every denial on time: 60 days from receipt at each stage, with a 5-day mailing presumption (20 C.F.R. § 404.901; §§ 404.909, 404.933, 404.968; 42 U.S.C. § 405(g)).
• Build the record: Provide complete, longitudinal treatment records and targeted medical opinions on work-related limitations.
• Anticipate vocational issues: Be ready to address why you cannot perform past work or adjust to other work.
• Consider representation: SSA must approve fees, and trained representatives can help with evidence development, hearing preparation, and post-hearing briefs.
• Use official resources: File appeals and track your case using SSA’s official portals and contact your local Texas SSA office for appointments or assistance.

Authoritative Resources

SSA: Appeal a Decision (Official Steps and Deadlines)eCFR: Title 20, Part 404 (SSDI Regulations)Social Security Act § 205 (42 U.S.C. § 405)SSA Office Locator (Texas Field Offices)State Bar of Texas LRIS (Find a Texas Attorney)

Legal Disclaimer

This guide is for informational purposes only and is not legal advice. Laws and regulations change, and outcomes depend on specific facts. Consult a licensed Texas attorney about your situation.

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