SSDI/SSI Denied? 13 Common Reasons & How to Win (2025)

A quick note before we dive in

Most first-time disability applications get denied at the initial level. That’s frustrating—but not final. You have a structured appeal path with strict 60-day deadlines at each stage, and many people win on appeal when they add the right evidence. (Social Security)

What this guide covers

• The 13 most common SSDI/SSI denial reasons in plain English
• The exact rules, limits, and citations the SSA uses (so you can fix gaps)
• Step-by-step fixes and pro tips for each reason
• Appeal essentials and timelines
• A printable checklist and an FAQ designed for rich results

This article focuses on U.S. Social Security disability programs: SSDI (based on work credits) and SSI (needs-based). We cite .gov sources throughout.

The 5-Step Disability Decision SSA Uses (why it matters)

Every claim goes through a five-step sequential evaluation: (1) Are you working at SGA? (2) Do you have a severe, medically determinable impairment? (3) Does it meet/equal a Listing? (4) Can you do your past relevant work? (5) Can you adjust to other work considering age, education, and experience? If SSA says “yes” at step 1 (you’re doing SGA) or “no” at step 2 (not severe), you’re denied before they even assess the rest. (Social Security)

13 common reasons disability claims get denied (and how to fix each)

1) You’re working over SGA (earnings are too high)

What SSA looks at: If you earn more than 2025 SGA amounts—$1,620/mo (non-blind) or $2,700/mo (blind)—you’re generally not disabled at step 1. SSA evaluates employee earnings, self-employment, and can deduct impairment-related work expenses. (Social Security)

Fix it:

• If your gross pay fluctuates, document unsuccessful work attempts and IRWEs that reduce countable earnings below SGA. (Social Security)
• If you’re self-employed, follow the special self-employment SGA rules and explain your actual value to the business. (Social Security)

2) Not enough medical evidence (or no acceptable medical source)

SSA needs objective medical evidence from acceptable medical sources to establish a medically determinable impairment (MDI). Without it, the claim is denied or a consultative exam (CE) is ordered. (Social Security)

Fix it:

• Ask your providers for treatment notes, test results, imaging, medication lists, and functional assessments tied to work limits (sitting, standing, lifting, concentration).
• If SSA schedules a CE, attend it; missing a CE can lead to a decision based on the file—often unfavorable. (Social Security Administration)

3) Your condition isn’t “severe” or doesn’t last 12 months

At step 2, SSA denies if your impairment doesn’t significantly limit basic work activities or won’t last at least 12 months (or result in death). (Social Security)

Fix it:

• Show longitudinal treatment (consistent visits, objective findings) and how symptoms limit basic work tasks.
• If symptoms are intermittent, provide frequency, duration, and recovery time; bring logs and provider statements.

4) SSA thinks you can still do your past work or other work

You may be denied at step 4 (can still do past relevant work) or step 5 (can do other work) based on your Residual Functional Capacity (RFC) and vocational factors (age, education, experience). (Social Security)

Fix it:

• Submit detailed Work History Reports (tools, lifting, posture, mental demands). Clarify why you can’t meet those demands now. (Social Security)
• Ask your doctor for a function-by-function assessment aligned to SSA’s RFC framework. (Social Security)

5) Failure to cooperate (not returning forms, missing CE, “whereabouts unknown”)

DDS can deny for failure to cooperate/insufficient evidence if you don’t return forms, can’t be contacted, or miss exams. HALLEX/POMS detail FTC (failure-to-cooperate) handling and “whereabouts unknown.” (Social Security Administration)

Fix it:

• Keep your address/phone updated with SSA; return forms promptly.
• If you missed a CE for good cause, notify SSA immediately and reschedule; provide proof. (Social Security Administration)

6) Failure to follow prescribed treatment (without good cause)

If prescribed treatment would restore your ability to work and you fail to follow it without good cause, SSA can deny. Good cause can include inability to afford, severe side effects, or mental limitations. (Social Security Administration)

Fix it:

• Document why you couldn’t follow the plan (cost, access, adverse effects) and share alternatives you are pursuing.

7) Drug or alcohol (DAA) materiality

If you’d not be disabled without substance use, SSA finds DAA material and denies. They evaluate which limitations would remain if you stopped using. (Social Security)

Fix it:

• Provide evidence of disability during periods of sobriety, or medical opinion that limitations persist independent of DAA.

8) Insufficient work credits (SSDI) or resources/income too high (SSI)

• SSDI requires being insured and meeting recent work tests (often 20 credits in the last 10 years; fewer for younger workers). In 2025, $1,810 earnings = 1 credit (max 4/yr). (Social Security)
• SSI is needs-based; resource limits are $2,000 individual / $3,000 couple; 2025 FBR: $967 / $1,450. (Social Security)

Fix it:

• For SSDI, verify your Earnings Record (w-2 self-employment postings can be missing).
• For SSI, review countable resources/income (many items don’t count); spend-down lawfully or apply when under limits. (Social Security)

9) Medical evidence shows only minimal limitation

SSA denies at step 2 if your MDI has no more than a minimal effect on basic work activities. (Social Security)

Fix it:

• Provide functional evidence (PT/OT notes, neuropsych testing, pain management records) linking symptoms to work tasks.

10) Doesn’t meet/equal a Listing, and RFC still allows work

You can be denied at step 3 if you don’t meet a Listing and, after RFC, SSA finds you can do past/other work. (Social Security)

Fix it:

• If you’re close to a Listing, obtain missing objective criteria (e.g., imaging, spirometry, MRIs) and clarify frequency/severity.

11) Short duration or improvement expected

SSA denies if the impairment won’t last 12 months or is expected to improve enough to work. (Social Security)

Fix it:

• Show ongoing treatment trajectory, prognosis, and failed conservative measures (not just a diagnosis code).

12) Missed appeal deadline (or re-filed instead of appealing)

You generally have 60 days from receipt of a denial to appeal (SSA presumes 5 mailing days). Late appeals require good cause. Re-filing often resets your protective filing date and can weaken back pay. (Social Security)

Fix it:

• File reconsideration within 60 days; if denied, request an ALJ hearing within 60 days of the reconsideration decision. (Social Security)

13) Non-medical technical issues (paperwork, identity, eligibility)

Technical denials can include not pursuing the claim, non-citizen status issues, or administrative matters. Always read your notice’s specific reason and fix it directly. (Social Security Administration)

Quick comparison: medical vs. technical denials

Authoritative sources for the rules above: SSA’s SGA limits and evaluation rules; evidentiary requirements; Listings; appeals deadlines; SSI resource/FBR amounts; work credits/quarters of coverage. (Social Security)

Exact fixes & pro tips (copy/paste checklist)

Before applying or appealing:

• ✅ Confirm you’re under SGA or have unsuccessful work attempt proof. (Social Security)
• ✅ Pull your medical records from every provider (12+ months), including test results and functional notes. (Social Security)
• ✅ Ask a treating provider for a work-related functional assessment (sitting/standing/walking/lifting/mental pace). (Social Security)
• ✅ For SSDI, check work credits and quarters of coverage; for SSI, tally countable resources (aim ≤ $2,000 / $3,000). (Social Security)
• ✅ If SSA schedules a CE, attend (or promptly reschedule with proof of good cause). (Social Security Administration)
• ✅ Track medication side effects, flares, and bad days in a symptoms log.

When you get a denial letter:

• ⏱️ Appeal within 60 days (SSA presumes you received the letter 5 days after the date). Use Request for Reconsideration (SSA-561), then HA-501 for the hearing if needed. (Social Security)
• ➕ Add new medical evidence and a short cover letter explaining exactly what changed or what was missing.

Appeals roadmap (plain English)

1. Reconsideration – A different examiner reviews your case. Deadline: 60 days. Add new evidence and explain prior gaps. (Social Security Administration)
2. ALJ Hearing – You (and possibly a vocational expert) appear before a judge; you can submit evidence up to 5 business days before the hearing. Deadline: 60 days after reconsideration denial. (Social Security)
3. Appeals Council – Review for legal/technical errors; deadline: 60 days post-ALJ decision. (Social Security)
4. Federal Court – If needed after Appeals Council decision.

The rules behind SSA decisions (key citations you can show your doctor/advocate)

• Definition of disability & duration (12 months): 20 CFR 404.1505, 404.1509; SSR 23-1p. (Social Security)
• Severe vs. not severe: 20 CFR 404.1520, 404.1522; SSR 85-28, SSR 16-3p (symptoms). (Social Security)
• Evidence requirements & insufficiency: Blue Book evidentiary rules; 20 CFR 404.1520b. (Social Security)
• SGA thresholds (2025): SSA Red Book/Actuarial SGA page. (Social Security)
• Past work/other work & RFC: SSA Step 4/5, 20 CFR 404.1560, Appendix 2 (grids). (Social Security)
• Failure to follow treatment: 20 CFR 404.1530/416.930, POMS DI 23010.006. (Social Security Administration)
• DAA materiality: 20 CFR 404.1535; SSR 13-2p. (Social Security)
• Work credits & credits-per-dollar (2025): SSA Qualify page; How You Earn Credits; QOC amount $1,810. (Social Security)
• SSI resource limits & 2025 FBR: SSA Resources page; FBR (2025). (Social Security)
• Appeal deadlines: SSA pubs & appeals pages. (Social Security)

Real-world examples of “fixes” that move claims from denied to approved

• Back pain denied at step 2 → Added MRI with nerve root compression, PT notes, and surgeon restrictions; now meets severity and RFC supports less than sedentary → allow at step 5. (Social Security)
• Anxiety/Depression claim denied for “not severe” → Submitted psych testing, therapy notes, med changes, and work-pace limits; ALJ applied vocational factors for a person approaching advanced age. (Social Security)
• SSDI technical denial for credits → Corrected a missing self-employment year with IRS transcript; insured status met on onset date. (Social Security)
• SSI denial for resources → Excluded non-countable resources (primary home, one vehicle) and documented resource spend-down to ≤$2,000. (Social Security)

PAA (People Also Ask) style questions you can target

• “Why was my Social Security disability claim denied?”
• “What disqualifies you from SSDI or SSI in 2025?”
• “How much can you earn on disability (SGA) before denial?”
• “Do I have enough work credits for SSDI?”
• “Can SSA deny me for missing a consultative exam?”
• “I missed my deadline—can I still appeal a disability denial?”
• “How do drugs or alcohol affect disability eligibility (DAA)?”
• “What’s the difference between medical vs. technical denials?”

FAQs

1) What are the top reasons SSDI and SSI get denied?
The big ones: earning over SGA, lack of objective medical evidence from acceptable sources, impairments that aren’t “severe” or won’t last 12 months, SSA finding you can do past/other work, failure to cooperate (forms/CE), failure to follow treatment without good cause, DAA materiality, insufficient work credits (SSDI), and SSI income/resource overages. (Social Security, Social Security Administration)

2) How much can I earn in 2025 before SSA denies me for SGA?
$1,620/month (non-blind) or $2,700/month (blind). Different tests apply if you’re self-employed, and IRWEs may reduce countable earnings. (Social Security)

3) What if I missed a consultative exam?
SSA can decide based on the evidence in file or deny for failure to cooperate. Call immediately, explain good cause, and reschedule. (Social Security Administration)

4) How many work credits do I need for SSDI?
It depends on age. Generally 40 credits (with 20 in the last 10 years) for adults; fewer for younger workers. Each 2025 credit = $1,810 in earnings (max 4 credits/year). (Social Security)

5) What are the SSI limits in 2025?
Resource limits: $2,000 (individual) / $3,000 (couple). Federal Benefit Rate: $967 (individual) / $1,450 (couple). States may add supplements. (Social Security)

6) Can SSA deny me for not following treatment?
Yes—if prescribed treatment would restore work ability and you don’t follow it without good cause. Cost, access, and certain medical or mental reasons can be good cause. (Social Security Administration)

7) Do drugs or alcohol automatically disqualify me?
No. SSA asks if you’d still be disabled if you stopped using. If not, DAA is material → denial. If yes, DAA is not material. (Social Security)

8) How long do I have to appeal a denial?
Generally 60 days from the date you receive SSA’s notice (SSA presumes 5 mailing days). Appeal online or with SSA-561 (reconsideration) and HA-501 (hearing). (Social Security)

Bottom line (and your next best step)

If you were denied, don’t panic. Read your denial reason, plug the exact gap (medical or technical), and appeal within 60 days with new, targeted evidence. If you’re working or considering work, leverage WIPA experts so you don’t accidentally cross SGA and sink your claim. (Social Security)