Last Update: 3/25/16 (Transmittal I-3-133)
When determining disability, the Social Security Administration (SSA) will use each of the age categories applicable to a claimant during the period for which SSA is determining whether the claimant is disabled. SSA will not apply the age categories mechanically in a borderline age situation. If a claimant is within a few days to a few months of reaching an older age category (hereinafter “higher age category”), and using the higher age category would result in a determination or decision that the claimant is disabled, SSA will consider whether to use the higher age category after evaluating the overall impact of all the factors of the case. See 20 CFR 404.1563 and 416.963.
For more information on identifying a borderline age situation and deciding whether to apply a higher age category in a borderline age situation, see Hearings, Appeals and Litigation Law (HALLEX) manual I-2-2-42 and Program Operations Manual System DI 25015.006.
B. Handling Borderline Age Situations That Existed When the Decision Was Issued
1. Denying Review
If the administrative law judge (ALJ) decision is supported by substantial evidence, including the findings regarding the existence of a borderline age situation and whether to apply a higher age category, and there is no other basis for granting review present, the Appeals Council (AC) will deny review.
When denying review is appropriate but the ALJ did not expressly state in the decision that he or she considered a borderline age situation and whether to apply a higher age category, the AC will add the following language to the “Rules We Applied” section in the denial notice:
We considered the borderline age situation in this case, and we found that the factors in the record do not support application of the higher age category.
2. Granting Review
If the findings in the ALJ decision regarding the existence of a borderline age situation and whether to apply a higher age category in the situation are not supported by substantial evidence, the AC will grant review.
If the only reason to grant review involves a borderline age situation where the ALJ should have applied the higher age category, the AC will issue a partially favorable decision specifically finding a borderline age situation and applying the higher age category. See HALLEX I-2-2-42 B and C. If the AC issues a decision, the AC will determine the appropriate onset date in accordance with HALLEX I-2-2-42 C.4.
If other bases for granting review (see HALLEX I-3-3-1) are present in addition to a borderline age situation and application of a higher age category, the AC may find it appropriate to issue a partially favorable decision specifically addressing the borderline age issue and higher age category, and remand the unfavorable period of time to the ALJ for further action. If the AC issues a decision, it will determine the appropriate onset date in accordance with HALLEX I-2-2-42 C.4. The AC may also find it appropriate to return the entire case to the ALJ for further consideration or development on the borderline age issue. In this circumstance, the AC will provide the ALJ with specific directives for addressing the issue.