Carrillo-Yeras v. Astrue

When the Social Security Administration ("SSA") needlessly delays for over a year in reopening a claim without a showing that it “diligently pursued” investigation, it can not reverse any decision that was beneficial to applicant.

Cynthia Carrillo-Yeras had a history of lower back problems dating back to 1996, when she broke her tailbone. In 2000, Carrillo-Yeras was denied disability insurance benefits for her injury and asked for a review. In 2003, Carrillo-Years filed a second application that included a request for supplemental security income that was accepted. However, in 2004 she was granted a review of the denial of her first claim where an Administrative Law Judge ("ALJ") consolidated the her denial and acceptance into one request and remanded the case for a new hearing. In 2006, the case was opened again and Carrillo-Yeras was found to be ineligible for benefits because she had residual functional capacity to perform her former job. After filing a complaint in the district court where the ALJ’s decision was affirmed, Carrillo-Yeras appealed. The Ninth Circuit held that the ALJ lacked authority to reverse her benefits in 2006 as the agency had needlessly delayed for over 2 years in reviewing her claim. By regulation, the Social Security Administration can only wait 12 months before revising a determination with a showing that the investigation was "diligently pursued." Here, there was no showing that Carrillo-Yeras's case had been "diligently pursued" to give her a prompt decision. REVERSED and REMANDED with instructions to reinstate the 2003 determination.