{"package_id":"USCOURTS-cofc-1_07-vv-00137","decision_granule_id":"USCOURTS-cofc-1_07-vv-00137-cl6659570","petitioner_identifier":"Dr. Peter Broekelschen","is_minor":0,"age_at_vaccination":63.37,"age_unit_raw":"years","vaccine_type":"influenza","vaccination_date":"2005-10-28","condition_raw":"anterior spinal artery syndrome","condition_category":"other","autism_spectrum_adjacent":0,"outcome":"denied","award_amount_usd":null,"decision_date":"2009-08-18","extraction_version":"gemini-v2","extracted_at":"2026-04-30T14:30:50.589071+00:00","number_of_concurrent_vaccines":1,"dose_number":null,"time_to_onset_days":49,"theory_of_causation":"Flu vaccine Oct 28, 2005 → spinal cord injury onset Dec 16, 2005 (48 days). Disputed diagnosis: TM (petitioner's Dr. Steinman) vs. anterior spinal artery syndrome (respondent's Dr. Greenberg). Angiogram supported vascular etiology. SM Moran Feb 4, 2009: DENIED — anterior spinal artery syndrome (not TM); Althen prong 1 failed as to anterior spinal artery syndrome (no coherent mechanism). CFC Judge Miller Aug 18, 2009: SM AFFIRMED. Diagnosis-first approach proper (TM/ASAS have different etiologies, unlike Kelley's GBS/CIDP). Credibility not a ruse. DB had decision_date = 2009-02-04 (SM denial); corrected to 2009-08-18 (CFC opinion).","is_death":0,"date_of_death":null,"petition_filed_date":"2007-03-01","case_summary":"Dr. Peter Broekelschen was born on June 18, 1942, and is a physician specializing in internal medicine and gastroenterology. He filed his petition on March 1, 2007, alleging that a flu vaccine he received on October 28, 2005 from his primary physician, Dr. John Storch, had caused him a spinal cord injury. The parties agree that any health issues Dr. Broekelschen experienced prior to October 28, 2005 were not relevant to the injury at issue.\n\nOn December 16, 2005 — approximately forty-eight days after the vaccination — Dr. Broekelschen was admitted to Hoag Memorial Hospital Presbyterian with sudden severe chest pain and pain in his arms, fingers, neck, and left scapula. He was hospitalized for nearly two weeks, until December 29, 2005, and had not fully recovered by the time of the special master's decision. During the hospitalization, treating physicians expressed multiple possible diagnoses without reaching consensus, including transverse myelitis (a rare inflammatory condition of the spinal cord) and anterior spinal artery syndrome (caused by reduced blood flow from a vascular event). Both conditions are types of myelopathy, but they differ in etiology, the part of the body affected, and appropriate treatment. One distinguishing marker is proprioception: intact proprioception tends to suggest anterior spinal artery syndrome, while impaired proprioception tends to suggest transverse myelitis. The hospital records were conflicting on petitioner's proprioception, though a preponderance of in-hospital notations recorded it as intact. Dr. Broekelschen testified that he had been told it was abnormal.\n\nPetitioner's expert was Dr. Lawrence Steinman, who testified that the correct diagnosis was transverse myelitis caused by the flu vaccine. Respondent's expert was Dr. Benjamin Greenberg, who concluded that the correct diagnosis was anterior spinal artery syndrome caused by a vascular event. Both parties agreed on the existence of a spinal injury approximately six weeks after the vaccination, but disagreed sharply on the diagnosis and cause. An angiogram performed during the hospitalization was among the most significant pieces of evidence; Dr. Greenberg's theory accounted for the angiogram findings, while Dr. Steinman did not offer a theory explaining how to reconcile the angiogram with a diagnosis of transverse myelitis. None of the treating physicians testified.\n\nSpecial Master Moran issued his decision on February 4, 2009. He first determined that the evidence supported a diagnosis of anterior spinal artery syndrome rather than transverse myelitis. He found Dr. Greenberg's theory more persuasive because it accounted for all the evidence including the angiogram and the preponderance of proprioception evidence, while Dr. Steinman had ignored the angiogram and failed to reconcile it with his theory. The special master then applied the Althen test to the question of whether the flu vaccine caused anterior spinal artery syndrome and found that petitioner had not established the first prong: neither petitioner's 1983 medical journal article (which documented anterior spinal artery syndrome in nine of sixty post-infection or post-vaccination patients but offered no mechanism) nor Dr. Steinman's testimony provided a coherent medical theory causally connecting the flu vaccine to anterior spinal artery syndrome. Because petitioner's expert had premised his entire theory on a transverse myelitis diagnosis, his testimony provided limited support for a causation theory regarding anterior spinal artery syndrome. The special master separately granted petitioner's application for attorneys' fees and costs, finding that the claim had been brought in good faith with a reasonable basis, in a decision issued on December 17, 2008.\n\nJudge Miller, writing for the Court of Federal Claims on August 18, 2009, denied the motion for review and affirmed the special master's decision. The court rejected petitioner's argument that the special master erred by first determining the diagnosis: unlike Kelley v. Secretary of HHS, 68 Fed. Cl. 84 (2005), where GBS and CIDP share the same pathogenesis and are on a clinical spectrum so that a precise diagnosis was unnecessary, transverse myelitis and anterior spinal artery syndrome have fundamentally different underlying causes, and Dr. Steinman had grounded his entire causation theory in the transverse myelitis diagnosis. The court found the special master's credibility determinations were not arbitrary, distinguishing Andreu v. Secretary of HHS, 569 F.3d 1367 (Fed. Cir. 2009) — the special master had not used credibility as a pretext to avoid Althen analysis, but had carefully evaluated all the evidence including the angiogram, and his preference for Dr. Greenberg's more comprehensive account of the evidence was supported by the record. Because petitioner failed to establish a prima facie case, the special master was not required to shift the burden to the government, consistent with de Bazan v. Secretary of HHS, 539 F.3d 1347 (Fed. Cir. 2008).","is_minor_inferred":0,"is_pediatric_broad":0,"special_master":"Christian J. Moran","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":null,"petitioner_attorney_firm":null,"petitioner_attorney_location":null,"adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":null,"firm_canonical_key":null,"package_title":"Broekelschen v. Secretary of Health & Human Services","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_07-vv-00137","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_07-vv-00137.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_07-vv-00137.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_07-vv-00137-cl6659570","title":"Broekelschen v. Secretary of Health & Human Services","docket_text":"lead-opinion","date_issued":"2009-08-18","pdf_url":"https://www.courtlistener.com/opinion/6776293/broekelschen-v-secretary-of-health-human-services/","pdf_bytes":null,"triage_decision":"keep","triage_reason":"recovered via CL opinion 6659570 (html_with_citations)","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_07-vv-00137/USCOURTS-cofc-1_07-vv-00137-cl6659570"}]}