Justin W. Gerhardt v. HHS - multiple, encephalitis and related illnesses (2014)

On March 23, 2009, Justin W. Gerhardt filed a petition seeking compensation under the National Vaccine Injury Compensation Program, alleging that he suffered encephalitis and related illnesses as a result of receiving multiple vaccines.

The vaccines in question were the tetanus-diphtheria (Td), measles-mumps-rubella (MMR), meningococcal, hepatitis A, hepatitis B, and trivalent influenza vaccines, administered on January 21 and 22, 2007. Mr.

Gerhardt was 23 years old at the time of vaccination. He presented to the medical clinic on January 25, 2007, with disorientation, a possible seizure, and cognitive impairment, including difficulty finding words and inability to recall his birthdate or Social Security number.

He was transferred to Potomac Hospital and then to Bethesda National Naval Medical Center (NNMC), where his diagnosis was unspecified non-arthropod-borne viral diseases of the central nervous system. Initial tests, including MRI, EEG, and CSF, were normal.

Treating physicians at NNMC favored a post-immunization effect, noting the normal test results and the temporal association with his vaccinations. An allergy/immunology consultation also considered post-vaccination encephalitis as a differential diagnosis, noting scattered case reports and a rapid onset of symptoms.

A neurology consultation concluded his symptoms were not neurologic in nature but diagnosed encephalopathy, possibly related to the MMR or Td vaccine. Tests for various viruses were negative, though an elevated Chlamydia pneumoniae IgG titer was noted, which was later deemed likely insignificant given a negative IgM titer.

Mr. Gerhardt was discharged on February 5, 2007, but became ill again and was readmitted to NNMC on February 27, 2007, with diagnoses including chronic/major depression, cognitive disorder, post-vaccination encephalitis, anxiety disorder, and chronic fatigue syndrome.

In May 2007, his family sought evaluation from the Vaccine Healthcare Center Network (VHC) at Walter Reed Army Medical Center. Dr.

Renata Engler and Dr. Limone Collins led the evaluation, considering an infectious etiology versus a hypersensitivity reaction to vaccines.

They noted reports of Chlamydia infection and encephalopathy and the possibility of Hashimoto's Encephalopathy. A multidisciplinary case conference was held, and a treatment plan included antibiotics for Chlamydia, steroids, intravenous immunoglobulin, and low-dose naltrexone.

In March 2008, Drs. Engler and Collins made final diagnoses including suspected hypersensitivity encephalopathy secondary to multiple immunizations, cognitive disorder, and chronic fatigue syndrome, recommending referral to the Vaccine Injury Compensation Program.

Mr. Gerhardt was determined unfit for duty by the Physical Evaluation Board (PEB) in December 2008 due to hypersensitivity encephalopathy with a cognitive disorder and chronic fatigue syndrome, and later permanently disabled and retired in March 2011 with a diagnosis of probable hypersensitivity encephalitis secondary to vaccination.

Respondent initially recommended against compensation, arguing Petitioner failed to prove causation and suggesting a Chlamydia infection as an alternative cause. The parties attempted informal resolution for over three years without success.

Petitioner filed an expert report from Dr. Engler, a treating physician and former director of the VHC, who opined that the vaccines "probably played a critical role" in his neurologic deficits, suggesting adjuvants could trigger an inflammatory/autoimmune process and noting the presence of circulating immune complexes.

Respondent argued Dr. Engler's opinion was insufficient, lacking a specific mechanism and relying too heavily on temporal association.

Petitioner responded that his treating physicians opined the vaccinations caused his injuries and pointed to encephalitis as a listed side effect on vaccine package inserts. The Special Master ordered Petitioner to supplement Dr.

Engler's report to address deficiencies, including the lack of a specific theory of causation. Dr.

Engler's supplemental report explained that vaccines can activate the immune system, potentially causing autoimmune inflammatory diseases like encephalitis through mechanisms such as molecular mimicry. She concluded it was "more probable than not that the combination of vaccines contributed significantly to the onset of the patient's illness." The Special Master found that Petitioner met the burden of proof for an "off-Table" claim, establishing a medical theory connecting the vaccines to the injury, a logical sequence of cause and effect, and a proximate temporal relationship.

The Special Master noted that while Dr. Engler's reports were sparse, they were strengthened by the extensive medical records and her dual role as treating physician and expert.

Respondent did not sufficiently demonstrate an alternative cause, specifically rejecting the Chlamydia infection hypothesis based on the treating physicians' own analysis. The Special Master granted entitlement.

Subsequently, on October 4, 2014, the parties filed a stipulation for interim attorneys' fees and costs, agreeing to a lump sum of $125,307.87, payable jointly to Petitioner and Petitioner's counsel, Richard Gage. Special Master Brian H.

Corcoran approved this amount as reasonable.