VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-00406
Package ID: USCOURTS-cofc-1_15-vv-00406
Petitioner: R.M.R.
Filed: 2015-04-22
Decided: 2018-06-12
Vaccine: diphtheria-tetanus-acellular pertussis (DTaP)
Vaccination date: 2012-05-10
Condition: DTaP Table encephalopathy; infantile spasms; severe developmental injury
Outcome: compensated
Award amount USD: 2005508.01

AI-assisted case summary:
On April 22, 2015, Marissa Arevalo, as guardian and mother of her minor daughter R.M.R., filed a petition under the National Childhood Vaccine Injury Act. R.M.R. was born in March 2012 and received a diphtheria-tetanus-acellular pertussis (DTaP) vaccine on May 10, 2012, at approximately two months of age. Ms. Arevalo alleged that R.M.R. suffered an "encephalopathy" as defined by the Vaccine Table, and also asserted an off-Table claim. A hearing was held to address the on-Table claim. The Vaccine Table lists "encephalopathy" within 72 hours for the DTaP vaccine. For children under 18 months, an acute encephalopathy is indicated by a significantly decreased level of consciousness lasting at least 24 hours, which can be shown by decreased or absent eye contact, decreased response to the environment, or inconsistent responses to external stimuli. Factors such as sleepiness, irritability, crying, bulging fontanelle, or seizures alone do not constitute an acute encephalopathy. The parties agreed that R.M.R. was healthy before the vaccination and after May 15, 2012. Before the May 10, 2012 vaccination, R.M.R. was noted to be healthy by her pediatrician, Dr. Ho, and was likely able to track objects with her eyes. By Monday, May 14, 2012, R.M.R. was taken to the emergency room due to seizures, which were later confirmed as infantile spasms. Following the seizures, R.M.R.'s development halted, and she subsequently required a G-tube and wheelchair, with her mother providing constant care. The critical period for determining an on-Table encephalopathy was between 3:00 p.m. on Thursday, May 10, and 3:00 p.m. on Sunday, May 13, 2012. Special Master Christian J. Moran focused on R.M.R.'s eye contact and responsiveness during this period. On Monday, May 15, 2012, treating pediatric neurologist Dr. Blas Zelaya recorded Ms. Arevalo's report that R.M.R. had good eye tracking except in the "last couple of days." This history, taken on Monday, indicated that the decreased eye tracking began on Saturday, May 12, before the 72-hour window closed and before the seizures started early Sunday morning. Ms. Arevalo testified that she noticed decreased eye tracking on Saturday and that R.M.R. was not responding during playtime. Special Master Moran found that the lack of eye tracking in a two-month-old satisfied the regulatory requirement for decreased or absent eye contact, thus establishing a Table encephalopathy. While Dr. Zelaya testified that R.M.R. suffered an encephalopathy, his definition was broader than the regulatory one. The Special Master found that the respondent did not present sufficient evidence to rebut the Table presumption, noting that Dr. Zelaya testified that no other reason for R.M.R.'s infantile spasms was found after extensive investigation. On December 15, 2016, Special Master Moran ruled that R.M.R. was entitled to compensation for a DTaP Table encephalopathy. The damages phase was resolved by a stipulation and proffer. Life-care planners M. Virginia Walton, RN, MSN, FNP, CNCLP, and Terry K. Arnold, RN, CDMS, CRRN, CLCP, CNLCP, were used to estimate R.M.R.'s future needs. The parties agreed that R.M.R. would not be gainfully employed in the future. On June 12, 2018, Special Master Moran found the proffer reasonable and awarded damages totaling $2,005,508.01. This included a lump sum of $1,437,806.43 payable to Marissa Arevalo as guardian of R.M.R.'s estate for lost future earnings, pain and suffering, and first-year life-care expenses; $3,852.60 payable to Ms. Arevalo for past unreimbursable expenses; $563,848.98 jointly payable to Ms. Arevalo and the State of Illinois to satisfy the Medicaid lien; and an amount sufficient to purchase a life-contingent annuity for future life-care items. The annuity payments were subject to a four percent annual growth rate for non-medical items and a five percent annual growth rate for medical items. Petitioner was represented by Peter C. Beard of Holley, Rosen & Beard. Respondent was represented by Adriana Teitel of the U.S. Department of Justice.

Theory of causation field:
On May 10, 2012, R.M.R., approximately two months old, received a DTaP vaccine. Petitioner alleged and Special Master Christian J. Moran found that R.M.R. suffered a Vaccine Table encephalopathy, meeting the regulatory definition of a significantly decreased level of consciousness lasting at least 24 hours, indicated by decreased or absent eye contact. This condition began on Saturday, May 12, 2012, within 72 hours of vaccination and persisted for at least 24 hours. The Special Master found entitlement on December 15, 2016, based on the presumption of causation, which the respondent did not rebut. Respondent did not present evidence sufficient to rebut the Table presumption, and treating neurologist Dr. Blas Zelaya testified that no other cause for R.M.R.'s infantile spasms was found. Damages were awarded on June 12, 2018, via proffer, totaling $2,005,508.01, including a lump sum of $1,437,806.43 for lost earnings, pain and suffering, and Year 1 life care; $3,852.60 for past unreimbursable expenses; $563,848.98 for the Illinois Medicaid lien; and a life-contingent annuity for future life care with 4% non-medical and 5% medical growth rates. Petitioner's counsel was Peter C. Beard; respondent's counsel was Adriana Teitel.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-00406-0
Date issued/filed: 2017-01-09
Pages: 6
Docket text: PUBLIC ORDER/RULING (Originally filed: 12/15/16) regarding 47 Ruling on Entitlement. Signed by Special Master Christian J. Moran. (dh) Copy to parties.
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Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 1 of 6
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * *
MARISSA AREVALO, Guardian & *
Mother of R.M.R., a minor, *
* No. 15-406V
Petitioner, * Special Master Christian J. Moran
*
v. * Filed: December 15, 2016
*
SECRETARY OF HEALTH * Table claim for encephalopathy
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * *
Peter C. Beard, Holley, Rosen & Beard, Springfield, IL, for petitioner;
Adriana Teitel, United States Dep’t of Justice, Washington, DC, for respondent.
PUBLISHED RULING FINDING
ENTITLEMENT TO COMPENSATION1
RMR, daughter of petitioner Marissa Arevalo, was born in March 2012. At
approximately two months of age, on Thursday, May 10, 2012, RMR received a
dose of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine. By Monday,
May 14, 2012, medical personnel were documenting seizures consistent with
infantile spasms. Doctors have since confirmed the diagnosis of infantile spasms,
a horrible condition that prevented RMR’s development.
Ms. Arevalo alleges that the DTaP vaccination harmed RMR. The petition
asserts two causes of action, one based on the Vaccine Table, and the other an off-
1 The E-Government Act, 44 U.S.C. § 3501 note (2012) (Federal Management and
Promotion of Electronic Government Services), requires that the Court post this decision on its
website. Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing
redaction of medical information or other information described in 42 U.S.C. § 300aa-12(d)(4).
Any redactions ordered by the special master will appear in the document posted on the website.

Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 2 of 6
Table claim. To address the on-Table claim, a hearing was held. In this hearing,
Ms. Arevalo produced persuasive evidence that showed RMR suffered an
“encephalopathy” as the regulations define that term. Therefore, Ms. Arevalo is
entitled to compensation.
Background
Congress created the Vaccine Program to promote recovery for people
injured by vaccinations. In doing so, Congress created a table that associates
certain vaccines with certain conditions that arise in a certain amount of time.
When a petitioner establishes an on-Table injury, there is a presumption that the
vaccine caused the injury. The Secretary may rebut this presumption with other
evidence. Shalala v. Whitecotton, 514 U.S. 268, 270-71 (1995).
The current version of the table is found at 42 C.F.R. § 100.3(a). (For a
discussion about the Secretary’s authority to modify the Vaccine Table, see Terran
v. Sec’y of Health & Human Servs., 195 F.3d 1302, 1312-15 (Fed. Cir. 1999)).
For the DTaP, the Vaccine Table lists “encephalopathy” within 0-72 hours. 42
C.F.R. § 100.3(a) ¶ II.B.
Through Qualifications and Aids to Interpretation, the Secretary has further
defined “encephalopathy.” An “acute encephalopathy” means “one that is
sufficiently severe so as to require hospitalization (whether or not hospitalization
occurred).” 42 C.F.R. § 100.3(b)(2)(i). For children who are less than 18 months
of age, including RMR, “an acute encephalopathy is indicated by a significantly
decreased level of consciousness lasting for at least 24 hours.” 42 C.F.R.
§ 100.3(b)(2)(i)(A). The definition of the critical phrase “significantly decreased
level of consciousness” is found in paragraph D. This provision provides:
A “significantly decreased level of consciousness” is
indicated by at least one of the following clinical signs
for at least 24 hours or greater (see paragraphs (2)(i)(A)
and (2)(i)(B) of this section for applicable time frames):
(1) Decreased or absent response to environment
(response, if at all, only to loud voice or painful
stimuli);
2

Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 3 of 6
(2) Decreased or absent eye contact (does not fix
gaze upon family members or other individuals);
or
(3) Inconsistent or absent responses to external
stimuli (does not recognize familiar people or
things).
42 C.F.R. § 100.3(b)(2)(i)(D).
The Secretary has also excluded some factors from contributing to an
“encephalopathy.”
The following clinical features alone, or in combination,
do not demonstrate an acute encephalopathy or a
significant change in either mental status or level of
consciousness as described above: Sleepiness, irritability
(fussiness), high-pitched and unusual screaming,
persistent inconsolable crying and bulging fontanelle.
Seizures in themselves are not sufficient to constitute a
diagnosis of encephalopathy. In the absence of other
evidence of an acute encephalopathy, seizures shall not
be viewed as the first symptom or manifestation of the
onset of an acute encephalopathy.
42 C.F.R. § 100.3(b)(2)(i)(E).
Analysis
This regulatory structure means the field of evidence relevant to determining
whether RMR suffered an encephalopathy is relatively circumscribed. Evidence is
relevant if it tends to show or tends not to show that RMR suffered a “decreased
level of consciousness” arising within 72 hours of vaccination and persisting for 24
hours. The factors for a “decreased level of consciousness” include: (1) a
decreased response to the environment, (2) decreased eye contact, or (3) an
inconsistent response to external stimuli. 42 C.F.R. § 100.3(b)(2)(i)(D).
3

Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 4 of 6
Conversely, evidence about fussiness, inconsolable crying, etc. is not relevant. 42
C.F.R. § 100(3)(b)(2)(i)(E).2
The hearing was held because the parties disputed RMR’s health in the 72
hours after the vaccination. The parties, however, agree about RMR’s health
before the vaccination on May 10, 2012, and after May 15, 2012.
On May 10, 2012, RMR was seen for her two-month well baby visit with
her pediatrician, Dr. Ho. Dr. Ho noted no health concerns. Exhibit 4 at 10-11. It
is likely that by two months, RMR was able to track an object with her eyes. See
Faoro v. Sec’y of Health & Human Servs., No. 10-704V, 2016 WL 675491, at *7
(Fed. Cl. Spec. Mstr. Jan. 29, 2016), mot. for rev. denied, 128 Fed. Cl. 61 (2016);
see also Bayless v. Sec’y of Health & Human Servs., No. 08-679V, 2015 WL
638197, at *7 (Fed. Cl. Spec. Mstr. Jan, 15, 2015) (relying upon milestones listed
in What to Expect the First Year). At the two-month appointment, RMR received
the DTaP vaccination. The DTaP vaccination was given at approximately 3:00
PM. Exhibit 4 at 13-14; Tr. 18, 127.3 RMR’s good health before the vaccination
serves as one bookend to the parties’ debate.
The other bookend to the debate is that on Monday, May 14, 2012, RMR’s
parents brought her to the emergency room at Saint Francis Medical Center in
Peoria, Illinois. Exhibit 5 at 3. They were concerned that RMR was having
seizures. Id.; Tr. 54-56. While in the hospital, RMR’s parents gave various
accounts of her condition since the vaccination approximately four days earlier.
E.g., exhibit 5 at 3, 13-14. Although the histories are not absolutely consistent, the
records created on Monday evening tend to show that RMR’s seizures started early
Sunday morning, perhaps 1:00 or 2:00 AM. Exhibit 4 at 18; exhibit 5 at 16, 21;
see also exhibit 10 (Ms. Arevalo’s affidavit) at 1-2; Tr. 137-38. A more extensive
discussion of seizures is not needed because “Seizures in themselves are not
2 Also irrelevant is the testimony from RMR’s treating pediatric neurologist, Blas Zelaya,
that RMR suffered an encephalopathy in his opinion. Tr. 80-81. The Secretary’s cross-
examination brought out that Dr. Zelaya’s definition of “encephalopathy” was broader than the
regulatory definition. Tr. 91-92. Thus, although the undersigned appreciates Dr. Zelaya’s
testimony, the undersigned cannot simply defer to his opinion. See Nordwall v. Secʼy of Health
& Human Servs., No. 05-123V, 2008 WL 857661, at *5 (Fed. Cl. Spec. Mstr. Feb. 19, 2008)
(distinguishing how the medical community uses the term “encephalopathy” from the regulatory
definition), mot. for rev. denied, 83 Fed. Cl. 477 (2008).
3 The 72-hour window, therefore, closes at approximately 3:00 PM on Sunday.
4

Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 5 of 6
sufficient to constitute a diagnosis of encephalopathy.” 42 C.F.R.
§ 100.3(b)(2)(i)(E).
It is sufficient to note that after the seizures, RMR’s development
essentially halted. See Tr. 41, 141-43. Today, RMR requires a G-tube and a
wheelchair. Ms. Arevalo spends almost all her time caring for her. Tr. 16-17, 124-
26.
The issue requiring more thorough analysis is RMR’s health between 3:00
PM Thursday and 3:00 PM Sunday. In this time, did RMR experience symptoms
of a “decreased level of consciousness?”
Here, Ms. Arevalo has produced sufficient evidence to answer this question
affirmatively. In the initial consultation with Dr. Zelaya, which occurred relatively
late in the evening on Monday, May 15, 2012, after RMR had been admitted to the
hospital, Dr. Zelaya obtained the following history from Ms. Arevalo: “The mother
has observed that the infant did have good eye tracking except in the last couple of
days.” Exhibit 5 at 41. Several aspects are significant. As mentioned earlier, it is
not surprising for a two-month infant to track objects. Moreover, Ms. Arevalo
used the phrase “last couple of days.” Because Dr. Zelaya was seeing RMR on
Monday, two days places the problem of tracking at some time on Saturday, well
before the Sunday 3:00 PM cut off. Ms. Arevalo’s observation that her daughter
was not tracking with her eyes could have occurred only when RMR was awake on
Saturday. This sequence means that the decreased eye tracking must have started
before the seizures, which began on Sunday morning. See Tr. 174 (Ms. Arevalo:
“I definitely noticed [a decrease in eye tracking] on Saturday. 100 percent”).
Dr. Zelaya created his May 15, 2012 record within two days of the decrease
in eye tracking, meaning that the account is presumptively accurate. See Cucuras
v. Sec’y of Health & Human Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993). Ms.
Arevalo’s additional testimony simply adds detail to information already contained
in a medical record. Ms. Arevalo testified that on Saturday afternoon, RMR was
“not responding to our little play time with her face.” Tr. 135.
One way to demonstrate a “decreased level of consciousness” is to show
“decreased or absent eye contact.” 42 C.F.R. § 100.3(b)(2)(i)(D)(2). Here, the
lack of tracking in a two-month old fulfills this criterion. After Ms. Arevalo
establishes that RMR suffered the regulatory definition of an encephalopathy, Ms.
5

Case 1:15-vv-00406-UNJ Document 49 Filed 01/09/17 Page 6 of 6
Arevalo is entitled to a presumption that the DTaP vaccine caused the associated
injury.4
The Vaccine Act affords the Secretary an opportunity to rebut the
presumption of causation. 42 U.S.C. § 300aa–13(a)(1)(B); see also 42 C.F.R.
§ 100.3(b)(2)(iii). To do so, the Secretary must introduce evidence. The Secretary
has not done so. See Tr. 90-91 (Dr. Zelaya’s testimony that after extensive
investigation, no reason for RMR’s infantile spasms was found). Therefore, Ms.
Arevalo is entitled to compensation.
A separate order for the damages phase of the case will issue shortly.
IT IS SO ORDERED.
S/Christian J. Moran
Christian J. Moran
Special Master
4 This presumption means there is not a finding that the DTaP vaccine actually caused
RMR’s infantile spasms. In Congress, the relevant committee “recognize[d] that there is public
debate over the incidence of illnesses that coincidentally occur within a short time of
vaccination. The Committee further recognize[d] that the deeming of a vaccine-relatedness
adopted here may provide compensation to some children whose illness is not, in fact, vaccine-
related.” H.R. Rept. No. 99-908, pt. 1, p. 18, reprinted in 1986 U.S.C.C.A.N. 6344, 6359.
6

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DOCUMENT 2: USCOURTS-cofc-1_15-vv-00406-1
Date issued/filed: 2018-08-13
Pages: 24
Docket text: PUBLIC DECISION (Originally filed: 6/12/2018) regarding 89 DECISION Stipulation/Proffer. Signed by Special Master Christian J. Moran. (abs) Service on parties made.
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 1 of 24
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * *
MARISSA AREVALO, guardian *
and mother of R.M.R., a minor, *
* No. 15-406V
Petitioner, * Special Master Christian J. Moran
*
v. *
* Filed: June 12, 2018
SECRETARY OF HEALTH *
AND HUMAN SERVICES, * Damages; decision based on proffer;
* diphtheria-tetanus-acellular pertussis
* (“DTaP”) vaccine; encephalopathy.
Respondent. *
* * * * * * * * * * * * * * * * * * * * *
Peter C. Beard, Springfield, IL, for Petitioner;
Adriana R. Teitel, United States Department of Justice, Washington, DC, for
Respondent.
UNPUBLISHED DECISION AWARDING DAMAGES1
On April 22, 2015, Marissa Arevalo filed a petition on behalf of her
daughter, R.M.R., for compensation under the National Childhood Vaccine Injury
Act, 42 U.S.C. §§ 300aa-1 to 34 (2012). Ms. Arevalo alleged that R.M.R. suffered
an on-Table encephalopahty as a result of a diphtheria-tetanus-acellular pertussis
(“DTaP”) vaccination administered on May 10, 2012.
Following a hearing, the undersigned ruled that petitioner had established
entitlement to compensation for R.M.R.’s on-Table encephalopathy claim under
the Vaccine Act. Ruling, issued Dec. 15, 2016, 2016 WL 7666535.
1 The E-Government Act, 44 § 3501 note (2012) (Federal Management and Promotion of
Electronic Government Services), requires that the Court post this decision on its website.
Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing redaction of
medical information or other information described in 42 U.S.C. § 300aa-12(d)(4). Any
redactions ordered by the special master will appear in the document posted on the website.
1

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 2 of 24
On June 8, 2018, respondent filed a Proffer on Award of Compensation, to
which petitioner agrees. Based upon the record as a whole, the special master
finds the Proffer reasonable and that petitioner is entitled to an award as stated in
the Proffer. Pursuant to the attached Proffer the court awards petitioner:
a. A lump sum of $1,437,806.43 in the form of a check payable to
petitioner as court-appointed guardian of R.M.R.’s estate for lost
earnings, pain and suffering, and life care expenses for year one;
b. A lump sum of $3,852.60 in the form of a check payable to petitioner
for past unreimbursable expenses;
c. A lump sum of $563,848.98 for compensation for satisfaction of
the State of Illinois Medicaid lien in the form of a check jointly
payable to petitioner and
Illinois Department of Healthcare & Family Services
Bureau of Collections
Technical Recovery Section
P.O. Box 19174
Springfield, IL 62794-9174
Attn: Mr. Kevin Thornton
Medicaid #: 96-080-091613
Petitioner agrees to endorse this payment to the State of Illinois.
d. An amount sufficient to purchase the annuity contract described
in section II. D of the attached Proffer.
These amounts represent compensation for all damages that would be
available under 42 U.S.C. §300aa-15(a)
In the absence of a motion for review filed pursuant to RCFC, Appendix B,
the clerk is directed to enter judgment in case 15-406V according to this decision
and the attached proffer.2
2 Pursuant to Vaccine Rule 11(a), the parties can expedite entry of judgment by each
party filing a notice renouncing the right to seek review by a United States Court of Federal
Claims judge.
2

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 3 of 24
Any questions may be directed to my law clerk, Andrew Schick, at (202)
357-6360.
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 4 of 24
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
MARISSA AREVALO, guardian and mother
of R.M.R., a minor,
Petitioner,
No. 15-406V
Special Master Moran
v.
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
PROFFER ON AWARD OF COMPENSATION
On December 15, 2016, Special Master Moran issued a Ruling on Entitlement, which
found that petitioner was entitled to Vaccine Act compensation for R.M.R’s alleged Table
Encephalopathy injury.
I. Items of Compensation
A. Life Care Items
The respondent engaged life care planner, M. Virginia Walton, RN, MSN, FNP, CNCLP,
and petitioner engaged Terry K. Arnold, RN, CDMS, CRRN, CLCP, CNLCP, to provide an
estimation of R.M.R.’s future vaccine-injury related needs. For the purposes of this proffer, the
term “vaccine related” is as described in the Special Master’s Ruling Finding Entitlement. All
items of compensation identified in the joint life care plan are supported by the evidence, and are
illustrated by the chart entitled Appendix A: Items of Compensation for R.M.R., attached hereto
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 5 of 24
as Tab A.1 Respondent proffers that R.M.R. should be awarded all items of compensation set
forth in the joint life care plan and illustrated by the chart attached at Tab A.2 Petitioner agrees.
B. Lost Future Earnings
The parties agree that based upon the evidence of record, R.M.R. will not be gainfully
employed in the future. Therefore, respondent proffers that R.M.R. should be awarded lost
future earnings as provided under the Vaccine Act, 42 U.S.C. § 300aa-15(a)(3)(B). Respondent
proffers that the appropriate award for R.M.R.'s lost earnings is $829,794.00. Petitioner agrees.
C. Pain and Suffering
Respondent proffers that R.M.R. should be awarded $250,000.00 in actual pain and
suffering. See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.
D. Past Unreimbursable Expenses
Evidence supplied by petitioner documents her expenditure of past unreimbursable
expenses related to R.M.R.'s vaccine-related injury. Respondent proffers that petitioner should
be awarded past unreimbursable expenses in the amount of $3,852.60. Petitioner agrees.
E. Medicaid Lien
Respondent proffers that R.M.R. should be awarded funds to satisfy a State of Illinois
lien in the amount of $563,848.98, which represents full satisfaction of any right of subrogation,
1 The chart at Tab A illustrates the annual benefits provided by the joint life care plan. The
annual benefit years run from the date of judgment up to the first anniversary of the date of
judgment, and every year thereafter up to the anniversary of the date of judgment.
2 The parties have no objection to the proffered award of damages. Assuming the Special
Master issues a damages decision in conformity with this proffer, the parties intend to waive
their right to seek review of such damages decision, recognizing that respondent reserves his
right, pursuant to 42 U.S.C. § 300aa-12(f), to seek review of the Special Master’s December 15,
2016, decision finding petitioner entitled to an award under the Vaccine Act.
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 6 of 24
assignment, claim, lien, or cause of action the State of Illinois may have against any individual as
a result of any Medicaid payments the State of Illinois has made to or on behalf of R.M.R. from
the date of her eligibility for benefits through the date of judgment in this case as a result of her
vaccine-related injury suffered on or about May 10, 2012, under Title XIX of the Social Security
Act.
II. Form of the Award
The parties recommend that the compensation provided to R.M.R. should be made
through a combination of lump sum payments and future annuity payments as described below,
and request that the Special Master's decision and the Court's judgment award the following3:
A. A lump sum payment of $1,437,806.43, representing compensation for lost earnings
($829,794.00), pain and suffering ($250,000.00), and life care expenses for Year One
($358,012.43), in the form of a check payable to petitioner as guardian of the estate of R.M.R.,
for the benefit of R.M.R. No payments shall be made until petitioner provides respondent with
documentation establishing that she has been appointed as the guardian of R.M.R.'s estate. If
petitioner is not authorized by a court of competent jurisdiction to serve as guardian of the estate
of R.M.R., any such payment shall be made to the party or parties appointed by a court of
competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of R.M.R. upon
submission of written documentation of such appointment to the Secretary.
B. A lump sum payment of $3,852.60, representing compensation for past
unreimbursable expenses, in the form of a check payable to petitioner.
3 Should R.M.R. die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future medical
expenses, future lost earnings, and future pain and suffering.
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 7 of 24
C. A lump sum payment of $563,848.98, representing compensation for satisfaction of
the State of Illinois Medicaid lien, payable jointly to petitioner and
Illinois Department of Healthcare & Family Services
Bureau of Collections
Technical Recovery Section
P.O. Box 19174
Springfield, IL 62794-9174
Attn: Mr. Kevin Thornton
Medicaid #: 96-080-091613
Petitioner agrees to endorse this payment to the State of Illinois.
D. An amount sufficient to purchase the annuity contract,4 subject to the conditions
described below, that will provide payments for the life care items contained in the life care plan,
as illustrated by the chart at Tab A attached hereto, paid to the life insurance company5 from
which the annuity will be purchased.6 Compensation for Year Two (beginning on the first
anniversary of the date of judgment) and all subsequent years shall be provided through
4 In respondent’s discretion, respondent may purchase one or more annuity contracts from one
or more life insurance companies.
5 The Life Insurance Company must have a minimum of $250,000,000 capital and surplus,
exclusive of any mandatory security valuation reserve. The Life Insurance Company must have
one of the following ratings from two of the following rating organizations:
a. R.M.R. Best Company: A++, A+, A+g, A+p, A+r, or A+s;
b. Moody's Investor Service Claims Paying Rating: Aa3, Aa2, Aa1, or Aaa;
c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-,
AA, AA+, or AAA;
d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability
Rating: AA-, AA, AA+, or AAA.
6 Petitioner authorizes the disclosure of certain documents filed by the petitioner in this case
consistent with the Privacy Act and the routine uses described in the National Vaccine Injury
Compensation Program System of Records, No. 09-15-0056.
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Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 8 of 24
respondent's purchase of an annuity, which annuity shall make payments directly to petitioner as
guardian of the estate of R.M.R., only so long as R.M.R. is alive at the time a particular payment
is due. At the Secretary's sole discretion, the periodic payments may be provided to petitioner in
monthly, quarterly, annual or other installments. The "annual amounts" set forth in the chart at
Tab A describe only the total yearly sum to be paid to petitioner and do not require that the
payment be made in one annual installment.
1. Growth Rate
Respondent proffers that a four percent (4%) growth rate should be applied to all non-
medical life care items, and a five percent (5%) growth rate should be applied to all medical life
care items. Thus, the benefits illustrated in the chart at Tab A that are to be paid through annuity
payments should grow as follows: four percent (4%) compounded annually from the date of
judgment for non-medical items, and five percent (5%) compounded annually from the date of
judgment for medical items. Petitioner agrees.
2. Life-Contingent Annuity
Petitioner will continue to receive the annuity payments from the Life Insurance
Company only so long as R.M.R. is alive at the time that a particular payment is due. Written
notice shall be provided to the Secretary of Health and Human Services and the Life Insurance
Company within twenty (20) days of R.M.R.’s death.
3. Guardianship
No payments shall be made until petitioner provides respondent with documentation
establishing that she has been appointed as the guardian of R.M.R.’s estate. If petitioner is not
authorized by a court of competent jurisdiction to serve as guardian of the estate of R.M.R., any
such payment shall be made to the party or parties appointed by a court of competent jurisdiction
5 of 6

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 9 of 24
to serve as guardian(s)/conservator(s) of the estate of R.M.R. upon submission of written
documentation of such appointment to the Secretary.
III. Summary of Recommended Payments Following Judgment
A. Lump sum paid to petitioner as court-appointed
guardian of R.M.R.’s estate: $ 1,437,806.43
B. Paid to petitioner: $ 3,852.60
C. Medicaid Lien: $ 563,848.98
D. An amount sufficient to purchase the annuity contract described
above in section II. D.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
ALEXIS BABCOCK
Assistant Director
Torts Branch, Civil Division
/s/Adriana Teitel
ADRIANA TEITEL
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Telephone: (202) 616-3677
Dated: June 8, 2018
6 of 6

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 10 of 24
Appendix A: Items of Compensation for R.M.R. Page 1 of 15
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9
2018 2019 2020 2021-2022 2023 2024 2025 2026
Insurance Premium 5% M 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96
Insurance MOP Participating 5% 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00
Insurance MOP Non-Participating 5% 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00
Medicare Part B Premium 5% M
Medicare Part B Deductible 5%
Medicare Part D 5% M
Medigap 5% M
Dev Pediatrian 5% *
Physiatrist 5% *
Pediatrician/ Internist 5% *
Orthopedist 5% *
X-rays of Pelvis & Hips 5% *
X-rays of Spine 5% *
Urologist 5% *
Labs: UA & Culture Sensitivity 5% *
Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41 22.41
Neurologist 5% *
Labs: CBC, CMP etc 5% *
MRI of Brain 5% *
Movement Disorder Clinic 5% *
Botox Clinic 5% *
Botox Inj 5% *
Dentist 5%
Optometrist 4% *
Gastro-enterologist 5% *
Nutritionist 4% *
Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72 837.72
Scoliosis Screen 5% *
Surgical Correction of Scoliosis 5% *
Post Op X-rays 5% *
TLSO 4% *

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 11 of 24
Appendix A: Items of Compensation for R.M.R. Page 2 of 15
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9
2018 2019 2020 2021-2022 2023 2024 2025 2026
G-Tube Revision 5% *
Sleep Study 5% *
Endometrial Ablation 5% *
Hospitalization 5% *
Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00
Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50
Nitrofurantoin 5% *
Felbamate 5% *
Onfi 5% *
Gabapentin 5% *
Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00 286.00
Diazepam 2.5mg 5% *
Diazepam 10mg 5% *
Robinul 5% *
Albuterol 5% *
Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22 18.22
Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35 271.35
Adaptive Equip Eval 4% *
Electric Bed 4% 9,551.58
Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80 83.80
Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99 52.99
Seizure Activity Monitor 4% 1,399.00 1,399.00
Reclining Shower Chair 4% 2,280.80 2,280.80
Hand Held Shower 4% 31.31 6.26 6.26 6.26 6.26 6.26 6.26 6.26
Rifton Chair 4% 3,545.00 3,905.00
Stander 4% *
Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95 135.95
Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92 249.92
Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00
YMCA 4% 916.00 816.00 816.00 816.00 816.00 816.00 816.00 816.00
Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00 250.00

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 12 of 24
Appendix A: Items of Compensation for R.M.R. Page 3 of 15
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9
2018 2019 2020 2021-2022 2023 2024 2025 2026
WC Accessible Swing 4% 2,678.00
Special Needs Bike & Access 4% 1,420.00 1,420.00
Service Dog 4% 19,550.00 19,550.00
Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40
Suction Machine 4% *
Portable Suction Machine 4% *
Suction Container Kit 4% *
Yankauer Tip 4% *
Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62 897.62
Nebulizer 4% *
Nebulizer Mask 4% *
Nebulizer Tubing 4% *
Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69 2.69
Pulse Oximeter 4% *
Stethescope 4% 43.07 8.61 8.61 8.61 8.61 8.61 8.61 8.61
Feeding Pump 4% *
IV Pole 4% *
Feeding Pump Set 4% *
Enteral Oral Syringe 4% *
Feeding Set 4% *
Gauze 4% *
Syringe 4% *
Cotton Applicators 4% *
Compleat 4% *
Nutren 4% *
Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40 152.40
Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80
Diapers 4% M 1,191.49 1,191.49 1,191.49
Briefs 4% M 1,326.47 1,326.47 1,326.47 1,326.47 1,326.47
Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88 698.88
Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34 238.34

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 13 of 24
Appendix A: Items of Compensation for R.M.R. Page 4 of 15
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9
2018 2019 2020 2021-2022 2023 2024 2025 2026
Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66 141.66
Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16 173.16
Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50 317.50
Supply Storage 4% 201.95 13.46 13.46 13.46 13.46 13.46 13.46 13.46
Bilateral AFOs 4% *
Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00 130.00
WC Seating Eval & Clinic 4% *
Quickie 4% *
WC Maint 4% * 504.50 504.50 504.50 504.50 504.50 504.50 504.50 504.50
Backpack 4% 25.00 12.50 12.50 12.50 12.50 12.50 12.50 12.50
Portable Ramp 4% 339.00
Case Mngt 4% M 4,080.00 4,080.00 4,080.00 3,060.00 3,060.00 3,060.00 3,060.00 3,060.00
Home Mods 4% 77,307.00
Ceiling Lift 4% 11,000.00
Lift Motor Repl 4%
Slings 4% 597.04 298.52 298.52 298.52 298.52 298.52 298.52 298.52
Lift Battery 4% 60.00 30.00 30.00 30.00 30.00 30.00
Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00
Generator 4% 23,140.00
Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00 315.00
Car Seat 4% 2,640.00
WC Access Van 4% 53,061.00 45,101.85
AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00 114.00
Attendant Care 4% M 106,740.00 106,740.00 106,740.00 106,740.00 106,740.00 106,740.00 189,540.00 189,540.00
Lost Future Earnings 829,794.00
Pain and Suffering 250,000.00
Past Unreimbursable Expenses 3,852.60
Medicaid Lien 563,848.98
Annual Totals 2,005,508.01 159,193.61 159,253.61 158,338.59 167,343.39 158,338.59 305,790.44 250,690.17

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 14 of 24
Appendix A: Items of Compensation for R.M.R. Page 5 of 15
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9
2018 2019 2020 2021-2022 2023 2024 2025 2026
Note: Compensation Year 1 consists of the 12 month period following the date of judgment.
Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment.
As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/
conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00),
pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43.
As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo,
for past un-reimbursable expenses: $2,058.62.
As soon as practicable after entry of judgment, respondent shall make the following payment jointly to
petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98.
Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment.
Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment.
Items denoted with an asterisk (*) covered by health insurance and/or Medicare.
Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent.

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 15 of 24
Appendix A: Items of Compensation for R.M.R. Page 6 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17
2027 2028 2029 2030 2031 2032 2033 2034
Insurance Premium 5% M 3,417.96 3,524.64 3,631.32 3,746.16 3,861.12
Insurance MOP Participating 5% 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00
Insurance MOP Non-Participating 5% 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00
Medicare Part B Premium 5% M 1,608.00 1,608.00 1,608.00
Medicare Part B Deductible 5% 183.00 183.00 183.00
Medicare Part D 5% M 5,025.00 5,025.00 5,025.00
Medigap 5% M 3,888.00 3,888.00 3,888.00
Dev Pediatrian 5% *
Physiatrist 5% *
Pediatrician/ Internist 5% *
Orthopedist 5% *
X-rays of Pelvis & Hips 5% *
X-rays of Spine 5% *
Urologist 5% *
Labs: UA & Culture Sensitivity 5% *
Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41 22.41
Neurologist 5% *
Labs: CBC, CMP etc 5% *
MRI of Brain 5% *
Movement Disorder Clinic 5% *
Botox Clinic 5% *
Botox Inj 5% *
Dentist 5% 198.00 198.00 198.00
Optometrist 4% *
Gastro-enterologist 5% *
Nutritionist 4% *
Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72 837.72
Scoliosis Screen 5% *
Surgical Correction of Scoliosis 5% *
Post Op X-rays 5% *
TLSO 4% *

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 16 of 24
Appendix A: Items of Compensation for R.M.R. Page 7 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17
2027 2028 2029 2030 2031 2032 2033 2034
G-Tube Revision 5% *
Sleep Study 5% *
Endometrial Ablation 5% *
Hospitalization 5% *
Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00
Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50
Nitrofurantoin 5% *
Felbamate 5% *
Onfi 5% *
Gabapentin 5% *
Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00 286.00
Diazepam 2.5mg 5% *
Diazepam 10mg 5% *
Robinul 5% *
Albuterol 5% *
Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22 18.22
Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35 271.35
Adaptive Equip Eval 4% *
Electric Bed 4%
Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80 83.80
Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99 52.99
Seizure Activity Monitor 4% 1,399.00 1,399.00
Reclining Shower Chair 4% 2,280.80 2,280.80
Hand Held Shower 4% 6.26 6.26 6.26 6.26 6.26 6.26 6.26 6.26
Rifton Chair 4% 3,905.00
Stander 4% *
Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95 135.95
Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92 249.92
Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00
YMCA 4% 816.00 816.00 816.00 816.00 816.00 816.00 816.00 816.00
Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00 250.00

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 17 of 24
Appendix A: Items of Compensation for R.M.R. Page 8 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17
2027 2028 2029 2030 2031 2032 2033 2034
WC Accessible Swing 4% 2,678.00
Special Needs Bike & Access 4% 1,420.00 1,420.00
Service Dog 4% 19,550.00
Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40
Suction Machine 4% *
Portable Suction Machine 4% *
Suction Container Kit 4% *
Yankauer Tip 4% *
Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62 897.62
Nebulizer 4% *
Nebulizer Mask 4% *
Nebulizer Tubing 4% *
Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69 2.69
Pulse Oximeter 4% *
Stethescope 4% 8.61 8.61 8.61 8.61 8.61 8.61 8.61 8.61
Feeding Pump 4% *
IV Pole 4% *
Feeding Pump Set 4% *
Enteral Oral Syringe 4% *
Feeding Set 4% *
Gauze 4% *
Syringe 4% *
Cotton Applicators 4% *
Compleat 4% *
Nutren 4% *
Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40 152.40
Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80
Diapers 4% M
Briefs 4% M 1,326.47 1,326.47 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79
Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88 698.88
Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34 238.34

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 18 of 24
Appendix A: Items of Compensation for R.M.R. Page 9 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17
2027 2028 2029 2030 2031 2032 2033 2034
Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66 141.66
Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16 173.16
Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50 317.50
Supply Storage 4% 13.46 13.46 13.46 13.46 13.46 13.46 13.46 13.46
Bilateral AFOs 4% *
Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00 130.00
WC Seating Eval & Clinic 4% *
Quickie 4% *
WC Maint 4% * 504.50 504.50 504.50 504.50 504.50
Backpack 4% 12.50 12.50 12.50 12.50 12.50 12.50 12.50 12.50
Portable Ramp 4% 339.00
Case Mngt 4% M 3,060.00 3,060.00 3,060.00 3,060.00 3,060.00 2,040.00 2,040.00 2,040.00
Home Mods 4% 77,307.00
Ceiling Lift 4% 11,000.00
Lift Motor Repl 4% 5,000.00
Slings 4% 298.52 298.52 298.52 298.52 298.52 298.52 298.52 298.52
Lift Battery 4% 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00
Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00
Generator 4%
Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00 315.00
Car Seat 4%
WC Access Van 4% 45,101.85
AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00 114.00
Attendant Care 4% M 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00
Lost Future Earnings
Pain and Suffering
Past Unreimbursable Expenses
Medicaid Lien
Annual Totals 241,417.59 254,641.07 245,661.27 241,871.11 241,986.07 290,104.30 318,859.25 225,452.45

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 19 of 24
Appendix A: Items of Compensation for R.M.R. Page 10 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17
2027 2028 2029 2030 2031 2032 2033 2034
Note: Compensation Year 1 consists of the 12 month period following the date of judgment.
Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment.
As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/
conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00),
pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43.
As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo,
for past un-reimbursable expenses: $2,058.62.
As soon as practicable after entry of judgment, respondent shall make the following payment jointly to
petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98.
Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment.
Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment.
Items denoted with an asterisk (*) covered by health insurance and/or Medicare.
Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent.

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 20 of 24
Appendix A: Items of Compensation for R.M.R. Page 11 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life
2035 2036 2037 2038 2039 2040-2076 2077-Life
Insurance Premium 5% M
Insurance MOP Participating 5%
Insurance MOP Non-Participating 5%
Medicare Part B Premium 5% M 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00
Medicare Part B Deductible 5% 183.00 183.00 183.00 183.00 183.00 183.00 183.00
Medicare Part D 5% M 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00
Medigap 5% M 3,888.00 3,888.00 3,888.00 3,888.00 3,888.00 3,888.00 3,252.00
Dev Pediatrian 5% *
Physiatrist 5% *
Pediatrician/ Internist 5% *
Orthopedist 5% *
X-rays of Pelvis & Hips 5% *
X-rays of Spine 5% *
Urologist 5% *
Labs: UA & Culture Sensitivity 5% *
Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41
Neurologist 5% *
Labs: CBC, CMP etc 5% *
MRI of Brain 5% *
Movement Disorder Clinic 5% *
Botox Clinic 5% *
Botox Inj 5% *
Dentist 5% 198.00 198.00 198.00 198.00 198.00 198.00 198.00
Optometrist 4% *
Gastro-enterologist 5% *
Nutritionist 4% *
Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72
Scoliosis Screen 5% *
Surgical Correction of Scoliosis 5% *
Post Op X-rays 5% *
TLSO 4% *

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 21 of 24
Appendix A: Items of Compensation for R.M.R. Page 12 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life
2035 2036 2037 2038 2039 2040-2076 2077-Life
G-Tube Revision 5% *
Sleep Study 5% *
Endometrial Ablation 5% *
Hospitalization 5% *
Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00
Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50
Nitrofurantoin 5% *
Felbamate 5% *
Onfi 5% *
Gabapentin 5% *
Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00
Diazepam 2.5mg 5% *
Diazepam 10mg 5% *
Robinul 5% *
Albuterol 5% *
Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22
Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35
Adaptive Equip Eval 4% *
Electric Bed 4% 9,551.58 955.16 955.16 955.16 955.16 955.16
Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80
Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99
Seizure Activity Monitor 4% 1,399.00 279.80 279.80 279.80
Reclining Shower Chair 4% 2,280.80 456.16 456.16 456.16
Hand Held Shower 4% 6.26 6.26 6.26 6.26 6.26 6.26 6.26
Rifton Chair 4% 3,905.00 650.83 650.83 650.83 650.83 650.83 650.83
Stander 4% *
Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95
Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92
Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00
YMCA 4% 816.00 816.00 816.00 816.00 816.00 816.00 816.00
Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 22 of 24
Appendix A: Items of Compensation for R.M.R. Page 13 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life
2035 2036 2037 2038 2039 2040-2076 2077-Life
WC Accessible Swing 4% 2,678.00 267.80 267.80 267.80
Special Needs Bike & Access 4% 1,420.00 284.00 284.00 284.00
Service Dog 4% 19,550.00 2,792.86 2,792.86
Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40
Suction Machine 4% *
Portable Suction Machine 4% *
Suction Container Kit 4% *
Yankauer Tip 4% *
Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62
Nebulizer 4% *
Nebulizer Mask 4% *
Nebulizer Tubing 4% *
Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69
Pulse Oximeter 4% *
Stethescope 4% 8.61 8.61 8.61 8.61 8.61 8.61 8.61
Feeding Pump 4% *
IV Pole 4% *
Feeding Pump Set 4% *
Enteral Oral Syringe 4% *
Feeding Set 4% *
Gauze 4% *
Syringe 4% *
Cotton Applicators 4% *
Compleat 4% *
Nutren 4% *
Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40
Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80
Diapers 4% M
Briefs 4% M 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79
Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88
Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 23 of 24
Appendix A: Items of Compensation for R.M.R. Page 14 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life
2035 2036 2037 2038 2039 2040-2076 2077-Life
Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66
Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16
Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50
Supply Storage 4% 13.46 13.46 13.46 13.46 13.46 13.46 13.46
Bilateral AFOs 4% *
Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00
WC Seating Eval & Clinic 4% *
Quickie 4% *
WC Maint 4% *
Backpack 4% 12.50 12.50 12.50 12.50 12.50 12.50 12.50
Portable Ramp 4% 339.00 33.90 33.90 33.90
Case Mngt 4% M 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00
Home Mods 4%
Ceiling Lift 4%
Lift Motor Repl 4% 5,000.00 500.00 500.00 500.00
Slings 4% 298.52 298.52 298.52 298.52 298.52 298.52 298.52
Lift Battery 4% 30.00 30.00 30.00 30.00 30.00 30.00 30.00
Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00
Generator 4% 23,140.00 1,157.00 1,157.00 1,157.00
Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00
Car Seat 4%
WC Access Van 4% 45,101.85 6,443.12 6,443.12
AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00
Attendant Care 4% M 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00
Lost Future Earnings
Pain and Suffering
Past Unreimbursable Expenses
Medicaid Lien
Annual Totals 418,897.45 425,194.86 416,598.44 452,855.24 484,228.95 428,813.08 428,177.08

Case 1:15-vv-00406-UNJ Document 93 Filed 08/13/18 Page 24 of 24
Appendix A: Items of Compensation for R.M.R. Page 15 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life
2035 2036 2037 2038 2039 2040-2076 2077-Life
Note: Compensation Year 1 consists of the 12 month period following the date of judgment.
Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment.
As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/
conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00),
pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43.
As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo,
for past un-reimbursable expenses: $2,058.62.
As soon as practicable after entry of judgment, respondent shall make the following payment jointly to
petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98.
Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment.
Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment.
Items denoted with an asterisk (*) covered by health insurance and/or Medicare.
Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent.