VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-00532
Package ID: USCOURTS-cofc-1_15-vv-00532
Petitioner: Karl Steger
Filed: 2015-09-22
Decided: 2016-02-08
Vaccine: MMR
Vaccination date: 2012-07-05
Condition: aplastic anemia
Outcome: dismissed
Award amount USD: 

AI-assisted case summary:
Karl Steger, born July 24, 1968, filed a petition on September 22, 2015, alleging that the measles-mumps-rubella (MMR), Twinrix, and chickenpox (Varicella) vaccines administered on July 5, 2012, caused him to develop aplastic anemia with an onset four and one-half months later. Mr. Steger also received other vaccines around this time, including influenza, meningococcal (Menactra), inactivated polio (IPV), tetanus-diphtheria-acellular pertussis (TdaP), typhoid, PPV23, Japanese encephalitis, and rabies vaccines. He reported symptoms including shortness of breath, joint pain, weakness, jaundice, and a change in vision with blind spots. Medical records from December 1, 2012, indicated critical pancytopenia consistent with aplastic anemia and optic neuritis. The respondent was the Secretary of Health and Human Services. Mr. Steger did not file a medical expert opinion to support his claim of causation and stated he would not pursue a hearing with expert witness testimony. Special Master Laura D. Millman reviewed the medical records and found they did not substantiate Mr. Steger's allegations. The Special Master noted that the Vaccine Act does not permit a ruling for the petitioner based solely on claims unsubstantiated by medical records or medical opinion. As Mr. Steger failed to meet his burden of proving causation by a preponderance of the evidence, the case was dismissed. Subsequently, on February 8, 2016, the parties filed a stipulation of fact regarding attorneys' fees and costs. Special Master Millman awarded $10,450.00, representing reimbursement for attorneys' fees and costs, payable jointly to Mr. Steger and his counsel, Maglio Christopher and Toale, P.A. Petitioner's counsel was Danielle A. Strait, and respondent's counsel was Douglas Ross.

Theory of causation field:
Petitioner Karl Steger alleged that MMR, Twinrix, and Varicella vaccines administered on July 5, 2012, caused aplastic anemia with onset four and one-half months later. The public decision does not describe the specific medical theory or mechanism of causation. Petitioner did not file a medical expert opinion to support his claim and stated he would not pursue a hearing with expert testimony. The Special Master found that the medical records did not substantiate the allegations and that petitioner failed to meet his burden of proving causation by a preponderance of the evidence, specifically citing the lack of a "reputable medical or scientific explanation" as required by Althen v. Sec’y of HHS. The case was dismissed. Attorneys for petitioner were Danielle A. Strait and respondent's counsel was Douglas Ross. Special Master Laura D. Millman issued the decision on September 22, 2015, dismissing the petition. A subsequent decision on February 8, 2016, awarded $10,450.00 in attorneys' fees and costs based on a stipulation.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-00532-0
Date issued/filed: 2015-10-13
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 09/22/2015) regarding 15 DECISION of Special Master Signed by Special Master Laura D Millman. (tlf) Copy to parties.
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Case 1:15-vv-00532-UNJ Document 16 Filed 10/13/15 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-532V
Filed: September 22, 2015
Not to be Published
*************************************
KARL STEGER, *
*
Petitioner, * Petitioner’s motion for a ruling
* on the record granted; no expert
v. * report to prove vaccinations
* caused aplastic anemia four and
SECRETARY OF HEALTH * one-half months later
AND HUMAN SERVICES, *
*
Respondent. *
*
*************************************
Danielle A. Strait, Washington, DC, for petitioner.
Douglas Ross, Washington, DC, for respondent.
MILLMAN, Special Master
DECISION1
On May 26, 2015, petitioner filed a petition under the National Childhood Vaccine Injury
Act, 42 U.S.C. § 300aa-10-34 (2012), alleging that measles-mumps-rubella (“MMR”), Twinrix
(hepatitis A and B), and chickenpox (“Varicella”) vaccines2 administered on July 5, 2012 caused
him aplastic anemia whose onset was four and one-half months later.
The undersigned, having reviewed the medical records, finds they do not support
petitioner’s allegations. The undersigned cannot rule in petitioner’s favor based solely on his
1 Because this decision contains a reasoned explanation for the special master’s action in this case, the special master
intends to post this decision on the United States Court of Federal Claims’ website, in accordance with the E-
Government Act of 2002, Pub. L. No. 107-347, 116 Stat. 2899, 2913 (Dec. 17, 2002). Vaccine Rule 18(b) states
that all decisions of the special masters will be made available to the public unless they contain trade secrets or
commercial or financial information that is privileged and confidential, or medical or similar information whose
disclosure would constitute a clearly unwarranted invasion of privacy. When such a decision is filed, petitioners
have 14 days to identify and move to redact such information prior to the document’s disclosure. If the special
master, upon review, agrees that the identified material fits within the categories listed above, the special master
shall redact such material from public access.
2 In addition, on July 5, 2012, petitioner received vaccines against Japanese encephalitis and rabies. These vaccines
are not included in the Vaccine Injury Table and, therefore, any damage attributable to them is not compensable
under the Vaccine Act. Moreover, on July 30, 2012, petitioner received another rabies vaccination.

Case 1:15-vv-00532-UNJ Document 16 Filed 10/13/15 Page 2 of 4
allegations unsupported by medical records or medical opinion. 42 U.S.C. § 300aa-11(a)(1).
Petitioner has not filed a medical expert opinion in support of his allegations.
On September 21, 2015, petitioner filed a Motion for a Decision on the Record, stating he
will not proffer the opinion of a medical expert and will not pursue a hearing with expert witness
testimony. Pet’r’s Mot. at 2.
The undersigned GRANTS petitioner’s motion and DISMISSES this case.
FACTS
Petitioner was born on July 24, 1968.
In preparation for a business trip to India, he took multiple vaccinations. On May 28,
2012, petitioner received the influenza, meningococcal (“Menactra”), inactivated polio (“IPV”),
tetanus-diphtheria-acellular pertussis (“TdaP”), Twinrix, typhoid, and PPV23 vaccines.3 Med.
recs. Ex. 1, at 1. On June 7, 2012, petitioner received the Japanese encephalitis vaccine, MMR,
and Varivax. Id. at 2. On July 5, 2012, petitioner received the Japanese encephalitis vaccine,
MMR, the rabies vaccine, Twinrix, and Varicella. Id. at 3. On July 20, 2012, petitioner received
the rabies vaccine. Id. at 4.
On December 1, 2012, petitioner saw RN Kimberly Brancato at Lee Memorial System
Emergency Department. Med. recs. Ex. 2, at 15. He complained of shortness of breath for one
week. Id. He had decreased activity tolerance. Id. Petitioner said he had been in India three
weeks previously (which would be early November 2012) and began having problems at that
time. Id. He had pain in his joints and chest, weakness, and breathing difficulties. Id. He was
pale and lightly jaundiced. Id. He said he had a change in vision with blind spots. Id.
Also on December 1, 2012, petitioner saw Dr. Roger A. Howell. Id. at 15. Petitioner
complained of not feeling well for the last several days, with shortness of breath, chest pain,
generalized arthralgias and myalgias, and associated nausea. Id. He recently returned from India
a few weeks ago. Id. He had been in India for about 10 days, but was not exposed to infectious
diseases. Id. Dr. Howell diagnosed petitioner with critical pancytopenia consistent with aplastic
anemia. Id. at 16.
On December 3, 2012, petitioner saw Dr. Esther E. Morrison in consultation. Id. at 27.
Petitioner had a history of chronic neck pain and occipital headache, and had been taking nine
aspirins daily for the past 10 years. Id. He went to India for 10 days and returned on November
9, 2012. Id. The onset of his illness was about one week later (or November 16, 2012). Id.
Petitioner took Malarone for malaria prophylaxis, the rabies vaccine in July, the Japanese
encephalitis vaccine in June and July, the hepatitis A and B vaccine with rubella vaccine in July,
the varicella vaccine, TdaP, and the pneumococcal vaccine. Id. at 28. He had optic neuritis. Id.
Dr. Morrison stated, “I suspect the etiology of the pancytopenia is also causing the optic
3 Typhoid vaccine and PPV23 (pneumococcal polysaccharide) vaccine are not included in the Vaccine Injury Table.
2

Case 1:15-vv-00532-UNJ Document 16 Filed 10/13/15 Page 3 of 4
neuritis.” Id.
On December 7, 2012, petitioner saw Dr. Andres Laufer. Id. at 17. Petitioner told Dr.
Laufer he had no problems during his travel in India. Id.
On December 7, 2012, petitioner was at Barnes Jewish Hospital. Med. recs. Ex. 4, at
284. The history he gave was that he was in his normal state of health when he began taking
Malarone on October 30, 2012 in preparation for a trip to India from November 1-3, 2012. Id.
He had multiple immunizations prior to the trip as well. Id. There was some mosquito exposure
in India. Id. Upon return to the United States, petitioner began having mild headaches,
blurring/spotty vision, joint pain, chills, nose bleed caused by blowing his nose, chest pain, and
dyspnea. Id. His symptoms worsened and he went to the emergency room on November 30,
2012. Id. He discontinued Malarone on November 16, 2012. Id.
On December 28, 2012, petitioner saw Dr. Peter Westervelt, an internist concerned with
bone marrow transplant. Med. recs. Ex. 13, at 156. In the family history, Dr. Westervelt notes
that petitioner’s aunt also had aplastic anemia felt to be related to a nonsteroidal anti-
inflammatory drug. Id. at 157.
DISCUSSION
To satisfy his burden of proving causation in fact, petitioner must prove by preponderant
evidence: “(1) a medical theory causally connecting the vaccination and the injury; (2) a logical
sequence of cause and effect showing that the vaccination was the reason for the injury; and (3) a
showing of a proximate temporal relationship between vaccination and injury.’” Althen v. Sec’y
of HHS, 418 F.3d 1274, 1278 (Fed. Cir. 2005). In Althen, the Federal Circuit quoted its opinion
in Grant v. Secretary of Health and Human Services, 956 F.2d 1144, 1148 (Fed. Cir. 1992):
A persuasive medical theory is demonstrated by “proof of a logical
sequence of cause of and effect showing that the vaccination was
the reason for the injury [,]” the logical sequence being supported
by a “reputable medical or scientific explanation[,]” i.e., “evidence
in the form of scientific studies or expert medical testimony[.]”
418 F.3d at 1278.
Without more, “evidence showing an absence of other causes does not meet petitioners’
affirmative duty to show actual or legal causation.” Grant, 956 F.2d at 1149. Mere temporal
association is not sufficient to prove causation in fact. Id. at 1148.
Petitioner must show not only that but for his July 5, 2012 vaccinations, he would not
have had aplastic anemia, but also that his July 5, 2012 vaccinations were a substantial factor in
causing his aplastic anemia. Shyface v. Sec’y of HHS 165 F.3d 1344, 1352 (Fed. Cir. 1999).
3

Case 1:15-vv-00532-UNJ Document 16 Filed 10/13/15 Page 4 of 4
The Vaccine Act does not permit the undersigned to rule for petitioner based on his
claims alone, “unsubstantiated by medical records or by medical opinion.” 42 U.S.C. § 300aa-
13(a)(1). In the instant action, none of petitioner’s medical records substantiate petitioner’s
allegation that vaccines administered July 5, 2012 caused his aplastic anemia whose onset was
four and one-half months later. Moreover, petitioner has not filed an expert medical opinion
substantiating his allegation.
The undersigned GRANTS petitioner’s Motion for a Ruling on the Record and
DISMISSES this case for petitioner’s failure to prove by a preponderance of the evidence the
matters required in the petition. 42 U.S.C. § 300aa-13(a)(1).
CONCLUSION
This petition is DISMISSED. In the absence of a motion for review filed pursuant to
RCFC, Appendix B, the clerk of the court is directed to enter judgment herewith.4
IT IS SO ORDERED.
Dated: September 22, 2015 /s/ Laura D. Millman
Laura D. Millman
Special Master
4 Pursuant to Vaccine Rule 11(b), entry of judgment can be expedited by each party, either jointly or separately,
filing a notice renouncing the right to seek review.
4

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DOCUMENT 2: USCOURTS-cofc-1_15-vv-00532-1
Date issued/filed: 2016-02-29
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 02/08/2016) regarding 20 DECISION Fees Stipulation/Proffer Signed by Special Master Laura D Millman. (tlf) Copy to parties.
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Case 1:15-vv-00532-UNJ Document 23 Filed 02/29/16 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-532V
Filed: February 8, 2016
Not for Publication
*************************************
KARL STEGER, *
*
Petitioner, *
*
Attorneys’ fees and costs decision
v. *
based on stipulation of fact
*
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
*
*************************************
Danielle A. Strait, Washington, DC, for petitioner.
Douglas Ross, Washington, DC, for respondent.
MILLMAN, Special Master
DECISION AWARDING ATTORNEYS’ FEES AND COSTS1
On February 8, 2016, the parties filed a stipulation of fact in which they agreed on an
appropriate amount for attorneys’ fees and costs in this case.
In accordance with General Order #9, petitioner asserts that he did not incur any costs in
pursuit of his petition. Petitioner submitted his request for attorneys’ fees and costs to
respondent. During informal discussions, respondent raised objections to certain aspects of
petitioner’s application. Based on these objections, petitioner amends his application for
attorneys’ fees and costs to $10,450.00. Respondent does not object to this amount. The
1 Because this unpublished decision contains a reasoned explanation for the special master’s action in this
case, the special master intends to post this unpublished decision on the United States Court of Federal
Claims’s website, in accordance with 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion
of Electronic Government Services). Vaccine Rule 18(b) states that all decisions of the special masters
will be made available to the public unless they contain trade secrets or commercial or financial
information that is privileged and confidential, or medical or similar information whose disclosure would
constitute a clearly unwarranted invasion of privacy. When such a decision is filed, petitioner has 14 days
to identify and move to redact such information prior to the document=s disclosure. If the special master,
upon review, agrees that the identified material fits within the banned categories listed above, the special
master shall redact such material from public access.

Case 1:15-vv-00532-UNJ Document 23 Filed 02/29/16 Page 2 of 2
undersigned finds this amount to be reasonable. Accordingly, the court awards $10,450.00,
representing reimbursement for attorneys’ fees and costs. The award shall be in the form of a
check payable jointly to petitioner and Maglio Christopher and Toale, P.A. for $10,450.00.
In the absence of a motion for review filed pursuant to RCFC Appendix B, the clerk of
the court is directed to enter judgment herewith.2
IT IS SO ORDERED.
Dated: February 8, 2016 s/ Laura D. Millman
Laura D. Millman
Special Master
2 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by each party, either separately or
jointly, filing a notice renouncing the right to seek review.
2