VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-01011
Package ID: USCOURTS-cofc-1_15-vv-01011
Petitioner: Amrit Dhanoa
Filed: 2015-09-11
Decided: 2018-03-09
Vaccine: influenza
Vaccination date: 2014-08-19
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 95763

AI-assisted case summary:
Amrit Dhanoa filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered a shoulder injury related to vaccine administration (SIRVA) caused in fact by the influenza vaccine she received on August 19, 2014. The case was assigned to the Special Processing Unit due to the nature of the claim. Respondent initially raised concerns about the evidence, particularly regarding the arm of vaccination and the onset of symptoms, but the court later determined that the vaccine was administered in the right arm and onset occurred within 48 hours. Although SIRVA was not yet on the Vaccine Injury Table at the time of filing, the court found that Ms. Dhanoa met the criteria for SIRVA and proved causation-in-fact under Althen. Following the ruling on entitlement, the parties were unable to agree on damages, leading to a decision awarding compensation. The court awarded Ms. Dhanoa $95,763.14, which included $862.15 for past unreimbursable medical expenses and $94,900.99 for past and future pain and suffering. This amount was determined after considering the severity and duration of her pain, limited range of motion, and impact on daily activities, as well as comparing her case to other SIRVA claims.

Theory of causation field:
Off-Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-01011-0
Date issued/filed: 2017-12-08
Pages: 7
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/19/2017) regarding 42 Findings of Fact & Conclusions of Law,, Scheduling Order, ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-1011V
Filed: April 19, 2017
Published
* * * * * * * * * * * * * * * * * * * * * * * * *
AMRIT DHANOA, *
*
Petitioner, * Finding of Fact; Influenza (“Flu”)
v. * Vaccine; Shoulder Injury Related to
* Vaccine Administration (“SIRVA”);
SECRETARY OF HEALTH * Adhesive Capsulitis; Location of
AND HUMAN SERVICES, * Vaccination; Special Processing Unit
* (“SPU”)
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for petitioner.
Ann Donohue Martin, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON FACTS1 AND SCHEDULING ORDER– SPECIAL PROCESSING UNIT
Dorsey, Chief Special Master:
On September 11, 2015, Amrit Dhanoa (“petitioner” or “Ms. Dhanoa”) filed a petition for
compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10,
et seq., (the “Vaccine Act” or “Program”). Petitioner alleges that she suffered an injury to her
right shoulder, including adhesive capsulitis and shoulder injury related to vaccine administration
(“SIRVA”), as a result of an influenza (“flu”) vaccine she received on August 19, 2014. Petition
at 1-2. The case was assigned to the Special Processing Unit (“SPU”).
Prompting this fact ruling is a joint status report filed on March 20, 2017, requesting a
written determination of whether the flu vaccine was administered in petitioner’s left or right arm
and whether the onset of petitioner’s right shoulder pain occurred within forty-eight hours of
petitioner’s flu vaccination. After a review of the record as a whole, a fact hearing, and for the
reasons set forth below, the undersigned finds by preponderant evidence that (1) Ms. Dhanoa
received her August 19, 2014 flu vaccination in her right arm and (2) the onset of Ms. Dhanoa’s
right shoulder pain occurred within forty-eight hours of her flu vaccination.
1 Because this unpublished order and ruling contains a reasoned explanation for the action in this case, the
undersigned intends to post it on the United States Court of Federal Claims' website, in accordance with the E-
Government Act of 2002. 44 U.S.C. § 3501 note (2012)(Federal Management and Promotion of Electronic
Government Services). In accordance with Vaccine Rule 18(b), petitioner has 14 days to identify and move to
redact medical or other information, the disclosure of which would constitute an unwarranted invasion of privacy.
If, upon review, the undersigned agrees that the identified material fits within this definition, the undersigned will
redact such material from public access.

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 2 of 7
I. Procedural History
In the petition filed on September 11, 2015, Ms. Dhanoa asserts that she received a flu
vaccine on August 19, 2014, at CVS Pharmacy in Richardson, Texas. Petition at 2, ¶3. The
statement of completion was also filed on September 11, 2015, signifying that petitioner believed
that all relevant medical records had been filed. See Statement of Completion (ECF No. 2). A
notice of assignment to Chief Special Master Nora Beth Dorsey as an SPU case was entered on
September 14, 2015. See Notice (ECF No. 7). An initial status conference was set for October
26, 2015.
On December 9, 2015, respondent filed a Rule 4(c) Report asserting that petitioner’s
request for entitlement to compensation under the Vaccine Act be denied. Respondent’s Report
at 1 (ECF No. 14). On January 15, 2016, the undersigned ordered petitioner to file additional
medical records, an updated exhibit list, and a second statement of completion. See Scheduling
Order at 1 (ECF No. 15). Petitioner was also ordered to file an affidavit to explain any
unavailable medical records. Id. Petitioner filed her CVS vaccination record on February 16,
2016, an affidavit of Petitioner on February 26, 2016, additional medical records and an exhibit
list on February 29, 2016, and a statement of completion on February 29, 2016. See Petitioner’s
Exhibits (“Pet. Exs.”) 10-12 (ECF Nos. 16-18); Exhibit List (ECF No. 19); Statement of
Completion (ECF No. 20).
A status conference was held on March 29, 2016. The parties were ordered to file a status
report regarding settlement discussions. See Scheduling Order (ECF No. 21). The joint status
report filed on May 2, 2016 indicated that the parties were unclear about whether the case could
be resolved by settlement, but the parties requested an extension of time to continue to pursue
settlement discussions. See Joint Status Report (ECF No. 22). A joint status report was filed on
May 26, 2016, in which the parties reported that they believed “resolving [the] case by
settlement [was] not feasible.” See Joint Status Report (ECF No. 24).
On June 30, 2016, the undersigned convened a telephonic status conference pursuant to
Vaccine Rule 5 to share with the parties her tentative findings and conclusions. The Rule 5
Scheduling Order filed on July 5, 2016 presents the undersigned’s tentative findings and
conclusions.2 See Rule 5 Scheduling Order at 2-3 (ECF No. 25). A joint status report filed on
July 27, 2016 stated that “the parties have discussed this case in detail following the Rule 5
Conference and believe a fact hearing is necessary to reach a resolution.” Joint Status Report
(ECF No. 26).
A fact hearing occurred before the undersigned in Dallas, Texas on December 8, 2016.
After the hearing, petitioner was ordered to file outstanding medical records. Post-Hearing Order
2 The undersigned’s preliminary findings and conclusions are as follows: (1) Petitioner received the flu vaccination
alleged as causal in her right (injured) arm; (2) Petitioner’s onset was immediate; (3) Petitioner’s failure to mention
her shoulder pain to her primary care physician on August 21, 2014 or her dermatologist on August 28, 2014 and
September 30, 2014 was reasonable; and (4) Petitioner’s clinical course and diagnosis was consistent with a SIRVA.
2

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 3 of 7
(ECF No. 31). She filed the additional medical records on January 10, 2017, February 10, 2017,
and February 22, 2017.3
On March 20, 2017, the parties filed a joint status report requesting a written
determination regarding whether the flu vaccine was administered in petitioner’s left or right arm
and whether the onset of petitioner’s right shoulder pain occurred within forty-eight hours of
petitioner’s flu vaccination. Status Report (ECF No. 41). The undersigned now issues this fact
ruling.
II. Factual History
Ms. Dhanoa’s medical history before her 2014 flu vaccination is significant for diabetes,
heart problems, and rash. On June 14, 2013, Ms. Dhanoa visited her cardiologist, Dr. Agrawal,
with complaints of weakness, fatigue, dizziness, atypical abdominal discomfort, and palpitations.
Pet. Ex. 5 at 9. Ms. Dhanoa “was hospitalized approximately 3 years ago with palpitations and
atypical chest pain.” Id. On June 4, 2014, Ms. Dhanoa called her cardiologist due to her
experience of waking up with chest pressure and sobbing at night. Id. at 8. On August 13, 2014,
Ms. Dhanoa visited Dr. Steinmetz with complaints of a spreading rash. Pet. Ex. 7 at 5.
On August 19, 2014, Ms. Dhanoa received a flu vaccine at CVS Pharmacy in Richardson,
Texas. Pet. Ex. 1 at 6; see also Pet. Ex. 10. The vaccination record indicates the vaccination was
administered by intramuscular injection but does not indicate the injection site. Id. Ms. Dhanoa
saw her primary doctor, Dr. Naghmi, on August 21, 2014 for the purpose of receiving treatment
for her rash. Pet. Ex. 2 at 7. The medical record does not mention any complaints of right arm or
shoulder pain. Id. Instead, the medical record states that Ms. Dhanoa “denies joint and muscle
pain” and “ROM intact for spine and extremities.” Id.
On August 28, 2014, Ms. Dhanoa saw her dermatologist, Dr. Aponte, to receive
treatment for her rash which was worsening and “ha[d] been occurring for 1 year.” Pet. Ex. 8 at
7. Ms. Dhanoa followed up with Dr. Aponte about her rash on September 30, 2014. Id. at 6. The
medical records from these two visits do not mention Ms. Dhanoa’s right shoulder pain. Id.
On October 31, 2014, Ms. Dhanoa visited her primary doctor, Dr. Naghmi, complaining
of pain in her right shoulder. Pet. Ex. 2 at 6. The medical record states that Ms. Dhanoa had
“joint and muscle pain” and that “ROM [is] mildly painful for right shoulder.” Id. The medical
record also states that Ms. Dhanoa had right shoulder pain for six weeks. Id.
On November 24, 2014, Ms. Dhanoa visited Dr. Jeffrey Klein at Orthopedic & Sports
Medical Center due to right shoulder pain. Pet. Ex. 4 at 16. Ms. Dhanoa completed a medical
3 On January 10, 2017, petitioner filed medical records from Procare Medical Center and billing records from
Orthopedic & Sports Medicine Center. See Pet. Exs. 13-14 (ECF No. 34). In a status report filed the same day,
petitioner indicated Orthopedic & Sports Medicine Center had mistakenly provided petitioner’s billing records
instead of her medical records. Status Report (ECF No. 35). Petitioner further indicated that she expected to receive
and file the medical records from Orthopedic & Sports Medicine Center within 30 days. Id. On February 10, 2017,
petitioner filed these medical records and a statement of completion. See Pet. Ex. 15 (ECF No. 37); Statement of
Completion (ECF No. 38). Petitioner also filed additional medical records from Orthopedic & Sports Medicine
Center on February 22, 2017. See Pet. Ex. 16 (ECF No. 40).
3

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 4 of 7
history information form during her visitation. Id. at 7-8. In response to a question which asked
Ms. Dhanoa if she intends to make any claims, Ms. Dhanoa stated, “if it does not go away after 6
months till Jan 15 or till March 15.” Id. at 8. The medical record states that Ms. Dhanoa had a
“three-month history of decreasing range of motion, increasing pain in the right shoulder,” and
that her pain “started after she got an influenza shot in August.” Id. at 16. Dr. Klein diagnosed
Ms. Dhanoa with adhesive capsulitis and prescribed anti-inflammatory medication. Id. He also
wrote a physical therapy prescription for Ms. Dhanoa. Id. at 23.
On December 15, 2014, Ms. Dhanoa visited her orthopedist for a follow up office visit.
Id. at 15. The medical record states that Ms. Dhanoa “has been taking the anti-inflammatory
medicines” and “going to therapy.” Id. The evaluation states that Ms. Dhanoa made slight
improvements since her last evaluation. Id.
On December 17, 2014, Ms. Dhanoa visited her cardiologist, Dr. Agrawal, and
mentioned her flu shot. Pet. Ex. 5 at 5. The medical record states that Ms. Dhanoa received “a
Flu shot in her right shoulder about 2-3 weeks ago and since then, she has experienced severe
pains in the shoulder and arm. As well as back.” Id.
On December 29, 2014, Ms. Dhanoa had a follow up visit with her primary doctor, Dr.
Naghmi, regarding a few complaints, one of them being the pain in her right shoulder. Pet. Ex. 2
at 5. She saw Dr. Naghmi again on January 5, 2015 regarding health complaints, but there is no
mention of right shoulder pain in the record from that visit. Id. at 4.
On January 9, 2015, Ms. Dhanoa had a follow up visit with her orthopedist and was
advised to continue physical therapy and home rehab. Pet. Ex. 4 at 14. Ms. Dhanoa saw her
orthopedist again on February 10, 2015, and the medical record notes that “[s]he is not making
much progress.” Id. at 13. On April 24, 2015, she was still experiencing pain in her right
shoulder and having trouble sleeping. Id. at 12. Ms. Dhanoa received an injection during this
visit, and was advised to continue her anti-inflammatory medicine and therapy. Id. On May 13,
2015, Ms. Dhanoa began her physical therapy at Rehab Management. Pet. Ex. 12 at 32. On June,
18, 2015, Ms. Dhanoa followed up with Dr. Klein, who stressed the importance of physical
therapy. Pet. Ex. 4 at 11. Ms. Dhanoa’s last formal physical therapy session was on August 13,
2015. Pet. Ex. 12 at 3. She was discharged from physical therapy for failure to schedule future
appointments. Id. at 2.
III. Parties’ Arguments
In her Rule 4, respondent argues that petitioner is not entitled to compensation. (ECF No.
14). The respondent notes that the vaccination record is silent as to the specific location of the
vaccine. Id. at 2, 5. Respondent argues that petitioner’s onset was not immediate. To support
respondent’s argument, respondent notes that petitioner’s examination by her primary doctor on
August 21, 2014 showed a normal range of motion in all extremities. Id. at 5. Respondent also
points out that petitioner did not complain of shoulder pain until October 31, 2014, when she
mentioned her pain began six weeks prior to this visit. Id. Respondent adds that the medical
report from petitioner’s visit to her cardiologist on December 17, 2015 states that petitioner
received her flu shot and experienced pain about two to three weeks prior to visit. Id. at 6.
4

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 5 of 7
Petitioner has no personal or family history of any shoulder injuries. Petition at 1, ¶2. In
her affidavit, she alleges that she felt severe pain in her right shoulder immediately after her flu
vaccination on August 19, 2014. Pet. Ex. 11 at 1, ¶4. She took Tylenol after her flu vaccine for
pain relief. Pet. Ex. 11 at 1, ¶5. Petitioner went to her primary care physician, Dr. Naghmi, on
August 21, 2014 for the purpose of treating a spreading rash and although “[her] right shoulder
was sore” she “thought it was normal pain from vaccination and did not think to mention it to
[her] doctor.” Id. at 1, ¶6. To provide additional clarification regarding her delay complaining of
shoulder pain, Ms. Dhanoa stated that she “ha[s] had vaccines before and experienced pain, [and]
I thought this was no different.” Id. Ms. Dhanoa did not mention her shoulder pain to her
dermatologist on August 28, 2014 and September 30, 2014, reasoning that she was treating the
pain on her own with Tylenol and that “Dr. Aponte is a dermatologist and was not the doctor
[she] would see for a shoulder injury.” Id. at 1-2, ¶7.
Ms. Dhanoa also clarified that her October 31, 2014 appointment, where the medical
record notes that her right shoulder pain began six weeks prior, “was an estimation regarding the
onset of the pain,” and “[t]he pain in [her] right shoulder began after receiving the influenza
vaccination and slowly got worse over the following weeks.” Id. at 2, ¶8; see also Transcript of
Proceedings (“Tr.”) at 23 (ECF No. 33). In regard to Ms. Dhanoa’s December 12, 2014 visit to
her cardiologist, Ms. Dhanoa clarified that her doctor’s note, which states that she received her
flu vaccination 2-3 weeks prior, is an incorrect timeline because she “received [her] flu
vaccination 2-3 months prior to this visit on August 19, 2014.” Pet. Ex. 11 at 2, ¶12.
Ms. Dhanoa testified that her shoulder pain became increasingly painful over time after
she received her flu shot on August 19, 2014. Her pain level started at a level five out of ten and
increased as high as 10.5. See Tr. at 10, 18, 24, 29. She testified that her pain limited her
activities of daily life such as Zumba, swimming, household work, opening doors, and getting
dressed and combing her hair. Tr. at 29, 44. At the hearing, Ms. Dhanoa demonstrated her
limitations to her range of motion. See Tr. at 81-82.
IV. Discussion
A. Applicable Legal Standard
A petitioner must prove, by a preponderance of the evidence, the factual circumstances
surrounding her claim. 42 U.S.C. § 300aa–13(a)(1)(A). To resolve factual issues, the special
master must weigh the evidence presented, which may include contemporaneous medical records
and testimony. See Burns v. Sec'y of Health & Human Servs., 3 F.3d 415, 417 (Fed.Cir.1993)
(explaining that a special master must decide what weight to give evidence including oral
testimony and contemporaneous medical records). Contemporaneous medical records are
presumed to be accurate. See Cucuras v. Sec’y of Health & Human Servs., 993 F.2d 1525, 1528
(Fed. Cir. 1993). To overcome the presumptive accuracy of medical records testimony, a
petitioner may present testimony which is “consistent, clear, cogent, and compelling.” Sanchez
v. Sec'y of Health & Human Servs., No. 11–685V, 2013 WL 1880825, at *3 (Fed. Cl. Spec. Mstr.
Apr. 10, 2013) (citing Blutstein v. Sec'y of Health & Human Servs., No. 90–2808V, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)).
5

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 6 of 7
B. Evaluation of the Evidence
Here, the undersigned finds that there is preponderant evidence to support Ms. Dhanoa’s
claim that the flu vaccine she received on August 19, 2014, was administered in her right arm.
The undersigned bases her finding on petitioner’s affidavit4 and consistent entries in the medical
records.5
The undersigned also finds that there is preponderant evidence to support that the onset of
Ms. Dhanoa’s right shoulder pain occurred within forty-eight hours of her August 19, 2014 flu
vaccination. Because this type of injury, SIRVA, is rare and not commonly known to the general
public, it is not unusual to see the lack of documentation that exists in petitioner’s case. The
undersigned finds petitioner’s affidavit and testimony to be credible. Petitioner’s clinical course
and diagnosis is consistent with a SIRVA. Additionally, the affidavit and testimony submitted by
petitioner offer corroboration of her claim that she experienced a progressive increase of right
shoulder pain after receiving her flu vaccine on August 19, 2014.
Petitioner’s failure to mention her shoulder pain to her primary care physician on August
21, 2014, or her dermatologist on August 28, 2014 and September 30, 2014 is reasonable. Based
on her experience in the Program, the undersigned notes that it is not uncommon for a petitioner
to delay seeking treatment for a shoulder injury after vaccination. Petitioner delayed seeking
treatment for her shoulder pain by self-treating with Tylenol and hoping that her pain would
cease. See Pet. Ex. 11 at 1, ¶5. It is reasonable that petitioner did not mention the pain she felt to
her primary care provider just a few days after vaccination or her dermatologist during two
subsequent visits. See Pet. Ex. 2 at 7; Pet. Ex. 8 at 6-7. The entries are not helpful but also are not
inconsistent with petitioner’s assertions. Petitioner visited her primary care provider on August
21, 2014 due to a spreading rash and did not mention her right shoulder pain because she
believed the soreness in her right shoulder from the flu vaccine was normal. See Pet. Ex. 11 at 1,
¶6. Petitioner’s visits with her dermatologist on August 28, 2014 and September 30, 2014 were
for the purpose of petitioner’s rash, and petitioner did not mention her right shoulder pain due to
her dermatologist’s limited specialty. It is reasonable that petitioner would not see her
dermatologist for a shoulder injury. See Pet. Ex. 11 at 2, ¶7; Tr. at 16-17. The undersigned
credits the explanation given by petitioner her in affidavit that she felt severe pain after injection
but attributed it to a normal outcome following vaccination and thus, did not seek treatment
sooner. See Pet. Ex. 11 at 1, ¶¶ 4-6.
Petitioner’s medical record from her December 17, 2014 visit with her cardiologist states
that petitioner received her flu shot two to three weeks ago and experienced severe shoulder and
arm pain since her flu shot. Pet. Ex. 5 at 5. The incorrect onset of petitioner’s shoulder pain
reported in the record from petitioner’s cardiologist is the result of petitioner’s failure to give an
accurate history or the cardiologist’s erroneous notation of “weeks” instead of “months.” By
4 The affidavit states that petitioner “received the influenza vaccination in [her] right arm” and “[i]mmediately
following the vaccination, [she] felt severe pain in [her] right shoulder.” See Pet. Ex. 11 at 1, ¶¶ 3-4.
5 For example, a medical record from Orthopedic & Sports Medicine Center states that petitioner visited with “about
three-month history of decreasing range of motion, increasing pain in the right shoulder” and that “[this issue]
started after [petitioner] got an influenza shot in August.” Pet. Ex. 4 at 16. A medical record from petitioner’s
cardiologist states that petitioner “received a flu shot in her right shoulder.” Pet. Ex. 5 at 5.
6

Case 1:15-vv-01011-UNJ Document 53 Filed 12/08/17 Page 7 of 7
petitioner’s own admission, she often was not exact when providing her medical history. Tr. at
23. On October 31, 2014, petitioner complained of “pain in right shoulder for 6 weeks.” See Pet.
Ex. 2 at 6. Petitioner agreed this entry was undoubtedly erroneous, suggesting she was providing
an approximate time frame and describing a point when the pain worsened. Tr. at 23. The
undersigned finds these incorrect entries regarding the onset of petitioner’s pain are not sufficient
to counter entries establishing petitioner’s pain began after her flu vaccination. See, e.g., Pet. Ex.
4 at 16. The undersigned finds petitioner’s assertion that she experienced pain immediately
following vaccination which slowly worsened over time to be credible. See Pet. Ex. 11 at 2, ¶8;
Tr. at 23.
V. Conclusion
Thus, the undersigned finds, based on the record as a whole, that petitioner received a flu
vaccine in her right arm on August 19, 2014, as alleged in the petition. The undersigned finds,
based on the record as a whole, that onset occurred within forty-eight hours of petitioner’s flu
shot on August 19, 2014.
The parties are encouraged to consider an informal resolution of this claim. Petitioner
shall file a joint status report by no later than Friday, May 19, 2017, updating the court on
the status of the parties’ settlement discussions.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
7

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DOCUMENT 2: USCOURTS-cofc-1_15-vv-01011-1
Date issued/filed: 2018-01-29
Pages: 4
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/10/2017) regarding 48 Ruling on Entitlement Signed by Chief Special Master Nora Beth Dorsey. (tlf) Service on parties made.
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Case 1:15-vv-01011-UNJ Document 56 Filed 01/29/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-1011V
Filed: October 10, 2017
Unpublished
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
AMRIT DHANOA, *
*
Petitioner, * Ruling on Entitlement (Non-Table); Fact
v. * Hearing; Findings of Fact; Influenza
* (“Flu”) Vaccine; Shoulder Injury Related
SECRETARY OF HEALTH * to Vaccine Administration (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for petitioner.
Ann Donohue Martin, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On September 11, 2015, Amrit Dhanoa (“petitioner”) filed a petition for
compensation under the National Vaccine Injury Compensation Program, 42 U.S.C.
§300aa-10, et seq.,2 (the “Vaccine Act”). Petitioner alleges that she suffered a shoulder
injury caused in fact by the influenza (“flu”) vaccine she received on August 19, 2014.
Petition at 1, ¶¶ 3, 14. Petitioner further alleges that she received the vaccine in the
United States, suffered the residual effects of her injury for more than six months, and
has not received any compensation for her injury, alleged as vaccine caused. Id. at ¶¶
3, 14-16. The case was assigned to the Special Processing Unit (“SPU”) of the Office
of Special Masters.
1 Because this unpublished ruling contains a reasoned explanation for the action in this case, the
undersigned intends to post it on the United States Court of Federal Claims' website, in accordance with
the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of
Electronic Government Services). In accordance with Vaccine Rule 18(b), petitioner has 14 days to
identify and move to redact medical or other information, the disclosure of which would constitute an
unwarranted invasion of privacy. If, upon review, the undersigned agrees that the identified material fits
within this definition, the undersigned will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for
ease of citation, all “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:15-vv-01011-UNJ Document 56 Filed 01/29/18 Page 2 of 4
I. Procedural History
Along with her petition, petitioner filed medical records and a statement of
completion. See Exhibits 1-9 (ECF No. 1); Statement of Completion (ECF No. 2). The
initial status conference was held on October 26, 2015. Maximillian Muller appeared on
behalf of petitioner. Ann Martin appeared for respondent.
At the conference, respondent’s counsel indicated respondent had not identified
any missing medical records but did have some concerns regarding the facts alleged in
petitioner’s claim. See Order, issued Oct. 26, 2015 (ECF No. 13). Respondent’s
counsel estimated respondent could file a Rule 4(c) report setting forth these concerns
within 45 days. See id.
On December 9, 2015, respondent filed his Rule 4(c) Report asserting that
petitioner’s request for entitlement to compensation under the Vaccine Act be denied.
Respondent’s Rule 4(c) at 1 (ECF No. 14). Respondent argued that petitioner
appeared to be advancing a SIRVA claim but had not provided “a preponderance of
evidence demonstrating the requisite facts to establish compensation under a causation
theory.” Id. at 5. Specifically, respondent argued “there is no medical documentation
demonstrating that petitioner received the flu vaccination in her right arm” and varying
and conflicting evidence regarding the onset of petitioner’s symptoms. Id. at 5-6.
Respondent also noted that at least some medical records appeared to be missing. Id.
at 3 n.1. Respondent maintained that “the most contemporaneous medical
documentation is inconsistent with a SIRVA claim.” Id. at 5. In February 2017,
petitioner filed additional medical records in an attempt to address respondent’s
concerns. See Exhibits 10-12 (ECF Nos. 16-18).
The OSM staff attorney managing this SPU case held a status conference on
March 29, 2016. During the call, she informed the parties that the undersigned had
reviewed the medical records and filings in this case and believed the case should
settle. See Order, issued April 1, 2016 (ECF No. 21). She told counsel the undersigned
would like them to engage in settlement discussions before holding a Rule 5 status
conference. See id.
For the next two months, the parties engaged in settlement discussions. After
exchanging settlement amounts, they agreed they did not believe settlement was
feasible and wished the case to “be placed on a litigation track.” Joint Status Report,
filed May 26, 2016 (ECF No. 24). The undersigned conducted a Rule 5 conference on
June 30, 2016. After hearing from the parties, the undersigned presented her tentative
findings and conclusions. Specifically, she found that petitioner received the influenza
vaccine in her right (injured) arm, that the onset of petitioner’s injury was immediate,
that petitioner’s failure to mention her shoulder pain to her primary care provider two
days after vaccination and to her dermatologist on visits in August and December 2014
was reasonable, and that petitioner’s clinical course and diagnosis is consistent with
SIRVA. Rule 5 Scheduling Order, issued July 5, 2016, at 2-3 (ECF No. 25). The
undersigned ordered the parties to file a joint status report within 30 days. Id. at 3-4.
2

Case 1:15-vv-01011-UNJ Document 56 Filed 01/29/18 Page 3 of 4
In their status report, the parties indicated they “have discussed this case in
detail following the Rule 5 Conference and believe a fact hearing is necessary to reach
a resolution.” Joint Status Report, filed July 27, 2016 (ECF No. 26). The undersigned
conducted a fact hearing in Dallas, Texas on December 8, 2016. During the hearing, it
became clear that some medical records were outstanding. See Post-Hearing Order,
issued Dec. 8, 2016, at 1 (ECF No. 31). The undersigned allowed petitioner thirty days
to file the outstanding medical records. Id. at 2.
Petitioner filed the additional medical records on January 10, February 10, and
February 22, 2017. (ECF Nos. 34, 37, 40). On March 20, 2017, the parties requested a
written determination from the undersigned regarding several areas of disagreement: 1)
the arm in which the vaccine was administered and 2) the onset of petitioner’s injury.
Joint Status Report (ECF No. 41). On April 19, 2017, the undersigned issued a fact
ruling finding the vaccination was administered in petitioner’s right arm as alleged and
her onset occurred within 48 hours. (ECF No. 42). In her ruling, the undersigned
included a detailed discussion of the evidence presented and the parties’ respective
arguments. She encouraged the parties to consider an informal resolution of the claim.
Id. at 7.
On June 21, 2017, respondent filed a joint status report on behalf of the parties
indicating he “conveyed a tentative offer of settlement to petitioner on June 12, 2017”
and petitioner was considering the offer. (ECF No. 45). At a July 7, 2017 status
conference with the staff attorney, petitioner’s counsel indicated petitioner was
considering respondent’s settlement offer. See Order, issued July 7, 2017, at 1 (ECF
No. 46). He further indicated petitioner could reach a decision and provide respondent
with a response within 30 days. The parties confirmed that the main area of
disagreement involved the appropriate amount for petitioner’s pain and suffering in this
case. Id. They discussed the options available if they could not informally resolve the
case. Id. at 1-2.
On August 7, 2017, the parties filed a joint status report indicating “they are
unable to resolve this case by settlement and request that the Chief Special Master
issue a decision determining whether Petitioner is entitled to compensation.” Joint
Status Report at 1 (ECF No. 47). They added that “[i]f the Chief Special Master
determines that Petitioner is entitled to compensation, the parties agree that efforts to
resolve damages informally will not be productive . . . [and] therefore anticipate
resolution of damages by decision of the Chief Special Master.” Id.
II. Causation
Having resolved the pertinent factual issues, the undersigned finds petitioner has
met all of the criteria for a SIRVA. As set forth in the April 19, 2017 fact ruling, the
undersigned found petitioner suffered symptoms of SIRVA within 48 hours of receiving
the August 19, 2014 influenza vaccine.
3

Case 1:15-vv-01011-UNJ Document 56 Filed 01/29/18 Page 4 of 4
Although petitioner’s claim was filed before SIRVA was added to the Vaccine
Injury Table, and thus cannot be found to be a SIRVA Table injury,3 the undersigned’s
findings were informed by the criteria used to evaluate such claims.4 Petitioner has met
her burden of proving causation-in-fact under Althen v. Sec’y of Health & Human Servs.,
418 F.3d 1274 (Fed. Cir. 2005).
III. Conclusion
In view of the submitted evidence, including the medical records, credible
witness testimony, and findings of fact, the undersigned finds petitioner entitled
to Vaccine Act compensation.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
3 Originally, the effective date for the new rule was February 21, 2017. Revisions to the Vaccine Injury
Table, 82 Fed. Reg. 6294 (Jan. 19, 2017) (to be codified at 42 C.F.R. pt. 100). This effective date was
delayed until March 21, 2017. Delay of Revisions to the Vaccine Injury Table, 82 Fed. Reg. 11321 (Feb.
22, 2017) (to be codified at 42 C.F.R. pt. 100).
4 The criteria are as follows:
A vaccine recipient shall be considered to have suffered SIRVA if such recipient
manifests all of the following: (i) No history of pain, inflammation or dysfunction of the
affected shoulder prior to intramuscular vaccine administration that would explain the
alleged signs, symptoms, examination findings, and/or diagnostic studies occurring after
vaccine injection; (ii) Pain occurs within the specified time-frame; (iii) Pain and reduced
range of motion are limited to the shoulder in which the intramuscular vaccine was
administered; and (iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy, brachial
neuritis, mononeuropathies, or any other neuropathy).
82 Fed. Reg. 6303 (Qualifications and Aids to Interpretation for SIRVA); see also National
Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table, 80 Fed. Reg.
45132, Notice of Proposed Rulemaking, July 29, 2015 (citing Atanasoff S, Ryan T, Lightfoot R,
and Johann-Liang R, 2010, Shoulder injury related to vaccine administration (SIRVA), Vaccine
28(51):8049-8052).
4

================================================================================
DOCUMENT 3: USCOURTS-cofc-1_15-vv-01011-2
Date issued/filed: 2018-03-09
Pages: 9
Docket text: PUBLIC DECISION (Originally filed: 02/01/2018) regarding 57 DECISION of Special Master ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Service on parties made.
--------------------------------------------------------------------------------
Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 1 of 9
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-1011V
Filed: February 1, 2018
UNPUBLISHED
AMRIT DHANOA,
Special Processing Unit (SPU);
Petitioner,
Decision Awarding Damages; Pain
v.
and Suffering; Influenza (Flu)
Vaccine; Shoulder Injury Related to
SECRETARY OF HEALTH AND
Vaccine Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for petitioner.
Ann Donohue Martin, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On September 11, 2015, Amrit Dhanoa (“petitioner”) filed a petition for
compensation under the National Vaccine Injury Compensation Program, 42 U.S.C.
§300aa-10, et seq.,2 (the “Vaccine Act”). Petitioner alleged that she suffered an injury
to her right shoulder, including adhesive capsulitis and shoulder injury related to vaccine
administration (“SIRVA”) caused in fact by the influenza (“flu”) vaccine she received on
August 19, 2014. Petition at 1, ¶¶ 3, 14. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On October 10, 2017, the undersigned issued a ruling on entitlement, finding
petitioner entitled to compensation for her SIRVA. Being previously informed that the
1 When this decision was originally issued, petitioner was informed that the decision would be posted on
the United States Court of Federal Claims' website, in accordance with the E-Government Act of 2002. 44
U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services).
Petitioner was notified that she could seek redaction pursuant to § 300aa-12(d)(4)(B); Vaccine Rule
18(b). Petitioner did not request redaction. When this decision was initially filed on February 1, 2018,
names and case numbers of other cases were referenced. The undersigned has since determined that it
is appropriate to redact the names and case numbers of other cases cited by petitioner in her brief and
discussed in this decision because information regarding those cases, although general in nature and
used only to support the amount of compensation sought by petitioner in this case, did not appear in the
decisions issued in those cases.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for
ease of citation, all “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 2 of 9
parties had been unable to agree upon an appropriate amount of compensation in this
case, the undersigned ordered the parties to file simultaneous briefs regarding the
damages to be awarded. For the reasons described below, the undersigned finds that
petitioner is entitled to an award of damages in the amount of $ 95,763.14.
I. Relevant Procedural History3
Respondent’s concerns regarding the merits of petitioner’s claim were first voiced
by respondent’s counsel during the initial status conference held on October 26, 2015.
Respondent reiterated these concerns in his Rule 4(c) report filed on December 9,
2015. During the subsequent six months, petitioner filed additional proof and the parties
attempted to reach an informal settlement. The undersigned conducted a Rule 5 status
conference on June 30, 2016.
After hearing from the parties, the undersigned presented her tentative findings
and conclusions. Specifically, she found that petitioner received the influenza vaccine
in her right (injured) arm, that the onset of petitioner’s injury was immediate, that
petitioner’s failure to mention her shoulder pain to her primary care provider two days
after vaccination and to her dermatologist on visits in August and December 2014 was
reasonable, and that petitioner’s clinical course and diagnosis was consistent with
SIRVA. Rule 5 Scheduling Order, issued July 5, 2016, at 2-3 (ECF No. 25). Thereafter,
the parties requested a fact hearing which they believed was “necessary to reach a
resolution.” Joint Status Report, filed July 27, 2016 (ECF No. 26).
The undersigned conducted a fact hearing in Dallas, Texas on December 8,
2016. During the hearing, it became clear that some medical records were outstanding.
See Post-Hearing Order, issued Dec. 8, 2016, at 1 (ECF No. 31). Petitioner filed the
additional medical records in January and February 2017. See Exhibits 13-16 (ECF
Nos. 34, 37, 40).
On March 20, 2017, the parties requested a written determination from the
undersigned regarding several areas of disagreement: 1) the arm in which the vaccine
was administered and 2) the onset of petitioner’s injury. Joint Status Report (ECF No.
41). The undersigned issued a fact ruling finding the vaccination was administered in
petitioner’s right arm as alleged and her onset occurred within 48 hours. (ECF No. 42).
In her ruling, the undersigned included a detailed discussion of the evidence presented
and the parties’ respective arguments. She encouraged the parties to consider an
informal resolution of the claim. Id. at 7.
For several months, the parties engaged in informal settlement discussions. At a
status conference on July 7, 2017, they confirmed that the main area of disagreement
involved the appropriate amount for petitioner’s pain and suffering. See Order, issued
July 7, 2017, at 1 (ECF No. 46). They discussed the options available if they could not
informally resolve the case. Id. at 1-2.
3 A more detailed recitation of the procedural history in this case can be found in the undersigned’s Ruling
on Entitlement, Dhanoa v. Sec’y of Health & Human Servs., No. 15-1011V which can be found on the
court’s website at www.uscfc.uscourts.gov (last visited on Jan. 30, 2018).
2

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 3 of 9
On August 7, 2017, the parties filed a joint status report requesting “that the Chief
Special Master issue a decision determining whether Petitioner is entitled to
compensation.” Joint Status Report at 1 (ECF No. 47). They added that, if the
undersigned determined petitioner was entitled to compensation, they anticipated she
would be required to resolve the issue of damages. Id.
Having resolved the pertinent factual issues, the undersigned found that
petitioner had met all of the criteria for a SIRVA. Although petitioner’s claim was filed
before SIRVA was added to the Vaccine Injury Table, and thus could not be found to be
a SIRVA Table injury,4 the undersigned’s determination was informed by the criteria
used to evaluate such claims.5 She concluded that petitioner had met her burden of
proving causation-in-fact under Althen v. Sec’y of Health & Human Servs., 418 F.3d
1274 (Fed. Cir. 2005).
The undersigned then ordered the parties to file simultaneous briefs detailing the
amount of damages they believe is appropriate and providing arguments and
documentation in support of these amounts. Damages Order, filed Oct. 10, 2017, at 1
(ECF No 49). Petitioner filed additional evidence on December 8, 2017 (see exhibits
17-19 (ECF Nos. 51-52)), and the parties filed their briefs on December 11, 2017 (ECF
Nos. 54-55).
II. Relevant Medical History
Prior to receiving the flu vaccine on August 21, 2014, petitioner’s medical history
was significant for diabetes, heart problems, and several instances of a rash, but there
was no evidence petitioner experienced any previous right shoulder pain. See generally
Exhibits 2, 5-6. The day before vaccination, petitioner had seen a dermatologist, Dr.
Steinmertz, for treatment of a rash she had been experiencing for months. Exhibit 7;
see also Transcript (“Tr.”) at 11. After vaccination, petitioner visited her primary care
4 Originally, the effective date for the new rule was February 21, 2017. Revisions to the Vaccine Injury
Table, 82 Fed. Reg. 6294 (Jan. 19, 2017) (to be codified at 42 C.F.R. pt. 100). This effective date was
delayed until March 21, 2017. Delay of Revisions to the Vaccine Injury Table, 82 Fed. Reg. 11321 (Feb.
22, 2017) (to be codified at 42 C.F.R. pt. 100).
5 The criteria are as follows:
A vaccine recipient shall be considered to have suffered SIRVA if such recipient
manifests all of the following: (i) No history of pain, inflammation or dysfunction of the
affected shoulder prior to intramuscular vaccine administration that would explain the
alleged signs, symptoms, examination findings, and/or diagnostic studies occurring after
vaccine injection; (ii) Pain occurs within the specified time-frame; (iii) Pain and reduced
range of motion are limited to the shoulder in which the intramuscular vaccine was
administered; and (iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy, brachial
neuritis, mononeuropathies, or any other neuropathy).
82 Fed. Reg. 6303 (Qualifications and Aids to Interpretation for SIRVA); see also National
Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table, 80 Fed. Reg.
45132, Notice of Proposed Rulemaking, July 29, 2015 (citing Atanasoff S, Ryan T, Lightfoot R,
and Johann-Liang R, 2010, Shoulder injury related to vaccine administration (SIRVA), Vaccine
28(51):8049-8052).
3

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 4 of 9
physician (“PCP”), Dr. Naghmi,6 complaining of this rash. Exhibit 2 at 7. Although
petitioner described her pain level as five on a scale of ten at this time, she testified that
she did not mention the pain during this visit because she believed that level of pain,
two days after vaccination, was normal. Tr. at 12-13. Similarly, petitioner did not report
her pain during visits to another dermatologist, Dr. Aponte, whom she saw on August 28
and September 30, 2014, for her rash. See Exhibit 8. Petitioner testified that, despite
an increase in pain level to seven, she did not mention her arm pain to Dr. Aponte
because she was a dermatologist. Tr. at 16-17. Petitioner testified that she also
experienced a decrease in her range of motion (“ROM”) at this time. Tr. at 18-19.
During the fact hearing, the undersigned clarified that petitioner had been prescribed
prednisone for her rash in both August and September 2014. Tr. at 83-85.
On October 31, 2014, Ms. Dhanoa visited her PCP, complaining of pain in her
right shoulder for six weeks. Pet. Ex. 13 at 1.7 The medical record states that Ms.
Dhanoa had “joint and muscle pain” and that her “ROM [was] mildly painful for right
shoulder.” Id. The medical record from that visit does not contain a diagnosis, but Dr.
Naghmi did order x-rays. Id. at 2. Additionally, it appears Dr. Naghmi referred petitioner
to an orthopedist, Dr. Klein. See Exhibit 4 at 16;8 Tr. at 25-26.
At the fact hearing, petitioner took issue with Dr. Naghmi’s description of her pain
as “mild,” claiming she would not have sought medical treatment if that had been the
case. Tr. at 77-78. She testified that her level of pain was nine out of ten and that Dr.
Naghmi informed her she was suffering from frozen shoulder. Tr. at 19, 24, 77-78. She
further testified that her injury began to impact her daily life, making it difficult to open a
car door, use the computer, perform household chores, and swim. Tr. at 24-25.
Petitioner first saw Dr. Klein at Orthopedic & Sports Medical Center on November
24, 2014, complaining of a “three-month history of decreasing range of motion,
increasing pain in the right shoulder,” after receiving the flu vaccine in August. Exhibit 4
at 16. Dr. Klein’s evaluation revealed a “limitation of abduction to about 80 degrees,”
“marked limitation of internal and external rotation,” and “pain and tenderness . . . with
positive impingement signs.” Id.; see also id at 17 (where these areas were marked as
abnormal). Dr. Klein diagnosed petitioner with adhesive capsulitis and prescribed a
home exercise program (“HEP”), formal physical therapy (“PT”), and a course of Mobic.
Id. at 16, 18. Petitioner described her pain level as nine and one-half to ten and one-
6 At this visit, petitioner saw Dr. Rifat Naghmi. During the fact hearing, petitioner explained that she sees
two physicians, Drs. Rifat and Shubhi Naghmi, who are husband and wife. Together, they act as
petitioner’s PCP. See Tr. at 62.
7 When the record from this visit was originally filed as part of exhibit 2, it appears the second page was
omitted. See Exhibit 2 at 6; Tr. at 92. Petitioner later re-filed the record in its entirety. See Exhibit 13.
8 This record also can be found in Exhibit 16. Compare Exhibit 4 at 16 with Exhibit 16 at 13. Both exhibits
4 and 16 contain medical records from Dr. Klein for visits occurring in 2014 and 2015. However, the
disclosure form signed by petitioner on November 24, 2014, can be found only in exhibit 4. See Exhibit 4
at 9-10. Similarly, a more detailed checklist for the musculoskeletal examination performed on November
24, 2014, and medication log are included only in exhibit 4. See Exhibit 4 at 17-18. Exhibit 16 contains
physical therapy notes which were not included in exhibit 4. See Exhibit 16 at 15-16. With the exception
of the pages found only in exhibit 16, citation to these records will to exhibit 4. Dr. Klein’s updated
medical records, from 2016 through 2017, were filed as exhibit 15.
4

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 5 of 9
half at this time. Tr. at 29. Dr. Klein noted that petitioner was having trouble dressing
and sleeping. Exhibit 4 at 16. At the fact hearing, petitioner testified that in addition to
her earlier difficulties, she was now having trouble dressing and washing and combing
her hair. Tr. at 29.
From December 2014 through February 2015, petitioner visited Dr. Klein on a
monthly basis. See Exhibit 4 at 13-15. In December 2014, Dr. Klein prescribed
additional PT and an additional course of Mobic. Id. at 18, 22. The billing records
submitted by petitioner show she attended thirteen PT sessions from December 3, 2014
through February 10, 2015. Exhibit 14 at 1-4. There is a prescription for additional PT
dated February 10, 2015, but Dr. Klein did not specify the frequency of this PT. Exhibit
4 at 21. Additionally, there is no evidence to show that petitioner attended additional
sessions in response to this prescription. Exhibit 4 at 21. Although she showed slight
improvement in December 2014 and January 2015 (exhibit 4 at 14-15), in February
2015, Dr. Klein noted that petitioner was “not making much progress” (id. at 13).
Petitioner testified she had a pain level of ten during this time. Tr. at 31.
On April 24, 2015, Dr. Klein noted that petitioner could not raise her right arm
more than 40 degrees and was having trouble sleeping. Exhibit 4 at 12. He
administered an injection comprised of “2cc of Kenalog and 2cc of 0.25% Marcaine
plan” in petitioner’s right subacromial space (id.) and prescribed additional formal PT (id.
at 20). Petitioner testified that the injection helped. Tr. at 33-34.
In May and early June 2015, petitioner attended six PT sessions. Exhibit 12 at
14-32. At her session on June 9, 2015, she reported that she had little pain but “just
can’t move her arm.” Id. at 14. She saw Dr. Klein again on June 18, 2015, reporting
that her “pain [was] much better . . . [and] [s]he [was] able to sleep at night.” Exhibit 4 at
10. Petitioner described herself as “a little better . . . but not fully recovered” at that
time. Tr. at 34.
After a six week gap, petitioner resumed formal PT in late July 2015, attending
four sessions. Exhibit 12 at 1-13. On July 28, 2015, petitioner reported that she had
improved since her last PT session “but still had difficulty reaching overhead or behind
her back.” Id. at 9. At her next session, she indicated she “was pretty sore after last
session,” describing most of her pain as occurring “at the tip of the shoulder blade and
around the shoulder joint.” Id. at 7. On August 11, 2015, petitioner stated that her pain
“comes and goes. But her arm is stiff.” Id. at 5. Two days later, she noted that she
“was sore after last session, but feels better today.” Id. at 3. On October 15, 2015,
petitioner was discharged from formal PT because she “had not been seen in PT since
8/13/15 and has not returned phone calls to schedule future appointments.” Id. at 2.
Petitioner testified that she discontinued formal PT because she because “it was too
much to keep going twice a week.” Tr. at 39. She added that she began taking
medication which helped and continued her HEP. Tr. at 39-40. Petitioner described her
pain level as six out of ten at that time. Tr. at 39.
Almost one year passed before petitioner returned to Dr. Klein on July 25, 2016.
Although there was “no change in character or location of problem,” Dr. Klein recorded
that “[t]here has been significant improvement in symptoms since last visit” with a pain
5

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 6 of 9
level of five and twenty percent improvement. Exhibit 15 at 9. He noted that the “[l]ast
injection helped some” but reported that petitioner had “some tingling and numbness
down to her arm at times and some more pain in the evening which prompted her visit.”
Id. After examining petitioner, he noted that she “has just about full range of motion with
pain at extremes” and equal gross motor and sensory reflexes. Id. at 10. Dr. Klein
discussed the possibility of another cortisone injection if petitioner’s pain worsened and
she had trouble sleeping, but instructed petitioner to continue her HEP. Id.
At the fact hearing in December 2016, petitioner characterized her shoulder as
“much better” (Tr. at 40) and noted that her condition “had improved a lot” (Tr. at 81).
However, she indicated that her pain would return at times, for example when she drove
for more than 30 to 40 minutes. Tr. at 40. She testified that she experienced pain “at
least two or three times” per week and could no longer participate in activities she
previously enjoyed such as swimming and Zumba dance classes. Tr. at 41. In
response to questioning from the undersigned, petitioner demonstrated her current
range of motion. She showed she could raise both arms overhead and extend them in
front of her, but could not move her right arm as far up as her left arm when placing it
behind her back. Tr. at 81-82. Testifying that she had difficulty washing her left side,
petitioner showed that she could not extend her right arm as far over her left shoulder
as she could extend her left arm over her right shoulder. Tr. at 82.
On July 18, 2017, petitioner saw Dr. Klein again. At this visit, she reported that
her symptoms had “worsened since last visit” but again rated her pain at five out of ten.
Exhibit 17 at 2. Dr. Klein observed that petitioner lacked the last ten degrees of internal
and external rotation and showed “[m]ildly positive impingement signs.” Id. He
described most of her pain and tenderness as occurring at the trigger point of the right
rhomboid group and extending up to the trapezius (id. at 2) and opined that petitioner’s
condition was “more triggering pointing of the rhomboid . . .then [sic] . . . adhesive
capsulitis” (id. at 3). He prescribed another course of Mobic, went over some stretching
exercises which should be performed daily, and emphasized the importance of staying
well hydrated. Id.
On November 22, 2017, petitioner visited a doctor in India who administered a
cortisone injection and ordered an MRI which was performed the next day. See Exhibits
18-19. The results of the MRI show subacromial-subdeltoid bursitis, supraspinatus
tendinosis, and degenerative changes. Exhibit 18.
III. The Parties’ Arguments
The parties have stipulated that petitioner is entitled to past unreimburseable
expenses in the amount of $862.15. Respondent’s Brief (“Res. Brief”) at 1 & n.2 (ECF
No. 54); Petitioner’s Brief (“Pet. Brief”) at 1 n.1 (ECF No. 55). Thus, the only issue
before the undersigned is the amount of pain and suffering to be awarded.
Petitioner asserts that she is entitled to $100,000.00 for pain and suffering. Pet.
Brief at 1. To support this claim, she maintains that she suffered excruciating pain in
the months following vaccination, endured more than three years of pain and limited
range of motion, and continues to experience pain and weakness. Id. at 6-7.
Emphasizing that petitioner “was forced to visit a doctor while abroad in India” in late
6

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 7 of 9
2017, petitioner “believes that she will suffer permanent residual effects from her SIRVA
injury.” Id. at 7. Petitioner claims that she still “experiences pain when driving and
using a computer,” noting that “[her] employment as a travel agent requires lengthy
hours on the computer.” Id. Petitioner stresses that she still needs pain medication
(Tylenol) and can no longer perform recreational activities such as “biking, gardening,
swimming, and Zumba.” Id.
Respondent argues for a lower amount, $75,000.00, for petitioner’s pain and
suffering. Res. Brief at 1. Emphasizing the mild nature of the pain and almost full range
of motion experienced by petitioner in 2016, he maintains that petitioner suffered “pain
and hardship for a period of about eleven months, from September 2014 through
August 2015.” Id. at 6. Respondent attributes the setbacks experienced by petitioner to
instances “when PT was not performed.” Id. Acknowledging that petitioner recently
underwent another MRI and may have received a cortisone injection while in India,
respondent suggests that “the November 23, 2017 MRI indicates that degenerative
findings, unrelated to SIRVA, may be playing a role in [petitioner’s] current condition.”
Id.
Both parties cite to other SPU cases involving SIRVA after receiving a flu vaccine
in support of their claimed amounts. Petitioner cites cases in which petitioners were
awarded $85,000.00 to $100,000.00 for pain and suffering. Pet. Brief 5-6. The amount
of $75,000.00 was awarded in all cases cited by respondent. Res. Brief at 6-7.
IV. Discussion
The evidence in this case shows petitioner suffered shoulder pain within 48 hours
of receiving the flu vaccine on August 19, 2014. Petitioner describes her level of pain
initially as five on a scale of ten. However, her pain level increased significantly, to nine
and one-half or ten and one-half, by the time petitioner first saw Dr. Klein on November
24, 2014.
On November 24, 2014, Dr. Klein diagnosed petitioner with adhesive capsulitis,
noting she had about 80 degrees of abduction. Despite thirteen sessions of PT during
December 2014 through early February 2015, petitioner’s range of motion decreased to
40 degrees by her April 24, 2015 appointment. This further reduction is evidence of the
pain petitioner was experiencing. Additionally, she reported difficulty performing basic
tasks such as washing and combing her hair.
The record shows, however, that petitioner obtained significant relief from the
injection she received on April 24, 2015 and ten PT sessions she attend thereafter.
Although petitioner continued to experience intermittent pain and a slight decrease in
range of motion after August 2015, her condition did not deteriorate to the level of pain
and limited movement she experienced in April 2015. Moreover, petitioner has dealt
with these more symptoms for more than three and one-half years.
The only case cited by the parties which involved an award not based an informal
agreement is Desrosier v. Sec’y of Health & Human Servs., No. 16-224V, 2017 WL
5507804 (Fed. Cl. Spec. Mstr. Sept. 19, 2017). In that case, the undersigned awarded
$85,000.00 for pain and suffering to a petitioner who suffered a SIRVA after receiving
7

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 8 of 9
the tetanus, diphtheria, acellular pertussis vaccine in March 2015. Id., at *1. A review
of the facts in Desrosier reveals symptoms which were less severe than those initially
experienced by petitioner in this case. For example, after approximately one month of
formal PT, the petitioner in Desrosier indicated “[s]he was only experiencing pain with
certain movements” and had improved range of motion and strength. Id., at *2. A few
weeks later, it was reported that the Desrosier petitioner had “full range of motion with
discomfort on full flexion and abduction.” Id. However, the petitioner in Desrosier was
hampered by the fact that she was six months pregnant at the time of the vaccination.
She was unable to avail herself of treatments which would have improved her condition
such as pain medication, steroid injections, and surgery. Additionally, petitioner was
attempting to work while caring for her one year old child and, after giving birth, her
infant. The Desrosier petitioner suffered a relapse after giving birth and attempting to lift
her one month old. Id., at *3. In that decision, the undersigned stressed that the
amount of petitioner’s award was calculated in part to reflect petitioner’s particular
circumstances and limitations in treatment options imposed by her pregnancy. Id., at
*5. Although the circumstances in this case are different than those in Desrosier, the
undersigned finds the amount awarded for pain and suffering in this case should be
comparable to that in Desrosier.
The remainder of the cases cited involved awards based upon amounts agreed
to by the parties.9 While less informative than Desrosier, it is still helpful to consider the
different amounts awarded in those cases. An examination of the cases cited by
respondent strengthens petitioner’s position that she should receive more than
$75,000.00 in pain and suffering. For example, in one case, petitioner was prescribed
Mobic and underwent formal PT, but required no injection. The facts in another case
are similar to the instant case in that the petitioner was also diagnosed with adhesive
capsulitis. However, that petitioner improved in less than one year, in response to one
injection and fewer PT sessions than attended by the petitioner in this case.
Of the cases cited by petitioner, there is one with facts closest to the instant
case. Like the petitioner in this case, the petitioner in that case participated in formal PT
and received multiple injections. However, that petitioner required three injections
which provided relief for approximately three weeks each time. Additionally, that
petitioner underwent seven months of formal PT, and at one point considered the
possibility of surgery. Petitioner in this similar case was awarded $95,000.00 in pain
and suffering.
As part of her argument, petitioner in this case maintains that she continues to
suffer the effects of her injury. She stresses that she was seen for shoulder pain as
recently as November 2017, at which time she received a second injection. However, it
is clear that petitioner’s pain following the April 24, 2015 injection was significantly less
than the pain she experienced previously. Additionally, her range of motion was much
improved. To cover additional pain petitioner is likely to experience for the next year,
the undersigned will award some compensation for future pain and suffering.
9 These cases are being discussed without identifying information such as names and case numbers
which have been redacted prior to posting. See supra note 1.
8

Case 1:15-vv-01011-UNJ Document 60 Filed 03/09/18 Page 9 of 9
Like the petitioner in this case, the petitioner who was awarded $95,000.00 for
pain and suffering claimed that she continued to suffer the effects of her injury.
Because the amount awarded was based on an amount agreed upon by the parties, the
portion being paid for future pain and suffering as opposed to actual pain and suffering
was not identified.
In this case, the undersigned awards $85,000.00 for actual pain and suffering
and an additional $10,000.00 for future pain and for the year following this decision.
The amount designated for future pain and suffering is reduced to its net present value,
$9,900.99, using a net discount rate of 1%. See § 15(f)(4)(A) (requiring a reduction to
net present value for future compensation being currently paid); see also Neiman v.
Sec’y of Health & Human Servs., No. 15-631V, 2016 WL 7741742, at *1 (Fed. Cl. Spec.
Mstr. Oct. 31, 2016) (using a net discount rate of 1% for the first 15 years and 2%
thereafter).
V. Conclusion
For all of the reasons discussed above, and based on consideration of the
record as a whole, the undersigned finds that $94,900.99 represents a fair and
appropriate amount of compensation for petitioner’s past and future pain and
suffering. In addition, the undersigned finds that petitioner is entitled to
compensation for $862.15 in past unreimburseable medical expenses.
Based on the record as a whole and arguments of the parties, the undersigned
awards petitioner a lump sum payment of $95,763.14 in the form of a check
payable to petitioner, Amrit Dhanoa. This amount represents compensation for all
damages that would be available under § 15(a).
The clerk of the court is directed to enter judgment in accordance with this
decision.10
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
10 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
9