VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-00875
Package ID: USCOURTS-cofc-1_16-vv-00875
Petitioner: Jon Martin
Filed: 2016-07-25
Decided: 2018-02-02
Vaccine: influenza
Vaccination date: 2015-10-10
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 71430

AI-assisted case summary:
Jon Martin filed a petition for compensation on July 25, 2016, alleging he received an influenza vaccine on October 10, 2015, and subsequently suffered an injury to his left shoulder secondary to the vaccination. The case was assigned to the Special Processing Unit. On February 9, 2017, the respondent conceded that the alleged injury was consistent with a shoulder injury related to vaccine administration (SIRVA) and that no other causes were identified. The respondent also agreed that the petitioner suffered the condition for more than six months, satisfying the legal prerequisites for compensation. A ruling on entitlement was issued on February 9, 2017, finding Jon Martin entitled to compensation. On August 8, 2017, the respondent filed a proffer on award of compensation, proposing a lump sum of $70,000.00 for pain and suffering and $1,430.87 for the satisfaction of the State of Nevada Medicaid lien. The petitioner agreed with the proffered award. On February 2, 2018, the court issued a decision awarding Jon Martin a total of $71,430.87 in compensation.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-00875-0
Date issued/filed: 2017-08-11
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/09/2017) regarding 18 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:16-vv-00875-UNJ Document 35 Filed 08/11/17 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-0875V
Filed: February 9, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
JON MARTIN, *
*
Petitioner, * Ruling on Entitlement; Concession;
v. * Influenza (“Flu”) Vaccine; Shoulder
* Injury Related to Vaccine Administration
SECRETARY OF HEALTH * (“SIRVA”); Special Processing Unit
AND HUMAN SERVICES, * (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On July 25, 2016, Jon Martin (“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 he received an influenza (“flu”) vaccine in his left
arm on October 10, 2015, and subsequently suffered an injury to his left shoulder
secondary to the vaccination. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On February 9, 2017, respondent filed his Rule 4(c) report in which he concedes
that petitioner is entitled to compensation in this case. Respondent’s Rule 4(c) Report
at 1. Specifically, respondent states that “the alleged injury is consistent with a shoulder
injury related to vaccine administration (‘SIRVA’),” and that no “other causes for
petitioner’s injury” were identified. Id. at 4. Respondent further agrees that petitioner
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 1:16-vv-00875-UNJ Document 35 Filed 08/11/17 Page 2 of 2
suffered the condition for more than six months and therefore, has satisfied all legal
prerequisites for compensation under the Act.” Id.
In view of respondent’s concession and the evidence before me, the
undersigned finds that petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_16-vv-00875-1
Date issued/filed: 2018-02-02
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 8/8/2017) regarding 31 DECISION Stipulation/Proffer. Signed by Chief Special Master Nora Beth Dorsey. (rp) Service on parties made.
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Case 1:16-vv-00875-UNJ Document 41 Filed 02/02/18 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-0875V
Filed: August 8, 2017
UNPUBLISHED
JON MARTIN,
Special Processing Unit (SPU);
Damages Decision Based on Proffer;
Petitioner,
Influenza (Flu) Vaccine; Shoulder
v.
Injury Related to Vaccine
Administration (SIRVA)
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On July 25, 2016, Jon Martin (“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 he received an influenza (“flu”) vaccine in his left
arm on October 10, 2015, and subsequently suffered an injury to his left shoulder
secondary to the vaccination. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On February 9, 2017, a ruling on entitlement was issued, finding petitioner
entitled to compensation for SIRVA. On August 8, 2017, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded a lump sum
of $70,000.00, for his actual and projected pain and suffering, and $1,430.87,
representing compensation for satisfaction of the State of Nevada Medicaid lien. Proffer
1 Because this unpublished decision 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 1:16-vv-00875-UNJ Document 41 Filed 02/02/18 Page 2 of 5
at 1-2. In the Proffer, respondent represented that petitioner agrees with the proffered
award. Based on the record as a whole, the undersigned finds that petitioner is entitled
to an award as stated in the Proffer.
Pursuant to the terms stated in the attached Proffer, the undersigned awards
the following:
A. A lump sum payment of $70,000.00, in the form of a check payable to
petitioner, Jon Martin.
B. A lump sum payment of $1,430.87, representing compensation for
satisfaction of the State of Nevada Medicaid lien, payable joint to petitioner
and
State of Nevada
Department of Health and Human Services
Division of Health Care Financing and Policy
HMS NV Casualty Unit
P.O. Box 167487
Irving, TX 75016
Medicaid#: 00001769855
Petitioner agrees to endorse this payment to the State of Nevada. These amounts
represent compensation for all damages that would be available under § 300aa-15(a).
The clerk of the court is directed to enter judgment in accordance with this
decision.3
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
3 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.
2

Case 1:16-vv-00875-UNJ Document 41 Filed 02/02/18 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
_________________________________________
)
JON MARTIN, )
)
Petitioner, )
) No. 16-875V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that the Court should award Jon Martin a lump sum of $70,000.00
for his actual and projected pain and suffering. This amount reflects that the award for projected
pain and suffering has been reduced to net present value. See § 300aa-15(a)(4). Petitioner
agrees.
B. Medicaid Lien
Respondent proffers that Jon Martin should be awarded funds to satisfy the State of
Nevada lien in the amount of $1,430.87, which represents full satisfaction of any right of
subrogation, assignment, claim, lien, or cause of action the State of Nevada may have against
any individual as a result of any Medicaid payments the State of Nevada has made to or on
behalf of Jon Martin from the date of his eligibility for benefits through the date of judgment in
1

Case 1:16-vv-00875-UNJ Document 41 Filed 02/02/18 Page 4 of 5
this case as a result of his vaccine-related injury suffered on or about October 10, 2015, under
Title XIX of the Social Security Act.
II. Form of the Award
The parties recommend that the compensation provided to Jon Martin should be made
through a combination of lump sum payments as described below, and request that the Chief
Special Master’s decision and the Court’s judgment award the following:1
A. A lump sum payment of $70,000.00, representing pain and suffering in the form
of a check payable to petitioner, Jon Martin.
B. A lump sum payment of $1,430.87, representing compensation for satisfaction of
the State of Nevada Medicaid lien, payable jointly to petitioner and
State of Nevada
Department of Health and Human Services
Division of Health Care Financing and Policy
HMS NV Casualty Unit
P.O. Box 167487
Irving, TX 75016
Medicaid#: 00001769855
Petitioner agrees to endorse this payment to the State of Nevada.
III. Summary of Recommended Payments Following Judgment
A. Lump Sum paid to petitioner, Jon Martin: $70,000.00
B. Medicaid Lien, paid jointly to petitioner and
State of Nevada: $ 1,430.87
1 Should petitioner die prior to entry of judgment, respondent reserves the right to move
the Court for appropriate relief. In particular, respondent would oppose any award for future
pain and suffering.
2

Case 1:16-vv-00875-UNJ Document 41 Filed 02/02/18 Page 5 of 5
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 B. BABCOCK
Assistant Director
Torts Branch, Civil Division
/s/ Claudia B. Gangi
CLAUDIA B. GANGI
Senior Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel.: (202) 616-4138
Dated: August 8, 2017
3