VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01026
Package ID: USCOURTS-cofc-1_16-vv-01026
Petitioner: John R. Belt
Filed: 2016-08-18
Decided: 2017-11-29
Vaccine: influenza
Vaccination date: 2015-10-30
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 75000

AI-assisted case summary:
John R. Belt filed a petition for compensation under the National Vaccine Injury Compensation Program on August 18, 2016, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccination in his left shoulder on October 30, 2015. The respondent, represented by Claudia Gangi of the U.S. Department of Justice, conceded that the alleged injury was consistent with SIRVA and that Mr. Belt satisfied all legal prerequisites for compensation. Bruce Slane of the Law Office of Bruce W. Slane, P.C. represented the petitioner. On January 26, 2017, Chief Special Master Nora Beth Dorsey issued a ruling on entitlement, finding Mr. Belt entitled to compensation based on the respondent's concession and the evidence. Subsequently, on March 28, 2017, the respondent filed a proffer on award of compensation, agreeing to an award of $75,000.00, which the petitioner also agreed to. Chief Special Master Dorsey issued a decision on November 29, 2017, awarding Mr. Belt a lump sum payment of $75,000.00, representing compensation for all damages available under the Vaccine Act. Mr. Belt is a competent adult, and no guardianship was required. The decision does not describe the specific onset, symptoms, medical tests, or treatments related to the alleged injury, nor does it name any medical experts.

Theory of causation field:
Petitioner John R. Belt received an influenza vaccination on October 30, 2015, and subsequently alleged a shoulder injury related to vaccine administration (SIRVA). The respondent conceded that the injury was consistent with SIRVA and that petitioner met all legal prerequisites for compensation. The case proceeded based on this concession, and no specific medical experts or detailed causation theories were presented in the public text. The theory of causation is based on the "Table" for SIRVA. Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on January 26, 2017, and a decision awarding damages on November 29, 2017. The award was a lump sum of $75,000.00, agreed upon by both parties, representing all damages available under the Vaccine Act. Attorneys for the petitioner were Bruce Slane and for the respondent was Claudia Gangi.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-01026-0
Date issued/filed: 2017-07-06
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 01/26/2017) regarding 16 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
--------------------------------------------------------------------------------
Case 1:16-vv-01026-UNJ Document 32 Filed 07/06/17 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1026V
Filed: January 26, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
JOHN R. BELT, *
*
Petitioner, * Ruling on Entitlement; Concession;
v. * Influenza (“Flu”); Shoulder Injury
* Related to Vaccine Administration
SECRETARY OF HEALTH * (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Bruce Slane, Law Office of Bruce W. Slane, P.C., for petitioner.
Claudia Gangi, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On August 18, 2016, 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 suffered a shoulder injury related to vaccine
administration (“SIRVA”) following an October 30, 2015 influenza (“flu”) vaccination in
his left shoulder. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On January 26, 2017, respondent filed her Rule 4(c) report in which she
concedes that petitioner is entitled to compensation in this case. Respondent’s Rule
4(c) Report at 1. Specifically, respondent determined the alleged injury is consistent
with a SIRVA. Id. at 3. Respondent further agrees that petitioner has satisfied all legal
prerequisites for compensation under the Vaccine Act. Id.
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-01026-UNJ Document 32 Filed 07/06/17 Page 2 of 2
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

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_16-vv-01026-1
Date issued/filed: 2017-11-30
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 03/29/2017) regarding 23 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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CCaassee 11::1166--vvvv--0011002266--UUNNJJ DDooccuummeenntt 2333 FFiilleedd 0131//2390//1177 PPaaggee 11 ooff 24
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1026V
Filed: March 29, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
JOHN BELT, *
*
Petitioner, * Damages Decision Based on Proffer;
v. * Influenza (“Flu”); Shoulder Injury
* Related to Vaccine Administration
SECRETARY OF HEALTH * (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Bruce Slane, Law Office of Bruce W. Slane, P.C., for petitioner.
Claudia Gangi, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On August 18, 2016, 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 suffered a shoulder injury related to vaccine
administration (“SIRVA”) following an October 30, 2015 influenza (“flu”) vaccination in
his left shoulder. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On January 26, 2017, a ruling on entitlement was issued, finding petitioner
entitled to compensation for a SIRVA. On March 28, 2017, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded $75,000.00.
Proffer at 1. 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.
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).

CCaassee 11::1166--vvvv--0011002266--UUNNJJ DDooccuummeenntt 2333 FFiilleedd 0131//2390//1177 PPaaggee 22 ooff 24
Pursuant to the terms stated in the attached Proffer, the undersigned awards
petitioner a lump sum payment of $75,000.00 in the form of a check payable to
petitioner, John Belt. This amount represents 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.
17 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

CCaassee 1 1:1:166-v-vvv-0-011002266-U-UNNJJ D Dooccuummeennt t2 333-1 F Fileiledd 1 013/3/209/1/177 P Paaggee 3 1 o of f4 2
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
_________________________________________
)
JOHN BELT, )
)
Petitioner, )
) No. 16-1026V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$75,000.00, which represents all elements of compensation to which petitioner would be entitled
under 42 U.S.C. § 300aa-15(a).1 Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner should be made through a
lump sum payment of $75,000.00, in the form of a check payable to petitioner. Petitioner agrees.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
1 Should petitioner die prior to the entry of judgment, the parties reserve the right to move the
Court for appropriate relief. In particular, respondent would oppose any award for future
medical expenses, future lost earnings, and future pain and suffering.

CCaassee 1 1:1:166-v-vvv-0-011002266-U-UNNJJ D Dooccuummeennt t2 333-1 F Fileiledd 1 013/3/209/1/177 P Paaggee 4 2 o of f4 2
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
ANN D. MARTIN
Senior Trial Attorney
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: March 28, 2017
2