VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00643
Package ID: USCOURTS-cofc-1_18-vv-00643
Petitioner: Debra Juno
Filed: 2018-05-07
Decided: 2022-12-02
Vaccine: influenza
Vaccination date: 2016-10-10
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 105400

AI-assisted case summary:
Debra Juno filed a petition for compensation under the National Vaccine Injury Compensation Program on May 7, 2018, alleging that an influenza vaccine administered on October 10, 2016, caused a shoulder injury related to vaccine administration (SIRVA). Ms. Juno, who was 60 years old at the time of vaccination, reported immediate pain in her right shoulder following the injection. Her condition worsened, and she sought medical attention 23 days post-vaccination, where she was diagnosed with bilateral arm pain and myalgia. An MRI revealed a full thickness supraspinatus tear and a partial bursal sided infraspinatus tear. She underwent arthroscopic surgery to repair these tears and subsequently engaged in physical therapy for approximately seven months. The respondent initially contested entitlement, arguing that the onset of pain did not occur within the 48-hour window required for a Table SIRVA claim. However, Chief Special Master Brian H. Corcoran ruled in favor of Ms. Juno on the entitlement issue on September 13, 2021, finding that the onset of pain occurred within 48 hours. The respondent accepted this ruling as the law of the case for further proceedings. On October 15, 2021, Chief Special Master Corcoran issued a ruling finding Ms. Juno entitled to compensation. The parties were unable to agree on the damages, leading to a "Motions Day" proceeding. Ms. Juno sought $110,000.00 for pain and suffering, while the respondent proposed $80,000.00. Chief Special Master Corcoran reviewed prior SIRVA cases and the specifics of Ms. Juno's treatment, including surgery and physical therapy. He found the case most similar to the Cates v. Sec'y of Health & Human Servs. case, which awarded $108,000.00, but noted Ms. Juno's treatment course was slightly shorter. Ultimately, on December 2, 2022, Chief Special Master Corcoran awarded Ms. Juno a total of $105,400.00. This award included $100,000.00 for pain and suffering, $815.00 for out-of-pocket medical expenses, and $4,585.00 in lost wages. Petitioner was represented by Bridget Candace McCullough of Muller Brazil, LLP, and the respondent was represented by Debra A. Filteau Begley of the U.S. Department of Justice.

Theory of causation field:
Petitioner Debra Juno, age 60, received an influenza vaccine on October 10, 2016, and alleged a shoulder injury related to vaccine administration (SIRVA). The respondent initially contested entitlement, arguing the onset of pain was outside the 48-hour window for a Table SIRVA claim. Chief Special Master Brian H. Corcoran ruled in favor of Petitioner on entitlement, finding the onset occurred within 48 hours. The parties then litigated damages. Petitioner sought $110,000.00 for pain and suffering, citing SIRVA cases involving surgery and comparable treatment. Respondent proposed $80,000.00, arguing Ms. Juno's treatment course was shorter than in cited cases. Chief Special Master Corcoran awarded $100,000.00 for pain and suffering, $815.00 for out-of-pocket expenses, and $4,585.00 for lost wages, totaling $105,400.00. The decision was issued on December 2, 2022. Petitioner was represented by Bridget Candace McCullough, and Respondent by Debra A. Filteau Begley.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00643-0
Date issued/filed: 2021-10-13
Pages: 9
Docket text: ran. (sw) Service on parties made.PUBLIC ORDER/RULING (Originally filed: 09/13/2021) regarding 46 Findings of Fact & Conclusions of Law,, Scheduling Order,, Order on Motion for Ruling on the Record, Signed by Chief Special Master Brian H. Corco
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Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 1 of 9
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0643V
UNPUBLISHED
DEBRA JUNO, Chief Special Master Corcoran
Petitioner, Filed: September 13, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Findings of Fact; Onset; Influenza
HUMAN SERVICES, (Flu) Vaccine; Shoulder Injury
Related to Vaccine Administration
Respondent. (SIRVA)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for Respondent.
FINDINGS OF FACT1
On May 7, 2018, Debra Juno 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 related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine administered to her
right shoulder on October 10, 2016. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
For the reasons discussed below, I find the onset of Petitioner’s shoulder injury
related to vaccine administration (“SIRVA”) occurred within 48 hours of vaccination.
1 Because this unpublished fact ruling contains a reasoned explanation for the action in this case, I am
required 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). This means the fact ruling will be available to anyone with access to the
internet. 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, I agree that the identified material fits within this definition, I 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 2 of 9
I. Relevant Procedural History
Ms. Juno filed her petition for compensation along with medical record exhibits on
May 7, 2018. (ECF No. 1). After reviewing the records, Respondent filed a status report
stating that he was amenable to engaging in settlement discussions, and requested that
Petitioner provide a demand. (ECF No. 14). The parties were unable to resolve the case
after more than a year of settlement discussions, however, so I ordered Respondent to
file the Rule 4(c) Report to identify the area of disagreement. (ECF Nos. 36, 37).
Respondent did so on February 2, 2020, maintaining therein that the case was not
appropriate for compensation under the terms of the Vaccine Act. Respondent’s Report
at 1 (ECF No. 38). Respondent argued that “petitioner’s records do not establish that her
shoulder pain began within 48 hours of vaccination, and when she first sought treatment
three weeks after vaccination, she actually reported bilateral shoulder pain.” Id. at 6.
Respondent further argued that Petitioner does not allege in the alternative that her
shoulder pain was caused-in-fact by the vaccination, and thus, cannot prove a causal link
between the alleged injuries and a covered vaccine. Id. at 7-8.
Petitioner filed a motion for a fact ruling (“Br.”) to resolve the onset issue. (ECF No.
43). Respondent filed his response (“Opp.”) on July 13, 2020. (ECF No. 44). Petitioner
filed a reply (“Reply”) on July 27, 2020. (ECF. No. 45). The matter is now ripe for
adjudication.
II. Issue
At issue is whether the onset of Petitioner’s right shoulder pain occurred within 48
hours after vaccination, as required by the Vaccine Injury Table. 42 C.F.R. §§ 100.3(a)
XIV.B. (2017) (influenza vaccination) and 100.3(c)(10).
III. Authority
Pursuant to Vaccine Act § 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
§ 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
§ 13(b)(1). “Medical records, in general, warrant consideration as trustworthy evidence.
The records contain information supplied to or by health professionals to facilitate
diagnosis and treatment of medical conditions. With proper treatment hanging in the
balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Human Servs.,
993 F.2d 1525, 1528 (Fed. Cir. 1993).
2

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 3 of 9
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Human Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. In Lowrie, the special master wrote that “written records which
are, themselves, inconsistent, should be accorded less deference than those which are
internally consistent.” Lowrie, at *19.
The United States Court of Federal Claims has recognized that “medical records
may be incomplete or inaccurate.” Camery v. Sec’y of Health & Human Servs., 42 Fed.
Cl. 381, 391 (1998). The Court later outlined four possible explanations for
inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Human Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery, 42 Fed.
Cl. at 391 (citing Blutstein v. Sec’y of Health & Human Servs., No. 90-2808, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998). However, the Federal Circuit recently
“reject[ed] as incorrect the presumption that medical records are accurate and complete
as to all the patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997
F.3d 1378, 1383 (Fed. Cir. 2021). The credibility of the individual offering such testimony
must also be determined. Andreu v. Sec’y of Health & Human Servs., 569 F.3d 1367,
1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Human Servs., 991 F.2d 1570, 1575
(Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” § 13(b)(2). “Such a finding may be
made only upon demonstration by a preponderance of the evidence that the onset [of the
injury] . . . did in fact occur within the time period described in the Vaccine Injury Table.”
Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing § 12(d)(3); Vaccine Rule 8); see also Burns v. Sec’y of
3

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 4 of 9
Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within the
special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
IV. Parties’ Positions
a. Petitioner’s Arguments
Petitioner asserts that her right shoulder pain started within 48 hours of
vaccination. Br. at 6-7. She notes that there are no complaints of shoulder pain prior to
vaccination, and that in all her post-injury medical records she continuously related her
right shoulder pain back to the flu vaccination. Id. at 7. In particular, just three weeks after
vaccination, Ms. Juno specifically complained to her primary care physician about the
pain in her shoulder “since” receiving the vaccinations on October 10, 2016. Id. And in all
subsequent records that mention onset, Petitioner continued to relate her right shoulder
pain back to her flu vaccination. Id. Petitioner also argues that the medical records are
supported by her sworn testimony and the testimony of her fact witnesses. Id. at 8.
b. Respondent’s Arguments
Respondent, on the other hand, argues that the 48-hour onset is only described in
Petitioner’s own statement and not corroborated by any objective evidence. Opp. at 4.
Respondent states that Petitioner “cannot overcome inconsistencies or discrepancies in
the medical records by simply filing Affidavits that state her preferred onset date.” Id. at
8. Respondent notes that in Petitioner’s initial visit to her PCP, she complained of bilateral
arm pain, and because the record does not specifically state “right” shoulder when
referring to the arm pain, such an inference cannot be made. Respondent also argues
that the term “worsening” can also relate to an onset of shoulder pain prior to vaccination.
Id. Finally, Respondent states that the Dearborn disability documents filed by Petitioner
which report an onset of shoulder symptoms within 48-hours of vaccination do not
substantiate her claim. Therefore, Petitioner’s SIRVA claim should be denied.
V. Finding of Fact
I make the following findings after a complete review of the record to include all
medical records, affidavits, Respondent’s Rule 4(c) report, the parties’ briefing and any
additional evidence filed. Specifically, I base the findings on the following evidence:
4

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 5 of 9
 Ms. Juno’s past medical history is significant for hypothyroidism, restless leg
syndrome, gastric reflux, and a hiatal hernia. Petitioner’s Exhibit (“Ex.”) 2 at 2.
She also reported a remote history of elbow surgery. Ex. 4 at 36.
 Approximately 10 days prior to receiving the vaccination at issue, on September
27, 2016, Ms. Juno was seen by her primary care provider (“PCP”), Dr. Elham
Siddiqui, for an annual exam. She reported “no current complaints,” and her
exam was normal. There is no history of shoulder complaints noted. Ex. 2 at 22-
24.
 Ms. Juno was 60 years old when she was administered a flu vaccine in her right
shoulder on October 10, 2016, by a nurse at her PCP’s office. Ex. 1 at 1; Ex. 7 at
8. Ms. Juno also received the Pneumovax 23 vaccine in her left deltoid during
this visit. Id.
 In her affidavit, Ms. Juno recalled that “[i]mmediately following the influenza
vaccination, I began to develop pain in my right shoulder.” Ex. 10 at 1, ¶2. She
stated that the nurse administering the vaccination was standing, while Ms. Juno
was seated. Ex. 11 at 1, ¶3.
 Ms. Juno stated in her affidavit that she was advised by her PCP’s office to wait a
week to see if her shoulder pain subsided. Id. at ¶ 6. When the pain did not
subside, she contacted her PCP again and made an appointment for November
2, 2016. Id. at ¶7.
 On November 2, 2016, 23 days after vaccination, Ms. Juno presented to Dr.
Siddiqui complaining of “worsening arm pain since getting flu and pneumonia
vaccines.” Ex. 2 at 36. Dr. Siddiqui diagnosed her with bilateral arm pain and
myalgia. She was prescribed a steroid taper. Id. at 38.
 By December 14, 2016, Ms. Juno was still experiencing pain in her right
shoulder. She returned to her PCP stating that she “still [had] difficulty raising her
arm, can’t take shirt off”, “aching, can’t reach behind,” “very sore to touch.” Ms.
Juno stated that she had tried steroid and anti-inflammatory medications to no
avail. Ex. 2 at 32. On exam, she exhibited decreased range of motion of the right
shoulder, tenderness, pain and decreased strength. Id. at 34. Dr. Siddiqui
ordered an MRI. Id.
 On December 21, 2016, Ms. Juno underwent an MRI of her right shoulder which
demonstrated a “full thickness supraspinatus tear, partial bursal sided
infraspinatus tear, and moderate osteoarthritis of the acromioclavicular joint.” Ex.
2 at 64.
5

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 6 of 9
 On January 11, 2017, Ms. Juno was examined by orthopedic surgeon, Dr. John
McPhilemy, who noted that Ms. Juno “began to experience right shoulder
symptoms following a flu shot she received on or about 10/10/2016. Symptoms
have persisted over the past three months…” Ex. 5 at 6-7. He recommended
arthroscopic surgery to repair the tears, followed by a course of physical therapy.
Id. at 7.
 On January 20, 2017, Ms. Juno underwent a right shoulder arthroscopic shoulder
repair. Ex. 3 at 9. The postoperative diagnoses included: (1) rotator cuff tear,
right shoulder, (2) degenerative glenoid labrum tear, and (3) early osteoarthritis,
right glenohumeral joint. Id.
 Five days later, on January 25, 2017, Ms. Juno was examined by Dr. McPhilemy
who noted that Ms. Juno’s incisions were healing and there were no signs of
infection or deep vein thrombosis. Ex. 5 at 5. She was to be reexamined in one
week.
 Ms. Juno had several post-operative appointments with Dr. McPhilemy on
February 1, 8, and 27, 2017. See generally Ex. 3, 5.
 On March 27, 2017, nine weeks after surgery, Dr. McPhilemy noted that Ms.
Juno’s pain was “slowly improving” although she was not yet pain free. Ex. 3 at 3.
He recommended that Ms. Juno work with a physical therapist to improve her
range of motion and to prevent adhesive capsulitis. Id.
 By April 17, 2017, Dr. McPhilemy noted that Ms. Juno’s range of motion “is
improved to about 90% of normal, pain is improved and strength is about 85% of
normal.” Ex. 3 at 2. Dr. McPhilemy recommended that Ms. Juno continue with
physical therapy for another two weeks. Id.
 At her May 3, 2017 appointment with Dr. McPhilemy, Ms. Juno’s right shoulder
had improved but she was not pain free. Ex. 3 at 1. Dr. McPhilemy confirmed that
Ms. Juno still had some restriction in her right shoulder and “uncomfortable
internal rotation”, but all other motion was “pretty close to normal.” Strength was
90% of normal. Id.
 Ms. Juno attended post-surgical physical therapy from March 27, 2017 to May
31, 2017. See generally Exs. 3, 4. She was discharged from physical therapy on
May 31, 2017, to a home exercise program. Ex. 3 at 5.
 Ms. Juno filed a short-term disability claim with Dearborn National Disability on
January 25, 2017. Ex. 12 at 10-11. Petitioner listed her injury as “torn rotator cuff”
6

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 7 of 9
with symptoms first manifesting on October 11, 2016, one day after vaccination.
Id.
The record as summarized above preponderantly supports the conclusion that
Petitioner experienced right shoulder pain immediately after administration of the flu
vaccine on October 10, 2016. Despite Respondent’s reluctance to admit that Petitioner
reported her right shoulder pain just three weeks after vaccination, the records make clear
that Petitioner’s right shoulder pain began immediately after vaccination and within the 48
hour onset period to prove a SIRVA claim.
Thus, just 23 days after vaccination, Ms. Juno had an appointment with her PCP
to specifically complain of her shoulder pain. In her affidavit, she states that she called
her PCP’s office more than once to complain of shoulder pain, although the phone records
have not been filed into the record. But clearly Ms. Juno made at least one phone call to
set the November 2, 2017 appointment – and it was within a month of the vaccine’s
administration.
In addition, the record from that first appointment with Dr. Siddiqui states that Ms.
Juno complained of “worsening arm pain since getting flu and pneumonia vaccines.” Ex.
2 at 36 (emphasis added). This descriptor “worsening” indicates that Ms. Juno’s bilateral
shoulder pain started prior to the November 2, 2017 visit, and provides further evidence
that her bilateral arm pain, which includes the right shoulder, was “worsening” “since”
receiving the vaccinations – supporting the contention that the pain itself began at or close
to the time of vaccination. Respondent’s view that the term “bilateral” discounts the
possibility of a Table onset is not persuasive, since Dr. Siddiqui clearly stated that Ms.
Juno’s arm pain stemmed from both the flu and pneumonia vaccines (and both are
grounds for a Table SIRVA claim). Equally unpersuasive is Respondent’s argument that
bilateral pain means Petitioner could not have experienced pain in her right shoulder after
receiving the flu vaccine. The medical record allows the conclusion that her left arm pain
from the Pneumovax vaccine resolved (consistent with the vast majority of vaccinations),
while the right arm pain lingered, and therefore it is the actionable vaccination.
The other factor that weighs in my finding of the 48-hour onset of right shoulder
pain is the absence of any statement or record that places the onset of Ms. Juno’s right
shoulder pain outside the 48-hour window. While Respondent correctly notes in a footnote
that Dr. McPhilemy’s record memorialized a three-month history of arm pain - which if
correct would place the onset of right shoulder pain prior to vaccination (see Opp. at 2,
fn. 2) - it is clear that Dr. McPhilemy was generalizing the onset period, rather than
precisely calculating the period for legal purposes (as is done in Vaccine Program
7

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 8 of 9
cases).3 Dr. McPhilemy otherwise clearly sets the onset of Petitioner’s right shoulder pain
as starting on 10/10/2016, and taken as a whole, this is the most reasonable interpretation
of his entire statement.
Respondent further argues that Petitioner cannot overcome inconsistencies or
discrepancies in the medical records simply by filing affidavits that gainsay or modify what
the records set forth. But the Federal Circuit has expressly recognized that witness
testimony on issues pertaining to fact matters like symptoms onset can be proven through
this kind of evidence (even if they must be weighed against the records, which also have
evidentiary significance). Kirby, 997 F.3d at 1383. Respondent has not otherwise
identified any other inconsistencies or discrepancies in the medical records. All other
references to onset clearly relate Petitioner’s right shoulder pain as occurring immediately
after vaccination.
Finally, Respondent questions the weight to be given affidavits filed by Petitioner
in support of her claim of onset, noting in particular that Ms. Juno’s second and third
affidavits were written over three years after her October 10, 2016 flu vaccination, “and
petitioner did not explain why she did not provide any of that information to her treating
doctor’s when she first sought treatment.” Opp. at 3. While I accept that the date of some
contentions or witness statements can be relevant to the weight they should be given, I
also note that such matters are a “two-way street.” Thus, as Petitioner aptly notes in her
Reply brief, Respondent filed his Rule 4(c) report challenging the issue of onset on
February 6, 2020 - a total of 640 days (21 months) after the Petition was filed. It was not
obvious that onset would be challenged in this case, especially since Petitioner reported
her shoulder injury less than 30 days after vaccination, and given that the parties did seek
to settle the matter for some time.
Weighing the evidence on the preponderance standard, I overall find that Petitioner
has met her burden. One of the most significant pieces of evidence is the fact that Ms.
Juno was seen by her primary care physician for her right shoulder pain just 23 days after
she was administered the flu vaccine. There are also many references in the medical
records (as listed above) that squarely place the onset of Ms. Juno’s shoulder pain in the
48-hour window. Despite Respondent’s seeming view that only evidence of onset in
records prepared within the 48-hour period set by the Table is credible, the Act says
otherwise. § 13(b)(2). Taken as a whole, I find the sworn testimony of Ms. Juno to be
credible and in agreement with most of the contemporaneously created treatment
records.
3 The entire statement by Dr. McPhilemy states that Ms. Juno “began to experience right shoulder pain
symptoms following a flu shot she received on or about 10/10/2016. Symptoms have persisted over the
past three months.” Ex. 5 at 6-7.
8

Case 1:18-vv-00643-UNJ Document 47 Filed 10/13/21 Page 9 of 9
Accordingly, I find the onset of Petitioner’s pain within 48 hours of vaccination.
VI. Scheduling Order
Given my finding of fact regarding the onset of Ms. Juno’s right shoulder pain,
Respondent should evaluate and provide his current position regarding the merits of
Petitioner’s case.
Accordingly, Respondent shall file, by no later than Friday, October 15,
2021, an amended Rule 4(c) Report reflecting Respondent’s position in light of
the above fact-finding.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
9

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DOCUMENT 2: USCOURTS-cofc-1_18-vv-00643-1
Date issued/filed: 2021-11-24
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/15/2021) regarding 49 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-00643-UNJ Document 51 Filed 11/24/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0643V
UNPUBLISHED
DEBRA JUNO, Chief Special Master Corcoran
Petitioner, Filed: October 15, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
Respondent. Administration (SIRVA)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On May 8, 2018, Debra Juno 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 following an influenza (“flu”) vaccination on October 10, 2016,
she suffered from a Vaccine Table injury, namely shoulder injury related to vaccine
administration (“SIRVA”). Petition at 1. Petitioner further alleges that her injuries lasted
for more than six months. Petition at 1. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On October 15, 2021, Respondent filed his Rule 4(c) report in which he states that
he does not contest that Petitioner is entitled to compensation in this case. Respondent’s
Rule 4(c) Report at 1. Specifically, Respondent states that “while preserving his right to
1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required
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). This means the Ruling will be available to anyone with access to the internet. 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, I agree that
the identified material fits within this definition, I 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:18-vv-00643-UNJ Document 51 Filed 11/24/21 Page 2 of 2
appeal the Chief Special Master’s September 13, 2021 finding that the onset of
petitioner’s right shoulder pain took place within 48 hours of her flu vaccination,
respondent accepts this ruling as the law of the case for purposes of further proceedings
before the Office of Special Masters.” Id. at 5. Respondent further states that based on
the fact ruling and medical evidence submitted, he will not continue to defend the case
on other grounds and requests that I issue a ruling on the existing record regarding
Petitioner’s entitlement to compensation. Id. at 2, 6.
In view of Respondent’s position and the evidence of record, I find that
Petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
2

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DOCUMENT 3: USCOURTS-cofc-1_18-vv-00643-2
Date issued/filed: 2022-12-02
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 11/02/2022) regarding 64 DECISION of Special Master ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:18-vv-00643-UNJ Document 67 Filed 12/02/22 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0643V
UNPUBLISHED
DEBRA JUNO, Chief Special Master Corcoran
Petitioner, Filed: November 2, 2022
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Decision Awarding Damages; Pain
HUMAN SERVICES, and Suffering; Influenza
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Injury (SIRVA)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On May 7, 2018, Debra Juno 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 related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine she received on
October 10, 2016. Petition at 1. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
After I issued my Ruling on Entitlement finding Petitioner entitled to compensation,
the parties could not agree on the damages to be awarded, and therefore the matter was
scheduled for a “Motions Day” proceeding. For the reasons discussed below, and after
1 Because this unpublished Decision contains a reasoned explanation for the action in this case, I am
required 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). This means the Decision will be available to anyone with access to the
internet. 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, I agree that the identified material fits within this definition, I 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

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hearing argument from the parties, I find that Petitioner is entitled to compensation in the
amount of $100,000.00 for her actual pain and suffering. (The parties have agreed that
Petitioner is entitled to $815.00 in out-of-pocket expenses, and $4,585.00 in lost wages).
I. Procedural History
Initially, Respondent contested entitlement in this case, arguing that the onset of
Petitioner’s shoulder pain had not begun within the 48-hour window for a Table SIRVA
claim. ECF No. 38. On September 13, 2021, I issued a ruling finding in favor of Petitioner
on that issue, and ordered Respondent to file an amended Rule 4(c) report based on my
finding. Thereafter, Respondent stated that “while preserving his right to appeal the Chief
Special Master’s September 13, 2021, finding that the onset of petitioner’s right shoulder
pain took place within 48 hours of her flu vaccination, respondent accepts this ruling as
the law of the case for purposes of further proceedings before the Office of Special
Masters.” Respondent’s Rule 4(c) Report at 5. ECF No. 48. On October 15, 2021, I issued
a ruling finding that Petitioner was entitled to compensation. ECF No. 49.
The parties were unable to agree on an appropriate amount to award Ms. Juno for
her pain and suffering, and agreed to brief the issue. ECF No. 54. On April 22, 2022,
Petitioner filed her Brief in Support of Damages (“Mot.”), and Respondent filed a
Response on June 16, 2022 (“Opp.”).3 ECF Nos. 57, 59. I heard arguments from both
parties during a Motions’ Day Damages hearing held on October 28, 2022.
II. Relevant Medical History
A complete recitation of the facts can be found in the petition, the parties’
respective pre-hearing filings, in Respondent’s Rule 4(c) Reports, and in the Findings of
Fact issued on September 13, 2021.
In brief summary, Ms. Juno’s past medical history was significant for
hypothyroidism, restless leg syndrome, gastric reflux, and a hiatal hernia. Petitioner’s
Exhibit (“Ex.”) 2 at 2. There is no history of shoulder complaints noted. Ex. 2 at 22-24.
Ms. Juno was 60 years old when she received a flu vaccine in her right shoulder
on October 10, 2016, by a nurse at her primary care physician’s (“PCP”) office. Ex. 1 at
1; Ex. 7 at 8.4 In her affidavit, Ms. Juno recalled that “[i]mmediately following the influenza
vaccination, I began to develop pain in my right shoulder.” Ex. 10 at 1, ¶2. She stated that
3 No Reply brief was filed.
4 Ms. Juno also received the Pneumovax 23 vaccine in her left deltoid during this visit, but this vaccine is
not covered under the Vaccine Program. Id.
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the nurse administering the vaccination was standing, while Ms. Juno was seated. Ex. 11
at 1, ¶3. Ms. Juno also stated in her affidavit that she was advised by her PCP’s office to
wait a week to see if her shoulder pain subsided. Id. at ¶ 6. When the pain did not subside,
she contacted her PCP again and made an appointment for November 2, 2016. Id. at ¶7.
On November 2, 2016, 23 days after vaccination, Ms. Juno presented to Dr. Elham
Siddiqui at Penn Internal & Family Medicine of Bucks County complaining of “worsening
arm pain since getting flu and pneumonia vaccines.” Ex. 2 at 36. Dr. Siddiqui diagnosed
her with bilateral arm pain and myalgia. She was prescribed a steroid taper. Id. at 38.
By December 14, 2016, Ms. Juno was still experiencing pain in her right shoulder.
She returned to her PCP stating that she “still [had] difficulty raising her arm, can’t take
shirt off”, “aching, can’t reach behind,” “very sore to touch.” Ms. Juno stated that she had
tried steroid and anti-inflammatory medications to no avail. Ex. 2 at 32. On exam, she
exhibited decreased range of motion of the right shoulder, tenderness, pain and
decreased strength. Id. at 34. Dr. Siddiqui ordered an MRI. Id.
On December 21, 2016, Ms. Juno underwent an MRI of her right shoulder which
demonstrated a “full thickness supraspinatus tear, partial bursal sided infraspinatus tear,
and moderate osteoarthritis of the acromioclavicular joint.” Ex. 2 at 64.
On January 11, 2017, Ms. Juno was examined by orthopedic surgeon, Dr. John
McPhilemy, who noted that Ms. Juno “began to experience right shoulder symptoms
following a flu shot she received on or about 10/10/2016. Symptoms have persisted over
the past three months…” Ex. 5 at 6-7. He recommended arthroscopic surgery to repair
the tears, followed by a course of physical therapy. Id. at 7.
On January 20, 2017, Ms. Juno underwent a right shoulder arthroscopic shoulder
repair. Ex. 3 at 9. The postoperative diagnoses included: (1) rotator cuff tear, right
shoulder, (2) degenerative glenoid labrum tear, and (3) early osteoarthritis, right
glenohumeral joint. Id. Five days later, on January 25, 2017, Ms. Juno was examined by
Dr. McPhilemy who noted that Ms. Juno’s incisions were healing and there were no signs
of infection or deep vein thrombosis. Ex. 5 at 5. Ms. Juno had several post-operative
appointments with Dr. McPhilemy on February 1, 8, and 27, 2017. See generally Ex. 3,
5.
On March 8, 2017, Ms. Juno underwent an initial physical therapy evaluation at
Hand & Orthopedic Physical Therapy Associates. She was prescribed a course of therapy
two (2) to three (3) times per week for four (4) weeks. Ex. 4.
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On March 27, 2017, nine weeks after surgery, Dr. McPhilemy noted that Ms. Juno’s
pain was “slowly improving” although she was not yet pain free. Ex. 3 at 3. He
recommended that Ms. Juno work with a physical therapist to improve her range of motion
and to prevent adhesive capsulitis. Id.
By April 17, 2017, Dr. McPhilemy noted that Ms. Juno’s range of motion “is
improved to about 90% of normal, pain is improved and strength is about 85% of normal.”
Ex. 3 at 2. Dr. McPhilemy recommended that Ms. Juno continue with physical therapy for
another two weeks. Id.
At her May 3, 2017 appointment with Dr. McPhilemy, Ms. Juno’s right shoulder had
improved but she was not pain free. Ex. 3 at 1. Ms. Juno attended post-surgical physical
therapy from March 27, 2017, to May 31, 2017. See generally Exs. 3, 4. She was
discharged from physical therapy on May 31, 2017, to a home exercise program. Ex. 3 at
5.
III. The Parties’ Arguments
a. Petitioner
Ms. Juno seeks an award of $110,000.00 as compensation for her pain and
suffering. Mot. at 1. She notes that she reported her pain to a medical provider just 23
days after vaccination. Id. at 8. After her pain failed to improve and an MRI showed a full
thickness supraspinatus tear and a partial bursal sided surface tear, Petitioner underwent
arthroscopic surgery. Id. Petitioner attended a total of 19 post-operative physical therapy
(“PT”) sessions and seven follow-up appointments with her orthopedist. Id. She also
underwent seven and a half months of active treatment after vaccination, and still
complains of intermittent aching pain and she continues to have difficulty lifting heavy
items. Id.
During the hearing and in her brief, Petitioner discussed several prior SIRVA
cases5 that all involved injured claimants with mild to moderate shoulder injuries which
required surgical intervention, and all had similar physical therapy sessions. Thus,
Petitioner argued that an award of $110,000.00 was reasonable and appropriate given
that her circumstances were comparable. Mot. at 5-9.
5 The cases cited by Petitioner are Cates v. Sec’y of Health & Human Servs., No. 18-277, 2020 WL 3751072
(Fed. Cl. Spec. Mstr. June 5, 2020), Slugo v. Sec’y of Health & Human Servs., No. 19-635V, 2022 WL
627782 (Fed. Cl. Spec. Mstr. Jan. 31, 2022); Knudson v. Sec’y of Health & Human Servs., No. 17-1004V,
2018 WL 6293381 (Fed. Cl. Spec. Mstr. Nov. 7, 2018); Wilt v. Sec’y of Health & Human Servs., No. 18-
446V, 2020 WL 1490757 (Fed. Cl. Spec. Mstr. Feb. 24, 2020).
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b. Respondent
Respondent maintains that a slightly lower pain and suffering award of $80,000.00
is appropriate given the overall nature of Ms. Juno’s injury. Opp. at 15. Respondent
argued that while this case involves surgical intervention, the records document a very
short period of overall treatment, little treatment in the first two months after vaccination,
and no steroid injections or PT prior to surgery. Id.
Respondent notes that SPU petitioners have been awarded less than
$100,000.00, in a number of SIRVA cases involving surgery. For example, in Shelton v.
Sec’y of Health & Human Servs., No. 19-279V, 2021 WL 2550093 (Fed. Cl. Spec. Mstr.
May 21, 2021), the relevant petitioner sought “consistent” care both before and after
surgery that included three steroid injections, significant PT both before and after shoulder
surgery, and fluctuating levels of pain. Opp. at 16. While the Shelton petitioner delayed
seeking treatment for nearly five months after vaccination, that petitioner’s overall course
was lengthier than here, justifying a lower award in this case. Id.
At the hearing and in her brief, Respondent also attempted to distinguish the cases
cited by Petitioner, maintaining that the petitioners in each of those cases sought much
more pre-surgery care and had longer courses of overall treatment. Id. at 16-17.
Accordingly, Ms. Juno’s award should be significantly lower than the SIRVA cases cited
by Petitioner. Id. at 18-20.
IV. Legal Standard
Compensation awarded pursuant to the Vaccine Act shall include an award “[f]or
actual and projected pain and suffering and emotional distress from the vaccine-related
injury, an award not to exceed $250,000.” Section 15(a)(4). Additionally, a petitioner may
recover “actual unreimbursable expenses incurred before the date of judgment award
such expenses which (i) resulted from the vaccine-related injury for which petitioner seeks
compensation, (ii) were incurred by or on behalf of the person who suffered such injury,
and (iii) were for diagnosis, medical or other remedial care, rehabilitation . . . determined
to be reasonably necessary.” Section 15(a)(1)(B). Petitioner bears the burden of proof
with respect to each element of compensation requested. Brewer v. Sec’y of Health &
Human Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18,
1996).
There is no precise formula for assigning a monetary value to a person’s pain and
suffering and emotional distress. I.D. v. Sec’y of Health & Human Servs., No. 04-1593V,
2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013) (“Awards for emotional
5

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distress are inherently subjective and cannot be determined by using a mathematical
formula”); Stansfield v. Sec’y of Health & Human Servs., No. 93-0172V, 1996 WL 300594,
at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the assessment of pain and suffering is
inherently a subjective evaluation”). Factors to be considered when determining an award
for pain and suffering include: 1) awareness of the injury; 2) severity of the injury; and 3)
duration of the suffering. I.D., 2013 WL 2448125, at *9 (quoting McAllister v. Sec’y of
Health & Human Servs., No 91-1037V, 1993 WL 777030, at *3 (Fed. Cl. Spec. Mstr. Mar.
26, 1993), vacated and remanded on other grounds, 70 F.3d 1240 (Fed. Cir. 1995)).
A special master may also look to prior pain and suffering awards to aid in the
resolution of the appropriate amount of compensation for pain and suffering in each case.
See, e.g., Doe 34 v. Sec’y of Health & Human Servs., 87 Fed. Cl. 758, 768 (2009) (finding
that “there is nothing improper in the chief special master’s decision to refer to damages
for pain and suffering awarded in other cases as an aid in determining the proper amount
of damages in this case.”). And, of course, a special master may rely on his or her own
experience adjudicating similar claims. Hodges v. Sec’y of Health & Human Servs., 9 F.3d
958, 961 (Fed. Cir. 1993) (noting that Congress contemplated the special masters would
use their accumulated expertise in the field of vaccine injuries to judge the merits of
individual claims). Importantly, however, it must also be stressed that pain and suffering
is not determined based on a continuum. See Graves v. Sec’y of Health & Human Servs.,
109 Fed. Cl. 579 (2013).
V. Appropriate Compensation in this SIRVA Case
a. Awareness of Suffering
Neither party disputes that that Ms. Juno had full awareness of her suffering, and
I find that fact is supported by the record evidence.
b. Severity and Duration of Pain and Suffering
With respect to the severity and duration of the injury, Ms. Juno’s medical records
and affidavits provide a description of the pain she experienced throughout the duration
of her injury. As noted, Ms. Juno was seen by her PCP quickly, just 23 days after
vaccination, where she reported worsening pain in her right shoulder since receiving her
flu vaccination. Ex. 2 at 36. She was prescribed two courses of steroid treatment, but she
continued to complain of shoulder pain for more than two months after vaccination. Ex. 2
at 32. An MRI revealed several tears in her right deltoid, including a full thickness
supraspinatus tear and partial bursal infraspinatus tear, as well as mild atrophy,
tendinopathy and moderate arthritis of the acromioclavicular joint. Ex. 2 at 64-65. She
was referred to an orthopedist, who after conducting a physical examination and
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reviewing the recent MRI, suggested several treatment options, including surgery. Ex. 5
at 6-8. Petitioner elected surgery to repair the tears shown on the MRI. Ex. 9 at 13-14.
After surgery, she reported constant pain ranging from a 4/10 to 10/10. Ex. 3 at 18. She
attended 19 post-operative physical therapy sessions, and approximately 5 months after
surgery, showed significant improvement. Ex. 4 at 3-6. I note that Ms. Juno stopped
seeking treatment for her SIRVA within seven months of vaccination, and there is no
information in her affidavits specifically describing the pain and suffering she endured as
a result of her injury.
Although both parties cited to prior SIRVA cases in support of their proposed
awards that were reasonably comparable, I believe this case is most similar to Cates v.
Sec’y of Health & Human Servs., No. 18-0277, 2020 WL 0751072 (Fed. Cl. Spec. Mstr.
June 5, 2020) (awarding $108,000.00) cited by Petitioner. The Cates petitioner had a
course of treatment very similar to Ms. Juno’s – treatment by her PCP, one MRI, 19 total
physical therapy sessions, and a cessation of treatment approximately eight months after
vaccination. Id. at 1-4. The only material differences between that treatment course and
Ms. Juno’s were that Ms. Cates received a steroid injection and attended nine
occupational therapy sessions prior to surgery and 10 post surgery. Overall, Ms. Juno
had a very similar injury course, but I will award a slightly lesser amount than what the
Cates petitioner received, to account for Ms. Juno’s shorter overall treatment course and
the lesser amount of treatment she received prior to surgery.
I also found the Shelton case cited by Respondent to be a good comparable,
demonstrating that a six-figure award is not always warranted in SIRVA cases involving
surgery. At the same time, however, Shelton involved some particularly egregious factors
not evident here, like a lengthy delay in seeking initial post-vaccination treatment. In cases
where there is an obvious delay between the time an individual receives a vaccination
and when the individual seeks care for the related injury, the injury is likely to be less
severe. This is especially the case when the individual is seen during intervening
unrelated medical visits and could have reported the injury or symptoms during those
visits. These types of delays are factored into an award for damages.
Overall, Ms. Juno’s SIRVA was on the moderate side, but she did undergo surgical
intervention. Her overall treatment course was not very long, approximately six to eight
months, but Respondent’s proposed award is still too low. However, Ms. Juno’s
treatment, especially pre-surgery, was not extensive and her overall recovery was quick.
Thus, some discount in the award proposed by Petitioner is warranted.
Under such circumstances and considering the arguments presented by both
parties at the hearing, a review of the cited cases, and based on the record as a whole, I
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find that $100,000.00 in compensation for past pain and suffering is reasonable and
appropriate in this case.
c. Other Expenses
As noted, the parties agree that Petitioner has established the amounts sought for
out-of-pocket medical expenses ($815.00), and for lost wages ($4,585.00), for a total of
$5,400.00. Opp. at 2.
VI. CONCLUSION
In light of all of the above, the I award Petitioner the lump sum payment of
$105,400.000 (consisting of $100,000.00 for her actual pain and suffering, $815.00
for out-of-pocket medical expenses, and $4,585.00 in lost wages) in the form of a
check payable to Petitioner Debra Juno. This amount represents compensation for all
damages that would be available under Section 15(a) of the Vaccine Act. Id.
The Clerk of the Court is directed to enter judgment in accordance with this
Decision.6
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
6 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.
8