VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00704
Package ID: USCOURTS-cofc-1_18-vv-00704
Petitioner: Kevin Radford
Filed: 2018-05-18
Decided: 2023-02-22
Vaccine: influenza
Vaccination date: 2015-09-11
Condition: chronic inflammatory demyelinating polyneuropathy (CIDP)
Outcome: denied
Award amount USD: 

AI-assisted case summary:
Kevin Radford filed a petition on May 18, 2018, alleging that an influenza vaccine administered on September 11, 2015, significantly aggravated his pre-existing condition of chronic inflammatory demyelinating polyneuropathy (CIDP). Mr. Radford, born in 1963, had experienced symptoms consistent with CIDP prior to the vaccination, though it was not formally diagnosed until after the vaccination. The Secretary of Health and Human Services disputed the claim, arguing that Mr. Radford had not established a persuasive medical theory linking the flu vaccine to CIDP aggravation and that his condition had not significantly worsened post-vaccination. Special Master Christian J. Moran presided over the case. Petitioner was represented by Laura Levenberg of Muller Brazil, and Respondent was represented by Tyler King of the United States Department of Justice. The public decision was issued on February 22, 2023. Mr. Radford's claim presented two independent flaws: first, he failed to establish by a preponderance of the evidence a medical theory for how a flu vaccine can cause CIDP to worsen, and second, he did not persuasively show that his CIDP was meaningfully worse after the vaccination. The Special Master considered testimony from Mr. Radford, his treating physicians, and retained neurologists Dr. Maria Chen (for petitioner) and Dr. Brian Callaghan and Dr. Jacob Kaufman (for respondent). The court found that Mr. Radford failed to establish a credible medical theory for vaccine-induced CIDP aggravation, citing a lack of supporting literature and ambiguous expert opinions. Specifically, Dr. Chen's theory of molecular mimicry was not well-supported by the cited articles, and Dr. Kaufman's testimony was considered confusing and not illuminating on the specific issue of flu vaccine-induced CIDP aggravation. Furthermore, the court determined that the evidence did not preponderantly show a significant worsening of his CIDP after the vaccination, noting mixed results in strength and sensory tests between evaluations before and after the vaccination. Consequently, the court denied Mr. Radford's petition for compensation.

Theory of causation field:
Petitioner Kevin Radford, born in 1963, received an influenza vaccine on September 11, 2015, and alleged significant aggravation of his pre-existing Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). The claim was off-Table. The Special Master Christian J. Moran denied the petition on February 22, 2023. Petitioner was represented by Laura Levenberg, and Respondent by Tyler King. The decision relied on the six-prong test from Loving. Petitioner failed to establish Loving Prong 4 (medical theory) and Prong 3 (significant aggravation). Regarding theory, petitioner's expert, Dr. Maria Chen, proposed molecular mimicry, but her supporting articles (Kuitwaard et al., Goodridge et al., Toplak & Avčin) were found to lack direct links between flu vaccines and CIDP aggravation, with methodological concerns and small sample sizes noted. Respondent's expert, Dr. Brian Callaghan, also found no supporting literature. Dr. Jacob Kaufman, while stating flu vaccines could exacerbate CIDP, provided testimony considered confusing and not illuminating on causality. Regarding significant aggravation, the Special Master compared pre-vaccination (September 3, 2015, Dr. Lucas) and post-vaccination (November 11, 2015, Dr. Kaufman) evaluations. The evidence was mixed, with some indicators of decline (e.g., reflexes, certain strength tests) but also indicators of improvement or no change (e.g., other strength tests, use of cane). The Special Master concluded the evidence preponderated in favor of the finding that Mr. Radford's CIDP was not affected by the vaccination, thus failing the significant aggravation prong. No award was made.

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_18-vv-00704-0
Date issued/filed: 2023-02-22
Pages: 19
Docket text: PUBLIC DECISION (Originally filed: 1/31/2023) regarding 110 DECISION of Special Master Signed by Special Master Christian J. Moran. (cjaj) Service on parties made.
--------------------------------------------------------------------------------
Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 1 of 19
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * * *
KEVIN RADFORD, *
*
Petitioner, * No. 18-704V
* Special Master Christian J. Moran
*
v. *
* Filed: February 22, 2023
SECRETARY OF HEALTH *
AND HUMAN SERVICES, * entitlement, significant aggravation,
* flu vaccine, CIDP, theory
Respondent. *
* * * * * * * * * * * * * * * * * * * * * *
Laura Levenberg, Muller Brazil, Dresher, PA, for petitioner;
Tyler King, United States Dep’t of Justice, Washington, DC, for respondent.
PUBLISHED DECISION DENYING COMPENSATION1
Kevin Radford suffered from chronic inflammatory demyelinating
polyneuropathy (“CIDP”) before he received an influenza (“flu”) vaccine in
September 2015. He alleges that the flu vaccination significantly aggravated his
CIDP. The Secretary disputes this claim.
Mr. Radford, one of his treating doctors, a neurologist Mr. Radford retained,
and a neurologist the Secretary of Health and Human Services (“Secretary”)
retained all testified at a hearing. Based upon the testimonial and documentary
evidence, Mr. Radford is not entitled to compensation. Mr. Radford’s claim
suffers from two independent flaws. First, he has not established with
preponderant evidence how a flu vaccine can cause CIDP to worsen. Second, Mr.
1 The E-Government Act, 44 U.S.C. § 3501 note (2012) (Federal Management and
Promotion of Electronic Government Services), requires that the Court post this decision on its
website. The posting of this decision will make it available to anyone with the internet.
Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing redaction of
medical information or other information described in 42 U.S.C. § 300aa-12(d)(4). Any
redactions ordered by the special master will appear in the document posted on the website.

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 2 of 19
Radford has not persuasively shown that his CIDP was meaningfully worse after
the vaccination. Thus, the Clerk’s Office is instructed to dismiss Mr. Radford’s
petition.
I. Facts2
A. Before Vaccination
Mr. Radford was born in 1963. Tr. 10. Before the relevant vaccination, he
worked on a full-time basis directing counselors who worked with injured Federal
employees. Id. at 10-11, 96. He could perform the basic activities of daily living
and household chores such as taking out the trash. Id. at 16.
In December 2012, Mr. Radford began a series of appointments with a
podiatrist, Jeffrey Miller. Mr. Radford complained about bilateral heel pain and
plantar fasciitis. Exhibit 8 at 2; Tr. 17-18. Dr. Miller diagnosed Mr. Radford as
suffering from tarsal tunnel syndrome. Exhibit 8 at 2. Other appointments
occurred on February 4, 2013, and March 11, 2013. Id. A neurologist whom the
Secretary retained, Dr. Brian Callaghan, opined that tarsal tunnel syndrome is
“incredibly rare” and it is unlikely that Mr. Radford suffered from tarsal tunnel
syndrome. Tr. 269.
In addition to having pain in his feet for which Mr. Radford sought care
from a podiatrist, Mr. Radford also had pain and numbness in his hands. For these
problems, Mr. Radford sought care from a neurologist, Stephen Sacks, on March
20, 2014. Exhibit 11 at 6; Tr. 22-23. Dr. Sacks performed a nerve conduction
study and an EMG that Dr. Sacks interpreted as being consistent with carpal tunnel
syndrome. Exhibit 11 at 7-8.
Both the neurologist whom Mr. Radford retained, Dr. Maria Chen, and the
Secretary’s expert, Dr. Brian C. Callaghan, agreed that the EMG did not show
carpal tunnel syndrome. Instead, both experts opined that the March 20, 2014
EMG showed that Mr. Radford was suffering from CIDP. Tr. 129, 151, 174, 263.
Because of these opinions, Mr. Radford eventually alleged that a flu vaccination
significantly aggravated his previously undiagnosed CIDP.3
2 The parties generally agreed that the medical records accurately describe events
occurring around the time that the medical records were created. Although Mr. Radford
testified, he recognized the accuracy of the medical records. See, e.g., Tr. 70, 83.
3 The neurologist who eventually diagnosed Mr. Radford’s CIDP, Jacob Kaufman, was
less confident in placing the onset of CIDP in the spring of 2014. Tr. 191-92.
2

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 3 of 19
On April 3, 2014, Mr. Radford then visited his orthopedist, Dr. John
Nuvelis, and presented with a “mild aching, burning” pain is his right wrist since
five months prior, as well as numbness and tingling in his hand. Exhibit 12 at 12-
13. He also had mild chronic aching in his hips. Id. at 13. He was diagnosed with
carpal tunnel syndrome and hip pain. Id. at 14.
Over one month later, Mr. Radford had a follow up appointment with Dr.
Nuvelis on May 28, 2014. Exhibit 12 at 9-11. During the visit, Dr. Nuvelis
injected Mr. Radford with a steroid (cortisone). Id. at 11.
In October 2014, Mr. Radford was experiencing pain in his left lower
extremity, which he rated as a 6/10. Exhibit 6 at 10; Tr. 68-70. He, therefore,
sought care from his primary care physician, Mignon DeLeon. Id. Mr. Radford
also told Dr. DeLeon that he banged his elbow on a wall at work and had left
elbow pain. Dr. DeLeon prescribed ibuprofen. Exhibit 6 at 10.
After October 2014, Mr. Radford continued to have pain. Pet., ¶¶ 5-8; Tr.
73, 265. Due to pain in his heel and plantar fascia, Mr. Radford returned to Dr.
Miller on December 11, 2014. Exhibit 8 at 2. Dr. Miller’s impression remained
unchanged, in other words, Mr. Radford’s diagnosis remained chronic plantar
fasciitis and tarsal tunnel syndrome. Dr. Miller recommended stretching and
orthotics and prescribed Mobic. Id.
In December 2014, Mr. Radford was having sharp pain in his thigh and left
calf. This pain made walking quickly difficult and prevented him from attending
his office’s holiday party. Tr. 26, 74; see also Exhibit 7 at 1.
Mr. Radford reported his problems with walking when he saw Dr. Sacks
again on January 13, 2015. Exhibit 7 at 1-2; Tr. 71. Dr. Sacks performed another
NCS and EMG. Exhibit 7 at 4. He indicated that the clinical and
electrophysiological evidence supported a diagnosis of bilateral tarsal involvement
of the medial plantar nerves and recommended follow-up care with an orthopedist
and podiatrist. Id. However, again, Dr. Chen and Dr. Callaghan interpreted the
electrophysiological evidence differently from Dr. Sacks. In the opinion of Dr.
Chen and Dr. Callaghan, the EMG was consistent with CIDP. Tr. 131, 263, 269,
306, 311.
Around this time, Mr. Radford moved from his home in Norristown,
Pennsylvania to Atlanta, Georgia because his wife’s job had switched. Tr. 31. Mr.
Radford’s employer allowed him to telework some days and Mr. Radford often
flew back and forth. Id. at 31-33.
3

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 4 of 19
For his carpal tunnel problem, Mr. Radford underwent a bilateral release on
February 6, 2015. Exhibit 12 at 2. The surgeon was Dr. Nuvelis. Dr. Nuvelis saw
Mr. Radford for a follow-up on February 18, 2015 and recommended activities to
improve Mr. Radford’s “grip strength and range of motion.” Id. at 4.
In the winter and spring of 2015, Mr. Radford was still having trouble
walking due to pain in his thigh. He also stopped exercising in a gym. Tr. 30.
In February 2015, Mr. Radford visited Dr. Miller who noted he was
experiencing “heel pain bilaterally.” Exhibit 8 at 2; see also id. at 3 (showing that
in March 2015, Mr. Radford revisited Dr. Miller and again discussed that he was
having “heel pain bilaterally”).
On March 16, 2015, Mr. Radford visited Penn Specialty Care Valley Forge
Sports Medicine Center because he was experiencing “back pain” and was treated
by Dr. Michael Christopher Schettino. Exhibit 2 at 73-74 (noting Mr. Radford was
experiencing low back pain, left leg paresthesia, left leg weakness, abnormal
reflex, left lumber radiculopathy, and an antalgic gait). At the end of visit, Dr.
Schettino instructed Mr. Radford to “obtain x-rays . . . [and a] MRI of [his] L/S
spine.” Id. at 74.
An MRI of Mr. Radford’s lumbar spine showed that he had spinal stenosis
due to epidural lipomatosis. Id. at 11.4 “Epidural lipomatosis” means that Mr.
Radford had an excess amount of fat within his spinal cord. Tr. 214-15. This
excessive amount of fat compresses the nerve roots in the spinal cord, causing an
axonal injury. Id. at 215. While epidural lipomatosis is uncommon, the condition
sometimes requires surgery. Id. at 270. The location of the epidural lipomatosis
(L4 to S1) means that this condition could not be causing the problem that Mr.
Radford was experiencing in his hands. Id.
The location of the epidural lipomatosis was consistent with problems in Mr.
Radford’s lower extremities. Tr. 156-57, 216, 290. Around this time, Mr. Radford
was using a cane to help him walk. Exhibit 2 at 71; Tr. 79.
Mr. Radford’s use of a cane was part of the history a neurosurgeon, Timothy
Lucas, obtained on April 1, 2015. Exhibit 2 at 71. Dr. Lucas diagnosed him with
spinal stenosis of the lumbar region. Id.
4 Dr. Chen pointed out that the MRI did not image Mr. Radford’s cervical spine. Tr. 315.
4

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 5 of 19
In April 2015, Mr. Radford had episodes of foot drop and he fell several
times. He also had difficulty walking up stairs. Id. at 68.
For these reasons, Dr. Lucas operated on Mr. Radford’s herniated lumbar
disc on April 17, 2015. Exhibit 2 at 68. This operation was appropriate because
Mr. Radford had a structural problem in his spinal cord. Tr. 155, 178, 196. As
part of the recovery from the operation Dr. Lucas prescribed 60 mg of prednisone
for five days. Exhibit 2 at 48; see also Tr. 289.
After Mr. Radford started taking prednisone, he felt better. Id. In his
recovery, Mr. Radford spent time at a rehab clinic where he stopped using his cane.
Tr. 31. He missed more than two months of work and when he returned to work,
he teleworked on a full-time basis. Id.
When Mr. Radford returned to Dr. Lucas for postoperative care on June 11,
2015, Mr. Radford reported he had no pain, but he had numbness and tingling
along his lower leg. Exhibit 14 at 26. Mr. Radford also reported his balance was
improved. Id.
Mr. Radford testified that in summer of 2015, he was traveling back and
forth between Philadelphia and Atlanta. Tr. 34. While he said he had no trouble
with the traveling, he also reported that he used a wheelchair in the airport. Tr. 80.
By July 4, 2015, Mr. Radford was again having leg pain, which prevented
him from walking briskly. Tr. 37. Mr. Radford told Dr. Lucas that his “gait was
very disturbed.” Exhibit 14 at 33; see also Tr. 81. Dr. Lucas later memorialized a
complaint that Mr. Radford was having recurrent foot drops around this time.
Exhibit 2 at 48 (noting that “in 7/2015 . . . . [Mr. Radford’s] numbness became
continuous again and he began to have trouble walking due to recurrent foot
drops.”). Dr. Callaghan linked Mr. Radford’s severe weakness in his ankles to Mr.
Radford’s undiagnosed CIDP. Tr. 275.
In August 2015, Mr. Radford visited his podiatrist Dr. Miller twice, and at
both appointments, Mr. Radford reported that he continued to have heel pain.
Exhibit 8 at 3. Dr. Miller prescribed naproxen on August 14, 2015. Id. Naproxen
is an anti-inflammatory and nerve block that will relieve pain regardless of whether
the pain comes from plantar fasciitis or CIDP. Tr. 242-43. Dr. Chen and Dr.
Callaghan opined that the pain in Mr. Radford’s heels was traceable to CIDP. Id.
at 301, 312.
5

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 6 of 19
Mr. Radford returned to Dr. Lucas, the neurosurgeon, on September 3, 2015,
and this record from Dr. Lucas is one of the critical medical records in determining
whether Mr. Radford’s CIDP worsened after the flu vaccination. Mr. Radford told
Dr. Lucas that the numbness that Mr. Radford had been experiencing before the
operation had returned. Exhibit 14 at 32-33. Dr. Lucas also memorialized that Mr.
Radford reported having daily falls. Id.; see also Tr. 83.
Dr. Lucas tested Mr. Radford’s strength in various muscle groups.
Neurologists report their findings on a five-point scale with a three indicating the
person can barely move their leg against gravity. Tr. 271. Details about Dr.
Lucas’s evaluation of Mr. Radford’s strength as well as Mr. Radford’s reflexes and
sensation are set out below.
In the September 3, 2015 appointment, Dr. Lucas did not diagnose Mr.
Radford with CIDP, although Dr. Lucas was smart enough to realize that
re-growing fat could not explain all of Mr. Radford’s problems. Id. at 172, 270.
Through his expert, Dr. Chen, Mr. Radford emphasized that before he received the
vaccination, no doctor diagnosed Mr. Radford with CIDP. Id. at 130, 155-56, 160,
288. Likewise, before the vaccination, Mr. Radford had not received any
immunotherapy purposely directed at CIDP. Id. at 131. On the other hand, the
Secretary’s expert, Dr. Callaghan, viewed Mr. Radford as suffering a relapsing-
remitting course of CIDP in which flares and symptoms recur. Id. at 265-66.
B. Vaccination through March 2016
Mr. Radford received the allegedly harmful flu vaccination on September
11, 2015, at a Rite Aid near his apartment. Exhibit 1 at 1; Tr. 38. Mr. Radford
testified that after the vaccination, he had more difficulties. For example, he
recalled that shopping in a supermarket was difficult because he needed to use a
cart to go through the store. Tr. 57.
Because he was concerned about his situation and unhappy with his previous
primary care physician, Mr. Radford sought a new doctor. Id. at 41-42, 100. He
called Robyn Salky on September 22, 2015 and reported numbness and tingling in
his legs and shooting pain. Exhibit 3 at 17; Tr. 40-41, 132.
The appointment with Dr. Salky occurred on October 4, 2015. He presented
to her as a new patient and gave a history consistent with the above. Exhibit 3 at
17. Mr. Radford was using a cane as needed for an antalgic gait. Id.; but see Tr.
101 (Mr. Radford’s testimony that he does not remember whether he was using a
cane). Dr. Salky’s exam revealed tenderness in his lower lumbar spine, but her
6

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 7 of 19
neurologic exam produced normal results. Exhibit 3 at 17.5 Dr. Salky
recommended continuing to take gabapentin, losing weight, and seeing a
neurologist. Id.; Tr. 42.
The neurologist to whom Dr. Salky referred Mr. Radford was Dr. Jacob L.
Kaufman, but there was a delay before Dr. Kaufman could see Mr. Radford. Tr.
43. During this time, Mr. Radford was driving to work. At work, his supervisor
saw him lose his balance and almost fall into a filing cabinet. So, the supervisor
suggested that Mr. Radford tele-commute full-time. Id. at 45. In Mr. Radford’s
view, he thought of himself as going downhill quickly as his symptoms
worsened—he began walking with the assistance of a cane and had to drag himself
up and down the stairs. Id. at 44-45.
Dr. Kaufman saw Mr. Radford on November 11, 2015. Exhibit 13 at 22.
This visit is another important source of evidence in determining whether Mr.
Radford’s CIDP worsened after the September 11, 2015 flu vaccination and was
the subject of a great deal of testimony from Dr. Kaufman, Dr. Chen, and Dr.
Callaghan.
As part of Dr. Kaufman’s evaluation of Mr. Radford, Dr. Kaufman reviewed
the March 2014 EMG and the January 2015 EMG, which had been interpreted as
supporting carpal tunnel syndrome and tarsal tunnel syndrome. Dr. Kaufman
disagreed with these interpretations. Exhibit 13 at 22.6 Dr. Kaufman also obtained
a history from Mr. Radford in which Mr. Radford said that he worsened in July.
Id.; see also Tr. 277. This history does not mention the flu vaccination. Tr. 184.
Like Dr. Lucas, Dr. Kaufman conducted a neurologic evaluation, testing Mr.
Radford’s strength, reflexes, and sensation. The details are presented below.
Based upon this information Dr. Kaufman suspected that Mr. Radford had CIDP.
Exhibit 13 at 22; Tr. 174.
Dr. Kaufman ordered another EMG, which took place on November 17,
2015. The EMG showed “[s]evere, distal-predominant, sensorimotor,
demyelinating polyneuropathy, exceeding EFNS/PNS Joint Task Force criteria for
‘definite’ [CIDP].” Exhibit 4 at 19. Dr. Kaufman also stated: “While this study
does not exclude concomitant effects of lumbar epidural lipomatosis, that condition
5 With respect to Dr. Salky’s determination that Mr. Radford’s neurologic system was
normal, Dr. Chan and Dr. Callahan placed little stock in her assessment. Tr. 302, 314.
6 In Dr. Kaufman’s testimony, he softened his criticism, explaining that as a younger
doctor he was overconfident. Tr. 189.
7

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 8 of 19
alone would not produce absent lower extremity sensory responses or
demyelinating features.” Id.
Dr. Kaufman sent Mr. Radford to the hospital immediately. In the hospital,
Mr. Radford received a course of IVIG and steroids. Exhibit 2 at 48. After
starting a 5-day course of IVIG, Mr. Radford’s leg strength improved, and he could
move around the hospital without using a cane. Id.; Tr. 49-50, 192-93, 201. This
prescription for IVIG was the first treatment specifically intended to address CIDP.
Tr. 237. He was discharged from the hospital on November 26, 2015 with the
diagnosis of CIDP. Exhibit 2 at 49.
When Mr. Radford saw Dr. Kaufman during a follow-up on January 4, 2016,
Mr. Radford no longer needed a cane. Exhibit 13 at 49; Tr. 85, 202. Mr. Radford
was participating in physical therapy and told Dr. Kaufman that his right hand and
bilateral ankle weakness had resolved. Exhibit 13 at 52. When asked about Mr.
Radford’s improvement, Dr. Kaufman stated that the improvement does not
provide any helpful information about either the cause of Mr. Radford’s CIDP or
the reason Mr. Radford’s CIDP worsened. Tr. 213. The January 4, 2016
appointment with Dr. Kaufman was the last visit for Mr. Radford because he then
moved to the Atlanta, Georgia area full-time. Id. at 103.
C. After March 20167
After Mr. Radford permanently re-located in Georgia, he found new doctors
to care for him. Albert Cook, a neurologist, first saw Mr. Radford on February 29,
2016. Exhibit 25 at 62; Tr. 51. Dr. Cook has periodically seen Mr. Radford
through approximately March 2019. See Exhibit 25, passim. Dr. Cook arranged
for a nurse to come to Mr. Radford’s house to provide IVIG treatments once per
month. Tr. 52.
In May 2019, Mr. Radford sought a second opinion regarding his worsening
gait and worsening balance from a different neurologist, Julian Bragg. Exhibit 17
at 59. Dr. Bragg has cared for Mr. Radford through at least May 2020. See id.,
passim.
7 Because the recent events in Mr. Radford’s life do not contribute to determining
whether the 2015 flu vaccination harmed him, this evidence is presented summarily.
8

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 9 of 19
Besides these two neurologists, Mr. Radford also has a primary care
physician, Karita Gone. On October 13, 2016, a physician’s assistant in Dr.
Gone’s office gave Mr. Radford another flu shot. Exhibit 18 at 66-67.
Dr. Gone has followed Mr. Radford through a variety of problems including
a potential vitamin B12 deficiency. In this context, Mr. Radford told her that he
was pursuing a claim in the Vaccine Program. Id. at 32; see also Tr. 86-87. Dr.
Gone did not comment on whether she thought the flu vaccine could have caused a
worsening of his neurologic problems. See Tr. 87.
In his oral testimony, Mr. Radford described his daily life. He explained
that he cannot walk his dog. Tr. 61. He has trouble going up and down stairs. Id.
at 64. He has missed out on family events around holidays. Id. at 61. Although
his employer, the Federal government, allows him to telecommute, Mr. Radford
offered a view that his health problems have hindered his ability to be promoted at
work. Id. at 63. While he has not returned to his former self, Mr. Radford hopes to
get to that state someday. Id.
II. Procedural History
Originally, Mr. Radford alleged that the flu vaccination caused him to suffer
CIDP. Pet., filed May 18, 2018. Over the next few months, he submitted medical
records and affidavits. Exhibits 1-13.
The Secretary reviewed these materials and recommended that
compensation be denied. Resp’t’s Rep., filed Apr. 9, 2019. The Secretary
maintained that based upon Dr. Kaufman’s records, Mr. Radford experienced the
onset of CIDP years before the allegedly causal flu vaccination. Id. at 10. The
Secretary further asserted that the medical records did not support a finding that the
flu vaccine significantly aggravated Mr. Radford’s CIDP. Id.
In a May 10, 2019 status conference, Mr. Radford announced an intention to
present a report from an expert. To assist with the development of expert opinions,
the undersigned proposed a set of instructions. Order, issued May 10, 2019. The
parties did not comment on the proposed instructions.
Mr. Radford submitted a report from his neurologist, Dr. Chen, on July 30,
2019. Dr. Chen agreed with Dr. Kaufman that Mr. Radford was suffering from
CIDP before his vaccination. Exhibit 15 at 6. She, therefore, offered an opinion
that the flu vaccine aggravated Mr. Radford’s CIDP. Id. at 6-9.
9

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 10 of 19
The Secretary, in turn, filed a report from a neurologist, Dr. Callaghan, on
December 30, 2019. Dr. Callaghan, too, agreed that Mr. Radford manifested
symptoms of CIDP before the flu vaccination. Exhibit A at 4. However, Dr.
Callaghan questioned both of Dr. Chen’s opinions that the flu vaccine can
aggravate CIDP and that Mr. Radford’s CIDP worsened following the vaccination.
Id.
Mr. Radford determined that a supplemental report from Dr. Chen was not
needed. Pet’r’s Status Rep., filed Jan. 14, 2020. Accordingly, the next step was
for the parties to argue their cases through briefs. See Order, issued Mar. 17, 2020.
In advance of a potential adjudication, Mr. Radford updated his medical
records. Exhibits 17-19, 22-23. After multiple enlargements of time, Mr. Radford
presented his brief on August 18, 2020. However, the brief did not comply with all
aspects of the order for briefs. See Order, issued Sept. 17, 2020. Thus, Mr.
Radford submitted a revised brief on Nov. 9, 2020.
The Secretary addressed Mr. Radford’s arguments in his brief, which the
Secretary filed on May 24, 2021. Mr. Radford submitted a reply brief on July 8,
2021.
The undersigned determined that receiving oral testimony would be helpful.
Order, issued July 22, 2021. In the ensuing status conference, the parties discussed
whether doctors who treated Mr. Radford should testify. The parties planned for a
hearing to be held over two days, April 21-22, 2022. Order, issued Aug. 18, 2021.
In the months leading to the hearing, Mr. Radford expressed an interest in
having Dr. Kaufman testify. Pet’r’s Status Rep., filed Nov. 22, 2021. Through the
use of a subpoena, Mr. Radford secured Dr. Kaufman’s attendance at the hearing.
Pet’r’s Mot. to Issue Subpoena, filed Jan. 7, 2022. Mr. Radford submitted Dr.
Kaufman’s curriculum vitae as Exhibit 30.
The hearing was held, as scheduled, on April 21-22, 2022 via
videoconferencing. Mr. Radford testified about his health and movingly conveyed
how living with CIDP has affected his life. Dr. Chen and Dr. Callaghan testified
more or less in accord with their reports. Dr. Kaufman testified and his testimony
was greatly appreciated.
Because the testimony did not raise any unexpected issues, briefs were not
requested. See Arctic Cat Inc. v. Bombardier Rec., 876 F.3d 1350, 1372 (Fed. Cir.
2017) (ruling that a district court did not abuse its discretion in trebling damages
without asking for briefs). Accordingly, the case is ready for adjudication.
10

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 11 of 19
III. Standards for Adjudication
A petitioner is required to establish his case by a preponderance of the
evidence. 42 U.S.C. § 300aa-13(1)(a). The preponderance of the evidence
standard requires a “trier of fact to believe that the existence of a fact is more
probable than its nonexistence before [he] may find in favor of the party who has
the burden to persuade the judge of the fact’s existence.” Moberly v. Sec’y of
Health & Hum. Servs., 592 F.3d 1315, 1322 n.2 (Fed. Cir. 2010) (citations
omitted). Proof of medical certainty is not required. Bunting v. Sec’y of Health &
Hum. Servs., 931 F.2d 867, 873 (Fed. Cir. 1991).
Distinguishing between “preponderant evidence” and “medical certainty” is
important because a special master should not impose an evidentiary burden that is
too high. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379-80 (Fed.
Cir. 2009) (reversing the special master’s decision that petitioners were not entitled
to compensation); see also Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d
1357 (Fed. Cir. 2000); Hodges v. Sec’y of Health & Hum. Servs., 9 F.3d 958, 961
(Fed. Cir. 1993) (disagreeing with the dissenting judge’s contention that the special
master confused preponderance of the evidence with medical certainty).
In a case such as this, in which a petitioner seeks compensation for the
worsening of an injury not listed on the Vaccine Table, the Federal Circuit has
defined the elements of petitioner’s case. As confirmed in W.C. v. Sec’y of Health
& Hum. Servs., 704 F.3d 1352, 1357 (Fed. Cir. 2013), the elements of an off-Table
significant aggravation case were stated in Loving. There, the Court blended the
test from Althen v. Sec’y of Health & Hum. Servs., 418 F.3d 1274, 1279 (Fed. Cir.
2005), which defines off-Table causation cases, with a test from Whitecotton v.
Sec’y of Health & Hum. Servs., 81 F.3d 1099, 1107 (Fed. Cir. 1996), which
concerns on-Table significant aggravation cases. The resulting test has six
components. These are:
(1) the person’s condition prior to administration of the
vaccine, (2) the person's current condition (or the
condition following the vaccination if that is also
pertinent), (3) whether the person's current condition
constitutes a “significant aggravation” of the person's
condition prior to vaccination, (4) a medical theory
causally connecting such a significantly worsened
condition to the vaccination, (5) a logical sequence of
cause and effect showing that the vaccination was the
reason for the significant aggravation, and (6) a showing
11

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 12 of 19
of a proximate temporal relationship between the
vaccination and the significant aggravation.
Loving, 86 Fed. Cl. at 144.
IV. Analysis
Mr. Radford alleges that the flu vaccination significantly aggravated his
CIDP. Pet., at 1. Mr. Radford has both failed to provide a persuasive medical
theory and to show with preponderant evidence that his condition significantly
worsened due to the vaccination. Two prongs from Loving are discussed in the
order of importance, beginning with the more important element (theory).
Accordingly, Mr. Radford has failed to meet the required elements of Loving and
therefore is denied compensation.
A. Theory / Loving Prong 4
In the hearing, two neurologists, Dr. Chen and Dr. Kaufman, both opined
that a flu vaccine can cause (or aggravate) CIDP. However, neither doctor’s
testimony on this point was persuasive.
Dr. Kaufman’s testimony regarding potentially harmful consequences of the
flu vaccine was shorter than Dr. Chen’s and, therefore, is evaluated first. Although
Dr. Kaufman treated Mr. Radford after he received the allegedly causal
vaccination, Dr. Kaufman was not aware that Mr. Radford was recently vaccinated.
Tr. 184. This lack of knowledge explains the lack of discussion about vaccine-
induced aggravation in Dr. Kaufman’s medical records.
In his oral testimony, Dr. Kaufman discussed whether a flu vaccine can
aggravate a neurologic condition. When Mr. Radford’s attorney asked whether Dr.
Kaufman believe[d] “it [wa]s possible that a flu vaccine could cause an
aggravation of preexisting CIDP?,” Dr. Kaufman responded “[u]nquestionably.”
Tr. 185. To explain the basis of his opinion, Dr. Kaufman analogized CIDP to
GBS. Tr. 217. In this context, Dr. Kaufman stated: “I don’t think we understand
CIDP well enough to really attribute things like causality, you know. But there’s
no question that flu vaccines can exacerbate CIDP.” Id. Dr. Kaufman also
recognized that no cause of CIDP has been determined. Id. at 218.
With respect to the narrow question on whether a flu vaccine can cause or
aggravate CIDP, Dr. Kaufman’s testimony is not illuminating. To start, a question
based upon what is “possible,” does not, by itself, help a petitioner establish a
proposition of what is likely. See Paterek v. Sec’y of Health & Hum. Servs., 527
12

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 13 of 19
F. App’x 875, 883 (Fed. Cir. 2013). The remainder of Dr. Kaufman’s testimony is
confusing in that he simultaneously asserted (1) that a cause of CIDP is not known,
and (2) a flu vaccine can cause an aggravation. See Tr. 217-18. This ambiguous
testimony does not carry Mr. Radford’s burden. Therefore, the opinions from Dr.
Chen must be considered.
As a doctor whom Mr. Radford retained for purposes of this litigation, Dr.
Chen disclosed her opinions regarding causation in advance of the hearing. Dr.
Chen essentially presented an opinion that the flu vaccine can cause (or aggravate)
CIDP via molecular mimicry. Exhibit 15 at 7. Although her report uses the term
“bystander effect,” Dr. Chen’s testimony clarified that “bystander effect is . . . the
concept behind molecular mimicry.” Tr. 134; accord id. at 225-26. The theory of
molecular mimicry posits that if components of the flu vaccine have enough
similarity to components of a person’s nervous system, then the immune system of
a recipient of a flu vaccine attacks the nervous system. Id. at 225-26; see also id. at
134 (Dr. Chen), 278 (Dr. Callaghan’s discussion about molecular mimicry).
Dr. Chen did not present any articles linking flu vaccine to CIDP
specifically. Tr. 233. Dr. Callaghan averred that he was not aware of any studies
about flu vaccine and CIDP and further maintained that due to his participation in
organizations for neurologists, that if any literature did exist, he would be aware of
it. Id. at 259-62, 278. This lack of literature weakens Dr. Chen’s opinion.
Although literature is not required, Althen v. Sec’y of Health & Hum. Servs., 418
F.3d 1274 (Fed. Cir. 2005), “a scientific theory that lacks any empirical support
will have limited persuasive force.” Caves v. Sec’y of Health & Hum. Servs., 100
Fed. Cl. 119, 134 (2011), aff’d without op., 463 F. App’x 932 (Fed. Cir. 2012).
In the absence of any direct literature, Dr. Chen cited three articles to
support her opinion, which she and Dr. Callaghan discussed. Exhibit 15 at 6-7; Tr.
229.8 They are reviewed in turn.
The first article is by Kuitwaard.9 Here, researchers composed a set of
questions that they mailed to 461 people with neurologic disorders. Some
questions asked whether the person had received a vaccination within eight weeks
before the person developed GBS or CIDP. Exhibit 16-K at 311. It appears that
8 Before the hearing, Mr. Radford identified other potentially relevant articles. Pet’r’s
Revised Br. at 14-16. However, those other articles were not discussed during the hearing. In
any event, a review of those articles does not suggest that any of them meaningfully advance the
theory that a flu vaccine can aggravate CIDP. Thus, those articles are not discussed here.
9 Krista Kuitwaard et al., “Recurrences, Vaccinations and Long-Terms Symptoms in GBS
and CIDP,” 14 J. Peripheral Nervous Sys. 310 (2009) (filed as Exhibit 16-K).
13

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 14 of 19
researchers did not confirm the information recipients provided as the
“retrospective nature of part of the questionnaires could have introduced recall
bias. It is difficult to draw firm conclusions from a questionnaire in which patients
report their recurrences after vaccinations themselves.” Id. at 315.
Of the 461 people surveyed, 323 patients (70%) responded. Of this group,
76 people stated that they suffered from CIDP, although, again, each diagnosis was
not confirmed. Id. at 312. Eight people with CIDP stated they received a
vaccination within eight weeks of vaccination. Id. The most received vaccine in
the entire group was the flu vaccine. Id. “Of the 24 patients who received a flu
vaccination (range 1-17 times) after being diagnosed with CIDP, five reported an
increase in symptoms after one or more vaccinations.” Id.
With respect to their findings about preceding vaccinations, the researchers
seemed not to draw any conclusions. They stated:
Our study indicates that the risk of developing another
GBS episode after a flu vaccination is small. This
confirms a recent study that found no evidence of an
increased risk of GBS after seasonal influenza
vaccination (Stowe et al., 2009). Another study has also
suggested a low risk following vaccination, where only
4% (11/311) of GBS patients and 8% (5/65) of CIDP
patients experienced a recurrence of symptoms following
a vaccination (Pritchard et al., 2002).
Id. at 313.
When questioned about this article, Dr. Chen stated that a sample size of
twenty-four people is small. Tr. 146-47. Dr. Callaghan agreed that the sample size
was small and discussed the methodological problems that reduce the study’s
value. Id. at 282-83. Thus, Dr. Callaghan asserted that Kuitwaard might prompt
another study. Id.
The second article is by Goodridge et al.10 The basic thesis was that a
vaccination against one pathogen might protect against other pathogens. Exhibit
16-N at 1.11 According to Dr. Chen, this article helps explain why a flu vaccine
10 Helen S. Goodridge et al., “Harnessing the Beneficial Heterologous Effects of
Vaccination,” 16(6) Nat. Rev. Immunol. 392 (2016) (filed as Exhibit 16-N).
11 Because Mr. Radford submitted an author manuscript, this decision cites to the PDF
page, not the page appearing in the journal.
14

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 15 of 19
against some strains of the flu virus might protect against other strains of the flu
virus. Tr. 138-39. The article highlights the benefits of vaccinations and does not
mention CIDP. Id. at 149, 227-28, 279.
The last article is by Toplak and Avčin.12 The authors reviewed “published
data on autoimmune diseases following influenza infection and vaccination.”
Exhibit 16-O at 619. Dr. Chen testified that the point of the article is to remind
people that “the flu vaccine . . . is safe. It’s safer than getting the flu, but, again,
the autoimmune component can be - - can be aggravated in a few select
individuals.” Tr. 140. The article does not discuss CIDP. Id. at 231, 280.
In sum, the articles on which Dr. Chen relied do not meaningfully support
her opinion that a flu vaccine can cause (or aggravate) CIDP. Without some
undergirding for Dr. Chen’s opinion, Mr. Radford has not demonstrated that her
opinion is reliable. See Tullio v. Sec’y of Health & Hum. Servs., No. 15-51V,
2019 WL 7580149, at *12-14 (Fed. Cl. Spec. Mstr. Dec. 19, 2019) (discussing
appellate review of decisions involving molecular mimicry), mot. for rev. denied,
149 Fed. Cl. 448, 467-68 (2020). As such Mr. Radford has not met his burden of
establishing the fourth Loving prong, which corresponds to the first Althen prong.
B. Significant Worsening / Loving Prong 3
The third prong of the Loving test requires a petitioner to address “whether
the person’s current condition constitutes a ‘significant aggravation’ of the
person’s condition prior to vaccination.” W.C. v. Sec’y of Health & Hum. Servs.,
704 F.3d 1352, 1357 (Fed. Cir. 2013).
In considering this point, a special master should not consider the natural
course of the disorder, although a special master could find that the “petitioner’s
condition ‘was not affected by the vaccination.’” Sharpe v. Sec’y of Health &
Hum. Servs., 964 F.3d 1072, 1082 (Fed. Cir. 2020) (quoting Locane v. Sec’y of
Health & Hum. Servs., 685 F.3d 1375, 1378 (Fed. Cir. 2012)).
Here, the advocacy regarding how Mr. Radford’s CIDP did (or not change)
before the hearing was superficial. The parties’ briefs would have benefitted from
discussing more specific aspects of Mr. Radford’s history. For example, Mr.
Radford mostly argued that because treating doctors did not recognize his
symptoms as CIDP before the flu vaccination, his CIDP was “mild” and that the
recognition of CIDP after the vaccination meant his CIDP was more severe.
12 Nataša Toplak & Tadej Avčin, “Influenza and Autoimmunity,” 1173 Contemporary
Challenges in Autoimmunity 619 (2009) (filed as Exhibit 16-O).
15

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 16 of 19
Pet’r’s Reply at 4-5. The Secretary generally contended that because Mr. Radford
had (undiagnosed) CIDP before the vaccination and because Mr. Radford had
(diagnosed) CIDP after the vaccination, the CIDP was the same. Resp’t’s Br. at
18-21.
However, the parties (particularly the Secretary) presented more nuanced
positions in the hearing. The parties identified two critical records: Dr. Lucas’s
September 3, 2015 evaluation (Exhibit 14 at 32-38) and Dr. Kaufman’s November
11, 2015 evaluation (Exhibit 13 at 22-25).
Given that Mr. Radford received the allegedly harmful flu vaccination on
September 11, 2015, the records from Dr. Lucas and Dr. Kaufman allow for a
comparison of Mr. Radford’s CIDP before and after the vaccination. This pair of
records presents information in five components: history, clinical presentation,
sensory ability, reflexes, and strength.
History. The histories recorded by Dr. Lucas and Dr. Kaufman are relatively
similar. Each doctor records that Mr. Radford told him that Mr. Radford’s health
declined in July. Exhibit 14 at 32-33; Exhibit 13 at 22. After reviewing the
medical history obtained by Dr. Kaufman on November 11, 2015, Dr. Callaghan
emphasized that in the history Dr. Kaufman obtained on November 11, 2015, there
is no indication that Mr. Radford also told Dr. Kaufman that he worsened in
September or October. Tr. 276-77. This lack of notation, especially in the context
of a record in which worsening in July was mentioned, tends to suggest, but does
not absolutely establish, that Mr. Radford did not worsen in September or October.
Clinical Presentation. The reports have some similarities and some
differences. Dr. Lucas’s review of systems states Mr. Radford had “[n]umbness /
[t]ingling in [a]rms or [l]egs.” Exhibit 14 at 34. The remainder of Dr. Lucas’s
record does not say anything about problems with Mr. Radford’s upper extremities.
See id. at 34-38. Dr. Lucas reports that Mr. Radford was using a cane for antalgic
gain and pain. Id. at 33.
In Dr. Kaufman’s review of system, he indicates “arm weakness, arm
numbness, leg weakness, leg numbness and difficulty walking.” Exhibit 13 at 24;
accord Tr. 172. The report of “leg weakness” and “leg numbness” appears
consistent with Dr. Lucas’s notation about “numbness / tingling” in Mr. Radford’s
legs. The question is whether the more detailed information from Dr. Kaufman
about problems in Mr. Radford’s arms and hands marks a deterioration in Mr.
Radford’s health.
16

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 17 of 19
Dr. Kaufman’s identification of problems in Mr. Radford’s hands received
little attention from the experts during their testimony. Dr. Chen did not base her
opinion that Mr. Radford worsened on an expansion of problems to Mr. Radford’s
arms and hands. See Tr. 132-33. Dr. Callaghan indicated that Dr. Lucas “was
only concentrating on the legs.” Id. at 276. Although not spelled out, it seems that
Dr. Callaghan might have been suggesting that Mr. Radford was having problems
in his hands before the September 3, 2015 appointment. However, Dr. Lucas did
not elicit any information about any problems in Mr. Radford’s upper extremities.
Dr. Kaufman recorded that Mr. Radford “walks with a cane.” Exhibit 13 at
24. Dr. Kauman’s notation is similar to Dr. Lucas’s indication that Mr. Radford
was using a case. Exhibit 14 at 33.
Sensory. The pertinent portion of Dr. Lucas’s report shows:
Sensation Exam 4/1/2015 6/11/2015 9/3/2015
Sensation symmetric to RLE; LLE13 RLE; LLE RLE
EXCEPT decreased LLE LLE LLE
sensation
Exhibit 13 at 46.
Dr. Kaufman’s report says: “Vibration sensation was absent at the right great
toe and left ankle, reduced at the left great toe and right ankle. Temperature and
pinprick sensation were reduced distal to the wrists and mid-shins, with an overlay
of tingling and dysesthesias in the left peroneal distribution.” Exhibit 13 at 24.
Neither Dr. Chen nor Dr. Callaghan commented on whether Mr. Radford’s
sensory abilities declined.
Reflexes. On this topic, Dr. Lucas’s report shows:
Reflex Exam 4/1/2015 6/11/2015 9/3/2015
Normal Reflexes RLE; LLE RLE; LLE RLE; LLE
Exhibit 13 at 46.
13 “RLE” denotes right lower extremity and “LLE” denotes left lower extremity.
17

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 18 of 19
Dr. Kaufman’s report states: “Upper extremity reflexes were absent at the
biceps, 2+ at the brachioradialis and triceps. Lower extremity reflexes were absent
aside from 1+ adductors.” Exhibit 13 at 24.
There was some testimony about Mr. Radford’s reflexes. When testifying
about Dr. Lucas’s record, which Dr. Kaufman had reviewed before examining Mr.
Radford on November 11, 2015, Dr. Kaufman said that the report of normal
reflexes “surprised” him. Tr. 199. To challenge Dr. Callaghan’s overall opinion
that Mr. Radford did not decline, Mr. Radford brought forward Dr. Lucas’s report
of normal reflexes as compared to Dr. Kaufman’s report of diminished reflexes.
Id. at 292 (cross-examination of Dr. Callaghan). Dr. Callaghan averred that
because Mr. Radford had CIDP when Dr. Lucas examined him, “his reflexes
probably were not normal.” Id. Dr. Chen was not asked to comment on this aspect
of Dr. Callaghan’s testimony.
Strength. A final point of comparison is the two doctor’s evaluation of Mr.
Radford’s strength. Dr. Callaghan described the strength exams as the “most
important.” Tr. 271. On the other hand, Dr. Chen questioned the usefulness of
comparing strength results from two different evaluators. Id. at 317-19.
Dr. Lucas measured Mr. Radford’s strength in five lower extremity muscles,
of which two can be compared to Dr. Kaufman’s later examination. For
dorsiflexion, the results were L2, R3. Exhibit 14 at 36. For extensor hallucis
longis, the results were L3, R4. Id.
Dr. Kaufman measured Mr. Radford’s strength in those two areas as well as
other muscles. For dorsiflexion, the results were L3, R4-. Exhibit 13 at 38. For
greater toe extension, the results were L3, R3. Id.
Comparing the results in strength produces inconsistent results. For
dorsiflexion, Mr. Radford improved from L2, R3 to L3, R4-. But for extensor
hallucis longis, Mr. Radford declined from L3, R4 to L3, R3. See Tr. 276, 320,
323, 326.
Conclusion. When taken as a whole, the evidence does not support a finding
that Mr. Radford met his burden of showing he declined in the months following
the vaccination. Admittedly, the evidence is mixed. See Doe 11 v. Sec’y of
Health & Hum. Servs., 601 F.3d 1349, 1355 (Fed. Cir. 2010) (indicating that the
presence of contrary evidence does not make a special master’s finding of fact
arbitrary or capricious). For almost all points tending to show a decline, another
point tends to show either no change or an improvement. For example, although
18

Case 1:18-vv-00704-UNJ Document 114 Filed 02/22/23 Page 19 of 19
Mr. Radford walked with a cane in his visit to Dr. Kaufman in November 2015,
Mr. Radford used a cane in April 2015. Exhibit 2 at 71. Overall, the evidence
preponderates in finding that Mr. Radford’s CIDP “was not affected by the
vaccination.” Locane v. Sec’y of Health & Hum. Servs., 685 F.3d 1375, 1378
(Fed. Cir. 2012).
V. Conclusion
Mr. Radford effectively communicated how having CIDP has taken a toll on
him both before and after the flu vaccination. As such, he warrants sympathy for
suffering with a difficult disease. However, the evidence that the flu vaccination
worsened his course is lacking. Thus, Mr. Radford is not entitled to compensation.
The Clerk’s Office is directed to enter judgment in accord with this decision
unless a motion for review is filed. Information about filing a motion for review,
including a deadline, is presented in the Vaccine Rules, which are available on the
website for the Court of Federal Claims.
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
19