Terry Pitts v. HHS - Influenza, Shoulder Injury Related to Vaccine Administration (“SIRVA”) (2023)

Terry Pitts, a 42-year-old adult, filed a petition on September 28, 2018, alleging that he suffered a Shoulder Injury Related to Vaccine Administration (SIRVA) as a result of an influenza vaccine he received on October 8, 2016. Mr.

Pitts initially claimed immediate onset of shoulder pain, but later evidence suggested the onset occurred approximately one week after vaccination. The case was initially handled under the Special Processing Unit for expedited resolution.

Respondent, the Secretary of Health and Human Services, argued that the medical records did not support a timing of onset compatible with a Table SIRVA injury and that the claim lacked expert support for a cause-in-fact shoulder injury. A prior Chief Special Master found evidence supporting onset occurring one week post-vaccination, but not within 48 hours.

Mr. Pitts later amended his petition to explicitly assert a causation-in-fact claim and submitted an expert report from orthopedist Uma Srikumaran, M.D.

Respondent filed a responsive expert report from orthopedist Paul Cagle, M.D. Petitioner's counsel later withdrew due to irreconcilable differences, and Mr.

Pitts proceeded pro se. The case was reassigned to Special Master Daniel T.

Horner, who reviewed the existing record without a hearing. Petitioner's medical records indicated he received the flu vaccine in his left deltoid on October 8, 2016.

He stated he experienced immediate upper arm pain and called his doctor's office that day. His wife's affidavit corroborated that he had pain the morning after vaccination.

However, his doctor's records did not document this call. Petitioner returned to his doctor approximately one month later, with records suggesting an encounter on November 7, 2016, where his "joint pain denies" under musculoskeletal review of systems.

Dr. Oh's later letters indicated he recalled petitioner mentioning shoulder pain in early November 2016, with one letter clarifying that petitioner mentioned pain began "immediately after" the vaccination.

Petitioner did not seek further care until February 21, 2017, complaining of left arm pain and difficulty with exercise. He was referred to orthopedist Steven Levin, M.D., who noted a history of left shoulder pain for four months after the flu shot, with pain starting "specifically after he got a flu shot." Dr.

Levin diagnosed bursitis, attributing it to the vaccination, and noted prior patients with similar vaccine-related bursitis. Petitioner reported to physical therapy on March 14, 2017, stating pain began "about 1 week" after vaccination and had been worsening.

His physical therapist noted no significant progress. Further evaluations included an EMG/NCV study which was normal, a cervical spine MRI showing disc protrusion at C5-C6 without cord compression, and a shoulder MRI showing edema consistent with adhesive capsulitis.

Dr. Levin recommended follow-up with a cervical spine specialist, a steroid injection for his shoulder, and aggressive therapy for adhesive capsulitis.

Petitioner's primary care physician, Dr. Oh, noted in March 2017 that he made it clear to the patient that his shoulder pain was "not the result of the flu shot." Dr.

Srikumaran opined that vaccine antigens can cause inflammatory reactions leading to shoulder pathology, citing literature supporting a link between vaccination and shoulder injury, including bursitis and adhesive capsulitis, and suggested a latency period of up to two months was appropriate. Dr.

Cagle countered that petitioner's symptoms were mixed, potentially indicating cervical spine issues, and that the shoulder MRI did not show increased bursal fluid. He questioned the literature cited by Dr.

Srikumaran. Dr.

Srikumaran responded, emphasizing Dr. Levin's findings of shoulder pathology and disputing the cervical spine as the sole cause.

Special Master Horner revisited the onset issue. He concluded there was not preponderant evidence of onset within 48 hours, thus defeating the Table SIRVA claim.

For the causation-in-fact claim, he found Dr. Srikumaran's theory of general causation persuasive (Althen prong one).

He also found that petitioner likely suffered shoulder pathology, supported by Dr. Levin's opinion (Althen prong two), but noted a significant issue with the temporal relationship.

Regarding the proximate temporal relationship (Althen prong three), Special Master Horner found Dr. Srikumaran's assertion of a two-month latency unpersuasive, and the one-week onset insufficient to infer causation.

He noted that while some cases support a causation-in-fact claim with onset within a week, the evidence in this record did not meet that standard. Therefore, Special Master Horner concluded that Mr.

Pitts had not established entitlement to compensation and dismissed the case.