VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01550
Package ID: USCOURTS-cofc-1_19-vv-01550
Petitioner: H.F.
Filed: 2019-08-26
Decided: 2025-04-21
Vaccine: influenza
Vaccination date: 2016-10-13
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 175416

AI-assisted case summary:
On October 4, 2019, H.F., a 40-year-old attorney, filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that he suffered a shoulder injury related to vaccine administration (SIRVA) caused by an influenza vaccine he received on October 13, 2016. The respondent, the Secretary of Health and Human Services, conceded entitlement to compensation, finding that the petitioner met the criteria for SIRVA as defined by the Vaccine Injury Table. The case then proceeded to a damages determination. Petitioner sought compensation for pain and suffering and unreimbursable expenses, attributing his symptoms, including pain, limited mobility, numbness, and tingling, to the vaccine. He underwent extensive treatment, including physical therapy, steroid injections, and surgery for a labral tear and bursitis. The parties disputed the extent to which Petitioner's subsequent symptoms, including thoracic outlet syndrome (TOS), were related to the vaccine-induced SIRVA. Petitioner argued that all his upper extremity symptoms stemmed from the vaccine, while Respondent contended that some symptoms, particularly TOS, were unrelated. Petitioner's treating orthopedic surgeon, Dr. G. Russell Huffman, opined that the vaccine was causally related to the TOS symptoms, while Respondent's expert, Dr. Paul J. Cagle, questioned the link and stated TOS was unrelated to the vaccination. After reviewing medical records, expert reports, and prior case law, Chief Special Master Brian H. Corcoran awarded H.F. $170,000.00 for past pain and suffering and $5,416.58 for past unreimbursable expenses, totaling $175,416.58. The award was based on a finding that H.F. suffered a moderate SIRVA injury with some continuing symptoms, but that not all later-diagnosed conditions, specifically TOS, were sufficiently linked to the vaccine. Petitioner was represented by Ronald Craig Homer of Conway, Homer, P.C., and Respondent was represented by Alexis B. Babcock of the U.S. Department of Justice.

Theory of causation field:
Petitioner H.F. alleged a shoulder injury related to vaccine administration (SIRVA) caused by an influenza vaccine received on October 13, 2016. Respondent conceded entitlement, agreeing Petitioner met the criteria for SIRVA under the Vaccine Injury Table. The dispute centered on damages, specifically whether Petitioner's subsequent symptoms, including thoracic outlet syndrome (TOS), were causally related to the SIRVA. Petitioner's treating physician, Dr. G. Russell Huffman, opined that the vaccine caused the SIRVA and subsequent TOS. Respondent's expert, Dr. Paul J. Cagle, disagreed, stating TOS was unrelated to the vaccination. Chief Special Master Brian H. Corcoran found Petitioner suffered a moderate SIRVA injury with some continuing symptoms, but determined that most of the later symptoms, including TOS, were not sufficiently linked to the vaccine. The award was $170,000.00 for past pain and suffering and $5,416.58 for past unreimbursable expenses, totaling $175,416.58. Petitioner was represented by Ronald Craig Homer, and Respondent by Alexis B. Babcock. The decision was issued by Chief Special Master Brian H. Corcoran on April 21, 2025.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01550-0
Date issued/filed: 2021-07-12
Pages: 6
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/30/2021) regarding 41 Findings of Fact & Conclusions of Law, Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 1 of 6
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1550V
UNPUBLISHED
H.F., Chief Special Master Corcoran
Petitioner, Filed: March 30, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Findings of Fact; Onset and Site of
HUMAN SERVICES, Vaccination; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
Respondent. Administration (SIRVA)
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Mollie Danielle Gorney, U.S. Department of Justice, Washington, DC, for Respondent.
FINDINGS OF FACT1
On October 4, 2019, H.F. filed a petition for compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine
Act”). Petitioner alleges that he suffered a shoulder injury related to vaccine administration
(“SIRVA”) after receiving an influenza (“flu”) vaccine on October 13, 2016. Petition at 1,
¶¶ 1-3. The case was assigned to the Special Processing Unit (“SPU”) of the Office of
Special Masters.
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 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 2 of 6
For the reasons discussed below, I find the flu vaccine was most likely
administered in Petitioner’s left deltoid, as alleged, and that onset of Petitioner’s pain
occurred within 48 hours of vaccination.
I. Relevant Procedural History
H.F. filed the Petition in this case, without medical records, shortly before the
expiration of the Vaccine Act’s statute of limitations.3 Over the subsequent eight-month
period, he filed the affidavit and medical records required by the Vaccine Act. Exhibits 1-
20, ECF Nos. 6, 11, 15, 19, 22, 25-26. The case was activated and assigned to the SPU
on June 5, 2020. ECF No. 29.
During the July 27, 2020 initial status conference, the parties discussed the lack of
a notation in the vaccine record indicating the situs of administration. Scheduling Order,
issued July 28, 2020, at 1, ECF No. 33. The vaccine record from CVS Pharmacy indicates
only that the vaccine was administered intramuscularly in Petitioner’s deltoid. Exhibit 1.
However, there are multiple entries in the medical records created shortly thereafter
indicating Petitioner reported that the flu vaccine was administered in his injured, left
deltoid. E.g. Exhibit 2 at 61 (visit one month after vaccination on October 14, 2016). Thus,
Petitioner was instructed to forward his demand and supporting documentation and to file
a status report regarding his progress accomplishing this task. Scheduling Order at 3,
ECF No. 33.
On December 1, 2020, Respondent was ordered to file a status report providing a
better estimate of the time needed for the Health & Human Services (“HHS”) review and
to provide an informal assessment from Respondent’s counsel. In the status report,
Respondent’s counsel noted two potential issues: 1) the lack of documentation regarding
the exact site of vaccination and 2) Petitioner’s later description of pain which traveled
down his arm and of tingling and numbness in his fingers. ECF No. 38. In recent email
communications with the parties, Respondent’s counsel indicated that she could not state
for certain whether a factual ruling regarding the site of vaccination would be needed. See
Informal Remark, dated Mar. 15, 2021. She also confirmed the HHS review would, most
likely, not occur for at least four more months. Id.
When ordered to file his next status report regarding his demand, Petitioner was
instructed to file any additional evidence regarding the site of vaccination. Non-pdf
3 Under the Vaccine Act, for a vaccine administered after October 1, 1988, “no petition may be filed for
compensation under the Program for such injury after the expiration of 36 months after the date of the
occurrence of the first symptom or manifestation of onset or of the significant aggravation of such injury.”
Section 16(a)(2). Petitioner received the vaccine alleged as causal on October 13, 2016. Exhibit 1. He filed
the Petition on October 4, 2019.
2

Case 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 3 of 6
Scheduling Order, issued Jan. 29, 2021. In his latest status report, filed on March 15,
2021, Petitioner indicated that he continues to seek further evidence to show the site of
vaccination and to finalize his demand. ECF No. 40.
During the parties’ email communications, Petitioner’s counsel confirmed that it is
unlikely further evidence regarding the site of vaccination can be obtained. See Informal
Remark, dated Mar. 15, 2021. Thus, I have determined, while awaiting the HHS review,
a fact ruling regarding both the site of vaccination and onset of Petitioner’s left shoulder
pain may help the parties informally resolve this case.
II. Issues
At issue is whether Petitioner received the vaccination alleged as causal in his
injured left arm and whether Petitioner’s first symptom or manifestation of onset after
vaccine administration (specifically pain) occurred within 48 hours as set forth in the
Vaccine Injury Table and Qualifications and Aids to Interpretation (“QAI”) for a Table
SIRVA. 42 C.F.R. § 100.3(a) XIV.B. (2017) (Table entry for SIRVA following the influenza
vaccination); 42 C.F.R. § 100.3(c)(10)(ii) (required onset for pain listed in the QAI).
III. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 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.
Section 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).
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, 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
3

Case 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 4 of 6
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 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
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. Findings of Fact
I make the findings after a complete review of the record to include all medical
records, affidavits, and additional evidence filed. Specifically, I base the findings on the
following evidence:
• The Administration and Consent Form from CVS Pharmacy indicates that
the flu vaccine was administered to Petitioner intramuscularly in his deltoid.
It does not specify whether the site of vaccination was Petitioner’s left or
right deltoid. Exhibit 1.
• When Petitioner first sought medical care for his left shoulder pain from his
primary care provider (“PCP”) on November 14, 2016, approximately one
month after vaccination, he attributed his pain to the flu vaccine he received
in his left arm on October 13, 2016. Exhibit 2 at 61. Reporting immediate
pain which worsened over time, he described a constant ache, weakness,
swelling, limited range of motion (“ROM”), and difficulty sleeping due to the
pain. Id. at 61, 65. Petitioner denied any numbness. Id. at 65. Petitioner’s
PCP observed soft tissue and subdeltoid tenderness and limited ROM. Id.
at 65-66. Elbow, wrist, and hand examinations were normal. Id. at 66.
• At a follow-up appointment on January 26, 2017, Petitioner again attributed
his left shoulder pain to the flu vaccine he received. Exhibit 2 at 71. He
described the vaccination as administered “very high in shoulder.” Id. For
the first five to six weeks, Petitioner experienced left shoulder pain with all
4

Case 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 5 of 6
movement. After that, he indicated that he also had “a distracting abnormal
sensation traveling down the arm.” Id.
• In the history he provided before undergoing an EMG on February 6, 2017,
Petitioner again attributed his left shoulder pain to the flu vaccine he
received in October 2016. Exhibit 16 at 5.
• When seen by his dermatologist for rough spots and eyelid droopiness on
February 14, 2017, Petitioner listed “Flu Shot” on his intake form as another
concern. Exhibit 19 at 3.
• Petitioner continued to attribute his left shoulder pain to the flu vaccine when
seen by an orthopedist on February 17, 2017 (Exhibit 2 at 91) and assessed
for physical therapy (“PT”) on February 24, 2017 (Exhibit 4 at 6, 12). During
his initial PT evaluation, Petitioner reported that the individual administering
the flu vaccine “injected it too high and deep,” hitting the rotator cuff and
bursa. Id. at 12.
• When seeking a second orthopedic opinion on August 7, 2017, Petitioner
“state[d] he received a flu shot on October 13, 2016 on the lateral aspect of
the left shoulder.” Exhibit 7 at 13. He described immediate pain which
became significant by the next day which was his wife’s birthday. In this
medical record, it is noted that Petitioner is right-hand dominant. Id.
• Throughout the medical records from Petitioner’s PCP, lists of his
immunizations identify the site of vaccination for flu vaccines he received in
2013, 2014, and 2016 as his left deltoid and in 2017 and 2018 in his right
and left buttocks, respectively. Exhibit 2 at 62. It appears Petitioner did not
receive a flu vaccine in 2015. Id.
In every post-vaccination record containing a medical history, from the time he first
sought treatment on November 14, 2016, Petitioner consistently reported left shoulder
pain immediately upon vaccination. Without fail, he attributed his injury to the flu vaccine
he received on October 13, 2016, which he described as administered too high and deep.
Petitioner also provided extremely consistent accounts of immediate onset, left shoulder
pain, and limited ROM during the five to six weeks after vaccination, and additional
symptoms of radiating pain, tingling and numbness thereafter. While these entries were
based upon information provided by Petitioner, they still should be afforded greater weight
than more current representations, as they were uttered contemporaneously with
Petitioner’s injury for the purposes of obtaining medical care.
5

Case 1:19-vv-01550-UNJ Document 52 Filed 07/12/21 Page 6 of 6
The Federal Circuit has stated that “[m]edical records, in general, warrant
consideration as trustworthy evidence . . . [as they] contain information supplied to or by
health professionals to facilitate diagnosis and treatment of medical conditions.” Cucuras,
993 F.2d at 1528 (emphasis added). Thus, the Circuit has instructed that greater weight
should be accorded to this information even when the information is provided by
Petitioner.
Additionally, Petitioner’s claim of administration in his left deltoid is consistent with
where he received prior flu vaccines. Vaccinations Petitioner received in 2013 and 2014
were also administered in his left deltoid. Exhibit 2 at 62. The site of future vaccinations
differed, however, suggesting Petitioner may have believed that the vaccine administered
in 2016 caused his left shoulder pain. Id. Furthermore, it is noted in the medical records
that Petitioner is right-handed. Such information provides added support for Petitioner’s
assertion.
The vaccine record clearly states that Petitioner received the flu vaccine
intramuscularly in the deltoid on October 13, 2016. There is nothing in the vaccine record
or medical records in this case to indicate administration was in Petitioner’s other arm
(right) or that the onset of Petitioner’s pain was not immediate as Petitioner consistently
reported. But I find there is preponderant evidence to establish the vaccination alleged as
causal in this case was administered to Petitioner in the left deltoid, and that onset of
Petitioner’s pain occurred within 48 hours of vaccination.
V. Scheduling Order
Despite my rulings regarding site of vaccination and onset, there are several issues
which still exist in this case. Petitioner’s SIRVA presentation is not typical, since (starting
in December 2016) it included pain which radiated down his arm and numbness and
tingling in his fingers. E.g. Exhibit 2 at 71. Additionally, Petitioner suffered significant
spinal issues in 2014-15. Exhibit 2 at 5-56; Exhibit 21 at 8-48. Petitioner’s settlement
demand should take into account the foregoing.
Petitioner shall file a status report regarding his demand and supporting
documentation by no later than Friday, May 28, 2021. The status report shall indicate
the date by which Petitioner provided, or intends to provide, a demand and supporting
documentation to Respondent.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
6

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-01550-1
Date issued/filed: 2021-09-29
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 08/26/2021) regarding 59 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:19-vv-01550-UNJ Document 62 Filed 09/29/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1550V
UNPUBLISHED
H.F., Chief Special Master Corcoran
Petitioner, Filed: August 26, 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)
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Mollie Danielle Gorney, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On October 4, 2019, H.F. filed a petition for compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine
Act”). Petitioner alleges that he suffered a shoulder injury related to vaccine administration
(“SIRVA”), which meets the Table definition for SIRVA, or, in the alternative, was caused
by the influenza vaccine he received on October 13, 2016. Petition at 1, ¶¶ 1-3. Petitioner
further alleges that he received the vaccine in the United States and that neither he nor
any other party has filed a civil action or received compensation for his SIRVA.3 Petition
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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).
3 Petitioner did not address the Vaccine Act’s six-month severity requirements, but indicated, in the Petition,
that additional documents and affidavits would be filed. Petition at ¶ 7. A cursory Petition was filed in this
case shortly before the expiration of the Vaccine Act’s statute of limitations. See Section 16(a)(2).

Case 1:19-vv-01550-UNJ Document 62 Filed 09/29/21 Page 2 of 2
at ¶¶ 5-6. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On August 26, 2021, Respondent filed his Rule 4(c) report in which he concedes
that Petitioner is entitled to compensation in this case. Respondent’s Rule 4(c) Report at
1. Specifically, Respondent indicates that he believes “[P]etitioner has satisfied the criteria
set forth in the revised Vaccine Injury Table and the Qualifications and Aids to
Interpretation.” Id. at 9. Respondent further agrees that “based on the case record as it
now stands, [P]etitioner has satisfied all legal prerequisites for compensation under the
Act.” Id. at 10.
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_19-vv-01550-2
Date issued/filed: 2025-04-21
Pages: 17
Docket text: PUBLIC DECISION (Originally filed: 03/19/2025) regarding 114 DECISION of Special Master Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:19-vv-01550-UNJ Document 118 Filed 04/21/25 Page 1 of 17
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1550V
H.F.,
Chief Special Master Corcoran
Petitioner,
v. Filed: March 19, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Alexis B. Babcock, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On October 4, 2019, H.F. 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 alleged that he suffered a shoulder injury related to vaccine
administration (“SIRVA”), which meets the Table definition for SIRVA, or, in the
alternative, was caused by the influenza vaccine he received on October 13, 2016.
Petition at 1, ¶¶ 1-3. Respondent conceded entitlement, but the parties were unable to
resolve damages on their own,3 so I ordered briefing on the matter.
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (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 (2018).
3 Approximately six months after I determined Petitioner was entitled to compensation, the parties informed
me that they had reached an impasse in their damages discussions and requested that I set a briefing
schedule. Status Report, filed Feb. 18, 2022, ECF No. 68.
.

Case 1:19-vv-01550-UNJ Document 118 Filed 04/21/25 Page 2 of 17
For the reasons set forth below, I find that Petitioner is entitled to an award of
damages in the amount of $175,416.58, representing $170,000.00 for actual pain and
suffering, plus $5,416.58 for past unreimbursable expenses.
I. Legal Standard
Compensation awarded pursuant to the Vaccine Act shall include “[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). The petitioner bears the burden of proof
with respect to each element of compensation requested. Brewer v. Sec’y of Health &
Hum. Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18,
1996).
There is no mathematic formula for assigning a monetary value to a person’s pain
and suffering and emotional distress. I.D. v. Sec’y of Health & Hum. Servs., No. 04-1593V,
2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013) (“[a]wards for emotional
distress are inherently subjective and cannot be determined by using a mathematical
formula”); Stansfield v. Sec’y of Health & Hum. 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 & Hum. 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)).
I may also consider prior pain and suffering awards to aid my resolution of the
appropriate amount of compensation for pain and suffering in this case. See, e.g., Doe
34 v. Sec’y of Health & Hum. 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, I may rely on my own experience (along with my
predecessor Chief Special Masters) adjudicating similar claims. Hodges v. Sec’y of
Health & Hum. 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).
2

Case 1:19-vv-01550-UNJ Document 118 Filed 04/21/25 Page 3 of 17
Although pain and suffering in the past was often determined based on a
continuum, as Respondent argues, that practice was cast into doubt by the Court several
years ago. Graves v. Sec’y of Health & Hum. Servs., 109 Fed. Cl. 579 (Fed. Cl. 2013).
The Graves court maintained that to do so resulted in “the forcing of all suffering awards
into a global comparative scale in which the individual petitioner’s suffering is compared
to the most extreme cases and reduced accordingly.” Id. at 590. Instead, Graves
assessed pain and suffering by looking to the record evidence, prior pain and suffering
awards within the Vaccine Program, and a survey of similar injury claims outside of the
Vaccine Program. Id. at 595. Under this alternative approach, the statutory cap merely
cuts off higher pain and suffering awards – it does not shrink the magnitude of all possible
awards as falling within a spectrum that ends at the cap. Although Graves is not
controlling of the outcome in this case, it provides reasoned guidance in calculating pain
and suffering awards.
II. Prior SIRVA Compensation Within SPU4
A. Data Regarding Compensation in SPU SIRVA Cases
SIRVA cases have an extensive history of informal resolution within the SPU. As
of January 1, 2025, 4,545 SPU SIRVA cases have resolved since the inception of SPU
ten years before. Compensation has been awarded in the vast majority of cases (4,397),
with the remaining 148 cases dismissed.
2,506 of the compensated SPU SIRVA cases were the result of a ruling that the
petitioner was entitled to compensation (as opposed to an informal settlement), and
therefore reflect full compensation.5 In only 270 of these cases, however, was the amount
of damages determined by a special master in a reasoned decision.6 As I have previously
4 All figures included in this decision are derived from a review of the decisions awarding compensation
within the SPU. All decisions reviewed are, or will be, available publicly. All figures and calculations cited
are approximate.
5 The remaining 1,891 compensated SIRVA cases were resolved via stipulated agreement of the parties
without a prior ruling on entitlement. These agreements are often described as “litigative risk” settlements,
and thus represent a reduced percentage of the compensation which otherwise would be awarded.
Because multiple competing factors may cause the parties to settle a case (with some having little to do
with the merits of an underlying claim), these awards from settled cases do not constitute a reliable gauge
of the appropriate amount of compensation to be awarded in other SPU SIRVA cases.
6 The rest of these cases resulting in damages after concession were either reflective of a proffer by
Respondent (2,206 cases) or stipulation (30 cases). Although all proposed amounts denote some form of
agreement reached by the parties, those presented by stipulation derive more from compromise than
instances in which Respondent formally acknowledges that the settlement sum itself is a fair measure of
damages.
3

Case 1:19-vv-01550-UNJ Document 118 Filed 04/21/25 Page 4 of 17
stated, the written decisions setting forth such determinations, prepared by neutral judicial
officers (the special masters themselves), provide the most reliable guidance in deciding
what similarly-situated claimants should also receive.7
The data for all categories of damages decisions described above reflect the
expected differences in outcome, summarized as follows:
Damages Proffered Stipulated Stipulated8
Decisions by Damages Damages Agreement
Special Master
Total Cases 270 2,206 30 1,891
Lowest $30,000.00 $5,000.00 $45,000.00 $1,500.00
1st Quartile $67,305.16 $60,000.00 $90,000.00 $32,500.00
Median $89,500.00 $80,000.00 $122,866.42 $50,000.00
3rd Quartile $125,000.00 $107,987.07 $162,000.60 $75,000.00
Largest $1,569,302.82 $1,845,047.00 $1,500,000.00 $550,000.00
B. Pain and Suffering Awards in Reasoned Decisions
In the 270 SPU SIRVA cases in which damages were the result of a reasoned
decision, compensation for a petitioner’s actual or past pain and suffering varied from
$30,000.00 to $215,000.00, with $87,000.00 as the median amount. Only ten of these
cases involved an award for future pain and suffering, with yearly awards ranging from
$250.00 to $1,500.00.9 In one of these cases, the future pain and suffering award was
limited by the statutory pain and suffering cap.10
7 Of course, even though all independently-settled damages issues (whether by stipulation/settlement or
proffer) must still be approved by a special master, such determinations do not provide the same judicial
guidance or insight obtained from a reasoned decision. But given the aggregate number of such cases,
these determinations nevertheless “provide some evidence of the kinds of awards received overall in
comparable cases.” Sakovits v. Sec’y of Health & Hum. Servs., No. 17-1028V, 2020 WL 3729420, at *4
(Fed. Cl. Spec. Mstr. June 4, 2020) (discussing the difference between cases in which damages are agreed
upon by the parties and cases in which damages are determined by a special master).
8 Two awards were for an annuity only, the exact amounts which were not determined at the time of
judgment.
9 Additionally, a first-year future pain and suffering award of $10,000.00 was made in one case. Dhanoa v.
Sec’y of Health & Hum. Servs., No. 15-1011V, 2018 WL 1221922 (Fed. Cl. Spec. Mstr. Feb. 1, 2018).
10 Joyce v. Sec’y of Health & Hum. Servs., No. 20-1882V, 2024 WL 1235409, at *2 (Fed. Cl. Spec. Mstr.
Feb. 20, 2024) (applying the $250,000.00 statutory cap for actual and future pain and suffering set forth in
Section 15(a)(4) before reducing the future award to net present value as required by Section 15(f)(4)(A));
see Youngblood v. Sec’y of Health & Hum. Servs., 32 F.3d 552, 554-55 (Fed. Cir.1994) (requiring the
application of the statutory cap before any projected pain and suffering award is reduced to net present
value).
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In cases with lower awards for past pain and suffering, many petitioners commonly
demonstrated only mild to moderate levels of pain throughout their injury course. This
lack of significant pain is often evidenced by a delay in seeking treatment – over six
months in one case. In cases with more significant initial pain, petitioners usually
experienced this greater pain for three months or less. Most petitioners displayed only
mild to moderate limitations in range of motion (“ROM”), and MRI imaging showed
evidence of mild to moderate pathologies such as tendinosis, bursitis, or edema. Many
petitioners suffered from unrelated conditions to which a portion of their pain and suffering
could be attributed. These SIRVAs usually resolved after one to two cortisone injections
and two months or less of physical therapy (“PT”). None required surgery. Except in one
case involving very mild pain levels, the duration of the SIRVA injury ranged from six to
30 months, with most petitioners averaging approximately nine months of pain. Although
some petitioners asserted residual pain, the prognosis in these cases was positive.
Cases with higher awards for past pain and suffering involved petitioners who
suffered more significant levels of pain and SIRVAs of longer duration. Most of these
petitioners subjectively rated their pain within the upper half of a ten-point pain scale and
sought treatment of their SIRVAs more immediately, often within 30 days of vaccination.
All experienced moderate to severe limitations in range of motion. MRI imaging showed
more significant findings, with the majority showing evidence of partial tearing. Surgery or
significant conservative treatment, up to 133 PT sessions - occasionally spanning several
years, and multiple cortisone injections, were required in these cases. In nine cases,
petitioners provided sufficient evidence of permanent injuries to warrant yearly
compensation for future or projected pain and suffering.
III. Relevant Medical History
Prior to vaccination, Petitioner suffered from lower back pain (described as knife-
like and aching when sitting) since at least 2014. Ex. 2 at 6. In the record from an April
24, 2014 primary care provider (“PCP”) visit, it was noted that a recent MRI showed
“where his inverted disc [wa]s impinging his verve (left paracentral L5-S1)” and a note
from his PCP suggesting Petitioner should contact pain management. Id. at 21; see id. at
26-27 (MRI results). Throughout 2014, Petitioner sought treatment for this condition,
receiving oral steroids and attending PT. E.g., id. at 28, 32, 45-46, 54-55; Ex. 24 (October
2014 PT visit). And it was listed as an ongoing problem, along with insomnia and herpes
zoster, when Petitioner first complained of left arm pain in November 2016. Ex. 2 at 61-
62.
Petitioner, a 40-year-old attorney, received the flu vaccine alleged as causal on
October 13, 2016. Ex. 2 at 3. Approximately one month later, he visited his PCP
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complaining of swelling, limited mobility, and a constant ache which made sleep difficult
which he attributed to the flu vaccine. Ex. 2 at 61. At a follow-up appointment one week
later, the PCP discussed the need for an MRI and physical therapy PT. Id. at 67. That
MRI (performed on January 9, 2017) showed only “marrow changes of the humeral head
most likely degenerative in origin,” but no rotator cuff issues or evidence of bursitis. Ex. 9
at 2.
Approximately two months later, Petitioner began to experience additional
symptoms – numbness and tingling. During a January 26, 2017 visit to a neurologist, he
complained of continued pain with all arm movements, now accompanied by “a distracting
abnormal sensation traveling down the arm.” Ex. 10 at 14. He again attributed his
symptoms to the flu vaccine, stating that it “appeared to be given very high in the
shoulder.” Id. Opining that Petitioner was suffering from adhesive capsulitis of the left
shoulder joint causing secondary numbness/tingling in the left arm,” the neurologist
ordered an EMG and referred Petitioner to an orthopedist. Id. at 15.
After undergoing the EMG, the results of which were normal (Ex. 16 at 10),
Petitioner sought treatment from Dr. Huffman on February 17, 2017. Ex. 2 at 91-96.
Noting the poor quality of Petitioner’s MRI,11 which he believed showed some fluid around
the rotator cuff indicative of bursitis, Dr. Huffman administered a steroid injection and
ordered PT. Id. at 91-92.
At his first PT session on February 24, 2017, Petitioner reported some relief from
the steroid injection, rating his current pain as five – ranging from five to ten at the worst.
Ex. 4 at 12. He continued to show improvement in pain, tingling, and ROM during PT
sessions from late February through April 2017.12 E.g., Ex. 4 at 24, 37, 59, 64-65, 70, 92,
103, 107, 113, 118. Thoracic outlet syndrome (“TOS”) was added to Petitioner’s list of
diagnoses in the record from a PT session on March 30, 2017. Ex. 4 at 85. In his signed
declaration, Petitioner stated that his physical therapist diagnosed him with this condition.
Ex. 26 at ¶ 23.
In late April and May 2017, Petitioner began to experience more serious setbacks
during PT. E.g., Ex. 4 at 124, 129, 133, 139. Noted to have reached a plateau, and having
gained maximum improvement, he was discharge from PT on May 23, 2017, following a
total of 27 sessions. Id. at 155.
11 In his declaration, signed under penalty of perjury as required by 28 U.S.C.A. § 1746, Petitioner
complained that the staff taking the MRI were disorganized and made many mistakes when completing the
paperwork. Ex. 26 at ¶ 15.
12 Petitioner experienced a slight pain increase in early April 2017, but attributed it to a second steroid
injection administered by Dr. Huffman the previous day. Id. at 98 (April 8, 2017 PT session); see Ex. 2 at
101 (April 7, 2017 orthopedic visit).
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At a follow-up appointment on May 25, 2017, Dr. Huffman noted that PT “has
helped alleviate the thoracic outlet symptomatology . . . [and][h]e has also regained his
motion, however, he continues to have pain anterolaterally in the region of the
subacromial subdeltoid bursa.” Ex. 2 at 111. Dr. Huffman ordered a repeat MRI due to
the poor quality of the previous one. Id. Performed on June 1, 2017, the MRI revealed
early tendinosis of the supraspinatus and trace fluid in the subacromial/subdeltoid bursa
that “may be related to underlying mild bursitis.” Ex. 16 at 14.
At Petitioner’s next orthopedic visit on June 8, 2017, Dr. Huffman noted that the
MRI showed some labral abnormality. Ex. 2 at 115. He administered another steroid
injection – this time in the glenohumeral joint. Id. at 116. In August 2017, Petitioner sought
a second opinion from another orthopedic surgeon who recommended surgery. Ex. 7 at
15. Dr. Huffman agreed (Ex. 2 at 125-126) and performed an extensive left shoulder
debridement on September 20, 2017.13 Ex. 15 at 15-16. During surgery, Dr. Huffman
observed a small amount of labrum fraying, type 1 superior labrum tear, small adhesions
present in the glenohumeral joint, and thick and abundant adhesions in the subacromial
space. Id. at 15.
At his first post-surgical orthopedic visit on September 27, 2017, Petitioner’s listed
diagnoses were left shoulder biceps tendonitis, bursitis, and superior glenoid labrum
lesion. Ex. 2 at 134. The physician’s assistant who saw Petitioner ordered PT and
additional oxycodone. Id. at 137.
Approximately three weeks later, on October 18, 2017, Petitioner attended his first
post-surgical PT session, reporting pain that ranged from four to nine, currently at six. Ex.
4 at 173. He reported a similar pain level (five) at his next orthopedic visit two days later.
Ex. 2 at 148. Confirming that he was attending PT, Petitioner stated that “[h]is shoulder
is feeling well and his is gaining a lot of motion.” Id. at 127. Although Petitioner denied
any numbness and tingling (id. at 147), TOS was added to his list of diagnoses (id. at
142). He was prescribed Gabapentin and told to continue PT. Id. at 149.
By his thirteenth PT session on January 13, 2018, Petitioner reported being happy
with his progress, but still having some pain when sleeping. Ex, 4 at 242. His current pain
level was three, ranging from two to seven. Id. At his orthopedic visit on February 2, 2018,
Dr. Huffman observed that Petitioner “has close to full range of motion now.” Ex. 2 at 181.
13 Although Dr. Huffman originally thought a biceps tenodesis might be required, it was not performed See
Ex. 2 at 125. “Biceps tenodesis is done by detaching your biceps tendon from your labrum and moving the
tendon to your upper arm bone (humerus).” https://my.clevelandclinic.org/health/treatments/21926-biceps-
tenodesis (last visited Mar. 17, 2025). It is used to “treat[] biceps tendon tears caused by injury or overuse
. . . [and] SLAP tears — tears in your labrum.” Id.
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Predicting that Petitioner “will continue to make progress,” he opined that his condition
“seems to be fairly clear evidence of a SIRVA type of reaction.” Id.
At PT sessions in March and April 2018, Petitioner continued to report milder pain
– at a level of three. E.g., Ex. 4 at 310. During his next orthopedic visit on May 4, 2018,
Dr. Huffman noted that Petitioner “has very close to full range of motion [but] a little bit of
a reactivity in his subacromial space.” Ex. 2 at 188. He assessed Petitioner as “doing as
well as he has been since I met him.” Id. Dr. Huffman administered a subacromial
corticosteroid injection and prescribed additional Gabapentin. Id. at 187-89.
During his next orthopedic appointment on August 3, 2018, Dr. Huffman noted that
Petitioner’s SIRVA-related symptoms were much better, but that Petitioner “still has
limitations in motion.” Ex. 2 at 194. Petitioner stated that he continued to take Gabapentin
and “has started having more constant numbness and tingling in the ulnar nerve
distribution.” Id. In response, Dr. Huffman ordered an EMG.
After Petitioner’s EMG results were normal, Dr. Huffman instructed him to return
to PT. Ex. 2 at 200. He added that the next steps thereafter would be a brachial plexus
MRI and referral to a colleague who specialized in TOS. Id.
Although Petitioner’s current pain level had decreased to two by June 2018 (Ex. 4
at 354), he again reported a moderate level (five) at his 38th and last PT session on
September 15, 2018 (id. at 383). His symptoms were described as “[p]ain, weakness,
[and] [p]oor [e]ndurance.” Id. When Dr. Huffman saw Petitioner six days later, he provided
a recap of Petitioner’s “myriad of symptoms” which included “intermittent episodes of
thoracic outlet syndrome.” Ex. 2 at 208. Dr. Huffman added that Petitioner “was doing well
from the standpoint of getting all of his shoulder motion back, having relief of the pain that
he had in his shoulder and upper arm and started developing more issues with both
vascular and neurogenic thoracic outlet syndrome.” Id. He ordered an MRI of Petitioner’s
left brachial plexus and recommended that Petitioner pursue treatment with two
specialists, Drs. Zager and Chou. Id.
The subsequent MRI (performed on October 1, 2018) showed “[n]o discrete mass
in the left brachial plexus. Ex. 11 at 11. In a signed declaration, he stated that he
attempted to schedule an appointment with Dr. Chou but was told he was not taking new
consultations for several months and would not accept Petitioner’s medical insurance.
Ex. 26 at ¶ 46. Instead, Petitioner shared his concerns and frustration regarding his TOS
and left shoulder pain with his PCP during a physical on October 19, 2018. Ex. 2 at 215.
The PCP noted that he would seek additional information regarding Petitioner’s TOS from
a specialist. Id. at 217.
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On December 12, 2018, Petitioner began PT at a different clinic (Apple PT) upon
a referral from Dr. Huffman. Ex. 5 at 8. He complained of “numbness/tingling pain into his
L hand and pain in [his] shoulder post shoulder surgery.” Id. He estimated that his pain
ranged from four to six, currently at five. Id. By his eighth PT session on February 13,
2019, Petitioner was assessed as “continu[ing] to respond well to treatment, feeling less
frequent and intense pain into his L arm/hand.” Id. 20.
On February 11, 2019, Petitioner visited the Princeton Spine & Joint Center – a
clinic he had found from an internet search. Ex. 6 at 3. Recounting his history of left
shoulder pain, Petitioner noted that “[a]t some point, he began to devop [sic] paresthesias
in hsis left arm, forearm, and fourth and fifth fingers.” Id. at 4. He reported that currently
he “has intermittent associated paresthesias into left hand” and was taking Gabapentin.
Id. Upon examination, he was observed to have cervical tenderness - greater on the left
than right, “positive L trapezius trigger point palpated with characteristic referral pain
pattern,” and decreased ROM. Id. at 5. Petitioner was administered the first in a series of
three treatments, involving an ultrasound guided left suprascapular nerve block and intra-
articular hyaluronic acid viscosupplementation injection. Id. at 7-8. He received two more
treatments in late February 2019. Id. at 9-12.
Petitioner completed his last PT session at Apple PT (the ninth) on February 27,
2019. Ex. 5 at 22. And he underwent another EMG the next day which “reveal[ed]
evidence of mildly increased cervical paraspinal muscle activity, which may reflect
underlying cervical radiculopathy [and] no definitive electrophysiologic evidence of
associated focal neuropathy, brachial plexopathy, or myopathy at this time.” Ex. 18 at 7.
In late August and September 2019, Petitioner underwent another three treatments at
Princeton Spine & Joint Center. Ex. 6 at 13-18.
On October 16, 2019, Petitioner began PT at another clinic, Strive PT. Ex. 23 at 6.
At his initial evaluation, Petitioner described a three- to four-year history of left shoulder
symptoms that started with the October 2016 flu vaccine and included a labral tear and
several TOS flares. Id. At his January 20, 2020 reevaluation, he reported that his left
shoulder felt stronger and more flexible, although he still felt “less motion at extreme
ranges compared to right and it still does fatigue quicker than right.” Id. at 29. His
symptoms were described as “currently getting better” at his last (and 17th) PT session
on March 9, 2020. Id. at 23. In his signed declaration, Petitioner stated that he stopped
PT due to the worldwide COVID Pandemic. Ex. 26 at ¶ 65.
On June 23, 2020, Petitioner called his PCP, seeking Gabapentin and Naproxen.
Ex. 22 at 9. Three days later, he described his symptoms, success with injection at
Princeton Spine & Joint Center, and concerns regarding his parent’s health and COVID
at a telemedicine appointment with his PCP. Id. at 23. The PCP prescribed Gabapentin
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and Naproxen. Id. at 24. He continued to receive injections from Princeton Spine & Joint
Center in March 2022, October 2022, February 2024, and June 2023, and
October/November 2024, and to seek treatment from his PCP. Exs. 27, 43, 45, 57-58
(Princeton Spine & Joint Center records); Ex. 44 (PCP records).
IV. The Parties’ Arguments
A. Briefing
The parties dispute the extent of Petitioner’s SIRVA-related sequela in this case.
Disagreeing with Respondent’s assertion that Petitioner’s TOS is unrelated to his SIRVA,
Petitioner maintains “that all symptomology in [his] left upper extremity, including pain,
limited range of motion, weakness, numbness and tingling began with his October 13,
2016 flu vaccine and can be attributed to his SIRVA and/or treatment for his SIRVA.”
Petitioner’s Memorandum in Support of Damages (“Brief”), filed Sept. 27, 2022, at 41,
ECF No. 86 (citing Respondent’s Rule 4(c) Report at 10 n.3). The parties have provided
expert reports to support their positions which will be discussed further in Section III.B.
See Ex. 29, filed Sept. 14, 2022, ECF No. 79-1; Ex. A, filed Jan. 31, 2023, ECF No. 87-
1; Ex. 46, filed Aug. 8, 2023, ECF No. 97-1.
Petitioner seeks a net present value of $210,000.00 for his past and future pain
and suffering. Brief at 53. He emphasizes his prior good health and vigorous fitness
routine; negative side effects of treatment; effect on his sleep, family life, and work; and
overall SIRVA duration – which he asserts is more than six years. Id. at 44-50. Petitioner
favorably compares the facts and circumstances in his case to those suffered by the
petitioners in S.C., Tumolo, and Reed14 – decisions featuring one arthroscopic surgery
and past pain and suffering awards of $160,000.00; and Pruitt, McDorman, and M.W.15 -
decisions featuring two arthroscopic surgeries and past pain and suffering awards ranging
from $185,000.00 to $200,000.00. Brief at 49-52. Claiming that “the duration and extent
of [his] injury exceeds even that of two-surgery cases,” Petitioner cites Elmakky and
Welch,16 - two additional cases involving three arthroscopic surgeries each and awards
14 S.C. v. Sec’y of Health & Hum. Servs., No. 19-0341V, 2021 WL 2949763 (Fed. Cl. Spec. Mstr. June 14,
2021); Tumolo v. Sec’y of Health & Hum. Servs., No. 16-0343V, 2020 WL 6279711 (Fed. Cl. Spec. Mstr.
Oct. 1, 2020); Reed v. Sec’y of Health & Hum. Servs., No. 16-1670V, 2019 WL 1222925 (Fed. Cl. Spec.
Mstr. Feb. 1, 2019).
15 Pruitt v. Sec’y of Health & Hum. Servs., No. 17-0757V, 2021 WL 5292022 (Fed. Cl. Spec. Mstr. Oct. 29,
2021) (awarding $185,000.00 for past pain and suffering); McDorman v. Sec’y of Health & Hum. Servs.,
No. 19-0814V, 2021 WL 5504698 (Fed. Cl. Spec. Mstr. Oct. 18, 2021) (awarding $200,000.00 for past pain
and suffering); M.W. v. Sec’y of Health & Hum. Servs., No. 18-0267V, 2021 WL 3618177 (Fed. Cl. Spec.
Mstr. Mar. 17, 2021) (awarding $195,000.00 for past pain and suffering).
16 Elmakky v. Sec’y of Health & Hum. Servs., No. 17-2032V, 2021 WL 6285619 (Fed. Cl. Spec. Mstr. Dec.
3, 2021) (awarding $205,000.00 for past pain and suffering); Welch v. Sec’y of Health & Hum. Servs., No.
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of $205,000.00 and $210,000.00, respectively. Brief at 52, 52 n.11.
Petitioner also requests $11,600.47 for past expenses, and $2,781.72 per year for
future expenses. Brief at 53. The provided list of past expenses shows $11,112.62 for co-
pays for medical visits and prescription medication and mileage costs of $487.85. Exs.
41-42, Sept. 27, 2022, ECF No 84. The requested future expenses are to cover the cost
of ultrasound guided suprascapular nerve blocks and ultrasound guided intra-articular
hyaluronic acid viscosupplementation injections every six months until 65 years old. Brief
at 34-36. Petitioner bases his cost calculation for these injections, administered in a series
of three twice a year, on $463.62 per injection, representing the $100.00 co-payment and
$363.62 for a portion of his current insurance deductible ($2,500.00). Id. at 36.
Respondent counters that Petitioner should be awarded $110,000.00 for past pain
and suffering. Respondent’s Brief in Support of Damages (“Opp.”), filed Jan. 31, 2023, at
20, ECF No. 88. Emphasizing the improvements Petitioner reported in August 2018, and
differing symptoms thereafter (id.at 19-20), he argues that “the analysis on pain and
suffering should center on [P]etitioner’s treatments for his SIRVA during the immediate
two-year period following his vaccination” (id.). As comparable cases, Respondent
proposes Shelton, Felland, and Guymon,17 featuring awards ranging from $97,500.00 to
$110,000.00. Opp. at 20-22. Regarding Petitioner’s assertion that his case is similar to
cases involving multiple arthroscopic surgeries – specifically Elmakky, he notes that such
a comparison would necessitate the inclusion of the symptoms related to TOS, suffered
after August 2018. Id. at 22-23.
Regarding Petitioner’s expenses, Respondent argues that only the expenses
related to his SIRVA – paid prior to August 3, 2018 ($5,416.58), should be reimbursed.
Opp. at 23. He maintains that most of the remaining past expenses ($4,521.41), as well
as all amounts sought for future expenses are related to Petitioner’s TOS, which has not
been shown to be vaccine caused. Id. at 23-25. The remaining deduction to past
expenses ($1,662.48) is due to Respondent’s inability to find corresponding medical or
billing records for eight entries (one of which appears to be a duplication) or a medical
recommendation for a shoulder brace purchase from Amazon. Id. at 24. Respondent adds
that even if I find his TOS to be SIRVA-related, Petitioner has not provided sufficient
evidence to show that the VISCO Injections and nerve blocks Petitioner plans to undergo
18-0074V, 2021 WL 1795205 (Fed. Cl. Spec. Mstr. Apr. 5, 2021) (awarding $210,000.00 for past pain and
suffering).
17 Shelton v. Sec’y of Health & Hum. Servs., No. 19-0297V, 2021 WL 2550093 (Fed. Cl. Spec. Mstr. May
21, 202) 1(awarding $97,500.00 for past pain and suffering); Felland v. Sec’y of Health & Hum. Servs., No.
20-0406V, 2022 WL 10724100 (Fed. Cl. Spec. Mstr. Sept. 6, 2022) (awarding $100,000.00 for past pain
and suffering); Guymon v. Sec’y of Health & Hum. Servs., No. 19-1411V, 2022 WL 1447006 (Fed. Cl. Spec.
Mstr. Mar. 25, 2022) (awarding $110,000.00 for past pain and suffering).
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in the future are reasonably necessary. Id. at 24-25.
Noting that surgery does not always result in a resolution of SIRVA symptoms,
Petitioner disputes Respondent’s assertion that his symptoms did not extend beyond
August 3, 2018. Petitioner’s Damages Reply Brief (“Reply”), filed Aug. 10, 2023, at 4, ECF
No. 107. He cites his orthopedist’s observation that his symptoms had improved, but not
resolved at that time, and that the numbness and tingling he was experiencing
supplemented, rather than replaced, his prior SIRVA symptoms. Id. at 4-5. He also
emphasizes a March 2022 statement from the doctor administrating Petitioner’s ongoing
injections, describing his past history and opining that the injections are needed every six
months for Petitioner’s chronic pain. Id. at 7 (quoting Ex. 7 at 3). Respondent insists that
this evidence establishes that his symptoms of TOS are SIRVA-related sequela. Id. at 9-
14. Arguing that the comparable cases cited by Respondent “are vastly dissimilar” (id. at
20), Petitioner reiterates his assertion that his facts and circumstances should be
favorably compared to SIRVA cases involving multiple surgeries (id. at 21-23).
Regarding expenses, Petitioner agrees that the past amount should be decreased
by $127.18, a duplicative amount which was mistakenly included. Reply at 28. Adding
further costs which have been expended, he now seeks $14,376.32 for past expenses
(including mileage costs). Id. Regarding future expenses, he reiterates his request for
$2,781.32 per year until age 65, insisting that this treatment is effective and necessary.
Id. 20-31.
On January 16, 2025, Petitioner filed supplemental briefing, updating his past
expenses to account for additional expenditures from 2022 and 2023. Petitioner’s
Supplemental Memorandum in Support of Damages (“2nd Reply”) at 2-4, 7, ECF No. 113.
He now seeks $16,885.69 for past expenses and the same amount yearly amount for
future expenses. Id. at 7.
B. Expert Reports
On September 14, 2022, Petitioner filed an expert report and curriculum vitae
(“CV”) from G. Russell Huffman, MD, MPH,18 the orthopedic surgeon who treated
Petitioner, and performed his September 20, 2017 surgery. Exs. 29-30, ECF No. 79. Dr.
Huffman first opined that Petitioner’s “diagnoses of bursitis, biceps and rotator cuff
inflammation and adhesive capsulitis all fit the with the reported criteria for SIRVA and
vaccine causality.” Ex. 29 at 4. Asserting that “[b]oth thoracic outlet syndrome and
adhesive capsulitis are independently associated with adverse vaccination reactions” (id.
at 4), he concluded that further adhesive capsulitis and later diagnoses of biceps
18 MPH stands for Master of Public Health.
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tendonitis and TOS were also vaccine caused. Id. at 5. Although he stated that Petitioner’s
TOS “could be a direct result of the vaccination occurring concurrent to his SIRVA,” Dr.
Huffman opined that “it is more likely that he developed thoracic outlet syndrome
secondary to his acute SIRVA, which was secondarily reinforced by his adhesive
capsulitis and ongoing symptoms.” Id. at 6. To support his opinion, Dr Huffman provided
medical literature regarding autoimmune reactions generally, SIRVA, adhesive capsulitis,
Parsonage-Turner syndrome, brachial neuritis, and a VAERS19 report of limb swelling
post-vaccination. Exs. 31-39, ECF No. 80.
Regarding the treatment that Petitioner has received, Dr. Huffman concluded that
“[i]t is also my opinion that the treatment that [Petitioner] has undergone has been
reasonable, medically necessary and related to the sequelae of the vaccination reaction.
Ex. 29 at 6. He stated that Petitioner “continues to suffer from sequelae of the vaccination
to this date.” Id.
On January 31, 2023, Respondent provided an expert report and CV from Dr. Paul
J. Cagle, an orthopedic surgeon. Exs. A-B, ECF No. 87. Pointing to multiple differences
between SIRVA and TOS, Dr. Cagle criticized Dr. Huffman’s assertion “that TOS is
independently associated with adverse vaccination events.” Ex. A at 3. He also
questioned Petitioner’s TOS diagnosis, observing that it “is not a diagnosis of exclusion .
. . [and] there needs to be clear evidence of a physical anomaly that can be corrected.”
Id. Observing that none of the medical literature Dr. Huffman provides mentions TOS,
and most discuss conditions not found in this case, he asserted that “none . . . support
the assertion that TOS correlated with a SIRVA In this case.” Id. In addition to the delayed
timing for Petitioner’s TOS symptoms, Dr. Cagle emphasized that “a viable mechanism
for how a [SIRVA] caused a delayed presentation of TOS is unsupported by the medical
record, the published literature regarding SIRVA and the report by Dr. Huffman.” Id.
Instead, he opined that Petitioner’s TOS “is unrelated to vaccination.” Id. at 4. To support
his opinion, Dr Cagle cited an article regarding SIRVAs that he wrote, and an article
regarding TOS. Exs. A1, A2.
Dr. Cagle also questioned the need for long-term injections that Petitioner believes
are needed. Ex. A at 4. Insisting instead that common treatments for musculoskeletal
conditions are more normally needed only short-term, Dr. Cagle argued that “[a]ny
suggestions that a treatment like injections would be absolutely needed over the course
of years or even decades is well outside the bounds of reasonable medical advice.” Id.
19 “Established in 1990, the Vaccine Adverse Event Reporting System (VAERS) is a national early warning
system to detect possible safety problems in U.S.-licensed vaccines. . . . [It] accepts and analyzes reports
of adverse events (possible side effects) after a person has received a vaccination. Anyone can report an
adverse event to VAERS.” https://vaers.hhs.gov/about.html (last visited on Mar. 18, 2025).
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In a supplemental report filed on August 8, 2023, Dr. Huffman reiterated his original
opinion that “the vaccine is causally related to the TOS symptoms experienced by
[Petitioner].” Ex. 46 at 3. Discussing his extensive experience relate to TOS and the
difficulty diagnosing this condition (id. at 2-3), He described a process by which
“[c]ompression of the lower trunk of the brachial plexus (involving the ulnar nerve) can
occur” at the pectoralis minor20 - a condition that often fails to produce positive EMG
results (id. at 2).
V. Appropriate Compensation for Pain and Suffering
In this case, awareness of the injury is not disputed. The record reflects that at all
times Petitioner was a competent adult with no impairments that would impact his
awareness of his injury. Therefore, I analyze principally the severity and duration of
Petitioner’s injury.
When performing this analysis, I review the record as a whole, including the filed
medical records, affidavits, and sworn declarations and all assertions made by the parties
in written documents. I consider prior awards for pain and suffering in both SPU and non-
SPU SIRVA cases and rely upon my experience adjudicating these cases. However, I
base my determination on the circumstances of this case.
A thorough review of the medical records reveals that Petitioner suffered a
moderate SIRVA injury, with pain levels estimated at five, some limited ROM, and
accompanying tingling and numbness that began approximately two months post-
vaccination. He obtained some relief during the first seven months of his SIRVA from two
steroid injections and 27 PT sessions, but reached a plateau in May 2017. A diagnosis of
TOS was added to his PT records by his therapist in late-March 2017.
After undergoing arthroscopic surgery, consisting of extensive debridement in
September 2017, Petitioner made good improvement during the subsequent eleven
months, benefiting after 38 PT sessions and another steroid injection. He reported pain
at a level of two out of ten in June 2018, and mild limitations in ROM in August 2018.
However, Petitioner also began to experience increased numbness and tingling
down his arm and into his hand. He later complained of a feeling of coldness. At his last
appointment with Dr. Huffman in September 2018, Petitioner was referred to two TOS
experts. After encountering some difficulty scheduling an immediate appointment, he
opted to rely upon his PCP and injections administered up to twice a year at Princeton
20 Pectoralis minor is the smaller muscle under the pectoralis major, extending from the third to fifth ribs to
the scapula. DORLAND’S ILLUSTRATED MEDICAL DICTIONARY at 1192 (32th ed. 2012).
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Spine & Joint Center.
Like most SIRVA cases, some of Petitioner’s shoulder issues were likely present
prior to vaccination, but asymptomatic until aggravated by an improperly-injected vaccine.
As usual, it is difficult to differentiate between the impact of the vaccine mis-administration
and its effect on preexisting but asymptomatic problems. Due to their location, conditions
such as the type 1 labrum tear observed during surgery are not likely to have been directly
affected by a vaccination – regardless of how administered. But Petitioner clearly
experienced some vaccine-related symptoms, and Respondent concedes that point.
It is also difficult to determine whether the symptoms Petitioner experienced after
August 2018, were related to Petitioner’s SIRVA. The lack of an obvious alternate cause
for these symptoms,21 as well as the opinion of Petitioner’s treating orthopedic surgeon,
Dr. Huffman weigh in Petitioner’s favor. However, Petitioner was never seen by the TOS
experts Dr. Huffman recommended. And it appears he did not return to Dr. Huffman for
further treatment after his September 2018 visit, which occurred less than two years post-
vaccination and more than four years prior to the filing of Dr. Huffman’s expert report. As
Respondent’s expert noted, there is a lack of evidence in the record as it currently stands
supporting the TOS diagnosis and its potential causes.
In his expert report, Dr. Huffman theorizes that the numbness and tingling
Petitioner began to experience in January 2017, was due to his limited ROM and pressure
applied to his pectoralis minor, and that appears to be a logical explanation for those
earlier, fairly mild symptoms. However, it would not account for the symptoms Petitioner
described post-surgery, which continued to increase in severity during 2018, even as the
symptoms which were clearly vaccine-related (shoulder pain and limitations in ROM)
improved. And testing revealed that Petitioner experienced some conditions – specifically
the labrum tear, not likely to have been caused or aggravated by the vaccine he received.
In addition to the lack of evidence showing a causal link between Petitioner’s later
symptoms and his earlier SIRVA, there is insufficient evidence to support Dr. Huffman’s
assertion that, in general, TOS has been shown to be vaccine-related. The medical
literature he cites does not address the matter. And he has provided no other evidence
to support this claim.
Although I find there is not sufficient evidence to link most of Petitioner’s later
symptoms to his SIRVA, he may have continued to experience some mild limitations and
pain from the damage done by the improperly administered flu vaccine which I will take
into account when determining pain and suffering. Thus, he is entitled to a pain and
21 Petitioner did suffer from lower back pain prior to vaccination, but neither expert theorizes that could be
the source of Petitioner’s later symptoms.
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suffering award on higher end of the applicable range for SIRVA cases involving one
arthroscopic surgery. For example, S.C. and Tumolo are instructive, but involved more
definitive gaps in treatment during the two years prior to and following surgery than were
seen in Petitioner’s case. S.C., 2021 WL 2949763, at *4; Tumolo, 2020 WL 6279711, at
*14-15.
However, I do not agree that Petitioner is entitled to an award similar to that usually
provided in cases involving multiple surgeries, especially those cited by Petitioner which
involved circumstances showing more severe pain levels for greater periods of time.
Elmakky, 2021 WL 6285619, at *5-6; Welch, 2021 WL 1795205, at *1-2; Pruitt, 2021 WL
5292022, at *1-4; McDorman, 2021 WL 5504698, at *2-3; M.W., 2021 WL 3618177, at
*2-4. No doubt Petitioner was frustrated by some continuing symptoms, but his SIRVA-
related symptoms had primarily resolved within two years. I thus find that $170,000.00
represents an appropriate past pain and suffering award.
VI. Compensation for Unreimbursed Expenses
Although I have determined that Petitioner did not experience a complete
resolution of all SIRVA-related symptoms in August 2018, as Respondent maintains, I
also have found he has not sufficiently connected most of his symptoms thereafter to his
SIRVA. Thus, Respondent’s proposed timeframe for the reimbursement of expenses in
this case, is logical.
Additionally, Petitioner has attributed most of the expenses for which Respondent
was unable to find sufficient documentation to the payment of a portion of his medical
insurance deductible. However, he has failed to show out-of-pocket payment for these
amounts. Thus, I find that the amount proposed by Respondent ($5,416.58) is
appropriate.
Conclusion
For all of the reasons discussed above and based on consideration of the record
as a whole, I find that $170,000.00 represents a fair and appropriate amount of
compensation for Petitioner’s actual pain and suffering.22 I also find that Petitioner
is entitled to $5,416.58 in actual unreimbursable expenses.
22 Since this amount is being awarded for actual, rather than projected, pain and suffering, no reduction to
net present value is required. See Section 15(f)(4)(A); Childers v. Sec’y of Health & Hum. Servs., No. 96-
0194V, 1999 WL 159844, at *1 (Fed. Cl. Spec. Mstr. Mar. 5, 1999) (citing Youngblood v. Sec’y of Health &
Hum. Servs., 32 F.3d 552 (Fed. Cir. 1994)).
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Based on the record as a whole and arguments of the parties, I award Petitioner
a lump sum payment of $175,416.58 to be paid through an ACH deposit to
Petitioner’s counsel’s IOLTA account for prompt disbursement. This amount
represents compensation for all damages that would be available under Section 15(a).
The Clerk of Court is directed to enter judgment in accordance with this Decision.23
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
23 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.
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