VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01958
Package ID: USCOURTS-cofc-1_19-vv-01958
Petitioner: Angela Quinn Cross
Filed: 2019-12-26
Decided: 2023-03-01
Vaccine: influenza
Vaccination date: 2018-09-12
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 102500

AI-assisted case summary:
Angela Cross filed a petition for compensation under the National Vaccine Injury Compensation Program on December 26, 2019, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on September 12, 2018. The case was assigned to the Special Processing Unit. After settlement negotiations reached an impasse, the parties proceeded to litigate entitlement. Respondent argued that Petitioner had not established the statutory "severity" requirement of six or more months of injury-related sequelae and that her pain was not limited to the shoulder in which she received the vaccine. Petitioner argued that her pain, though sometimes radiating, originated in the left shoulder and that the injury persisted for more than six months. The public decision does not describe the specific clinical presentation or diagnostic tests beyond medical records and declarations. Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement on December 2, 2022, finding that Petitioner's injury was limited to her left shoulder, that the injury and its residual effects lasted for more than six months, and that she met the Table criteria for SIRVA. The Chief Special Master noted that while there was a six-month gap in treatment, it was partially explained by a steroid injection providing relief, relocation, and self-care. The ruling also addressed the "radiating" pain, concluding that musculoskeletal pain primarily occurring in the shoulder is valid under the Table even if it extends to adjacent parts of the body, as long as the essence of the claim is that the vaccine administered to the shoulder primarily caused pain there. Petitioner was found to have met all requirements for a Table SIRVA claim. Subsequently, on January 26, 2023, Respondent filed a proffer on the award of compensation, agreeing to an award of $102,500.00 for actual pain and suffering, which Petitioner accepted. On March 1, 2023, Chief Special Master Corcoran issued a Decision Awarding Damages, awarding Petitioner a lump sum payment of $102,500.00 for her actual pain and suffering.

Theory of causation field:
Petitioner Angela Cross received an influenza vaccine on September 12, 2018, and alleged a Shoulder Injury Related to Vaccine Administration (SIRVA), a Table injury. The Chief Special Master, Brian H. Corcoran, ruled on December 2, 2022, that Petitioner was entitled to compensation, finding the injury was limited to her left shoulder, lasted more than six months, and met the Table criteria. Respondent had argued the injury did not meet the duration requirement and that pain radiated beyond the shoulder. The Special Master found the duration requirement met, noting a gap in treatment was explained by a steroid injection, relocation, and self-care, and that radiating pain did not disqualify the claim as the primary injury was to the shoulder. Petitioner's counsel was John Leonard Shipley, and Respondent's counsel was Alexa Roggenkamp. On March 1, 2023, a decision awarded Petitioner a lump sum of $102,500.00 for pain and suffering based on a joint proffer, representing compensation for all damages available under 42 U.S.C. § 300aa-15(a).

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01958-0
Date issued/filed: 2023-01-06
Pages: 11
Docket text: PUBLIC ORDER/RULING (Originally filed: 12/02/2022) regarding 31 Ruling on Entitlement, Order on Motion for Ruling on the Record, Signed by Chief Special Master Brian H. Corcoran. (kp) Service on parties made.
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Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 1 of 11
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1958V
UNPUBLISHED
ANGELA QUINN CROSS, Chief Special Master Corcoran
Petitioner,
v. Filed: December 2, 2022
SECRETARY OF HEALTH AND Special Processing Unit (SPU);
HUMAN SERVICES, Ruling on Entitlement; Findings of
Fact; Severity; Localized Injury to
Respondent. Shoulder; Influenza (Flu); Shoulder
Injury Related to Vaccine
Administration (SIRVA)
John Leonard Shipley, Davis, CA, for Petitioner.
Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLMENT1
On December 26, 2019, Angela Cross 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 a Table injury - that she suffered a shoulder injury
related to vaccine administration (“SIRVA”) after receiving an influenza (“flu”) vaccine on
September 12, 2018. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters (“SPU”).
1 Because this unpublished opinion 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 opinion 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-01958-UNJ Document 34 Filed 01/06/23 Page 2 of 11
After a full review of the evidence, I find it most likely that Petitioner’s injury was
limited to her left shoulder; that the injury and its residual effects lasted for more than six
months; and that she is otherwise entitled to compensation.
I. Relevant Procedural History
After the case’s initiation and SPU assignment, the parties attempted to settle the
claim, but by July 2021 they informed me they had reached an impasse in their
negotiations. ECF No. 24; ECF No. 25. I therefore at Petitioner’s request set deadlines
for the filing of briefs addressing her entitlement to compensation. ECF No. 26.
On August 8, 2021, Petitioner filed a Motion for Ruling on Record. ECF No. 27. On
September 7, 2021, Respondent filed his Rule 4(c) Report and Response to Petitioner’s
Motion, recommending that entitlement to compensation be denied under the terms of
the Vaccine Act. ECF No. 29. Specifically, Respondent argued that (1) Petitioner had not
established the statutory “severity” requirement of six or more months of injury-related
sequelae, and (2) Petitioner had failed to establish that she suffered the Table injury of
SIRVA, because Petitioner’s pain was not limited to the shoulder in which she received
the vaccine. ECF No. 29 at 8-11 (citing Section 11(c)(1)(D)(i); 42 C.F.R. §
100.3(c)(10)(iii)). Petitioner filed a Reply brief on September 14, 2021. ECF No. 30. This
matter is ripe for my resolution.
II. Authority
Before compensation can be awarded under the Vaccine Act, a petitioner must
demonstrate, by a preponderance of evidence, all matters required under Section
11(c)(1), including the factual circumstances surrounding his claim. Section 13(a)(1)(A).
In making this determination, the special master or court should consider the record as a
whole. Section 13(a)(1). Petitioner’s allegations must be supported by medical records or
by medical opinion. Id.
To resolve factual issues, the special master must weigh the evidence presented,
which may include contemporaneous medical records and testimony. See Burns v. Sec'y
of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (explaining that a special
master must decide what weight to give evidence including oral testimony and
contemporaneous medical records). Contemporaneous medical records are presumed to
be accurate. See Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed.
Cir. 1993). To overcome the presumptive accuracy of medical records testimony, a
petitioner may present testimony which is “consistent, clear, cogent, and compelling.”
Sanchez v. Sec'y of Health & Hum. Servs., No. 11–685V, 2013 WL 1880825, at *3 (Fed.
2

Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 3 of 11
Cl. Spec. Mstr. Apr. 10, 2013) (citing Blutstein v. Sec'y of Health & Hum. Servs., No. 90–
2808V, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)).
In addition to requirements concerning the vaccination received, the duration and
severity of petitioner’s injury, and the lack of other award or settlement,3 a petitioner must
establish that she suffered an injury meeting the Table criteria, in which case causation
is presumed, or an injury shown to be caused-in-fact by the vaccination she received.
Section 11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria
establishing a SIRVA under the accompanying QAI are as follows:
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time-frame;
3 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception; suffered the residual effects of his injury for more than six months, died from his injury, or
underwent a surgical intervention during an inpatient hospitalization; and has not filed a civil suit or collected
an award or settlement for her injury. Section 11(c)(1)(A)(B)(D)(E).
3

Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 4 of 11
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
III. Relevant Factual Evidence
I have reviewed all evidence filed to date, but limit my discussion below to the
evidence most relevant to my determination of whether Petitioner experienced the
seqeula of her injury for more than six months, and whether Petitioner’s “pain and reduced
range of motion are limited to the [left] shoulder in which the intramuscular vaccine was
administered.” Section 11(c)(1)(D)(i); 42 C.F.R. § 100.3(c)(10)(iii).
A. Medical Records
• On September 12, 2018, Petitioner received a flu vaccination in her left shoulder
from Rite Aid Pharmacy. Ex. 3 at 1.
• On September 24, 2018 (12 days after vaccination), Petitioner was seen by
Kathryn Martin, PA, for a “[r]eaction to flu shot.” Ex. 4 at 54. The medical record
indicates that Petitioner presented with “left shoulder pain, which started after
receiving a flu shot on 9/12/2018 at Rite Aid. She states that she thought the flu
shot was given too high, and she points directly to the acromi[on], stating it was
given there.” Id. The records further indicates that Petitioner’s “pain radiates down
to the left elbow and sometimes across the left shoulder to the neck. No numbness
or tingling. Has decreased range of motion of the left shoulder due to the pain. No
pain in the neck or previous issues in the neck.” Id. The record also details the
Petitioner does “office work. No heavy lifting or repetitive lifting.” Id. Ms. Martin
assessed Petitioner as suffering from “[a]cute pain of left shoulder.” Id. at 55.
• Petitioner returned to see Ms. Martin on October 5, 2018, for a “[f]lu shot injury.”
Ex. 4 at 52. The medical records indicates that Petitioner presented “for follow-up
of her left shoulder pain, which started after receiving a flu shot to the area on
9/24/2018.” Id. The record details that the “[p]ain is located within the shoulder
joint. No history of previous issues to the left shoulder, and no precipitating injury
besides the flu shot. She does office work and has been resting the shoulder since
4

Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 5 of 11
last visit.” Id. Ms. Martin again assessed Petitioner as suffering from “[a]cute pain
of left shoulder.” Id. at 53.
• On October 22, 2018, Petitioner was seen again by Ms. Martin for a “flu shot
reaction.” Ex. 4 at 50. The record states Petitioner presented for a “follow-up of left
shoulder pain” which began after receipt of a flu vaccine on September 12, 2018.
Id. The records notes that Petitioner “had been thinking about the shoulder
injection,” discussed at the last visit, and would now like to receive it. Id. It was
further noted that pain had “flared up a few days ago when she had to drive four
hours” and that her “pain is intense with lifting the arm” and that “holding the
steering wheel with the left arm for extended periods of time exacerbates the pain.”
Id. Ms. Martin’s notes also indicate that the “pain is mostly to the left shoulder, and
sometimes radiates down the left upper arm and over left shoulder blade.” Id.
Petitioner was again assessed by Ms. Martin with “[a]cute pain of left shoulder”
and a steroid injection was administered to her left shoulder to treat her pain. Id.
at 51.
• Petitioner moved to Billings, Montana in November 2018, and began transitioning
her medical care to the Department of Veteran Affairs (the “VA”) in Billings. Ex. 2
at 123. She had an initial visit with a nurse on December 18, 2018, where her vitals
and prescriptions were recorded, and screenings for depression, alcohol use,
vaccinations, and PTSD conducted. Id. at 116-121. A physical examination was
not conducted, nor was her shoulder pain mentioned.
• On March 19, 2020, Petitioner underwent a mammogram at Community Care, a
non-VA related program. Ex. 2 at 109. The following day, Petitioner was seen
outside the VA for a rash on her left shoulder and abnormal vaginal bleeding at the
Billings Clinic. Ex. 5 at 22-29. These records contain no discussion of Petitioner’s
left shoulder pain.
• Petitioner next treated for her left shoulder pain on April 21, 2019, when she
presented to Nancy Beckman, APRN, at the Billings Clinic, for “left shoulder pain
for several months.” Ex. 5 at 16. The record notes that Petitioner received “a flu
shot in October, states it was given in the joint and her arm went limp in 2 days,
she was then seen three more times, treated with pain medication and a steroid
injection in the left shoulder joint. This injection was very helpful in alleviating the
pain.” Id. The record describes that Petitioner “present[ed] with pain in the left
shoulder, deep in the shoulder, pain from the shoulder to the palm, no weakness
or numbness. She is right handed and works with arms over head sometimes and
can’t raise her arm.” Id. Ms. Beckman assessed Petitioner with left shoulder pain
and administered a Toradol injection to treat her shoulder pain. Id. at 18-19.
5

Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 6 of 11
• On May 1, 2019, Petitioner was evaluated by Orthopedics PA, Lanny Schneider,
for left shoulder pain. Ex. 5 at 7. It was noted that Petitioner had recently moved
back to the area and was establishing care with Ms. Beckham. Id. The record
further documented that Petitioner reported “she has had ongoing shoulder pain
since about September 2018. She [is] relating this to a flu shot that she states went
into the joint. She was seen about 3 times in her past hometown. . . . Apparently
she responded well to a cortisone injection, but did not get any physical therapy.”
Id. Ms. Schneider noted that Petitioner described “pain today for me at the shoulder
on the lateral side with some radiation down to the elbow, but nothing beyond that.
She states it is difficult to raise her arm above her head, sometimes. She does feel
like the cortisone shot did help considerably but did ‘wear off.’” Id. In her
assessment, Ms. Schneider noted “[i]t is difficult for me to [s]ay whether problems
now are related to the previously mentioned flu shot. It seems like this is more of
a rotator cuff[,] tendonitis[,] bursitis type of thing, more associated with her job and
overhead lifting.” Id. at 8. Ms. Schneider recommended physical therapy which she
indicated Petitioner was going to try and administered another steroid injection. Id.
• Petitioner continued to treat thereafter for her shoulder injury. Petitioner was
evaluated by orthopedic surgeon, James Elliot, MD, on March 16, 2020. Dr. Elliot’s
history of Petitioner’s left shoulder pain describes an onset of left shoulder pain
“almost immediately after she got a flu shot.” Ex. 10 at 20. He notes she “complains
of left shoulder pain mostly lateral and anterior” and indicates she “has no radiation
of pain down her arm . . . . no numbness and tingling in her left extremity. She
never had any neurologic symptoms in her left upper extremity following the
incident. Symptoms were restricted to pain only in the left shoulder. She denies
any neck pain.” Id. Dr. Elliot notes an MRI impression of a 50% partial tear of
Petitioner’s left rotator cuff. Ex. 10 at 21-22. Prior to undergoing shoulder surgery,
Dr. Elliot recommended she undergo an EMG to rule out Parsonage-Turner
syndrome. Ex. 10 at 22.
• Petitioner underwent an EMG on March 25, 2020 of the left upper extremity. A
history described Petitioner’s “pain in her left shoulder and difficulty using left
shoulder in September 2018 after a flu shot. Onset was abrupt and she has had
continued left shoulder and upper arm pain.” Ex. 10 at 23. The EMG revealed no
evidence of Parsonage-Turner syndrome or cervical radiculopathy. An “incidental
finding of electrical median mononeuropathy at or near the wrist (carpal tunnel
syndrome)” was noted as asymptomatic. Id. at 23-24. After reviewing her EMG,
that same day, Dr. Elliot noted an impression of “[o]ngoing issues with h[er] left
shoulder. No true neuro[logical] component to this.” Ex. 10 at 19.
6

Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 7 of 11
• Petitioner subsequently underwent left shoulder surgery and further physical
therapy to treat her left shoulder. Ex. 9 at 15-16; Ex. 11.
B. Declarations
Petitioner and her husband, Sean Cross, executed signed and sworn declarations
describing the onset and sequela of Petitioner’s shoulder injury. Ex. 6; Ex. 7. They
describe the onset of Petitioner’s pain as immediately following her September 12, 2018
flu vaccine. Ex. 6, ¶4; Ex. 7, ¶ 4.
Petitioner explains that her October 22, 2018 steroid injection did provide
temporary relief of the pain she was experiencing in her left shoulder. Ex. 6, ¶¶ 11-12.
Petitioner further explained that in November 2018 she moved to Billings, Montana from
California. Ex. 6, ¶ 13. She continued to experience pain in her left shoulder, and as a
veteran was attempting to transfer her care to the local VA clinic in Billings. Ex. 6, ¶¶ 14-
15. In the interim, she treated her shoulder through self-care to include limiting use of her
shoulder and performing stretching and other exercises recommended by her previous
provider. Ex. 6, ¶ 14. Ultimately, her pain grew severe enough that on April 21, 2019, she
sought care outside the VA (where she still could not get an appointment) at the Billings
Clinic where she received treatment for her shoulder until she was able to receive care at
the local VA hospital in Billings in July 2019. Ex. 6, ¶¶ 16, 18-19.
IV. Findings of Fact
A. Severity
The threshold issue to be resolved is whether Ms. Cross has demonstrated that
she suffered “residual effects or complications of” the injury alleged injury “for more than
six months after the administration of the vaccine,” as required for eligibility under the
Vaccine Program. Section 11(c)(1)(D)(i).
As Respondent points out, there is a six-month temporal gap in Petitioner’s
treatment for her left shoulder symptoms - between October 22, 2018 and April 21, 2019.
ECF No. 29 at 10. He also maintains that Petitioner has not introduced corroborating
documentation or expert testimony linking her left shoulder pain from September 2018 to
her complaints in April 2019, and notes that Ms. Schneider, a physician’s assistant,
questioned whether a vaccination could cause this type of injury and thought it likely to
be “more associated with her job and overhead lifting.” Id. at 11(citing Ex. 5 at 8).
Respondent also points out that Petitioner did not report shoulder pain to the providers
she saw in the interim time period. Id. at 10.
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Case 1:19-vv-01958-UNJ Document 34 Filed 01/06/23 Page 8 of 11
Respondent’s contentions have merit, but are overcome by a review of the record
in its totality. The record demonstrates that Petitioner immediately experienced post-
vaccination pain, and then consistently reported the onset of her shoulder pain as
following her flu shot, including at her April 21, 2019 appointment (the first treatment
instance after the gap). Ex. 5 at 7, 16. Moreover, the six-month gap in Petitioner’s
treatment for her shoulder is at least partially explained by the fact that she received a
cortisone injection on October 22, 2018, for her shoulder pain, which subsequently
provided significant relief for a period of time. Ex. 4 at 51; Ex. 5 at 7, 16. Additionally,
during the gap Petitioner relocated from California to Montana, receiving limited
professional care of a specialized nature,4 while attempting to manage her pain on her
own. Ex. 6, ¶¶ 13-14.
Finally, the record does not reflect that Petitioner’s shoulder pain in the Spring of
2019 was distinct from her post-vaccination shoulder pain in the Fall of 2018. Despite Ms.
Schneider’s speculation that Petitioner’s shoulder pain might have been caused by her
work/overhead lifting, the record convincingly evidences Petitioner’s shoulder pain
originated with her September 2018 flu vaccination, and there is no evidence of an
alternate cause or a new injury.
Based on the record as a whole, there is preponderant evidence that Petitioner’s
shoulder injury and residual effects thereof persisted for more than six months, and
therefore severity is established. (I note, however, that the lengthy treatment delay is
evidence that Petitioner’s SIRVA was manageable without medical intervention for a
significant period of time – and therefore any pain and suffering sum to be awarded in this
case may take this into account).
B. Injury Limited to Shoulder
The second disputed issue is whether Ms. Cross’s “[p]ain and reduced range of
motion are limited to the [left] shoulder in which the intramuscular vaccine was
administered.” 42 C.F.R. § 100.3(c)(10)(iii).
Respondent points to several records, beginning with Petitioner’s first post-
vaccination medical encounter, that indicate that Petitioner’s shoulder pain “radiated” from
her shoulder down her arm, to her elbow, over her shoulder blade, to the neck, and/or her
palm. ECF No. 29 at 9 (citing Petition, ¶ 8; Ex. 4 at 50, 54; Ex. 5 at 7). Respondent agues
4 In addition, it is not surprising that Petitioner’s shoulder pain was not documented in her December 2018
VA appointment - as this was a nursing appointment aimed at establishing certain baseline health screening
information (related to alcohol, depression, prescription), and did not involve a physical examination. Nor
would I necessarily expect Petitioner to discuss her shoulder pain at her mammogram appointment on
March 19, 2020, Ex. 2 at 109, or her Billings Clinic appointment the following day, which was specific to an
acute rash and abnormal vaginal bleeding. Ex. 5 at 22-29.
8

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that these “instances of radiating arm, pain, and neck symptoms are inconsistent with
SIRVA.” Id. 5
Petitioner, however, argues that these records demonstrate she subjectively
experienced pain in her left shoulder (the site of her vaccination) that was so severe that
she felt as if the pain radiated out from her shoulder – even though the shoulder was its
primary emanating situs. ECF No. 30 at 4-7. Petitioner further observes that her
examinations consistently found reduced range of motion limited to her left shoulder, and
that there is no evidence of reduced range of motion, or injury, in any other part of
Petitioner’s body. Id. at 7.
Petitioner also argues that in promulgating 42 C.F.R. § 100.3(c)(10)(iii), the
Secretary of Health and Human Services (the “Secretary”) intended that pain outside the
shoulder, to the back or neck, “with an injury to the shoulder in which the individual
received a vaccine could still be considered SIRVA.” Id. at 7-8. This argument warrants
some weight. As I observed in K.P. v. Sec'y of Health & Hum. Servs., No. 19-0065V, 2022
WL 3226776, at *8 (Fed. Cl. May 25, 2022), in establishing that criterion, the Secretary of
Health & Human Services (the “Secretary”) emphasized that a SIRVA must only be
“localized to the shoulder in which the vaccine is administered.” Revisions to the Vaccine
Injury Table on Jan. 19, 2017, 82 Fed. Reg. 6294, 6296 (emphasis added). Although this
wording may be more restrictive than stating, for example, that a SIRVA must “originate”
or be “centralized” at the shoulder, additional commentary on the criterion allows for a
slightly broader reading. The Secretary has also observed that the criterion is intended to
advance a definition of SIRVA as a musculoskeletal condition caused by intramuscular
vaccine administration into the shoulder, which must include an injury to the shoulder,
and excludes a claim for “pain in the neck or back without an injury to the shoulder.” Id.
(emphasis added).
5 Respondent does acknowledge that Petitioner ultimately underwent an EMG on March 25, 2020, that
demonstrated medial nerve abnormalities (consistent with carpal tunnel), but no indications of neuropathy,
radiculopathy, or plexopathy. ECF No. 29 at 9, n.1 (citing Ex. 8 at 192; Ex. 10 at 17). Respondent somewhat
dismisses the negative EMG findings, however, as Petitioner’s EMG occurred 11 months following her last
report of radiating pain. Id.
Additionally, I note that Respondent does not contend that Petitioner’s medial nerve abnormality was a
condition or abnormality “that would explain the patient’s symptoms” in contravention of the fourth QAI
requirement, nor do I find it to be. 42 C.F.R. § 100.3(c)(10)(iv). Rather, Petitioner’s medial nerve abnormality
is more likely than not a coexisting condition unrelated to Petitioner’s shoulder injury or September 2018
vaccination. Additionally, that EMG finding was noted to be asymptomatic. Ex. 10 at 23-24. I have previously
recognized that a petitioner may be able to distinguish the evidence supporting a Table SIRVA from
“simultaneous areas of pain due to unrelated conditions.” Rodgers v. Sec’y of Health & Hum. Servs., No.
18-0559V, 2021 WL 4772097, at *8 and n. 16 (Fed. Cl. Spec. Mstr. Sept. 9, 2021).
9

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Accordingly, claims involving musculoskeletal pain primarily occurring in the
shoulder are valid under the Table even if there are additional allegations of pain
extending to adjacent parts of the body, since the essence of the claim is that a vaccine
administered to the shoulder primarily caused pain there.6 This reading has support in
the determinations of other special masters. Grossmann v. Sec’y of Health & Hum.
Servs., No. 18-0013V, 2022 WL 779666, at *15 (Fed. Cl. Spec. Mstr. Feb. 15, 2022)
(explaining that the criterion is intended to “guard against compensating claims involving
patterns of pain or reduced range of motion indicative of a contributing etiology beyond
the confines of a musculoskeletal injury to the affected shoulder”) (emphasis added).
Here, despite the notations of pain extending beyond the shoulder, Petitioner’s injury is
consistent with the definition of SIRVA and there is not preponderant evidence of another
etiology. Thus, I find Petitioner has satisfied the third SIRVA QAI criterion. 42 C.F.R. §
100.3(c)(10)(iii).
To the extent that any sequelae deemed not related to the shoulder pain remain a
contested issue, those can be resolved in the context of damages.
V. Other Table Requirements and Entitlement
Petitioner has established all other requirements for a Table SIRVA claim. The
vaccine administration record reflects the administration site as the left deltoid. Sections
11(c)(1)(A) and (B)(i); Ex. 3 at 1. There is no history of shoulder pain, inflammation, or
dysfunction that would explain the post-vaccination injury. 42 C.F.R. § 100.3(c)(10)(i). Her
pain began within 48 hours after vaccination. 42 C.F.R. §§ 100.3(a)(XIV)(B), (c)(10)(ii).
There is not preponderant evidence of another condition that would explain the
symptoms. 42 C.F.R. § 100.3(c)(10)(iv). Petitioner has not pursued a civil action or other
compensation. Section 11(c)(1)(E); Ex. 6, ¶¶ 32-33. Thus, Petitioner has satisfied all
requirements for entitlement under the Vaccine Act.
6 By contrast, a claim alleging pain only in the neck after vaccination would not be a valid SIRVA, absent
proof of pain initially and/or primarily in the shoulder.
10

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Conclusion
Based on the entire record, I find that Petitioner has provided preponderant
evidence satisfying all requirements for a Table SIRVA. Petitioner is entitled to
compensation. A Damages Order will issue.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
11

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-01958-1
Date issued/filed: 2023-03-01
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 01/27/2023) regarding 36 DECISION Stipulation/Proffer ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:19-vv-01958-UNJ Document 40 Filed 03/01/23 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1958V
UNPUBLISHED
ANGELA QUINN CROSS, Chief Special Master Corcoran
Petitioner, Filed: January 27, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Damages Decision Based on Proffer;
HUMAN SERVICES, Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
Respondent. Administration (SIRVA)
John Leonard Shipley, Davis, CA, for Petitioner.
Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On December 26, 2019, Angela Cross 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 a Table injury - that she suffered a shoulder injury
related to vaccine administration (“SIRVA”) after receiving an influenza (“flu”) vaccine on
September 12, 2018. Petition at 1. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On December 2, 2022, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. On January 26, 2023, Respondent filed a proffer on
award of compensation (“Proffer”) indicating Petitioner should be awarded $102,500.00
for her actual pain and suffering. Proffer at 1. In the Proffer, Respondent represented that
1 Because this unpublished Decision contains a reasoned explanation for the action in this case, I am
required to post it on the United States Court of Federal Claims' website in accordance with the E-
Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic
Government Services). This means the Decision will be available to anyone with access to the
internet. In accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact
medical or other information, the disclosure of which would constitute an unwarranted invasion of privacy.
If, upon review, I agree that the identified material fits within this definition, I will redact such material from
public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:19-vv-01958-UNJ Document 40 Filed 03/01/23 Page 2 of 4
Petitioner agrees with the proffered award. Id. Based on the record as a whole, I find that
Petitioner is entitled to an award as stated in the Proffer.
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $102,500.00 (for her actual pain and suffering) in the form of a
check payable to Petitioner. 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.3
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
2

Case 1:19-vv-01958-UNJ Document 40 Filed 03/01/23 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
ANGELA QUINN CROSS,
Petitioner,
No. 19-1958V
v.
Chief Special Master Corcoran
SECRETARY OF HEALTH AND ECF
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On December 26, 2019, Angela Quinn Cross (“petitioner”) filed a petition for
compensation (“Petition”) under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C.
§§ 300aa-1 to -34 (“Vaccine Act” or “Act”), as amended, alleging that she suffered a left
shoulder injury related to vaccine administration (“SIRVA”) as a result of an influenza (“flu”)
vaccine she received on September 12, 2018. Petition at 1. On December 2, 2022, the Chief
Special Master issued a Ruling on Entitlement finding petitioner entitled to compensation. ECF
No. 31.
I. Items of Compensation
Pain and Suffering
Respondent proffers that Angela Quinn Cross should be awarded $102,500.00 in actual
pain and suffering. See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees. This amounts represent
all elements of compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-
15(a). Petitioner agrees.

Case 1:19-vv-01958-UNJ Document 40 Filed 03/01/23 Page 4 of 4
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner be made as a lump sum
payment of $102,500.00, in the form of a check payable to petitioner.1
Respectfully submitted,
BRIAN M. BOYNTON
Principal Deputy Assistant Attorney General
C. SALVATORE D’ALESSIO
Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
LARA A. ENGLUND
Assistant Director
Torts Branch, Civil Division
/s/ Alexa Roggenkamp
ALEXA ROGGENKAMP
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
(202) 616-4179
alexa.roggenkamp@usdoj.gov
DATED: January 26, 2023
1 Should petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future lost earnings
and future pain and suffering.
2