VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00277
Package ID: USCOURTS-cofc-1_20-vv-00277
Petitioner: Renee LaCourse-Burmeister
Filed: 2020-03-12
Decided: 2022-10-07
Vaccine: influenza
Vaccination date: 2018-09-25
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 45824

AI-assisted case summary:
On March 12, 2020, Renee LaCourse-Burmeister filed a petition under the National Vaccine Injury Compensation Program, alleging that an influenza vaccine administered on September 25, 2018, caused her to suffer a shoulder injury related to vaccine administration (SIRVA). Petitioner was 52 years old at the time of vaccination and had no prior relevant medical history. The respondent, the Secretary of Health and Human Services, initially contended that the evidence did not demonstrate six months of residual effects or onset of symptoms within 48 hours of vaccination. After preliminary review, the respondent formally opposed compensation, maintaining these two points were not established. Petitioner filed a motion for a ruling on the record, arguing that her SIRVA symptoms began within 48 hours and persisted for more than six months. Chief Special Master Brian H. Corcoran issued a ruling on entitlement on February 16, 2022, finding that Petitioner had established both the six-month residual effects requirement and the 48-hour onset period, thus entitling her to compensation. The ruling detailed the medical history, including Petitioner's report of left shoulder and arm pain starting on September 25, 2018, after receiving the flu vaccine, which she believed was administered too high in her shoulder. Medical records documented tenderness, pain with movement, and abnormal findings on several tests. Petitioner underwent physical therapy and was prescribed medication. An MRI showed mild tendinosis, fraying, a grade 2 intramuscular tear pattern, and a possible SLAP tear. The orthopedist noted edema around the deltoid where the flu shot was given and projected resolution within three to five months. Despite a February 8, 2019, orthopedics record stating no other concerns, the Chief Special Master found that subsequent records established the injury had not resolved more than six months post-onset. The Chief Special Master also found preponderant evidence of onset within 48 hours, citing medical records beginning 24 days post-vaccination that memorialized pain starting on the vaccination date and increasing over the following weeks. The ruling also addressed the possibility of pre-existing pathology being provoked by the vaccine. Following the entitlement ruling, a damages decision was issued on October 7, 2022. Based on a proffer agreed to by both parties, Petitioner was awarded a total of $45,824.68. This amount comprised $45,000.00 for pain and suffering and $824.68 for past unreimbursable medical expenses, to be paid as a lump sum check to Petitioner. Leigh Finfer of Muller Brazil, LLP represented Petitioner, and Debra A. Filteau Begley of the U.S. Department of Justice represented the Respondent.

Theory of causation field:
Renee LaCourse-Burmeister, age 52, received an influenza vaccine on September 25, 2018, and alleged a Shoulder Injury Related to Vaccine Administration (SIRVA). The case proceeded as a Table claim. The primary disputes were whether the injury caused residual effects for more than six months and whether symptoms began within 48 hours of vaccination. The public decision does not detail the specific mechanism of injury or name medical experts. Chief Special Master Brian H. Corcoran found that Petitioner established both requirements by a preponderance of the evidence. Medical records indicated left shoulder pain onset on the date of vaccination, with increased pain over the following weeks, and continued symptoms and limitations in range of motion for at least eleven months post-vaccination, supporting the six-month residual effects requirement. The Chief Special Master found sufficient evidence of onset within 48 hours despite a workplace wellness visit seven days post-vaccination not mentioning shoulder pain. The case resulted in compensation. On October 7, 2022, Petitioner was awarded $45,824.68 ($45,000.00 for pain and suffering, $824.68 for past unreimbursable medical expenses) based on a proffer agreed to by the parties. Leigh Finfer represented Petitioner, and Debra A. Filteau Begley represented Respondent.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00277-0
Date issued/filed: 2022-03-03
Pages: 13
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/16/2022) regarding 36 Ruling on Entitlement, Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00277-UNJ Document 37 Filed 03/03/22 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0277V
UNPUBLISHED
RENEE LACOURSE-BURMEISTER, Chief Special Master Corcoran
Petitioner,
v. Filed: February 16, 2022
SECRETARY OF HEALTH AND Special Processing Unit (SPU);
HUMAN SERVICES, Ruling on Entitlement; Findings of
Fact; Severity; Onset; Influenza (Flu);
Respondent. Shoulder Injury Related to Vaccine
Administration (SIRVA).
Leigh Finfer, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On March 12, 2020, Renee LaCourse-Burmeister 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 as a result of an influenza (“flu”) vaccine
received on September 25, 2018, she suffered a shoulder injury related to vaccine
administration (“SIRVA”) as defined on the Vaccine Injury Table (the “Table”). Petition
(ECF No. 1) at Preamble. The case was assigned to the Special Processing Unit (“SPU”)
of the Office of Special Masters.
1 Because this unpublished ruling contains a reasoned explanation for the action in this case, I am required
to post it on the United States Court of Federal Claims' website in accordance with the E-Government Act
of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government
Services). This means the Ruling will be available to anyone with access to the internet. In accordance
with Vaccine Rule 18(b), petitioner has 14 days to identify and move to redact medical or other information,
the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I agree that
the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:20-vv-00277-UNJ Document 37 Filed 03/03/22 Page 2 of 13
For the reasons discussed below, I find it most likely that Petitioner suffered the
residual effects of her alleged SIRVA for more than six months, that she suffered the
onset of symptoms within 48 hours, and that she is otherwise entitled to compensation.
I. Relevant Procedural History
Petitioner filed supporting documentation required by the Vaccine Act, followed by
a statement of completion in September 2020. ECF No. 20. In light of the volume of cases
awaiting HHS medical review, on October 21, 2020, Respondent duly provided a
preliminary review of the case in lieu of a Rule 4(c) Report, which identified only one
substantive issue: that the evidence did not appear to demonstrate six months of residual
effects. ECF No. 21.3 Later, on June 28, 2021, Respondent more formally opposed
compensation for Petitioner’s Table SIRVA claim, contending that Petitioner had not
established the six-month requirement or, moreover, the onset of pain within 48 hours
after vaccination. Rule 4(c) Report (ECF No. 30).
On August 16, 2021, I directed the parties to file any additional evidence and
briefing pertaining to the above issues, which would then be ripe for adjudication without
need for a hearing. ECF No. 32. On October 12, 2021, Petitioner filed a Motion for a
Ruling on the Record (ECF No. 33). On November 19, 2021, Respondent filed his
Response (ECF No. 35). Petitioner did not file a reply.
II. Issues
As noted above, the first issue is whether Petitioner has established that her
alleged SIRVA was sufficiently severe to be eligible for compensation under the Vaccine
Act. Petitioner specifically has the burden of establishing that she suffered “residual
effects” of that injury for more than six months. Section 11(c)(1)(D)(i).4 The second is
whether Petitioner’s first symptom or manifestation of onset after vaccine administration
(specifically pain in the affected shoulder) occurred within 48 hours after vaccination, 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); (c)(10)(ii).
3 Respondent also requested several categories of potentially outstanding evidence. ECF No. 21.
Petitioner’s responsive filings (Exhibits 9-11) did not appear to change Respondent’s position nor do I find
them to be relevant to the issues disputed herein.
4 Petitioner does not allege, nor would the evidence support, either alternative for establishing the severity
requirement: that the alleged injury resulted in death, or “inpatient hospitalization and surgical intervention.”
Section 11(c)(1)(D)(ii), (iii).
2

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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 & Hum. 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 & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. “Written records which are, themselves, inconsistent, should be
accorded less deference than those which are internally consistent.” Murphy v. Sec’y of
Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25,
1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd
per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as
incorrect the presumption that medical records are accurate and complete as to all the
patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021).
The United States Court of Federal Claims has outlined four possible explanations
for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y
of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health
& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998).
The credibility of the individual offering such fact testimony must also be determined.
3

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Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley
v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v.
Sec’y of Health & Hum. 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 have fully reviewed the evidence, including all medical records, Petitioner’s
affidavit, Respondent’s Rule 4(c) Report, and the parties’ briefing. The evidence most
relevant to my analysis is presented below:
• At the relevant time, Ms. LaCourse-Burmeister was fifty-two (52) years old
and had a non-contributory medical history. See generally Ex. 2.
• She was employed as a purchasing agent for Belmark, Inc., and separately
as a real estate agent. See Ex. 2 at 17, 37, 60; Ex. 4 at 37.
• On August 7, 2018, Petitioner met with a nurse onsite at Belmark, Inc., to
start a ten-week “Eat Right for Life” program focused on weight
management and wellness. Ex. 3 at 45. After reviewing the program format
and providing instructional materials, the nurse instructed Petitioner to
return within the next five weeks “for health coaching specific to nutrition.”
Id. at 45.
4

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• On September 25, 2018, during Petitioner’s annual employee health risk
assessment (“HRA”), a second nurse administered the flu vaccine to her left
deltoid. Ex. 1 at 1; Ex. 6 at ¶ 4.
• Seven (7) days post-vaccination, on October 2, 2018, Petitioner met with a
third nurse for her Eat Right for Life mid-program check-in. Ex. 3 at 46.
Petitioner reported that she had done well so far by cutting portions;
balancing her consumption of carbohydrates, protein, and fat; and avoiding
processed foods. Id. She had been a runner until undergoing surgeries on
her hip, back, and jaw in 2015 and 2016. Id. Petitioner reported currently
walking for exercise; she did not engage in high impact exercise due to her
back. Id. The nurse encouraged Petitioner to continue with good food
choices, portion control, and regular exercise. Id. at 47. This record does
not include a review of systems, physical exam, or any references to her
left shoulder.
• Twenty-four (24) days post-vaccination, on October 29, 2018, Petitioner
presented to her primary care provider at Bellin Health for evaluation of two
separate issues: (1) right elbow pain, which was assessed as ulnar nerve
entrapment,5 and (more central to the present claim) (2) left shoulder and
arm pain which “started on 09/25/2018 after receiving influenza injectio[n]”
which, Petitioner believed, was “given higher than other injections… pushed
right into her shoulder joint.” Ex. 3 at 48. The pain “ha[d] only increased,”
and was worse “with lying on the shoulder and any activity even walking.”
Id.
• On physical examination, Petitioner had tenderness on palpation of the
acromioclavicular (“AC”) joint and subacromial bursa. Ex. 3 at 49. She had
pain with movement and abnormal findings on several tests (touchdown,
arc/drop, empty can, Neers, Hawkins, subscapularis, and cross-body
adduction). Id. The primary care provider did not offer a specific assessment
for the left shoulder pain. Id. At the end of the encounter, she recommended
ice and heat, placed a referral for physical therapy, prescribed Voltaren (oral
tablets of diclofenac sodium, a non-steroidal anti-inflammatory drug
(“NSAID”)) – without indicating which measures were for Petitioner’s right
elbow versus left shoulder. Id.
5 Petitioner does not allege, nor would the record support, that the vaccination in her left deltoid caused or
contributed to her separate right elbow injury.
5

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• On November 1, 2018, Petitioner met with a physical therapist for an initial
consult regarding both her right elbow and her left shoulder. Ex. 3 at 1-9.
Petitioner again reported that the left shoulder pain had been present since
the September 25th flu vaccine. Id. at 1. She had “waited for a couple of
weeks to seek treatment but the [shoulder] pain never improved with
exception of slight improvement with steroid.”6 Id. at 1-2. The therapist
documented the pain location as the posterior lateral left shoulder, a current
pain rating of 2/10, and limitations in both active and passive range of
motion. He planned one to two PT sessions per week for four to six weeks.
Id. at 2-9.
• On November 6, 2018, Petitioner completed a second PT session, during
which she reported increased left shoulder pain of 4/10. Ex. 3 at 10-12.
• On November 8, 2018, Petitioner presented for an initial consult with an
orthopedist at Bellin Health. Ex. 4 at 59-62. He assessed that her right elbow
pain represented epicondylitis,7 for which he administered a cortisone
steroid injection and prescribed a wrist splint. Id. at 61-62.
• Also on November 8th, the orthopedist recorded Petitioner’s history of left
shoulder pain onset on September 25th, upon receiving a flu shot which she
believed was administered in “the wrong place.” Ex. 4 at 59. Petitioner
recounted her 2 PT sessions, as well as “heating pad, ice, diclofenac
tablets, does provide some relief.” Id. The orthopedist recorded left shoulder
range of motion as “170/60/T10,” slightly decreased strength (4/5) in the
supraspinatus tendon and upon external rotation, pain, and impingement
signs. Id. at 61. The orthopedist recommended an MRI to assess whether
Petitioner had a “full thickness rotator cuff tear… [which] will not heal on its
own.” Id. at 62. Alternatively, if the MRI supported “a biceps tendinitis,
superior labral injury (a/k/a SLAP tear), or rotator cuff tendinitis,” they would
“consider a course of injections and physical therapy, as well as anti-
inflammatory treatment.” Id.
6 As noted above, Petitioner was only administered the non-steroidal drug diclofenac.
7 External humeral epicondylitis (also known as radio-humeral epicondylitis, bursitis, and popularly, tennis
elbow) is defined as an overuse injury of the lateral humeral epicondyle at the elbow, due to inflammation
or irritation of the area where the common extensor tendon attaches to it. Dorland’s Illustrated Medical
Dictionary, available at https://www.dorlandsonline.com (hereinafter “Dorland’s”).
6

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• Also on November 8th, the orthopedist noted Petitioner’s ongoing
prescription for diclofenac oral tablets and added a prescription for
diclofenac topical gel, without specifying the right elbow versus the left
shoulder. Ex. 4 at 55-56. But as noted above, he had previously recorded
that diclofenac had helped to relieve her left shoulder pain. Id. at 59.
• On November 21, 2018, Petitioner underwent the recommended left
shoulder MRI. Ex. 5 at 42-43. The radiologist perceived “mild, diffuse…
SST/IST [supraspinatus and infraspinatus] tendinosis with both bursal and
articular surface-sided fraying, but no evidence for full-thickness retracted
tear.” Id. at 42. There was also a grade 2 intramuscular tear pattern. Id. at
42-43. The AC joint contained “mild degenerative arthropathy.” Id. at 43.
There was a “possible SLAP tear.” Id. The subacromial and subdeltoid
bursa were “unremarkable.” Id.
• Later that same day, the orthopedist’s physician assistant (“PA”) telephoned
Petitioner to convey the MRI results. Ex. 4 at 69. The PA recorded: “Plan:
follow up in clinic to re-examine. Edema present over the deltoid where her
flu shot was done. No evidence of abscess. SLAP tear, biceps tendonitis,
RC tendonitis. Appt made for next week per patient’s schedule.” Ex. 4 at 69.
• At the follow-up appointment on November 28, 2018, the orthopedist
documented a region of edema around the fascia in the lateral deltoid, as
well as tenderness on palpation at the deltoid and minimally at the biceps
tendon. Ex. 4 at 73. However, the orthopedist did not document the
presence or absence of any limitations to range of motion or impingement
signs. Id. While the orthopedist recorded that Petitioner “hasn’t had much
for changes in the shoulder” and “is here today to discuss MRI results,” but
he did not restate the specific MRI findings or revisit his earlier suggestions
of injections, physical therapy, and anti-inflammatory treatment. Compare
id. at 62, 74.
• On November 28th, the orthopedist’s assessment was limited to: “Left
shoulder lateral deltoid pain consistent with region of injection without
evidence of abscess or significant intraarticular infection, but some
evidence of trauma in the region… I am hopeful that over the course of the
next 3-5 months, this improves for her. She is going to come back to see us
in a couple of months and will see how things are progressing.” Ex. 4 at 73.
7

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• Finally, on November 28th, Petitioner mentioned that her right elbow was
“so much better.” Ex. 4 at 73.
• On December 26, 2018, the physical therapist recorded that Petitioner had
not returned for over a month and therefore, she would be administratively
discharged from PT. Ex. 3 at 53-54.
• Petitioner’s next medical encounter was on February 8, 2019, with the same
orthopedist and was focused on her right elbow. Ex. 4 at 79. He
documented that after the November 8th steroid injection, the right elbow
was “improved… until mid-January 2019 without any new injury.” Id. This
pain was worse upon gripping and grasping objects and when trying to
sleep. Id. Wearing the wrist splint provided some relief. Id. The orthopedist
then recorded: “There are no other concerns at this time.” Id. After
conducting a physical exam limited to the right shoulder, he maintained the
assessment of lateral epicondylitis, for which he administered a second
cortisone injection. Id. at 81. He recommended continued use of the wrist
splint and maximization of anti-inflammatory drugs. Id. He also prescribed
a 90-day supply of the muscle relaxant meloxicam, for the diagnosis of “right
elbow pain.” Id. at 81-82.
• On April 4, 2019, the orthopedist’s office approved Petitioner’s request for
a refill of meloxicam over the telephone, without an appointment. The
telephone encounter record does not document Petitioner’s current
complaints (although the prescription was originally written for the elbow,
rather than the shoulder). Ex. 4 at 84-85.
• Petitioner’s next medical encounter was on May 29, 2019, when she
returned to the same physical therapist. Ex. 3 at 13-18. She reported
“continue[d]… L shoulder discomfort especially with overhead movements
following the vaccination late last fall… She did end up pursuing an MRI of
the L shoulder and reported there was a small tear of the rotator cuff, but
the physician recommended it didn’t warrant any surgery.” Id. at 13.
Petitioner reported that her shoulder pain was alleviated by “a pain cream,”
meloxicam, CBD oil, and avoiding certain positions. Id. at 13-14. She had
stopped the recommended home exercise program at the beginning of 2019
and wanted to give PT “another trial to further help reduce the level of
soreness.” Id. at 13.
8

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• On May 29th, the therapist observed Petitioner’s discomfort upon active and
passive flexion beyond 110 degrees, and abduction beyond 100 degrees.
Ex. 3 at 15. The therapist recorded that her pain was causing deficits
especially with overhead movements, but it did not warrant immediate
referral for additional medical services and could be managed
conservatively. He reviewed exercises that she could complete at home. Id.
at 15-16.
• At the next PT appointment on June 5, 2019, Petitioner reported that since
performing the home exercises, she had made some gains in active range
of motion. Ex. 3 at 19. The therapist recorded increases in both flexion (114
degrees active and 145 degrees passive) and abduction (110 degrees
active and 125 passive). Id. He instructed Petitioner to continue with the
home exercises. Id.
• On June 17, 2019, the orthopedist’s office approved Petitioner’s request for
a refill of diclofenac, without an appointment. Again, the telephone
encounter record does not address whether Petitioner was requesting the
medication for shoulder versus elbow pain. Ex. 4 at 89.
• At the final PT appointment on August 1, 2019, the therapist documented
that Petitioner had further increases in flexion (143 degrees active and 153
passive) and abduction (125 degrees active and 135 passive). Ex. 3 at 21.
He approved Petitioner’s pan to continue exercises at home and follow up
if necessary. Id. at 21-22. There are no further records from PT or any other
medical encounters pertaining to her left shoulder.
• In an affidavit signed on March 10, 2020, Petitioner recalls thinking that the
nurse cleaned an area “a bit too high on [her] shoulder” prior to
administering the vaccine. Ex. 6 at ¶ 4. Petitioner recalls “immediat[e]…
sharp, intense pain” upon vaccination, which she initially “wait[ed]… out,”
but “[a]fter a few weeks, [her] pain did not improve and [she] sought medical
treatment.” Id. at ¶¶ 4, 5.
• She recalls, referring to the first two sessions in November 2018, that PT
was “extremely painful” and “truly felt like… a waste of time.” Ex. 6 at ¶ 6.
In late May 2019, she “decided to give [PT] another try.” She experienced
just as much pain as before, but she was told that PT was necessary to
prevent “frozen shoulder.” Id.
9

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• She does not address the orthopedics consultations. See generally Ex. 6.
• She recalls using home exercises, medicated pain cream, and over-the-
counter pain medications to manage her pain between appointments. Ex. 6
at ¶ 7.
The above medical records reflect that after the September 25, 2018, flu
vaccination, Petitioner experienced fairly mild left shoulder pain and limitations in ROM
particularly with overhead movements. Although she first sought medical attention within
30 days, she opted out of PT in favor of pain-protective behavior and anti-inflammatory
medications. After a limited return to PT and review of appropriate home exercises, her
shoulder was largely rehabilitated eleven months after vaccination.
On November 8, 2018, the orthopedist documented Petitioner’s left shoulder
reduced range of motion and impingement signs. He recorded that she may have
tendinitis or partial tearing, which could be treated with anti-inflammatory treatment,
injections, and PT. But after an MRI confirmed those findings, the orthopedist did not
document any reassessment of her shoulder function or revisit the potential treatments
thereof. That omission creates doubt about the presumed accuracy of the orthopedics
records. Regardless, Petitioner notes that on November 8th, the orthopedist did document
the persistent observable edema, which he projected would self-resolve within three to
five months (approximately between five to seven months after vaccination). Petitioner’s
Motion at 8-9.
More problematic is the February 8, 2019, orthopedics record, which is focused on
Petitioner’s right elbow and states, “[t]here are no other concerns at this time.” But this
same record lacks any specific questions pertaining to or physical examination of her left
shoulder. Accord Kirby, 997 F.3d at 1383 (reasoning that a neurological examination
which only ruled out dizziness did not “indicate that Ms. Kirby was asked about or tested
negative for any pain, numbness, or tingling related to her vaccine injury”). Moreover in
this case, the orthopedist had previously failed to offer any treatment for her left shoulder
and projected that the symptoms he did document would resolve on their own. Accord
Kirby at 1383. (concerning silence in a medical record after Ms. Kirby had “exhausted all
available treatment” for the injury alleged and was visiting her doctor for unrelated
reasons).
Accordingly, the orthopedics record from this date do not clearly “indicate a
resolution of symptoms.” Petitioner’s Motion at 8. At most, that orthopedics record – and
Petitioner’s waiver of any follow-up appointments or second opinions for her shoulder,
10

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even while undergoing two steroid injections for her other elbow– point towards a lower
potential damages award.
But the February 2019 record at issue is contained within an overall span of
treatment evidence that supports Petitioner’s severity arguments. That treatment history
documents shoulder injury spanning from October 2018 to August 2019 (eleven months
after vaccination); consistently reveals the existence of tenderness to palpation, painful
and reduced range of motion, and impingement signs; and reflects Petitioner’s consistent
history of injury since the vaccination and without any other inciting events.8 Thus, even
if I were to give more weight to the February record, subsequent records do establish that
Petitioner’s SIRVA injury had yet to resolve thereafter – and more than six months post-
onset.
Respondent also observes that the November 2018 MRI depicts an
“unremarkable” subdeltoid bursa, with an underlying pathology (e.g., tearing and
tendinosis) that “cannot be explained by vaccination.” Response at 9. But the SIRVA QAI
does not contemplate injury solely to the bursa, but more generally to “the
musculoskeletal structures of the shoulder,” including the tendons. 42 C.F.R. §
100.3(c)(10). Moreover, upon creating the Table SIRVA injury, the Secretary recognized
reliable medical literature which explains:
In general, chronic shoulder pain with or without reduced shoulder joint
function can be caused by a number of common conditions including
impingement syndrome, rotator cuff tear, biceps tendonitis, osteoarthritis,
and adhesive capsulitis. In many cases, these conditions may cause no
symptoms until provoked by trauma or other events…. Therefore, some of
the MRI findings… may have been present prior to vaccination and became
symptomatic as a result of vaccination-associated synovial inflammation.
S. Atanasoff et al., Shoulder Injury Related to Vaccine Administration (SIRVA), 28
Vaccine 8049, 8051 (2021) (emphasis added), quoted in Lang v. Sec’y of Health & Human
Servs., No. 17-995V, 2020 WL 7873272, *12 (Fed. Cl. Spec. Mstr. Dec. 11, 2020). Thus
in Lang, Special Master Horner articulated: “findings consistent with impingement, rotator
cuff tears, or AC arthritis do not per se preclude a finding that a Table SIRVA exists,”
8 Compare, e.g., Hartman v. Sec’y of Health & Human Servs., No. 19-1106V, 2022 WL 444456, *5 (Fed.
Cl. Spec. Mstr. Jan. 14, 2022) (reasoning that the petitioner sustained a SIRVA in October 2018, but she
substantially recovered before experiencing pain while moving boxes in June 2020); Bergstrom v. Sec’y of
Health & Human Servs., No. 19-784V, 2021 WL 5754968, *7 (Fed. Cl. Spec. Mstr. Nov. 2, 2021)
(recognizing that a vaccination aggravated a rotator cuff tear in January 2018 but was not linked to shoulder
pain in February 2021).
11

Case 1:20-vv-00277-UNJ Document 37 Filed 03/03/22 Page 12 of 13
rather, the question was whether the petitioner’s “shoulder pathology wholly explain[ed]
her symptoms independent of vaccination.” Id. at *13.
I have also recognized this proposition that vaccine administration can “provoke”
underlying asymptomatic shoulder pathology.9 (In this sense, while the Table listing
suggests the occurrence of a wholly new injury, it could be understood as an aggravation
of the underlying pathology – provided, of course, that the petitioner establish all QAI
criteria, including the lack of any pre-vaccination “pain, inflammation, or dysfunction of the
affected shoulder…” 42 C.F.R. § 100.3(c)(10)(i)).10 In any event, preexisting
musculoskeletal pathology is not listed as a specific exclusionary finding for SIRVA. 42
C.F.R. § 100.3(c)(10)(iv) (only separating out “NCS/EMG or clinical evidence of
radiculopathy, brachial neuritis, mononeuropathies, or any other neuropathy”).
Accordingly, I find preponderant evidence establishes that Petitioner suffered
residual effects of her injury for more than six months.
Respondent also questions whether there is preponderant evidence of onset within
48 hours, in light of the record from seven days post-vaccination which does not document
Petitioner’s shoulder pain, even while discussing her exercise routine of walking.
Response at 6-7. But the subsequent medical records, beginning just twenty-four (24)
days after vaccination, support Petitioner’s allegations. Those records memorialize that
her pain began on the date of vaccination, she waited a couple of weeks to seek
treatment, and during that time the pain only increased. Despite the one intervening
record from a workplace wellness program, I find that there is preponderant evidence that
onset was within 48 hours of vaccination.
V. Other Table Requirements and Entitlement
In light of the lack of other objections and my own review of the record, I find that
Petitioner has established the other requirements for a Table SIRVA claim. Specifically,
the record does not reflect a history of prior left shoulder pathology that would explain
Petitioner’s post-vaccination injury. 42 C.F.R. § 100.3(c)(3)(10)(i). There is no evidence
of any other condition or abnormality that represents an alternative cause. 42 C.F.R. §
9 See, e.g., Fry v. Sec’y of Health & Human Servs., No. 18-1901V, 2020 WL 8457671, n. 8 (Fed. Cl. Spec.
Mstr. Dec. 16, 2020) (citing the Atanasoff article); Hartman v. Sec’y of Health & Human Servs., No. 19-
1106V, 2021 WL 4823549, n.1 (Fed. Cl. Spec. Mstr. Sept. 14, 2021) (reasoning that the vaccine
administration can exacerbate underlying pathology such as a posterior superior labral tear).
10 I also recognize that if a documented pre-vaccination shoulder injury may foreclose a Table SIRVA claim,
the petitioner may still be able to establish causation-in-fact for the same. See, e.g., Lesher v. Sec’y of
Health & Human Servs., No. 17-1076V, 2020 WL 4522381 (Fed. Cl. Spec. Mstr. July 2, 2020).
12

Case 1:20-vv-00277-UNJ Document 37 Filed 03/03/22 Page 13 of 13
100.3(c)(3)(10)(iii). The pain and reduced range of motion were limited to the shoulder.
C.F.R. § 100.3(c)(3)(10)(iv). The contemporaneous vaccine administration record reflects
the site of administration as the left deltoid. Ex. 7 at 2, 4; Sections 11(c)(1)(A) and (B)(i).
Petitioner has not pursued a civil action or other compensation. Ex. 1 at ¶ 12; Section
11(c)(1)(E). Thus, Petitioner has satisfied all requirements for entitlement under the
Vaccine Act.
VI. Conclusion and Damages Order
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. Thus, this case is now in the damages phase.11
By no later than Monday, April 4, 2022, Petitioner shall file a status report
updating me on the parties’ progress towards informally resolving damages. The
status report shall indicate the date by which Petitioner provided, or intends to
provide, a demand for damages to Respondent.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
11 The parties are reminded that in Vaccine Act cases, damages issues are typically resolved
collaboratively. Therefore, the parties should begin actively discussing the appropriate amount of
compensation in this case. In many cases, damages can be resolved by Petitioners communicating a
demand to Respondent, who may agree to the demand or may make a counter-offer.
The parties shall not retain a medical expert, life care planner, or other expert without consulting with
each other and the Chief Special Master. If counsel retains an expert without so consulting in advance,
reimbursement of those costs may be affected.
13

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_20-vv-00277-1
Date issued/filed: 2022-10-07
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 08/18/2022) regarding 42 DECISION Stipulation/Proffer, Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
--------------------------------------------------------------------------------
Case 1:20-vv-00277-UNJ Document 46 Filed 10/07/22 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0277V
UNPUBLISHED
RENEE LACOURSE-BURMEISTER, Chief Special Master Corcoran
Petitioner,
v. Filed: August 18, 2022
SECRETARY OF HEALTH AND Special Processing Unit (SPU);
HUMAN SERVICES, Damages Decision based on Proffer;
Influenza (Flu) Vaccine; Shoulder
Respondent. Injury Related to Vaccine
Administration (SIRVA)
Leigh Finfer, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON DAMAGES1
On March 12, 2020, Renee LaCourse-Burmeister 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 as a result of an influenza (“flu”) vaccine
received on September 25, 2018, she suffered a shoulder injury related to vaccine
administration (“SIRVA”) as defined on the Vaccine Injury Table (the “Table”). Petition
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 1:20-vv-00277-UNJ Document 46 Filed 10/07/22 Page 2 of 5
(ECF No. 1) at Preamble. The case was assigned to the Special Processing Unit (“SPU”)
of the Office of Special Masters.
On February 16, 2022, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. On August 18, 2022, Respondent filed a proffer on
award of compensation. In the Proffer, Respondent represented that 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 $45,824.68 (representing $45,000.00 for pain and suffering, and
$824.68 for past unreimbursable expenses) 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 1:20-vv-00277-UNJ Document 46 Filed 10/07/22 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
__________________________________________
)
RENEE LACOURSE-BURMEISTER, )
)
Petitioner, )
) No. 20-277V (ECF)
v. ) Chief Special Master Corcoran
)
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On March 12, 2020, petitioner filed a Petition for Compensation alleging that she
suffered a shoulder injury related to vaccine administration (“SIRVA”), following the receipt of
a flu vaccine administered on September 25, 2018. On June 28, 2021, respondent filed a Rule
4(c) Report stating that the medical records in this case do not establish that petitioner’s
condition began within 48 hours of vaccination, which is a Vaccine Table requirement for
SIRVA. ECF No. 30 at 5-7, 42 C.F.R. § 100.3 (c)(3)(10)(ii). Respondent further explained that
the record did not establish that petitioner’s symptoms persisted for at least six months. ECF No.
30 at 5-7; 42 U.S.C. § 300aa-11 (c)(1)(D)(1). On October 12, 2021, petitioner moved for a
Ruling on the Record arguing that her symptoms of SIRVA began within forty-eight hours of
vaccination, and that she suffered the residual effects or complications of her injury for more
than six months. ECF No. 33 at 1. On October 19, 2021, respondent filed a response to
petitioner’s motion arguing that the medical record evidence did not support either of petitioner’s
proposed findings. ECF No. 35.
On February 12, 2022, the Chief Special Master issued a Ruling on Entitlement

Case 1:20-vv-00277-UNJ Document 46 Filed 10/07/22 Page 4 of 5
concluding “that [p]etitioner suffered the residual effects of her alleged SIRVA for more than six
months, [and] that she suffered the onset of symptoms within 48 hours.” ECF no. 36 at 2. He
explained that the parties only presented a dispute on those two elements of petitioner’s claim,
and that the record otherwise satisfies the remaining Table SIRVA and statutory criteria. See
ECF No. 36 at 12-13 citing 42 C.F.R. § 100.3 (c)(3)(10)(i-iv). Thus, he concluded that petitioner
was entitled to compensation under the Vaccine Act.1
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
the following, and requests that the Chief Special Master’s decision and the Court’s judgment
award:
a. a lump sum payment of $45,000.00, which represents compensation for pain and
suffering, see 42 U.S.C. § 300aa-15(a)(4), and
b. a lump sum payment of $824.68, which represents compensation for past
unreimbursed medical expenses, see 42 U.S.C. § 300aa-15(a)(1).
These amounts represent all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a).2 Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that petitioner be awarded a lump sum payment of $45,824.68, in the
form of a check payable to petitioner. Petitioner agrees.
1 Nothing stated in this filing should be construed as a concession on any issues previously
raised by respondent, or as a waiver of respondent’s right to seek review of the Court’s February
16, 2022, Ruling on Entitlement.
2 Should petitioner die prior to the entry of judgment, the parties reserve the right to move the
Court for appropriate relief. In particular, respondent would oppose any award for future pain
and suffering.
2

Case 1:20-vv-00277-UNJ Document 46 Filed 10/07/22 Page 5 of 5
Respectfully submitted,
BRIAN M. BOYNTON
Principal Deputy Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
ALEXIS B. BABCOCK
Assistant Director
Torts Branch, Civil Division
/s/ DEBRA A. FILTEAU BEGLEY
DEBRA A. FILTEAU BEGLEY
Senior Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Phone: (202) 616-4181
Dated: August 18, 2022
3