VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01423
Package ID: USCOURTS-cofc-1_20-vv-01423
Petitioner: Buddy Kindle
Filed: 2020-09-23
Decided: 2025-08-07
Vaccine: influenza
Vaccination date: 2017-11-01
Condition: Guillain-Barré syndrome
Outcome: dismissed
Award amount USD: 

AI-assisted case summary:
Buddy Kindle, a 72-year-old man, received an influenza vaccine on November 1, 2017. He later developed Guillain-Barré syndrome (GBS). Mr. Kindle filed a petition alleging that his GBS was either a Table injury or caused-in-fact by the vaccine. The respondent argued that the onset of Mr. Kindle's GBS symptoms occurred outside the Table's 3-42 day window and that a preceding upper respiratory infection was a more likely cause. The Special Master reviewed the evidence, including Mr. Kindle's own statement and that of his friend, as well as contemporaneous medical records. The Special Master found that Mr. Kindle's subjective statements about feeling unwell were too vague to establish an early onset. Medical records indicated that his GBS symptoms first clearly manifested around January 5, 2018, approximately 65 days after vaccination, which is outside the Table's timeframe. The Special Master also considered symptoms like eye pain, dizziness, and back pain that occurred within the Table timeframe but found them to be either unrelated to GBS or pre-existing conditions, not indicative of GBS onset. Consequently, the claim was dismissed because Mr. Kindle failed to establish a Table injury. Furthermore, the Special Master determined that the nine-week delay between vaccination and symptom onset was too remote to establish causation-in-fact under the Althen standard, as it exceeded the generally accepted eight-week timeframe for inferring vaccine causation for off-Table claims. This decision was later reviewed by the Court of Federal Claims, which upheld the Special Master's findings, concluding that the onset determination and the dismissal of both the Table and off-Table claims were not arbitrary or capricious.

Theory of causation field:
Influenza vaccine on November 1, 2017, age 72, followed by GBS with onset found around January 5, 2018, about 65 days later. DISMISSED/DENIED. Petitioner Buddy Kindle argued Table GBS or causation-in-fact; respondent argued onset was outside the 3-42 day Table window and that a preceding respiratory illness was a more likely cause. Chief Special Master Corcoran dismissed the petition on January 21, 2025. Judge Eleni M. Roumel affirmed on August 7, 2025, holding the onset and causation findings were not arbitrary or capricious. No injury compensation awarded.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-01423-0
Date issued/filed: 2025-02-24
Pages: 13
Docket text: PUBLIC DECISION (Originally filed: 01/21/2025) regarding 31 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:20-vv-01423-EMR Document 37 Filed 02/24/25 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1423V
UNPUBLISHED
BUDDY KINDLE, Chief Special Master Corcoran
Petitioner, Filed: January 21, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Andrew D. Downing, Downing, Allison & Jorgenson, Phoenix, AZ , for Petitioner.
Camille M. Collett, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION1
On October 20, 2020, Buddy Kindle 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 received an influenza (“flu”) vaccine on
November 1, 2017, and thereafter suffered Guillain-Barré syndrome (“GBS”). Petition at
1. The case was assigned to the Special Processing Unit of the Office of Special Masters.
For the reasons discussed below, this claim is hereby DISMISSED.
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 1:20-vv-01423-EMR Document 37 Filed 02/24/25 Page 2 of 13
I. Procedural History
After the claim’s initiation, Respondent filed a Rule 4(c) Report opposing
compensation. Respondent’s Rule 4(c) Report (ECF No. 17). Petitioner thereafter filed a
motion for a ruling on the record with regard to entitlement on March 10, 2023. Motion for
Ruling on the Record (“Mot.”) (ECF No. 25). Petitioner argues that he meets the Table
requirements for GBS following a flu vaccine, or in the alternative that his injury was
caused-in-fact by the flu vaccine. Mot. at 26-30.
Respondent reacted to the motion on May 4, 2023, arguing that Petitioner has not
established that onset of his injury occurred within forty-two days of vaccination
administration, thus preventing him from succeeding on a flu vaccine-GBS Table claim,
and also that he cannot otherwise prove causation-in-fact. Response to Motion for Ruling
on the Record (“Resp.”) (ECF No. 26). Petitioner filed a reply on May 23, 2023, addressing
Respondent’s arguments. Petitioner’s Reply in Support of his Motion for Ruling on the
Record (“Reply”) (ECF No. 28).
II. Evidence in the Record
Petitioner’s prior history includes chronic kidney disease, hypertension, suspected
hypertrophic cardiomyopathy, hypothyroidism, obesity, obstructive sleep apnea, gout,
and septic arthritis of his right knee. Ex. 3 at 391, 1054, 1218; Ex. 3-2 at 579. Petitioner
was 72 years old when he received a flu vaccine in his left deltoid on November 1, 2017,
at the Dallas Veteran’s Affairs (“VA”) Medical Center. Ex. 2 at 2. The purpose of the visit
was for ongoing management of Petitioner’s constipation, shoulder and lower back pain,
and vitamin B12 deficiency. Ex. 3 at 2180.
On November 7, 2017, Petitioner saw Dr. Kyawt Shwin, a rheumatologist,
complaining of a recent gout attack on October 17th, but adding that symptoms had
resolved spontaneously. Ex. 3 at 2169. In addition, Petitioner noted that he had recently
withdrawn from a drug study for gout - and also complained of ongoing left shoulder
rotator cuff pain during the visit. Id. On examination, Petitioner had no focal neurologic
deficits, and Dr. Shwin restarted Petitioner on allopurinol. Id.at 2171.
On December 13, 2017, Petitioner visited the VA clinic to request an
ophthalmology consult for chronic eye pain and discharge, nothing that “he was sent to
UTSW for this problem before he was sent from eye clinic to get ophthalmology consult
not optometry.” Ex. 3 at 2162. That appointment took place on December 21, 2017, when
Petitioner complained of “stringy mucous discharge OU since 1970s,” “heavy swollen
2

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lids,” “[t]ransient (Sev minutes) horiz diplopia resolved completely by unilat occlusion,
yesterday, first episode.” Ex. 3 at 2151.
On December 19, 2017, Petitioner saw Dr. Rebecca Jolissaint, an audiologist with
complaint about his hearing, and dizziness when standing/standing up to walk.” Ex. 3 at
2158. Petitioner’s history indicated that he has worn hearing aids since 2013 but that he
reported he did not wear them consistently over the past four years. Id. At this time he
also reported history of aural pain and pressure, frequent sinus/cold issues, and bilateral
tinnitus. Id. The result of this visit was that Petitioner was to return for a new hearing aid
fitting.
On December 20, 2017, Petitioner had a consult with Dr. Ugo Bitussi, a physical
medicine and rehabilitation physician, for lower back pain that he reported had started ten
days earlier, attributing it to bending over in the shower. Ex. 3 at 2153. Petitioner reported
that as he leaned over he felt pain across his whole lower back; he “didn’t feel any big
issues after this,” but noted that the pain had started to go down the left side of his leg.
Id. Dr. Bitussi reviewed an MRI of Petitioner’s spine taken on December 12, 2016, which
showed no evidence of spinal stenosis but did show multilevel disc degenerative changes
and numerous large renal cysts that were consistent with Petitioner’s known polycystic
kidney disease. Id. at 2153-2154. It was noted that Petitioner was walking with a cane,
his coordination as normal, and he was able to walk both on his toes and heels and
perform unilateral calf raises. Id. Dr. Bitussi’s impression was that his lower back pain
was likely due to a sprain/strain and referred Petitioner to PT for strengthening and
stretching. Id. at 2156.
Petitioner later contacted the VA clinic on December 30, 2017, complaining of a
productive cough that had been ongoing for five days. Ex. 3 at 2150. Petitioner was
advised to seek additional treatment at the Dallas VA clinic or a local emergency
department. Petitioner did not seek further treatment at this time because he was out of
town and 120 miles away from the VA clinic and was concerned about the cost of a visit
to a local emergency department. Ex. 3 at 2150.
Treatment in 2018
By the start of 2018, two months had passed since Petitioner’s receipt of the flu
vaccine - and during that period he had repeated medical encounters, but no objective
evidence of any neurological symptoms that could reflect onset of GBS.
On January 2, 2018, Petitioner visited the Dallas VA clinic with complaints of a ten-
day history of productive cough, associated shortness of breath, and chest pain. Ex. 3 at
3

Case 1:20-vv-01423-EMR Document 37 Filed 02/24/25 Page 4 of 13
2147. It was noted at this time he was moving well and his vital signs were stable. Id.
Petitioner was prescribed an albuterol inhaler, antibiotics, and cough medication. Id.
On January 7, 2018, Petitioner called his VA clinic – and he now seemed to be
exhibiting symptoms that could reflect onset of GBS. In particular, he reported a two-day
history of bilateral facial numbness and weakness, and that he was feeling week and had
collapsed while at a store earlier in the day. Ex. 3 at 2139-40. He indicated that he had
not been taking his thyroid medication recently and was wondering if his current condition
was related to his thyroid. Id. Petitioner was advised to seek emergency medical care. Id.
Petitioner drove to the VA clinic emergency department that same day and was
found laying in the hospital parking lot by a Good Samaritan, who brought Petitioner into
the hospital using a wheelchair. Ex. 3 at 2131. Petitioner reported that he had five falls
over the past two days along with numbness in his feet and hands. Id. An exam revealed
proximal muscle weakness in his upper and lower extremities and he was unable to stand
due to weakness. The attending nurse listed a working diagnosis of myopathy and muscle
weakness, thought to be secondary to Petitioner’s failure to take his thyroid medication.
Id. at 2124.
Petitioner was seen by Drs. Jafar Hashem and Meredith Bryarly on January 10,
2018, and their impression was progressive weakness, sensory loss, and loss of reflexes
that were “most concerning for GBS.” Ex. 3 at 2048. Dr. Bryarly observed that Petitioner
was unable to count past thirteen in a single breath which was suggestive of significant
diaphragmatic weakness, and that Petitioner had a positive Babinski on his right toe, and
opined that his proceeding respiratory illness may have been the inciting factor of his
current symptoms. Id. Dr. Bryarly ordered an MRI of Petitioner’s cervical and thoracic
spine to rule out a possible spinal court injury and a lumbar puncture to determine whether
he was suffering from GBS, and he was admitted to the Critical Care Unit. Id. at 2020.
The following day (January 11, 2018), Petitioner reported decreased sensation on
the left side of face and lack of reflexes. He also reported more difficulty breathing. Ex. 3
at 2020. Dr. Bryarly noted that Petitioner was areflexic in all extremities, and that his
physical exam findings and history of a URI in December 2018 “still fit with a GBS
etiology.” Id. Due to concerns of imminent respiratory failure, Petitioner was voluntarily
intubated that night. Id. at 2015.
Dr. Bryarly read Petitioner’s January 11, 2018 EMG/NCS as an “abnormal study”
that showed “electrophysiological evidence of a motor and sensory neuropathy with
demyelinating features.” Ex. 3 at 2307. Dr. Bryarly’s impression was that these findings
were consistent with the clinical diagnosis of GBS. Id. Accordingly, on January 14, 2018,
4

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Petitioner was started on intravenous immunoglobulin (“IVIG”) therapy for a presumptive
diagnosis of GBS. Id. at 2000. On January 16, 2018, Paul Hurd, M.D., a neurologist, noted
that petitioner’s “progressive weakness, sensory loss, dyspnea, [and] loss of reflexes”
were most concerning for GBS/AIDP. Id. at 1986. No spinal cord pathology was found on
MRI, and petitioner’s brain MRI was unremarkable. Id. Dr. Hurd noted that petitioner’s
EMG revealed absent F-waves that are typically seen in the early phase of GBS. Id.
On January 18, 2018, Petitioner received a fifth dose of IVIG and had a
tracheostomy placed due to ongoing respiratory failure. On January 24, 2018, a CT scan
showed worsening consolidation of Petitioner’s pneumonia, and he also had a recurrent
fever and leukocytosis, and he was placed again on antibiotic Vancomycin and Zosyn.
Ex. 3 at 1919, 1938-39.
By January 26, 2018, Petitioner began to show signs of improvement, with upper
extremity strength and was able to clench his hands and move his arms towards his
midline. On January 30, 2018, Petitioner was evaluated and showed 5/5 upper extremity
strength with 2/5 lower extremity strength and no plantar reflex movement. Ex. 3 at 1866-
73. Petitioner had PT and OT consultations on January 31, 2018. Id.
Petitioner saw neurologist Dr. Olaf Stuve on February 2, 2018, who noted
improvement, specifically in petitioner’s upper extremities. Ex. 3 at 1852. Dr. Stuve
indicated that there were no new recommendations other than supportive care for
Petitioner’s recovery from GBS, which would be a long-term process. Id. Petitioner also
showed neurological improvement in his lower extremities by February 9, 2018.
On February 14, 2018, Petitioner was seen by Dr. Nikhil Seth, a gastroenterologist
for Petitioner’s complaints of handling secretions and difficulty swallowing. The possibility
of surgery for implanting a PEG was discussed, but later scrapped when Petitioner began
to show improved tolerance of oral feeding. Ex. 3 at 1608. By February 27, 2018,
Petitioner had improved to the point where although he required a lift into a wheel chair,
he was able to self-propel the wheelchair in the hospital, and that he was able to feed
himself and speak with the use of a Passy Muir valve. Ex. 3 at 1621.
On March 1, 2018, Petitioner was discharged by the VA to the VA Community
Living Center for inpatient rehabilitation, from March 1, 2018 to June 6, 2018. Ex. 3 at 73.
He was seen again by Dr. Shwin on March 7, 2018, for gout management. Petitioner
indicated his legs were still weak and he was unable to move, walk, or transfer
independently, but declined to change any of his gout medications until his current
condition had improved. Id. at 1483.
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Petitioner saw Dr. Hashem on March 9, 2018, to discuss further treatment for his
GBS. Dr. Hashem noted that his clinical picture and EMG studies were consistent with
GBS, specifically the AIDP variant of GBS, and indicated that additional treatment such
as another course of IVIG would not improve his outcome. Id. at 1439. Petitioner had his
tracheostomy tube removed on March 19, 2018.
On April 27, 2018, Petitioner had a neurological consultation with Dr. Kyle
Blackburn to discuss treatment options given that Petitioner had not returned to his
baseline levels. Dr. Blackburn noted that Petitioner continued to improve and that
although he was still in a wheelchair, he was able to use a walker for short periods of time
although Petitioner still experienced burning and swelling in his feet. Id. at 463. He also
suggested an increase to Petitioner’s gabapentin prescription for neuropathic pain and
compression socks for swelling. Id.
By May 30, 2018, Petitioner’s recovery was noted to be going well, with Petitioner
now being able to walk “community distances” with a rolling walker and that he was
functionally able to perform all of his own ADLs. Id. at 148. Petitioner was referred for
outpatient PT and again was recommended to increase his dosage of gabapentin. Id.
On June 6, 2018, Petitioner was discharged home at his own request after learning
that his pension benefits would be reduced if he required further inpatient care. Ex. 3 at
70-76. At the time of discharge, it was noted that Petitioner was walking independently
with the use of a cane. All of Petitioner’s further medical records relate to routine care of
his other medical conditions and do not mention GBS sequelae with the exception of a
telephonic appointment with Dr. Swati Lederer, a nephrologist, on October 1, 2019, in
which Petitioner complained of shortness of breath with exertion and intermittent
dizziness when standing. Ex. 3 at 2841. Dr. Lederer mentioned orthostasis or possible
sequelae of GBS as possible causes. Id.
Petitioner has also submitted two statements which were signed under penalty of
perjury. The first statement is from Petitioner himself, dated August 1, 2022. Ex. 1.
Petitioner states that “a few days after the shot I did not feel well”, that this continued on
and within a few weeks, he was feeling pain in his lower back and legs. Id. at 1. He further
notes that he became ill with a fever while staying with a friend over Christmas, and that
thereafter he “drove home to east Texas and got a little better but not feeling well during
this time.” Id. He goes on to describe his initial fall at a convenience store, as well as
falling in the parking lot of the VA on his way to an appointment for his respiratory illness.
The second statement is from Petitioner’s friend, Jerry Edelman, with whom
Petitioner stayed with for several days around Christmas of 2017. Ex. 5. Mr. Edelman
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notes that Petitioner started having issues in “early December,” that he told Petitioner he
needed to go to the VA, and that he was concerned Petitioner’s coughing was contagious
and that he might have to leave the house. Id. at 1. He further states that he noticed
weakness, including trouble standing and walking, recalling Petitioner’s inability to help
him put up a fence and staying seated during a trip to a local casino. Id. at 1-2. He also
noted that Petitioner was unable to do “anything” on Christmas due to his ongoing illness.
Id. at 2.
III. Legal Standard
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 & Human 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). 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, the Federal Circuit has recently “reject[ed] as incorrect the
presumption that medical records are always accurate and complete as to all of the
patient’s physical conditions.” Kirby v. Sec'y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021). Medical professionals may not “accurately record everything” that
they observe or may “record only a fraction of all that occurs.” Id.
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 he suffered an injury meeting the Table criteria (i.e. a Table injury),
in which case causation is presumed, or an injury shown to be caused-in-fact by the
vaccination he received. If a petitioner establishes a Table injury the burden shifts to
respondent to establish a more likely alternative cause. Section 13(a)(1)(A),
3 In summary, a petitioner must establish that she 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 her injury for more than six months, died from her 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. See § 11(c)(1)(A)(B)(D)(E).
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11(c)(1)(C)(i), 14(a). If a petitioner cannot establish a Table injury, he or she may pursue
causation-in-fact under the legal standard set forth in Althen v. Sec'y of Health & Human
Servs., 418 F. 3d 1274, 1278 (Fed. Cir. 2005).
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, GBS is compensable if it manifests within 3-42 days
(not less than three days and not more than 42 days) of the administration of an influenza
vaccination. 42 C.F.R. § 100.3(a)(XIV)(D). (Further criteria for establishing a GBS Table
Injury case be found under the accompanying qualifications and aids to interpretation. 42
C.F.R. § 100.3(c)(15)).
Cases alleging a Table GBS injury have often been dismissed for failure to
establish proper onset. See, e.g., Randolph v. Sec'y of Health & Human Servs., No. 18-
1231V, 2020 WL 542735, at *8 (Fed. Cl. Spec. Mstr. Jan. 2, 2020) (finding GBS onset at
the earliest occurred 76 days post-vaccination, “well outside the 3-42-day window set by
the Table for a flu-GBS claim”); Upton v. Sec'y of Health & Human Servs., No. 18-1783V,
2020 WL 6146058, at *2-3 (Fed. Cl. Spec. Mstr. Sept. 24, 2020) (finding the petitioner did
not establish the onset of her GBS within the 3-42 day time frame prescribed and thus
did not establish a Table Injury). But even non-table claims have been dismissed when
onset occurs significantly outside the 42-day limit. See, e.g., Chinea v. Sec'y of Health &
Human Servs., No. 15-095V, 2019 WL 1873322, at *33 (Fed. Cl. Mar. 15, 2019), review
denied, 144 Fed. Cl. 378 (2019) (finding that the onset of the petitioner's GBS occurred
eleven to twelve weeks after her vaccination, which was beyond the six- to eight-week
medically appropriate timeframe for the occurrence of vaccine-induced GBS); Barone v.
Sec'y of Health & Human Servs., No. 11-707V, 2014 WL 6834557, at *13 (Fed. Cl. Spec.
Mstr. Nov. 12, 2014) (finding eight weeks (56 days) is the longest reasonable timeframe
for a flu vaccine/GBS injury).
Analysis
Petitioner asserts that he is entitled to compensation because he has established
a Table injury. Mot. at 26-28. Specifically, Petitioner submits that the onset of his GBS
first manifested “within a few days” of receiving the flu vaccine, citing Petitioner’s
statement that he started to not feel well a few days after the vaccination, and that within
a “few weeks” he started to get sick and feel pain in his lower back and legs. Mot. at 29.
Petitioner also points to his report of chronic eye pain on December 13, 2017, arguing
that his complaint of “continued dizziness” establishes GBS’s manifestation by December
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19, 2017. Petitioner finally contends that he was complaining of back pain “as early as
mid-December,” and that “other symptoms were present prior to that.” Id.at 30-31.
Alternatively, Petitioner argues he has met his burden in proving a cause-in-fact claim
because Althen Prong 1 is satisfied by the established science involving GBS caused by
the influenza vaccination; Althen Prong 2 is satisfied because Petitioner has shown he
did not have issues with GBS prior to vaccination and that after vaccination he was
affirmatively diagnosed with GBS; and that Althen Prong 3 is satisfied because of the
symptoms described in Petitioner’s statement as well has his eye issues and “other
symptoms.” Id. at 35.
Respondent maintains in response that Petitioner has not met the Table
requirements because the onset of his GBS occurred no sooner than January 5, 2018,
when Petitioner indicated he first fell due to weakness in his lower extremities - 65 days
(or more than nine weeks) after his November 1, 2017, vaccination. Resp. at 11.
Respondent also contends that there is evidence that Petitioner’s GBS was caused by
factors unrelated to the administration of the vaccine, specifically a preceding upper
respiratory infection. Id. at 12. And Petitioner has not established causation-in-fact
because he has failed to offer a reputable medical theory that the flu vaccine can cause
GBS over 60 days after administration, and that the flu vaccination was more likely the
cause of his GBS as opposed to his URI. Id. at 13-14.
I. Petitioner Has Not Established a Table Claim
The following factual findings are made after a complete and thorough review of
the record, including all medical records, affidavits, and all other additional evidence
and filings from the parties.4
Petitioner alleges he suffered a Table GBS injury following a flu vaccine
administered on November 1, 2017. Mot. at 28-31. To meet the onset requirement,
Petitioner would need to show his symptoms began within three to 42 days of his
vaccination, or no later than December 13, 2017. But credible contemporaneous
medical records preponderantly establish that the initial symptoms of Petitioner’s GBS
did not occur until approximately 65 days after his vaccination, on January 5, 2018,
when Petitioner first indicated he fell due to lower extremity weakness.
Petitioner has attempted to fit his symptoms into the Table timeframe by relying
almost exclusively on two sworn statements - one by Petitioner himself and one by his
4 Though every document is not specifically referenced in this ruling, the complete record was reviewed and
considered. See Moriarty ex rel. Moriarty v. Sec’y of Health & Human Servs., 844 F.3d 1322, 1328 (Fed.
Cir. 2016) (“We generally presume that a special master considered the relevant record evidence even
though [s]he does not explicitly reference such evidence in h[er] decision.”).
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friend, with whom it was alleged Petitioner stayed with for portions of December 2017.
Petitioner places great weight on his statement that “[w]ithin a few days after the shot I
did not feel well.” Ex 5 at 1. But this statement is far too vague to provide the necessary
support for Petitioner’s claim. There is a lower boundary on flu-GBS symptoms of three
days, which Petitioner’s assertion could fail to meet if the onset was too early, and it is
unclear what Petitioner means by a “few” days. It is also unclear what the actual
symptoms were, as “not feeling well” could consist of any multitude of potential symptoms
(many of which would not constitute onset of neurologic symptoms – even if they reflected
the kind of vaccination-related malaise individuals often experience). Six days after
receiving the vaccination in question, Petitioner saw Dr. Shwin concerning his gout, but
did not mention anything in association to the vaccination he had recently received.
The sworn statement of Petitioner’s friend, Mr. Jerry Edelman, is similarly vague.
Mr. Edelman says that Petitioner stayed at his house “quite a bit in December 2017, and
in January 2018 too” but is unable to provide specific dates, or even a range of potential
dates. Ex. 5 at 1. He notes that he “started to notice issues in early December of 2017”
which he goes on to describe as “weakness” with “trouble standing and trouble walking.”
Id. He also goes on to mention that at that time Petitioner was “coughing and sweating”
a lot, to the point where Mr. Edelman requested that Petitioner leave his house out of
concern of contagiousness. Id. And he mentions that he spent Christmas with Petitioner
but that he could not do anything that day, and that they took a trip to Missouri during
which Petitioner was still coughing. Id. at 2. This account roughly lines up with the medical
records, which show that on December 30, 2017, Petitioner contacted the VA clinic with
complaint of a productive cough for the past five days, which would place the start of that
cough on or about December 25, 2017.But this is still almost two weeks after the 42-day
timeframe window for manifestation of GBS symptoms would have closed – and
respiratory symptoms do not reflect the kind of neurologic concerns that would stand as
GBS’s onset.
The only other medical visit Petitioner had within the Table timeframe occurred on
December 13, 2017 (exactly 42-days post-vaccination), when he requested a referral to
an ophthalmologist for “chronic eye pain.” Ex. 3 at 2162. That appointment took place on
December 21, 2017, but the records noted that Petitioner had been dealing with “stringy
mucous discharge” since the 1970s – a preexisting condition as opposed to something
new. Id. at 2151. Further, Petitioner himself related his symptoms to conjunctivitis,
because in 2014 he was prescribed amoxicillin for a UTI and that caused him to
experience relief of his eye symptoms.
Petitioner also attempts to fit in his reported symptoms at medical appoints later
than December 13, 2017, as evidence of manifesting GBS in the six-week post-
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vaccination timeframe. For example, Petitioner contends that the dizziness when standing
up he complained of at his December 19, 2017, audiology consultation shows he was
“suffering from symptoms well before the onset date asserted by Respondent” because
he was ultimately assessed with autonomic dysfunction. Reply at 3. Petitioner further
associates his lower back and leg pain, reported to have started ten days before his
December 20, 2017 appointment (e.g., on December 10, 2017) as further evidence of the
manifestation of his GBS.
These contentions are unpersuasive. Although the Reply argues that “this record
does not mention a fall or a trauma in the shower to explain his symptoms, just leaning
over” (Id. at 4), the records indicate that Petitioner believed that bending over in the
shower was the particular mechanism which initiated that bout of pain, and the treating
physician Dr. Bitussi assessed it as a “sprain/strain” with an “inciting even [sic] that
occurred 10 days ago.” Ex. 3 at 2156. Petitioner’s prior medical history is also significant
for back pain. Indeed, the reason for the medical visit at which Petitioner received the
vaccination at issue was for shoulder pain, back pain, and vitamin B deficiency. Id. at
2180. His history of back pain was significant enough that an MRI was performed on his
back in 2016, which was reviewed by Dr. Bitussi at the December 20, 2017, appointment.
When the record is read in its entirety, the evidence of a purportedly-earlier onset
is thin, when compared to evidence of an onset in early January. Moreover, even if I gave
Petitioner’s assertions about an earlier onset more weight, they would describe a GBS
course wholly inconsistent with what is known about the illness. In the vast majority of
cases, GBS (when manifesting as the AIDP variant at issue herein) is an acute and
monophasic condition. It is not known to present with bouts of eye or audiological issues
prior to neurological symptoms, and which subsequently remain subacute for weeks or
months. Chinea, 2019 WL 1873322, at *31, 33. It is not preponderantly likely that
Petitioner would have experienced GBS onset in the form he described in December,
only to manifest acutely at the beginning of January – with all of these symptomatic events
occurring a fairly long time after the purported instigating event of vaccination.
Thus, a preponderance of evidence best supports the conclusion that the onset
of Petitioner’s GBS occurred 65 days after his flu vaccination. This is well outside the
42-day window set forth in the Table, and therefore Petitioner has not met the criterion
needed to establish a Table claim.
II. Petitioner Has Not Established a Causation-In-Fact Claim
To proceed on a theory of causation-in-fact, a petitioner must show by a
preponderance of the evidence that “a vaccination brought about her injury by providing:
11

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(1) a medical theory causally connecting the vaccination and the injury; (2) a logical
sequence of cause and effect showing that the vaccination was the reason for the injury;
and (3) a showing of a proximate temporal relationship between vaccination and injury.”
Althen, 418 F.3d at 1278. All three prongs must be met. Id. (providing a petitioner must
satisfy all three prongs).
The record preponderantly establishes that Petitioner’s GBS began no sooner than
65 days post vaccination, outside the longest timeframe (eight weeks) generally accepted
for a similar non-Table claim recognized in the Program. See, e.g., Barone, 2014 WL
6834557, at *13. Such a delay in manifestation of his symptoms is too lengthy to be
considered “medically acceptable to infer causation-in-fact.” See de Bazan v. Sec'y of
Health & Human Servs. Sec'y of Health & Human Servs., 539 F.3d 1347, 1352 (Fed. Cir.
2008). (Indeed, it is arguably the case that any onsets that exceed the 3-42 day timeframe
are suspect from a medical/scientific standpoint, even if some special masters have been
willing to deem up to an eight-week timeframe medically acceptable).
Here, a nine-week onset (coupled with symptoms that have not convincingly been
demonstrated to be GBS-specific) is simply too remote from the date of vaccination to
reasonably associate the two. To find otherwise would be to embrace a post hoc ergo
propter hoc kind of reasoning not accepted for causation cases. Bulman v. Sec'y of Health
& Hum. Servs., No. 19-1217V, 2023 WL 5844348, at *14 (Fed. Cl. Aug. 16, 2023)
(“Program case law recognizes that not all post-vaccination injuries are vaccine-caused
simply because vaccination predated them.”); see also Galindo v. Sec'y of Health & Hum.
Servs, No. 16-203V, 2019 WL 2419552, at *20 (Fed. Cl. Spec. Mstr. May 14, 2019) (citing
U.S. Steel Group v. United States, 96 F. 3d 1352, 1358 (Fed Cir. 1996) (“[b]ut to claim
that the temporal link between these events proves that they are casually related is simply
to repeat the ancient fallacy: post hoc ergo propter hoc”). Petitioner has not otherwise
persuasively established circumstances in which such an unusually lengthy post-
vaccination onset could still be deemed medically acceptable – especially since
Petitioner’s earlier symptoms are either unrelated to his GBS, or reflect pre-vaccination
conditions.
Conclusion
The evidentiary record does not preponderantly support Petitioner’s contention
that the flu vaccine he received in November 2017 caused his GBS in the timeframe at
issue, does not support the allegation that he suffered a Table Claim, and would not
support allegations that his GBS was caused-in-fact by the flu vaccine.
Petitioner has not established entitlement to a damages award, and therefore I
12

Case 1:20-vv-01423-EMR Document 37 Filed 02/24/25 Page 13 of 13
must DISMISS his claim in its entirety. The Clerk of Court shall enter judgment
accordingly.5
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
5 If Petitioner wishes to bring a civil action, he must file a notice of election rejecting the judgment pursuant
to § 21(a) “not later than 90 days after the date of the court’s final judgment.”
13

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_20-vv-01423-1
Date issued/filed: 2025-08-07
Pages: 48
Docket text: JUDGE VACCINE REPORTED OPINION (PUBLIC VERSION) (reissued for publication of 39 JUDGE VACCINE ORDER/OPINION denying 34 Petitioner's Motion for Review). Signed by Judge Eleni M. Roumel. (abo) Service on parties made.
--------------------------------------------------------------------------------
Case 1:20-vv-01423-EMR Document 42 Filed 08/07/25 Page 1 of 48
In the United States Court of Federal Claims
BUDDY KINDLE,
No. 20-1423
Petitioner,
Filed Under Seal: July 17,
v. 20251
SECRETARY OF HEALTH AND HUMAN
Publication Date: August 7,
SERVICES,
2025
Respondent.
Courtney Jorgenson of Siri & Glimstad LLP, Phoenix, AZ, for Petitioner.
Camille M. Collett of the United States Department of Justice, Civil Division, Torts Branch,
Washington, D.C. for Respondent. With her on the briefs were Yaakov M. Roth, Acting Assistant
Attorney General, United States Department of Justice; C. Salvatore D’Alessio, Director, United
States Department of Justice, Civil Division, Torts Branch; and Heather L. Pearlman, Deputy
Director, United States Department of Justice, Civil Division, Torts Branch.
MEMORANDUM AND ORDER
Petitioner Buddy Kindle seeks review of a decision dismissing his petition for
compensation under the National Vaccine Injury Compensation Program (Vaccine Act). 42
U.S.C. §§ 300aa-10 et seq. Petitioner filed a petition for compensation alleging that he suffered
from Guillain-Barré Syndrome (GBS) caused by the influenza vaccine he received on November
1, 2017. On January 21, 2025, the Chief Special Master dismissed Petitioner’s claim. Pending
1 On July 17, 2025, this Court issued a sealed version of this Memorandum and Order. ECF No.
39. On August 5, 2025, the parties filed a Joint Status Report indicating that they had no proposed
redactions to the Memorandum and Order. ECF No. 41. The sealed and public versions of this
Memorandum and Order are identical, except for this footnote, the addition of the publication date,
and corrections to minor typographical or citation errors.

Case 1:20-vv-01423-EMR Document 42 Filed 08/07/25 Page 2 of 48
before the Court is Petitioner’s Motion for Review of the Chief Special Master’s Decision
dismissing his petition for compensation.
This case involves circumstances that evoke sympathy from the Court. Petitioner’s illness
has caused him significant hardship, pain, and suffering. The difficulties associated with his
circumstances are not lost on this Court. Despite this, the Court is bound by the law and must
apply the Vaccine Act as written—even when doing so might lead to a disappointing result for
those involved. For the reasons explained below, Petitioner’s arguments do not provide a
sufficient basis for setting aside the Chief Special Master’s Decision. Accordingly, Petitioner’s
Motion for Review is DENIED.
BACKGROUND
I. Factual Background
The Chief Special Master’s Decision contains a thorough discussion of the evidence of
record. ECF No. 37 (Decision) at 2−7.2 What follows is a summary of the aspects of the record
pertinent to issues raised in Petitioner’s Motion for Review.
A. Petitioner’s Medical History
On November 1, 2017, Petitioner saw his Primary Care Physician (PCP), Dr. Keith
Wixtrom, for management of constipation, shoulder pain, back pain, and a vitamin B-12
deficiency. Pet. Ex. 3 at 2180. During that visit, Petitioner was administered the influenza vaccine
in his left deltoid. Id. at 2174−75. At this time, Petitioner was 72 years old and had a history of
numerous medical issues, including kidney disease, vertigo, sleep apnea, gout, and
2 For clarity and consistency with other filings in this case, citations to Petitioner’s medical records
reference the pagination assigned by Petitioner, noted at the bottom right corner of each page. See
Pet. Ex. 2 (ECF No. 6-2); Pet. Ex. 3, Part 1 (ECF No. 6-3); Pet. Ex. 3, part 2 (ECF No. 6-4); Pet.
Ex. 4 (ECF No. 20-1). Otherwise, citations throughout this Memorandum and Order reference the
ECF-assigned page numbers, which do not always correspond to the pagination within the
document.
2

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hypothyroidism. Id. at 2178–79 (medical history recorded on date of vaccination); see also id. at
1054−55 (noting significant medical issues).
1. Within 3–42 Days of Vaccination
Six days after his vaccination, on November 7, 2017, Petitioner saw a rheumatologist for
management of his gout, with which he was diagnosed in 2010. Id. at 2169−73. During the visit,
Petitioner complained of a gout attack on October 17, 2017, which had resolved spontaneously;
pain in his left rotator cuff; and an inability to jog or run. Id. at 2169. Petitioner noted that he
“probably . . . was not exercising enough” and that he had recently withdrawn from a gout study.
Id. Petitioner’s physical exam revealed “no gross focal [neurological] deficits,” and the
rheumatologist listed “gout, knee osteoarthritis, and rotator cuff tend[i]nopathy” on Petitioner’s
“[p]roblem list.” Id. at 2171, 2173.
On December 13, 2017—42 days post-vaccination—Petitioner requested an
ophthalmology consultation at the United States Department of Veterans Affairs’ Dallas Medical
Center (Dallas VA), for chronic eye pain and discharge. Id. at 2159−62. Petitioner relayed that
he had previously been referred to a different medical clinic for this problem and requested a refill
of eye drops. Id. at 2162.
2. More Than 42 Days After Vaccination
On December 19, 2017, Petitioner had an audiological evaluation in which he reported
“positive history of aural pain and pressure, frequent sinus/cold issues, and bilateral tinnitus” and
“continued dizziness when standing/standing up to walk.” Id. at 2158−59. The audiologist noted
that Petitioner “ha[d] limited to no concerns regarding changes in hearing since [his] last
evaluation” and “denie[d] aural infection/surgery or other major medical changes since his last
evaluation in May 2013.” Id. at 2158. Petitioner reported “[n]o other significant problems or
concerns” at the time of the appointment. Id.
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On December 20, 2017, Petitioner had a Physical Medicine Rehabilitation consultation for
“chronic lower back pain with an inciting even[t] that occurred 10 days ago.” Id. at 2153−58.
Specifically, Petitioner “leaned over in [the] shower and got pain accross [sic] his whole lower
back,” but he “didn’t feel any big issues after this.” Id. Petitioner’s PCP had referred him to this
appointment, specifically for a spine consultation and recommendations. Id. at 2153. The notes
from this appointment reflect that the onset of Petitioner’s injury occurred in 1966; when Petitioner
was in the Marine Corps, “he jumped from 35 ft up” and “[a]t that time he felt a dullness in his
back.” Id. (“ONSET: first event 1966.”). Petitioner described the pain as “constant,” “sharp
stabbing,” and “across the whole back and now going down the left side of the leg to just above
the knee on the posterior side.” Id. The work up from the visit noted Petitioner’s “[m]ultilevel
disc degenerative changes with small disc protrusions . . . but no signs of spinal stenosis” and
“large renal cysts . . . consistent with known polycystic kidney disease.” Id. at 2153−54; see also
id. at 2158 (attributing Petitioner’s back pain to “DDD” and “recent onset of lumbar
sprain/strain”); Pet. Ex. 4 at 198 (records from a June 2021 appointment noting “[h]istory of
lumbar degenerative disc disease on MRI in 2016”).3 The records also state that Petitioner’s back
pain was “most likely due to a sprain/strain,” and Petitioner was referred to physical therapy. Pet.
Ex. 3 at 2156, 2158.
On December 21, 2017, Petitioner attended his requested ophthalmology consultation. Id.
at 2151−52, 2159−62. Records from that appointment reflect that Petitioner complained of
“stringy mucous discharge [in both eyes] since [the] 1970s,” and that Petitioner “still note[d] heavy
swollen lids,” notwithstanding daily treatment. Id. at 2151. Further, the records note “[t]ransient
3 Based on these records, the Court interprets “DDD” as shorthand for “degenerative disc disease.”
4

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(sev minutes) horiz diplopia resolved completely by unilat occlusion, yesterday, first episode”;
“[o]cular motility: orthotropia with full ductions and versions OU”; and “acute transient
diplopia.”4 Id. at 2151−52. Additionally, the Assessment portion of the records from that visit
notes meibomian gland dysfunction and “fixat[ion] on possible ‘infected tear gland,’” and a prior
bout of what Petitioner seemed to believe was conjunctivitis.5 Id. at 2152. The Assessment also
suggested that “HT”—hypertension—was the suspected “underlying etiology” for the “acute
transient diplopia.” Id.
On December 30, 2017, Petitioner called the Dallas VA call center, complaining of a cough
which he reported had begun five days prior. Id. at 2148–49. Petitioner denied having pain,
“feeling feverish,” or having trouble breathing at the time of the appointment. Id. at 2149–50.
The nurse with whom Petitioner spoke suggested that he follow up with the emergency department
4 “Diplopia” is “double vision caused by defective function of the extraocular muscles or a disorder
of the nerves that innervate the muscles.” Diplopia, Mosby’s Medical Dictionary (10th ed. 2017).
“Occlusion” refers to “the state of being closed.” Occlusion, Mosby’s Medical Dictionary (10th
ed. 2017). Thus, “[t]ransient (sev minutes) horiz diplopia resolved completely by unilat occlusion”
refers to temporary double vision lasting for several minutes, in which the two images appear side-
by-side, which goes away when one eye is closed or covered. Further, “acute transient diplopia”
means sudden temporary double vision. “Motility” is “spontaneous but unconscious or
involuntary movement,” but also refers generally to the “condition of being capable of movement.”
Motility, Mosby’s Medical Dictionary (10th ed. 2017). “Ocular motility” specifically refers to the
movement of the eyes. “Orthotropia” refers to normal eye alignment, in which the eyes are looking
straight ahead. “Duction” means “the movement of an individual eyeball from the primary to
secondary or tertiary position of gaze.” Duction, Mosby’s Medical Dictionary (10th ed. 2017).
“Versions” are how the eyes move together, and “OU” (meaning oculus uterque) means both eyes.
5 The “Assessment” portion of the medical records, which is included in the notes of several of
Petitioner’s appointments between 2015 and 2022, appears to include historical notes regarding
Petitioner’s history with various eye conditions, which his doctors supplemented over time. See
Pet. Ex. 3 at 1267−68 (December 10, 2015 appointment), 2151−52 (December 21, 2017
appointment), 2494−96 (February 19, 2020 appointment), 2868−70 (August 19, 2019
appointment); Pet. Ex. 4 at 314−16 (June 3, 2022 appointment), 555−57 (June 24, 2021
appointment), 1397−400 (December 10, 2020 appointment).
5

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within two to eight hours, but Petitioner did “not wish to seek care at ER without pre-authorization
of VA payment.” Id. at 2148.
On January 2, 2018, Petitioner had an appointment with his PCP, Dr. Keith Wixtrom,
reporting a “productive cough” which had been ongoing for 10 days, along with chest pain and
shortness of breath. Id. at 2141–47. The nurse noted that Petitioner was “well oriented,”
ambulating well, and presenting stable vital signs. Id. at 2147. Though his appetite was
diminished, Petitioner was tolerating food and fluids well. Id. Petitioner was prescribed an
albuterol inhaler, antibiotics, and cough medication. Id. at 2143–44.
On January 7, 2018, Petitioner again called the Dallas VA call center, this time complaining
that his face had been numb on both sides since the previous day. Id. at 2139–40. Petitioner stated
that on the day he called, his feet began feeling numb, he felt weak, and he collapsed in a store.
Id. at 2140. Petitioner noted that he had not been taking his thyroid medication as directed and
considered whether he may be having a problem with his thyroid. Id. He denied chest pain or
difficulty breathing. Id. The nurse instructed him to seek medical care immediately. Id.
When Petitioner arrived at the Dallas VA Emergency Department later that day, his legs
“gave way” as he was getting out of his vehicle, causing him to collapse in the parking lot. Id. at
2130–31. Although Petitioner was unable to get up, a fellow veteran found him lying on the
ground and helped him inside. Id. at 2131. Petitioner reported “freuqent [sic] recent falls”—
specifically more than five falls in the previous two days—due to both legs “giv[ing] out” and
numbness in his feet and hands. Id. Petitioner again noted that he had not been taking his thyroid
medication; specifically, he reported that he had “been off his levothyroxine for the past 2-3 weeks
and [was] not always[s] compliant.” Id. Petitioner denied any visual changes, shortness of breath,
or passing out, and noted no difficulty with swallowing or speech. Id.
6

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The next day, on January 8, 2018, Petitioner reported more than six falls, that “his legs
fe[lt] sleepy and his face fe[lt] numb,” and fever and chills. Id. at 2118–19. His treating physician
confirmed that he had a low-grade fever. Id. at 2125. Petitioner’s doctor also ordered labs and
referred Petitioner to a physical and occupational therapy to determine whether his falls were
related to noncompliance with his thyroid medication. Id. at 2124–25.
Two days later, on January 10, 2018, while still at the Dallas VA, a neurologist, Dr.
Meredith Bryarly, described Petitioner’s symptoms as “most concerning for GBS.” Id. at 2042–
48. Dr. Bryarly noted “[p]rogressive weakness, sensory loss, dyspnea, loss of reflexes,” and
significant diaphragmatic weakness. Id. at 2048. She also suggested that Petitioner’s respiratory
illness may have been the inciting factor. Id. There was also concern that Petitioner’s “weakness
may quickly progress to involve his respiratory muscles and he is at risk of developing acute
respiratory failure.” Id. at 2047. Petitioner was admitted to the Critical Care Unit that day. Id. at
2020, 2023.
On January 11, 2018, Petitioner experienced “significant changes.” Id. at 2020–22.
Petitioner complained of a pain located between his eyes, and the left side of his face had less
sensation than the right. Id. at 2020. Petitioner also said that his left foot felt much warmer than
his right foot, but on examination, the right foot felt warmer. Id. at 2020–21. Petitioner stated that
he “believes his weakness and sensation loss is ascending and he is having more difficulty
breathing.” Id. at 2021. Dr. Bryarly and the medical student working with her noted that
Petitioner’s “physical exam findings and history of an [Upper Respiratory Infection (URI)] in
December 2017, still fit with a GBS etiology.” Id. at 2022.
Also on January 11, 2018, Dr. Bryarly analyzed Petitioner’s SNC Comparison, Motor
Nerve Conduction, F-Wave, and Electromyography (EMG) studies, concluding that the findings
7

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were “consistent with the clinical diagnosis of GBS.” Id. at 2307–08. The next day, a physician
resident noted that the studies “revealed absent F-waves, as would be typically seen in the early
phase of GBS.” Id. at 2011; see also id. at 1986 (noting the same on January 16, 2018). Petitioner
was intubated that day. Id. at 1917, 2014–15.6
Petitioner started Intravenous Immunoglobin (IVIG) three days later, on January 14, 2018.
Id. at 1989−91. Two days later, Petitioner had a follow up with a medical resident, Dr. Farukh
Ikram, and a neurologist, Dr. Paul Hurd. Id. at 1984–87. They concluded that Petitioner’s
“progressive weakness, sensory loss, dyspnea, [and] loss of reflexes” were “most concerning for
GBS/AIDP.”7 Id. at 1986. Petitioner received his fifth and final dose of IVIG on January 18,
2018. Id. at 1968.
On January 26, 2018, Petitioner began to show signs of improvement. Id. at 1905–08
(noting that Petitioner likely had the AIDP variant of GBS given the absent F-waves on his EMG
study). Petitioner’s condition continued to improve throughout February. Id. at 1852; id. at 1814–
15 (noting “daily neurologic improvement” but also difficulty breathing on February 9, 2018); id.
at 1620–22. On March 1, 2018, Petitioner was discharged to an inpatient rehabilitation center, or
“community living center,” at the Dallas VA. Id. at 1572–82, 1596−99.
On March 6, 2018, during an appointment for gout management, Petitioner noted that he
was still experiencing weakness in his legs and hands and was unable to walk, but he could swallow
6 Although Petitioner’s medical records note that he was intubated on “11/11,” that appears to be
a typographical error. See, e.g., Pet. Ex. 3 at 2014–15. Other records note that he was intubated
on January 11, 2018, which aligns with the timing of Petitioner’s stint in the Dallas VA and the
events at issue. Id. at 1917; see also Decision at 4 (citing Pet. Ex. 3 at 2015).
7 AIDP is a variant of GBS. 42 C.F.R. § 100.3(c)(15)(ii) (“The most common subtype [of GBS]
in North America and Europe, comprising more than 90 percent of cases, is acute inflammatory
demyelinating polyneuropathy (AIDP).”).
8

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and talk and his breathing was improving. Id. at 1482 (noting Petitioner’s “respiratory illness was
thought to be the inciting factor” of his GBS).
Petitioner had another neurology consultation on March 9, 2018—according to Petitioner’s
treating neurologist, this was “roughly 8 weeks from the initial illness.”8 Id. at 1435–40. Petitioner
requested the appointment to discuss treatment for his GBS, as he continued to have lower
extremity weakness and some numbness in his feet and hands. Id. at 1436. Petitioner did show
signs of improvement, however, and Petitioner said that he was “doing much better.” Id.
Petitioner’s neurologist noted that his “significantly improved strength,” suggested that it was
unlikely that he had Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)—the chronic
form of GBS. Id. at 1439. The neurologist also noted that Petitioner’s illness was consistent with
the AIDP variant of GBS, which the doctor described as a “monophosic [sic] illness.” Id.; see also
id. at 153 (“We again discussed that AIDP is a monophasic illness and that his active disease
occurred in January . . . .”).
Throughout April and May 2018, Petitioner continued to show signs of improvement. Id.
at 463 (noting that on April 27, 2018, “Mr. Kindle appear[ed] to have made significant strides in
his recovery from what seem[ed] to be GBS”); id. at 154–55 (physical therapist noting on May 30,
2018, that “in [her] professional opinion, [Petitioner] has made great srides [sic] in his recovery”).
In June, Petitioner was discharged to his home at his own request. Id. at 70–85.
In contrast to his contemporaneous medical records from 2018, which suggest that
Petitioner’s GBS may have been caused by his upper respiratory infection, some of Petitioner’s
subsequent medical records from 2021—after the inception of this case—contain notes reflecting
8 This statement was made by the neurology resident, Dr. Jafar Hashem, who treated Petitioner
along with Dr. Bryarly when Petitioner was initially admitted to the Emergency Department of the
Dallas VA. See Pet. Ex. 3 at 1435–36; Decision at 4, 6.
9

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Petitioner’s view that his GBS may have stemmed from his flu vaccination or observing that
Petitioner’s GBS occurred after his flu vaccine. Compare id. at 1482 (rheumatologist noting on
March 6, 2018, that Petitioner had GBS and his “respiratory illness was thought to be the inciting
factor”), and id. at 1962 (“Subsequent workup consistent with Guillain Barre after possible
bronchitis . . . .”), and id. at 2048 (Dr. Bryarly, noting on January 10, 2018, that Petitioner’s
“respiratory illness may have been the inciting factor” for his GBS), with Pet. Ex. 4 at 1392 (PCP
noting “[s]evere life-threatening reaction to a prior dose of influenza vaccine[,] [c]omment:
Guilla[i]n-Barre syndrome” on January 27, 2021), and id. at 1018 (noting on February 3, 2021 that
Petitioner was “very reluctan[t] to have the flu vaccine” as he “received the flu vaccine in 20189
and shortly afterward had a severe Guillain-Barre reaction”).
B. Affidavits
In support of his Petition, Petitioner filed two affidavits—his own statement and another
from a friend, Mr. Jerry Edelman. Pet. Ex. 1 (ECF No. 1-2) (Kindle Aff.); Pet. Ex. 5 (ECF No.
22-1) (Edelman Aff.).
1. Statement of Petitioner Buddy Kindle
According to Petitioner’s affidavit, “[w]ithin a few days” of receiving the flu vaccine on
November 1, 2017, he “did not feel well.” Kindle Aff. ¶¶ 2, 5. “This continued on and within a
few weeks [he] was feeling pain in [his] lower back and pain in [his] legs.” Id. ¶ 5. When he
“didn’t feel well” over Christmas and developed a fever, his friend suggested that Petitioner go to
the hospital. Id. ¶ 7. Instead, Petitioner drove home to east Texas. Id. During this time, Petitioner
avers that he “got a little better but [was] not feeling well.” Id.
9 It is undisputed that Petitioner received the influenza vaccine on November 1, 2017—not in 2018
as this record suggests. Pet. Ex. 3 at 2174−75; MFR Mem. at 15; Resp. at 6.
10

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On January 8, 2018, Petitioner’s “legs completely gave way,” and he collapsed at the
counter of a convenience store. Id. ¶ 8. The store clerk helped Petitioner get up and to his car. Id.
When Petitioner called the Dallas VA, he was instructed to immediately come to the Emergency
Room there. Id. ¶ 9. Petitioner drove home first to change his clothes; between his car and front
door he fell five times, but was able to get back in his car and drive to the Dallas VA. Id. When
Petitioner arrived at the Dallas VA and got out of his car, he collapsed again. Id. ¶ 10. A Marine
veteran helped Petitioner into the emergency room in a wheelchair. Id. Petitioner was ultimately
diagnosed with GBS during his stay in the Dallas VA. Id.
Following his diagnosis, Petitioner spent two months in the Intensive Care Unit (ICU). Id.
¶ 11. He was “on a respirator and being fed through a tube” during that time. Id. Since then,
Petitioner states that he has numerous medical problems he had “never had” prior to his GBS
diagnosis: his “feet and lower legs hurt and are swollen,” he has “severe cramps,” getting up after
sitting for a period of time “is difficult and painful,” he can only walk for a few hundred feet before
experiencing pain, he has shortness of breath, and is incontinent. Id. Beyond those symptoms, he
is “no longer able to walk in the woods”; “trips and falls frequently”; can no longer play tennis,
golf, or any other sports; can no longer swim; has gained weight; and has difficulty with basic
tasks such as getting dressed and tying his shoes. Id. ¶ 12. He has no balance and is in constant
pain. Id.
2. Statement of Jerry Edelman
In his affidavit, Mr. Edelman states that he has known Petitioner for around ten to twelve
years. Edelman Aff. ¶ 1. Petitioner stayed with Mr. Edelman in his home in Dallas often during
December 2017 and January 2018, and therefore Mr. Edelman states that he “had a pretty good
view of the changes that [Petitioner] went through.” Id. ¶¶ 2–3. Mr. Edelman states that he started
to notice Petitioner having issues in “early December of 2017.” Id. ¶ 3. Specifically, Mr. Edelman
11

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noticed Petitioner was coughing through the night, sweating, and going to the restroom constantly.
Id. ¶¶ 5–6. Further, Mr. Edelman noticed that Petitioner had weakness and trouble standing and
walking, and that Petitioner’s appetite was off. Id. ¶¶ 6−8. When Mr. Edelman and Petitioner
took a trip to a casino, Petitioner brought a breathing machine and stayed seated during the entire
trip. Id. ¶ 9. According to Mr. Edelman, he and Petitioner spent Christmas together, and Petitioner
“couldn’t do anything that day.” Id. ¶ 10.
C. Medical Literature
Petitioner filed three pieces of medical literature in support of his Petition: Yale Medicine,
Guillain-Barré Syndrome, Pet. Ex. 6 (ECF No. 27-1) (Yale Medicine); Mayo Clinic, Guillain-
Barré Syndrome (June 14, 2022), Pet. Ex. 7 (ECF No. 27-2) (Mayo Clinic); and Xianjun Ding et
al., Guillain-Barré Syndrome and Low Back Pain: Two Cases and a Literature Review, 13 Open
Med. 503 (2018), Pet. Ex. 8 (ECF No. 27-3) (Ding).
The Yale Medicine and Mayo Clinic articles explain that GBS causes muscle weakness,
and other symptoms including difficulty breathing, difficulty controlling eye movement, abnormal
heart rate, abnormal blood pressure, and muscle pain. Yale Medicine at 1−2; Mayo Clinic at 2−3.
Regarding timing and duration of onset, the Yale Medicine article notes that “[s]ymptoms can
rapidly worsen in severity over hours or days and early treatment can considerably shorten the
course of the illness,” “symptoms may progress over the course of one to four weeks before
leveling off,” and are most severe within four weeks of symptom onset. Yale Medicine at 1, 2, 4.
Similarly, the Mayo Clinic article notes that symptoms of weakness and tingling can “quickly
spread” and “worsen rapidly,” and that “[p]eople with Guillain-Barre syndrome usually experience
their most significant weakness within two weeks after symptoms begin.” Mayo Clinic at 1, 3, 4.
Further, “[t]he disorder usually appears days or weeks after a respiratory or digestive tract
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infection.” Id. at 4. Both articles also note that it is rare, but possible, for a vaccination to trigger
GBS. Yale Medicine at 1; Mayo Clinic at 4, 5.
Petitioner’s third article, Ding, describes two case studies of patients whose GBS initially
manifested as low back pain rather than limb weakness. See generally Ding. The article posits
that low back pain can be a symptom of GBS and is overlooked because “most attention is directed
towards the progression of weakness.” Id. at 4. This creates a “diagnostic challenge,” which can
“delay the diagnosis of GBS.” Id.
II. Procedural Background
On October 20, 2020, Petitioner filed a petition for compensation under the Vaccine Act,
alleging that he developed GBS after receiving the influenza vaccine on November 1, 2017, and
that (i) his symptoms first manifested within 42 days of the vaccine, supporting a Table claim, or,
alternatively, (ii) his GBS was caused-in-fact by the flu vaccine. ECF No. 1 at 1, ¶ 13. The claim
was assigned to the Special Processing Unit of the Office of Special Masters, which is “designed
to expedite the processing of claims that historically . . . have been resolved without extensive
litigation.” ECF No. 10 at 1.
On September 29, 2021, Respondent filed its Rule 4(c) Report with the Office of Special
Masters, asserting that this case was not appropriate for compensation under the terms of the
Vaccine Act. ECF No. 17 (Rule 4(c) Report) at 1. First, Respondent asserted that Petitioner could
not prove a Table injury, as (i) the evidence placed the onset of Petitioner’s GBS symptoms on or
around 67 days after receipt of the flu vaccination, rather than within the 3–42-day timeframe
required for a successful Table claim, and (ii) there was evidence that Petitioner’s GBS was caused
by factors unrelated to the vaccine—specifically Petitioner’s prior upper respiratory infection.
Second, Respondent asserted that Petitioner failed to satisfy his burden of proof to support a
causation-in-fact claim under Althen v. Secretary of Health & Human Services. Id. at 11–14.
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On January 9, 2023, after providing Petitioner additional time to “file any medical records,
detailed affidavits, or any additional evidence indicating that onset of Petitioner’s GBS was within
the prescribed Table timeframe,” the Chief Special Master issued an Order stating that after
reviewing the records in this matter, “a hearing d[id] not appear to be necessary,” and directing the
Petitioner to file a Motion for a Ruling on the Record. Minute Order, dated May 5, 2022; ECF
No. 24 at 2.
Subsequently, on March 10, 2023, Petitioner filed his Motion for Decision on the Record,
arguing that he had successfully carried his burden to prove a Table claim and, alternatively, a
causation-in-fact claim. ECF No. 25 at 28–35. Respondent, maintaining its position in its Rule
4(c) Report, countered that Petitioner had failed to prove both a Table and off-Table (causation-
in-fact) claim. ECF No. 26 at 1. Petitioner filed a Reply in support of his Motion on May 23,
2023. ECF No. 28.
A. The Decision
On January 21, 2025, the Chief Special Master dismissed Petitioner’s claim, concluding
that Petitioner failed to prove both his Table and off-Table claims. Decision at 9–12.10
The Chief Special Master first addressed Petitioner’s Table claim, concluding that the
evidence “preponderantly establish[ed] that the initial symptoms of Petitioner’s GBS did not occur
until approximately 65 days after his vaccination.” Id. at 9. The Chief Special Master reasoned
10 The Chief Special Master issued the Decision on January 21, 2025. ECF No. 31. Pursuant to
Rule 18(b) of Appendix B of the Rules of the Court of Federal Claims (Vaccine Rules), the Chief
Special Master provided the parties 14 days to identify and move to redact medical or other
information, “the disclosure of which would constitute an unwarranted invasion of privacy.” Id.
at 1 n.1; Vaccine Rule 18(b)(2). As neither party moved to redact any information, the Chief
Special Master publicly reissued the Decision on February 24, 2025. ECF No. 37. For clarity and
consistency, all references to the Chief Special Master’s Decision are to the public version,
docketed as ECF No. 37.
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that Petitioner’s onset argument relied “almost exclusively on two sworn statements,” and
addressed those sworn statements before addressing Petitioner’s medical records. Id. at 9–11.
Regarding Petitioner’s own affidavit, the Chief Special Master noted that “Petitioner
place[d] great weight on his” own statement that “[w]ithin a few days after the shot [he] did not
feel well.” Id. at 10 (quoting Kindle Aff. ¶ 5). The Chief Special Master found that this statement
was “far too vague to provide the necessary support for Petitioner’s claim.” Id. In the Chief
Special Master’s view, it was “unclear what Petitioner mean[t] by a ‘few’ days” and to what kinds
of symptoms Petitioner referred. Id. The Chief Special Master noted that Petitioner’s symptoms
could have occurred too early (less than three days after vaccination), and the symptoms
experienced within a few days of the vaccine may not have been neurologic symptoms. Id. The
Chief Special Master supported this reasoning with evidence from Petitioner’s medical records: in
an appointment concerning Petitioner’s gout, occurring six days after receiving the vaccine,
Petitioner did not mention any symptoms in association to the vaccine and Petitioner’s
rheumatologist did not note any. Id.
Next, the Chief Special Master concluded that Mr. Edelman’s statement was “similarly
vague.” Id. The Chief Special Master first noted that Mr. Edelman’s statement did not provide
specific dates that Petitioner stayed with him in December 2017 and January 2018. The Chief
Special Master acknowledged Mr. Edelman’s statement that “he ‘started to noticed issues [with
Petitioner] in early December of 2017,’” including weakness, trouble standing, trouble walking,
coughing, and sweating. Id. (quoting Edelman Aff. ¶ 3). Further, the Chief Special Master noted
that Mr. Edelman’s statement that “he spent Christmas with Petitioner but that [Petitioner] could
not do anything that day, and that they took a trip to Missouri during which Petitioner was still
coughing,” roughly lines up with Petitioner’s medical records, which place the start of his cough
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on December 25, 2017. Id. (citing Edelman Aff. ¶ 10). But the Chief Special Master observed
that (i) this was almost two weeks after the Table timeframe had closed, and (ii) “respiratory
symptoms do not reflect the kind of neurologic concerns that would stand as GBS’s onset.” Id.
The Chief Special Master then addressed Petitioner’s medical records. He concluded that,
aside from the previously mentioned gout appointment, “the only other medical visit Petitioner
had within the Table timeframe occurred on December 13, 2017 (exactly 42 days post-
vaccination), when he requested a referral to an ophthalmologist for ‘chronic eye pain.’” Id.
(quoting Pet. Ex. 3 at 2162). However, the Chief Special Master reasoned that records from the
requested appointment (which took place on December 21, 2017) noted Petitioner’s prior history
with various eye conditions—including “stringy mucous discharge,” which Petitioner had
experienced since the 1970s. Id. (quoting Pet. Ex. 3 at 2151).
The Chief Special Master found Petitioner’s reliance on medical records after the close of
the Table timeframe on December 13, 2017 “unpersuasive.” Id. at 10–11. This includes:
(1) Petitioner’s complaint of dizziness at his December 19, 2017 audiology appointment, and
(2) Petitioner’s lower back and leg pain noted at a December 20, 2017 appointment, reported to
have begun on December 10, 2017. Id. at 11. With respect to Petitioner’s lower back and leg pain,
the Chief Special Master found that the records indicate that back pain was caused by bending
over in the shower, noting that Petitioner’s doctor assessed it as a “sprain/strain” with an inciting
event occurring 10 days prior, and Petitioner’s “prior medical history is significant for back pain.”
Id. (citing Pet. Ex. 3 at 2156).
Ultimately, the Chief Special Master concluded that the record “in its entirety” best
supported the conclusion that Petitioner’s GBS symptoms first occurred 65 days post-vaccination,
and that Petitioner therefore had failed to prove a Table claim. Id. The Chief Special Master
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reasoned that Petitioner’s evidence of an earlier onset was thin in comparison to evidence
supporting a January 2018 onset. Id. Further, Petitioner’s theory “would describe a GBS course
wholly inconsistent with what is known about the illness,” as the AIDP variant of GBS is “acute
and monophasic,” and “is not known to present with bouts of eye or audiological issues prior to
neurological symptoms, and which subsequently remain subacute for weeks or months.” Id.
(citing Chinea v. Sec’y of Health & Hum. Servs., No. 15-095V, 2019 WL 1873322, at *31, 33
(Fed. Cl. Spec. Mstr. Mar. 15, 2019), review denied, 144 Fed. Cl. 378 (2019)).
Likewise, the Chief Special Master concluded that Petitioner had failed to prove his off-
Table causation-in-fact claim. Id. at 11–12. The Chief Special Master’s causation analysis focused
primarily on the nine weeks between the vaccine and the onset of Petitioner’s GBS symptoms—
which, he noted, exceeds the “longest timeframe (eight weeks) generally accepted for a similar
non-Table claim recognized in the [Vaccine] Program.” Id. at 12 (emphasis in original) (citing
Barone v. Sec’y of Health & Hum. Servs., No. 11-707V, 2014 WL 6834557, at *13 (Fed. Cl. Spec.
Mstr. Nov. 12, 2014)). The Chief Special Master explained that “a nine-week onset (coupled with
symptoms that have not convincingly been demonstrated to be GBS-specific) is simply too remote
from the date of vaccination to reasonably associate the two,” and therefore did not support a
finding of causation-in-fact. Id. (quoting de Bazan v. Sec’y of Health & Hum. Servs., 539 F.3d
1347, 1352 (Fed. Cir. 2008)). The Chief Special Master ultimately concluded that “Petitioner has
not . . . persuasively established circumstances in which such an unusually lengthy post-
vaccination onset could still be deemed medically acceptable,” noting that Petitioner’s earlier
symptoms were either (1) unrelated to his GBS or (2) reflected pre-vaccination conditions. Id.
B. Petitioner’s Motion for Review
On February 18, 2025, Petitioner filed a Motion for Review of the Chief Special Master’s
Decision. ECF No. 34 (Motion or Mot.); ECF No. 35 (MFR Mem.). Petitioner raises two
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objections to the Chief Special Master’s Decision. Mot. at 1–2. First, that the Chief Special
Master’s determination that the onset of Petitioner’s injury occurred outside of the 3–42-day
timeframe was arbitrary and capricious. Id. at 1. Second, that the Chief Special Master’s
conclusion that Petitioner failed to prove his Table claim or his causation-in-fact claim was
arbitrary and capricious. Id. at 2. On March 20, 2025, Respondent filed its Response to
Petitioner’s Motion, contending that Petitioner has failed to show that the Chief Special Master’s
Decision was arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the
law. ECF No. 38 (Response or Resp.) at 5. Specifically, Respondent argues that the “Chief Special
Master evaluated the entire record, drew plausible inferences, and came to a supported and
reasoned decision.” Id. at 12. The Motion is now fully briefed and ripe for resolution.11
STANDARD OF REVIEW
Pursuant to 42 U.S.C. § 300aa-12(e)(2), when ruling on a Motion for Review, this Court
may:
(A) uphold the findings of fact and conclusions of law of the special master and sustain the
special master’s decision,
(B) set aside any findings of fact or conclusion of law of the special master found to be
arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law and
issue its own findings of fact and conclusions of law, or
(C) remand the petition to the special master for further action in accordance with the
court’s direction.
42 U.S.C. § 300aa-12(e)(2). This Court reviews a special master’s factual determinations under
the arbitrary and capricious standard; legal questions under the “not in accordance with law”
11 Petitioner did not request oral argument in his Motion for Review or his supporting
Memorandum. See generally Mot.; MFR Mem; Vaccine Rule 20(c) (“A party desiring oral
argument on a motion must so request in the motion or response.”).
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standard; and any discretionary rulings under the abuse of discretion standard. Munn v. Sec’y of
Health & Hum. Servs., 970 F.2d 863, 870 & n.10 (Fed. Cir. 1992).
The scope of this Court’s review is “uniquely deferential.” Milik v. Sec’y of Health & Hum.
Servs., 822 F.3d 1367, 1376 (Fed. Cir. 2016) (quoting Hodges v. Sec’y of Health & Hum. Servs.,
9 F.3d 958, 961 (Fed. Cir. 1993)). This Court is required to uphold the factual findings of a special
master unless those findings are arbitrary or capricious. Lampe v. Sec’y of Health & Hum. Servs.,
219 F.3d 1357, 1360 (Fed. Cir. 2000) (noting that, with respect to factual findings—particularly
the “decision to credit the evidence”—“judicial review of the special master’s decision is very
limited”); Munn, 970 F.2d at 870 & n.10 (noting that the arbitrary and capricious standard is “well
understood to be the most deferential possible”); Hinton v. Sec’y of Health & Hum. Servs., No. 23-
2161, 2025 WL 763153, at *2 (Fed. Cir. Mar. 11, 2025) (same). “The Vaccine Act makes clear
that [the Court] do[es] not ‘second guess’ the special master’s fact-intensive conclusions that are
‘based upon [his] accumulated expertise in the field.’” Hinton, 2025 WL 763153, at *2 (quoting
Hodges, 9 F.3d at 961). It is not this Court’s role to “reweigh the factual evidence, assess whether
the special master correctly evaluated the evidence, or examine the probative value of the evidence
or the credibility of the witnesses—these are all matters within the purview of the fact finder.”
Porter v. Sec’y of Health & Hum. Servs., 663 F.3d 1242, 1249 (Fed. Cir. 2011); see also Burns v.
Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (noting that a special master has
discretion to determine the relative weight of the evidence, including medical records). If the
special master’s conclusion is “based on evidence in the record that [is] not wholly implausible,”
this Court is “compelled to uphold that finding as not being arbitrary or capricious.” Cedillo v.
Sec’y of Health & Hum. Servs., 617 F.3d 1328, 1338 (Fed. Cir. 2010) (alteration in original)
(quoting Lampe, 219 F.3d at 1363). “[R]eversible error is extremely difficult to demonstrate if the
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special master has considered the relevant evidence of record, drawn plausible inferences and
articulated a rational basis for the decision.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d
1378, 1381 (Fed. Cir. 2021) (alteration in original) (quoting Lampe, 219 F.3d at 1360); Hines v.
Sec’y of Health & Hum. Servs., 940 F.2d 1518, 1528 (Fed. Cir. 1991).
DISCUSSION
Congress enacted the Vaccine Act to compensate parties presumed or proven to be injured
by certain vaccines. 42 U.S.C. § 300aa–10 et seq. The Program was designed to “lessen the
number of lawsuits against manufacturers and provide relative certainty and generosity of
compensation awards in order to satisfy petitioners in a fair, expeditious, and generous manner.”
Cloer v. Sec’y of Health & Hum. Servs., 654 F.3d 1322, 1325–26 (Fed. Cir. 2011) (en banc)
(citation modified); see also K.G. v. Sec’y of Health & Hum. Servs., 951 F.3d 1374, 1380 (Fed.
Cir. 2020) (citing Cloer, 654 F.3d at 1325) (“The Vaccine Act is a pro-claimant regime meant to
allow injured individuals a fair and fast path to compensation . . . .”).
The Vaccine Act grants jurisdiction to the Court of Federal Claims and the Office of
Special Masters “over proceedings to determine if a petitioner . . . is entitled to compensation under
the Program” for vaccine-related injuries or deaths and the amount of compensation owed. 42
U.S.C. § 300aa–12(a). Petitions alleging injuries are initially reviewed by a Special Master, who
issues a decision on the petition. Bruesewitz v. Wyeth LLC, 562 U.S. 223, 228 (2011) (citing 42
U.S.C. §§ 300aa–11(a)(1), 300aa−12(d)(3)). To obtain compensation under the Vaccine Act, a
petitioner must prove that a vaccine caused an injury. Althen v. Sec’y of Health & Hum. Servs.,
418 F.3d 1274, 1278 (Fed. Cir. 2005). There are two ways for a petitioner to do this: (1) by proving
that he suffered a Table injury within the specified time window after vaccination—in which case,
causation is presumed (a Table claim), or (2) by proving causation-in-fact (an off-Table claim).
de Bazan, 539 F.3d at 1351.
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Table claims are based on “a statutorily-prescribed presumption of causation” created by
the Vaccine Injury Table. Althen, 418 F.3d at 1278; 42 U.S.C. § 300aa-14(a) (Vaccine Injury
Table); 42 CFR § 100.3 (current Vaccine Injury Table). The Table identifies vaccines covered
under the Vaccine Act, compensable injuries, and how soon after vaccination the first symptom or
manifestation of onset must occur for purposes of receiving compensation. Bruesewitz, 562 U.S.
at 228. If a petitioner can prove by a preponderance of the evidence that his injury meets the
criteria in the Table,12 he has successfully made a Table claim and is “prima facie entitled to
compensation.” Id.; de Bazan, 539 F.3d at 1351. In other words, “[b]ring the case within the
timetable and specifications of a Table Injury and the statute does the heavy lifting—causation is
conclusively presumed.” Hodges, 9 F.3d at 961. The Vaccine Act includes qualifications and aids
to interpretation (QAIs) which “shall apply to the Vaccine Injury Table.” 42 U.S.C. § 300aa–
14(b); 42 C.F.R. § 100.3(c); see Sharpe v. Sec’y of Health & Hum. Servs., 964 F.3d 1072, 1078
(Fed. Cir. 2020) (noting that for a significant aggravation Table claim, the petitioner “had to
demonstrate” that she experienced her alleged injury “as defined in the QAI promulgated by
HHS”); Terran v. Sec’y of Health & Hum. Servs., 195 F.3d 1302, 1307–08 (Fed. Cir. 1999)
(explaining that the Table is to be “read in conjunction with” the QAIs, which “provide[]
explanations and definitions for terms used in the [] Table”). For example, and as relevant here,
GBS is a Table injury for the flu vaccine when experienced within 3–42 days of vaccination. 42
CFR § 100.3(a)(XIV)(D); see also Hinton, 2025 WL 763153, at *1 n.1 (“The flu vaccine is listed
12 Specifically, in a Table injury case, a petitioner must demonstrate that he meets five criteria: (1)
he received a Table vaccine, see 42 U.S.C § 300aa-11(c)(1)(A); (2) he received the vaccine in the
United States or meets a limited exception, see id. § 300aa-11(c)(1)(B); (3) he either suffered a
Table injury or died, see id. § 300aa-11(c)(1)(C); (4) he suffered the “residual effects or
complications” from such injury for more than six months or that such injury led to “inpatient
hospitalization and surgical intervention,” see id. § 300aa-11(c)(1)(D); and (5) he has not already
collected civil damages via award or settlement for such injury, see id. § 300aa-11(c)(1)(E).
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in the Vaccine Injury Table as known to cause GBS.”). The QAIs describe GBS as “an acute
monophasic peripheral neuropathy,” and state that a GBS diagnosis requires, among other things,
“[a] monophasic illness pattern,” and an “interval between onset and nadir of weakness between
12 hours and 28 days,” followed by a “[s]ubsequent clinical plateau” leading to “stabilization at
the nadir of symptoms, or subsequent improvement without significant relapse.” 42 CFR
§ 100.3(c)(15)(i)−(ii).
Alternatively, where the petitioner alleges an off-Table claim—i.e., claims an injury not
listed in the Vaccine Injury Table, or which first appears outside of the time limits set by the
Table—“the heavy lifting must be done by the petitioner” to prove causation-in-fact. 42 U.S.C.
§ 300aa-11(c)(1)(C)(ii); Hodges, 9 F.3d at 961; Althen, 418 F.3d at 1278. This burden “is heavy
indeed.” Hodges, 9 F.3d at 961. To prove causation for such an off-Table claim, a petitioner must
prove by a preponderance of the evidence that his vaccine was “not only a but-for cause of the
injury but also a substantial factor in bringing about the injury.” Shyface v. Sec’y of Health &
Hum. Servs., 165 F.3d 1344, 1352 (Fed. Cir. 1999). To make this showing, a petitioner must prove
each of the three Althen prongs by a preponderance of the evidence:
(1) a medical theory causally connecting the vaccination and the injury;
(2) a logical sequence of cause and effect showing that the vaccination was the reason
for the injury; and
(3) a showing of a proximate temporal relationship between vaccination and injury.
Althen, 418 F.3d at 1278; Boatmon v. Sec’y of Health & Hum. Servs., 941 F.3d 1351, 1354–55
(Fed. Cir. 2019) (quoting Moberly v. Sec’y of Health & Hum. Servs., 592 F.3d 1315, 1321–22
(Fed. Cir. 2010)); Oliver v. Sec’y of Health & Hum. Servs., 900 F.3d 1357, 1361 (Fed. Cir. 2018)
(quoting Althen, 418 F.3d at 1278); see also Henkel v. Sec’y of Health & Hum. Servs., No. 23-
1894, 2024 WL 3873569, at *1 (Fed. Cir. Aug. 20, 2024) (“Because we conclude that the special
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master’s finding on Althen prong three was not arbitrary or capricious . . . and because Appellants
needed to prevail on all three prongs to have their petition granted, we affirm the petition’s denial
without reaching the prong-two finding.”).
“Once a petitioner establishes a prima facie case, the government then bears the burden of
establishing alternative causation by a preponderance of the evidence.” Cedillo, 617 F.3d at 1335
(citing Walther v. Sec’y of Health & Hum. Servs., 485 F.3d 1146, 1151 (Fed. Cir. 2007)). After
such a burden shift, the respondent must demonstrate by a preponderance of the evidence that the
injury described in the petition was caused by factors unrelated to the administration of the vaccine
described in the petition. 42 U.S.C. § 300aa–13(a)(1)(B); Althen, 418 F.3d at 1278 (citing Knudsen
v. Sec’y of Health & Hum. Servs., 35 F.3d 543, 547 (Fed. Cir. 1994)). However, if the petitioner
fails to establish a prima facie case, the burden does not shift to the respondent. See Doe v. Sec’y
of Health & Hum. Servs., 601 F.3d 1349, 1358 (Fed. Cir. 2010). Regardless of whether the burden
shifts, the special master may consider evidence of alternative causation presented by the
respondent in determining whether the petitioner has established a prima facie case, as the special
master is to consider the record as a whole in determining causation where multiple possible
sources of injury may exist. de Bazan, 539 F.3d at 1353; Stone v. Sec’y of Health & Hum. Servs.,
676 F.3d 1373, 1379–80 (Fed. Cir. 2012).
Here, Petitioner raises two objections to the Chief Special Master’s Decision.13 Mot. at 1–
2. First, he argues that the Chief Special Master’s determination that the onset of Petitioner’s
13 Petitioner’s GBS diagnosis is not disputed. Resp. Rule 4(c) Report at 12 (“Respondent agrees
that the diagnosis of GBS in petitioner is medically sound . . . .”); ECF No. 28 at 6 (“The diagnosis
of GBS is not in dispute in this case.”). Although Petitioner makes passing references to concerns
about the procedures the Chief Special Master followed in this case, Petitioner has waived any
such argument as he failed to expressly raise such a procedural argument in his Motion. MFR
Mem. at 7, 14–15 & n.2, 19; SmithKline Beecham Corp. v. Apotex Corp., 439 F.3d 1312, 1319
(Fed. Cir. 2006) (“Our law is well established that arguments not raised in the opening brief are
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symptoms occurred on January 5, 2018—outside of the 3–42-day window required by the Table—
was arbitrary and capricious.14 Id. at 1. Second, Petitioner argues that the Chief Special Master’s
conclusion that Petitioner has not established a Table claim or an off-Table causation-in-fact claim
was arbitrary and capricious. Id. at 2.
While this Court greatly empathizes with Petitioner, it is nevertheless bound by—and must
dutifully apply—the law. Having considered the medical records, medical literature, and affidavits
in the record and applicable law, for the reasons explained below, this Court rejects both of
Petitioner’s objections and holds that the Chief Special Master’s conclusions were not arbitrary or
capricious. Particularly “[g]iven the exacting ‘arbitrary and capricious’ standard of review that
applies to factual findings in Vaccine Act cases, [the Court] accept[s] the special master’s weighing
waived.”); Hodge ex rel. Elson v. Sec’y of Health & Hum. Servs., 168 Fed. Cl. 117, 129 n.13 (2023)
(“Because petitioner did not explicitly raise such an argument, she has waived it.”); Miller v. Sec’y
of Health & Hum. Servs., 172 Fed. Cl. 762, 779 (2024) (concluding that the petitioner waived her
challenge to a specific finding of the special master, where she “failed to state it as an objection or
adequately raise it in her Motion for Review or Memorandum of Objections”); see also Vaccine
Rule 24 (requiring that a motion for review of a special master’s decision must “be accompanied
by a memorandum of numbered objections to the decision” which “fully and specifically state[s]
and support[s] each objection” to the special master’s decision). Additionally, in his supporting
Memorandum, Petitioner states that “it is error of law to state that Petitioner ‘failed to meet his
burden’ here.” MFR Mem. at 7. However, in his Motion, Petitioner objects to the Decision on
the basis that two of the Chief Special Master’s conclusions were arbitrary and capricious. In any
event, resolving the objections Petitioner raises “entails primarily . . . factual work.” Echols v.
Sec’y of Health & Hum. Servs., 165 Fed. Cl. 9, 16 (2023) (quoting U.S. Bank Nat. Ass’n ex rel.
CWCapital Asset Mgmt. LLC v. Vill. at Lakeridge, LLC, 138 S. Ct. 960, 967 (2018)). Accordingly,
the Court reviews the Chief Special Master’s conclusions—which are factual in nature—under the
arbitrary and capricious standard. Munn, 970 F.2d at 870 & n.10 (“Fact findings are reviewed by
[the Federal Circuit], as by the [Court of Federal Claims], under the arbitrary and capricious
standard . . . .”).
14 Petitioner received the flu vaccine on November 1, 2017. Decision at 1; see also Pet. Ex. 3 at
2174−75. Thus, to satisfy the timing requirement of the Table, Petitioner’s GBS symptoms must
have first occurred sometime on November 4, 2017 through December 13, 2017.
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of the evidence in this case.” Hinton, 2025 WL 763153, at *5 (quotations and first alteration in
original) (quoting Lampe, 219 F.3d at 1362). The Chief Special Master’s Decision is sustained.
I. The Chief Special Master’s Onset Determination Was Not Arbitrary or Capricious.
Petitioner argues that he provided “clear evidence”—in the form of affidavits and medical
records—that the onset of his GBS symptoms occurred within the 3–42-day window required to
assert a Table injury. MFR Mem. at 10. Therefore, Petitioner contends, the Chief Special Master’s
conclusion that Petitioner’s onset occurred outside of the Table timeframe is arbitrary and
capricious. Id. at 8–14. Respondent counters that the Chief Special Master “properly considered
the relevant medical records, drew reasonable inferences, and rationally explained that the
contemporaneous medical records preponderantly establish that the initial symptoms of
petitioner’s GBS occurred on January 5, 2018, sixty-five days after his vaccination.” Resp. at 13.
As explained more fully below, the Court concludes that the Chief Special Master’s onset
determination was not arbitrary or capricious, as he “considered the relevant evidence of record,
dr[ew] plausible inferences and articulated a rational basis” in support of his conclusion that
Petitioner’s symptoms first occurred on January 5, 2018. Kirby, 997 F.3d at 1381 (quoting Lampe,
219 F.3d at 1360). Nothing in the Chief Special Master’s Decision suggests that he failed to
“consider[] the relevant evidence of record.” Hines, 940 F.2d at 1528. On the contrary, the Chief
Special Master affirmatively indicated that “the complete record was reviewed and considered.”15
Decision at 9 n.4. His findings of fact, which provide a detailed summary of the evidence, and his
analysis, which addresses all of the symptoms Petitioner claims mark an earlier onset, make clear
that he did so. Id. at 2–7, 9–12. As explained further below, the Chief Special Master considered
15 Indeed, even absent such an affirmative statement, under Federal Circuit precedent, “[w]e
generally presume that a special master considered the relevant record evidence even though he
does not explicitly reference such evidence in his decision.” Moriarty v. Sec’y of Health & Hum.
Servs., 844 F.3d 1322, 1328 (Fed. Cir. 2016).
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Petitioner’s affidavit evidence, drew plausible inferences, articulated a rational basis for his
conclusions, and did not ignore in Petitioner’s medical records symptoms occurring within 3–42
days of vaccination.
A. The Chief Special Master Considered Petitioner’s Affidavit Evidence, and
Drew “Plausible Inferences and Articulated a Rational Basis” for His
Conclusions.
Petitioner argues that both his affidavit and Mr. Edelman’s affidavit place the onset of his
GBS within the 3–42-day Table timeframe. MFR Mem. at 10, 12. The Decision, however, reflects
that the Chief Special Master considered, appropriately weighed, and “dr[ew] plausible inferences
and articulated a rational basis” for his conclusion that the affidavits submitted by Petitioner and
Mr. Edelman did not provide the necessary support to prove onset before January 5, 2018. Kirby,
997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360).
First, the Chief Special Master considered the statements in Petitioner’s affidavit and
“articulated a rational basis” for concluding that they do not provide the necessary support for a
successful Table claim. Id.; see MFR Mem. at 10 (citing Kindle Aff. ¶¶ 5, 6) (“Mr. Kindle explains
that within a few days after the shot, he did not feel well. This continued, and within a few weeks,
Mr. Kindle was feeling pain in his lower back and pain in his legs. He continued to get sick. Mr.
Kindle’s symptoms got worse, and he developed new symptoms.” (internal citations omitted)).
The Chief Special Master reasoned that Petitioner’s statement that he did not feel well within a
few days of receiving the vaccine was “far too vague” to support Petitioner’s claim. Decision at
10. Specifically, the Chief Special Master explained that it was unclear what symptoms Petitioner
experienced and precisely when he experienced those symptoms. Id. The Chief Special Master
supported his analysis of Petitioner’s affidavit with evidence in Petitioner’s medical records. Id.
Six days after receiving the vaccine, Petitioner had an appointment related to his gout, but “did not
mention anything in association to the vaccination he had recently received.” Id.; see also Pet. Ex.
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3 at 2169−73 (records from that appointment). It was reasonable for the Chief Special Master to
infer that Petitioner likely would have mentioned generalized complaints of “not feeling well”
when he saw his rheumatologist shortly after receiving the vaccine—particularly in view of the
thoroughness of the examination Petitioner appears to have undergone in that appointment. See
Pet. Ex. 3 at 2171; see also Kirby, 997 F.3d at 1383 (quoting Fed. R. Evid. 803 advisory
committee’s note to 1975 enactment) (explaining that medical records are not presumed to be
accurate and complete, but patients nevertheless have a “strong motivation to be truthful” to their
doctors). In sum, the Chief Special Master “articulated a rational basis” for his conclusion
regarding Petitioner’s affidavit, based on logical inferences and Petitioner’s own medical records.
Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360).
Second, as with Petitioner’s own affidavit, the Chief Special Master “articulated a rational
basis” for declining to give Mr. Edelman’s statements weight. Id.; Decision at 10. Mr. Edelman
stated that he started to notice issues with Petitioner in early December 2017, including coughing,
sweating, urinary issues, appetite issues, weakness, trouble standing, and trouble walking.
Edelman Aff. ¶¶ 3, 5−7. The Chief Special Master observed that Mr. Edelman’s affidavit was
temporally vague, as Mr. Edelman was “unable to provide specific dates, or even a range of
potential dates” that Petitioner had stayed in his home. Decision at 10. The Chief Special Master
also reasoned that, although Mr. Edelman noted that Petitioner was coughing around Christmas
(which aligned with Petitioner’s medical records), the onset of Petitioner’s cough was around
Christmas day—“almost two weeks after the 42-day timeframe window for manifestation of GBS
symptoms would have closed.” Id. (emphasis in original). Further, the Chief Special Master noted
that “respiratory symptoms do not reflect the kind of neurologic concerns that would stand as
GBS’s onset.” Id.
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Although Mr. Edelman’s statement that Petitioner “started to notice issues in early
December of 2017,” including weakness and trouble standing and walking, arguably could provide
some support for Petitioner’s claim, the broad discretion to weigh evidence is “within the purview
of [the special master as] the fact finder.” Porter, 663 F.3d at 1249; see R.J. ex rel. W.J. v. Sec’y
of Health & Hum. Servs., 93 F.4th 1228, 1235 (Fed. Cir. 2024) (“It is within a special master’s
discretion to weigh evidence.”); see also Munn, 970 F.2d at 869 (noting that this Court plays “the
role of a reviewing judge” in cases brought under the Vaccine Act). In view of the record as a
whole, the Chief Special Master concluded that Mr. Edelman’s statement did not provide the
necessary support for Petitioner’s claim.
Reversible error is “extremely difficult to demonstrate” where, as here, the special master
has “considered the relevant evidence of record, drawn plausible inferences and articulated a
rational basis for the decision.” Hines, 940 F.2d at 1528. Here, the Chief Special Master clearly
did so. The Chief Special Master reasoned that Petitioner’s evidence of an earlier onset as a
whole—which included this statement by Mr. Edelman—demonstrated that Petitioner’s earlier
symptoms were “either unrelated to his GBS” or “reflect pre-vaccination conditions.” Decision at
12. It was plausible for the Chief Special Master to infer that the weakness Mr. Edelman noticed
in early December 2017 was unrelated to Petitioner’s GBS, given Petitioner’s history of numerous,
significant medical issues. Id. at 2 (citing Pet. Ex. 3 at 391, 1054, 1218, 2179) (“Petitioner’s prior
history includes chronic kidney disease, hypertension, suspected hypertrophic cardiomyopathy,
hypothyroidism, obesity, obstructive sleep apnea, gout, and septic arthritis of his right knee.”); see
also id. at 4 (citing Pet. Ex. 3 at 2124) (noting that Petitioner had not been taking his thyroid
medication and that an attending nurse attributed his complaints of weakness in January to
Petitioner’s failure to take his medication); Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d
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1525, 1528 (Fed. Cir. 1993) (“Medical records, in general, warrant consideration as trustworthy
evidence.”); Rogero v. Sec’y of Health & Hum. Servs., 748 F. App’x 996, 1001 (Fed. Cir. 2018)
(“Determinations of relative weight of different evidence are generally for the trier of fact.”).
In sum, the Chief Special Master considered Petitioner’s affidavit evidence, but articulated
rational bases—grounded in logical inferences and record evidence—to conclude that this
evidence did not indicate symptom onset during the time period provided by the Table.16
B. The Chief Special Master Did Not Ignore Evidence of GBS Symptoms
Occurring Within 3–42 Days of Vaccination in Petitioner’s Medical Records.
Petitioner next contends that the Chief Special Master ignored evidence in Petitioner’s
medical records supporting onset during the Table timeframe. MFR Mem. at 12 (citing Decision
at 9−10). After a review of the record, the Court concludes the Chief Special Master considered
the symptoms Petitioner claims were ignored and “articulated a rational basis” for concluding that
they were not evidence of GBS. Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360).
As an initial mater, although Petitioner argues that the Chief Special Master “ignore[d] the
additional evidence provided by the medical chart,” in his Motion, Petitioner cites specific pages
of the Decision in which the Chief Special Master addressed each of these symptoms. See MFR
Mem. at 12–14 (citing Decision at 9–11). Further, when addressing Petitioner’s evidence of an
earlier onset generally, the Chief Special Master reasoned that “Petitioner’s assertions about an
earlier onset . . . would describe a GBS course wholly inconsistent with what is known about the
illness”—specifically referencing the fact that “in the vast majority of cases” the disease is “acute
16 The Court also notes that both affidavits were signed years after the initial onset of Petitioner’s
GBS. See Kindle Aff. at 3 (signature dated October 19, 2020); Edelman Aff. at 2 (signature dated
August 1, 2022); Perkins v. Sec’y of Health & Hum. Servs., No. 17-487V, 2021 WL 4877825, at
*8 (Fed. Cl. Aug. 27, 2021) (sustaining a special master’s decision which found “contemporaneous
medical records more reliable [than affidavits and testimony] because of the risk of confusion
when witnesses were recalling events from four years prior”).
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and monophasic.” Decision at 11 (citing Chinea, 2019 WL 1873322, at *31, 33). This is precisely
the kind of finding that warrants deference, given special masters’ “accumulated expertise”
regarding vaccines and associated injuries. Hodges, 9 F.3d at 961; see also Munn, 970 F.2d at 871
(“It is, after all, the special masters to whom Congress has accorded the status of expert, entitling
them to the special statutory deference in fact-finding normally reserved for specialized
agencies.”). Further, this understanding of GBS as “acute and monophasic” comports with the
statutory definition of GBS under the Vaccine Act. 42 C.F.R. § 100.3(c)(15)(i), (ii) (defining GBS
as an “acute monophasic peripheral neuropathy” and noting that a GBS diagnosis requires “[a]
monophasic illness pattern”). It is also well-documented in Petitioner’s own medical records. See
Pet. Ex. 3 at 153 (“We again discussed that AIDP is a monophasic illness and that his active disease
occurred in January . . . .”); id. at 1439 (“[H]is illness is consistent with AIDP variant of GBS,
which is a monophosic [sic] illness.”). As explained further below, the Chief Special Master fully
considered each of the symptoms that Petitioner contends evidenced an earlier onset of his GBS—
(1) eye symptoms, (2) dizziness, and (3) back pain—and provided a reasonable explanation as to
why they were insufficient to support a Table claim.
1. Eye Symptoms
As noted in the Chief Special Master’s Decision, the only encounter Petitioner had with a
medical professional within 3–42 days of vaccination, other than the November 7, 2017
rheumatology appointment referenced above and call to a nurse that same day to request a
consultation for “recurrent conjunctivitis,”17 was Petitioner’s visit to the Dallas VA to request an
17 Petitioner’s medical records also note that in November, the radiology department
unsuccessfully attempted to contact Petitioner regarding scheduling an ultrasound appointment
ordered by one of his doctors, and that, also in November, a nurse unsuccessfully attempted to
contact Petitioner. Pet. Ex. 3 at 2164−65. Additionally, Petitioner spoke to a research coordinator
and physician that month to confirm his withdrawal in a gout study. Id. at 2163; see supra
Background § I.A.1. These records are not pertinent to Petitioner’s arguments.
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ophthalmology consultation on December 13, 2017. Decision at 10; Pet. Ex. 3 at 2169−73 (records
from rheumatology appointment); Pet. Ex. 3 at 2173 (noting Petitioner’s November 7, 2017
request for an ophthalmology consultation for “recurrent conjunctivitis” which, according to
Petitioner, he had discussed with Dr. Wixtrom “a few days ago”); Pet. Ex. 3 at 2159−83 (medical
records from November 1, 2017 (vaccination date) to December 13, 2017 (Table timeframe end
date)). Petitioner argues that his report of “chronic eye pain” during that call (which took place on
the last day within the Table timeframe) and records from his December 21, 2017 appointment,
which note that Petitioner experienced double vision and “[o]cular motility: orthotropia with full
ductions and versions OU,” suggest that his GBS onset occurred within the Table timeframe. MFR
Mem. at 10–13; Pet. Ex. 3 at 2152.18 Petitioner contends that pain and difficulty controlling eye
movement can be symptoms of GBS, but concedes—as he must—that the symptom reported on
December 21, 2017 occurred more than 42 days post-vaccination.19 MFR Mem. at 13 (citing Yale
Medicine at 2).
The Chief Special Master considered Petitioner’s eye symptoms and “articulated a rational
basis” for concluding that they did not indicate that Petitioner’s GBS onset occurred within the
Table timeframe. Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360). Indeed, it is evident
on the face of the Decision that the Chief Special Master considered Petitioner’s eye symptoms.
18 Records from the December 21, 2017 appointment note “[t]ransient (sev minutes) horiz diplopia
resolved completely by unilat occlusion, yesterday, first episode”; “[o]cular motility: orthotropia
with full ductions and versions OU”; and “acute transient diplopia.” Pet. Ex. 3 at 2151–52. As
noted, “motility” can mean “spontaneous but unconscious or involuntary movement,” but also
refers generally to the “condition of being capable of movement.” See supra note 4.
19 Specifically, Petitioner’s medical records indicate that he experienced the onset of horizontal
diplopia beginning on December 20, 2017—49 days post-vaccination, and a week after the Table
timeframe had closed. See Pet. Ex. 3 at 2151.
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Decision at 2–3, 8, 10, 11. The Chief Special Master made the broader point that GBS “is not
known to present with bouts of eye or audiological issues prior to neurological symptoms, and
which subsequently remain subacute for weeks or months.” Id. at 11 (citing Chinea, 2019 WL
1873322, at *31, 33). This conclusion was also supported by Petitioner’s medical literature, which
notes that “[w]eakness and tingling in your hands and feet are usually the first symptoms” of GBS.
Mayo Clinic at 1. The Chief Special Master further noted that Petitioner’s medical records reflect
“that Petitioner had been dealing with ‘stringy mucous discharge’ since the 1970s—a preexisting
condition as opposed to something new.” Decision at 10 (quoting Pet. Ex. 3 at 2151); see also Pet.
Ex. 4 at 314–16 (noting that Petitioner suffered “[o]rbit trauma in service” and “has had mucus/eye
irritation for decades”).20 These findings and records ultimately supported the Chief Special
Master’s conclusion that Petitioner’s earlier symptoms (including, but not limited to, his chronic
eye pain, double vision, and any difficulty controlling eye movement) were “either unrelated to
his GBS, or reflect pre-vaccination conditions.” Decision at 12.
Petitioner also contends that the Chief Special Master’s reference to the fact that “Petitioner
himself related his [eye] symptoms to conjunctivitis” is improper, because “Petitioner is not a
medical professional” and “it is normal for individuals giving a personal history to physicians to
bring up previous stories from their past medical history.” MFR Mem. at 12−13 (citing Decision
at 10). But this line of reasoning was supplemental, and not critical to, the Chief Special Master’s
analysis, which relied primarily on Petitioner’s medical records evincing a history of eye-related
problems. See Decision at 10−11 (citing Pet. Ex. 3 at 2151). Thus, any error in the Chief Special
20 “Orbit trauma” is shorthand for orbital trauma, which refers to an injury to the eye socket. See
Orbit, Mosby’s Medical Dictionary (10th ed. 2017) (defining orbit as “one of a pair of bony,
conical cavities in the skull that accommodate the eyeballs and associated structures”).
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Master’s reasoning was harmless.21 Hines, 940 F.2d at 1526 (finding harmless error where “the
special master’s decision was based on a number of factors and [petitioner had] not shown that
reliance on the . . . [contested issue] was likely critical to the result”).
In sum, the Chief Special Master considered Petitioner’s eye symptoms and reasonably
found them not to be evidence of an earlier onset of his GBS, in view of Petitioner’s history of
eye-related ailments and because GBS is not known to present with eye issues prior to neurological
issues. Decision at 10−11. It is therefore clear that the Chief Special Master “articulated a rational
basis” for his conclusion. Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360).
2. Dizziness
Petitioner also argues that his report of “continued dizziness when standing/standing up to
walk” in a December 19, 2017 audiology consultation indicates GBS symptom onset within the
Table timeframe. MFR Mem. at 11 (emphasis omitted) (quoting Pet. Ex. 3 at 2158) (“Since the
records state ‘continued dizziness,’ then this symptom manifested before December 19, 2017.”);
id. at 14 (citing Mayo Clinic); Pet. Ex. 3 at 2158 (“Veteran has limited to no concerns regarding
21 The Court notes that the Chief Special Master’s statement that “Petitioner himself related his
[eye] symptoms to conjunctivitis” appears to refer to the “Assessment” portion of the records from
Petitioner’s December 21, 2017 appointment, which restates Petitioner’s history of eye-related
problems. Decision at 10; Pet. Ex. 3 at 2151; see supra note 5. Specifically, under an entry
entitled, “Meibomian gland dysfunction” the Assessment states: “1/7/15: He also believes that he
needs a conjunctival culture because around 10/2014 he took some amoxicillin for a UTI and also
happened to have some relief of his eye symptoms.” Pet. Ex. 3 at 2152. The Chief Special Master
appears to have understood this to reference a contemporaneous statement made by Petitioner.
Whether the statement was made in the past or contemporaneously in Petitioner’s appointment, it
supports the Chief Special Master’s conclusion that Petitioner’s eye symptoms were not GBS-
related. The Chief Special Master found Petitioner’s reference to his conjunctivitis significant, not
because it was an accurate self-diagnosis—but instead because it indicated that Petitioner had a
history of eye-related complications. Decision at 2−3 (citing Pet. Ex. 3 at 2151), 10, 11. As
explained above, Petitioner’s history of eye-related complications is well-documented in the
record.
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changes in hearing since last evaluation, but notes continued dizziness when standing/standing up
to walk.”).
After a review of the Decision and record, the Court concludes that the Chief Special
Master appropriately found Petitioner’s contention with respect to his dizziness “unpersuasive,”
given the acute and monophasic nature of GBS. See Decision at 11. The Chief Special Master
expressly considered Petitioner’s reported dizziness. Id. at 3, 10–11. And it was reasonable for
the Chief Special Master to not be persuaded by this fact. It does not necessarily follow from a
December 19, 2017 report of “continued dizziness when standing/standing up to walk” that
Petitioner experienced dizziness sometime between November 4, 2017 and December 13, 2017,
as required by the Table. Read in context, “continued” could simply mean that Petitioner
experienced prolonged dizziness after standing up; the records are not clear on what days Petitioner
experienced that dizziness. Further, given Petitioner’s acute manifestation of GBS symptoms in
early January and contemporaneous medical records supporting that the reported dizziness was
not GBS-related, the Chief Special Master could reasonably infer that Petitioner’s dizziness was
unrelated to his GBS. See id. at 11 (citing Chinea, 2019 WL 1873322, at *31, 33) (reasoning that
GBS “is not known to present with bouts of eye or audiological issues prior to neurological
symptoms, and which subsequently remain subacute for weeks or months”); see also Pet. Ex. 3 at
2188−89 (Petitioner reporting “occasional orthostatic dizziness”22—dizziness when standing up—
roughly a month prior to vaccine administration); Pet. Ex. 3 at 2202−03 (noting Petitioner’s
complaint of “weakness in his legs and vertigo as well as fatigue” on September 15, 2017); Pet.
Ex. 3 at 2178−79 (noting Petitioner’s prior history of vertigo). The Mayo Clinic article Petitioner
22 “Orthostatic” means “pertaining to an erect or standing position.” Orthostatic, Mosby’s Medical
Dictionary (10th ed. 2017).
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cites does not undermine the reasonableness of this conclusion. See MFR Mem. at 14 (citing Mayo
Clinic). Although Petitioner correctly notes that the article lists “rapid heart rate” and “[l]ow or
high blood pressure” as symptoms of GBS, the article states that “weakness” and “tingling in [the
patient’s] hands and feet are usually the first symptoms” of GBS—not dizziness. Mayo Clinic at
1–3; see MFR Mem. at 14 (citing Mayo Clinic).
In sum, the Chief Special Master considered Petitioner’s complaint of dizziness and
reasonably relied on “what is known” about GBS, to conclude that Petitioner’s dizziness did not
indicate GBS onset within the Table timeframe. Decision at 11. The Court therefore accepts the
Chief Special Master’s weighing of the evidence in this respect. Hinton, 2025 WL 763153, at *5
(quoting Lampe, 219 F.3d at 1362).
3. Back Pain
Petitioner next contends that his December 20, 2017 medical records reflecting lower back
pain and pain in his legs “with an inciting even[t] that occurred 10 days ago,” along with records
stating that he experienced back pain “as early as mid-December,” indicate a GBS onset within
the Table timeframe. MFR Mem. at 11–12 (first quoting Pet. Ex. 3 at 2156; and then citing Pet.
Ex. 3 at 2023–24) (alteration added and emphasis omitted).
The Chief Special Master considered Petitioner’s lower back pain and “articulated a
rational basis” for his conclusion that it did not mark the onset of Petitioner’s GBS. Kirby, 997
F.3d at 1381 (quoting Lampe, 219 F.3d at 1360). Specifically, the Chief Special Master provided
three reasons supporting his conclusion: (1) Petitioner himself believed that bending over in the
shower caused his pain; (2) Petitioner’s doctor assessed the back pain as a “sprain/strain” that first
occurred 10 days prior; and (3) Petitioner had a longstanding history of back pain. Decision at 11.
These rationales are well-documented in the medical records. Id. at 3 (citing Pet. Ex. 3 at 2153
(“Resently [sic] the paitent [sic] leaned over in shower and got pain accross [sic] his whole lower
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back. He didn’t feel any big issues after this.”)); id. (citing Pet. Ex. 3 at 2156 (noting that Petitioner
had back pain “with an inciting even[t] that occurred 10 days ago” which “is most likely due to a
sprain/strain”)); see also Pet. Ex. 3 at 2158 (“Exam consistent with DDD [degenerative disc
disease] and recent onset of lumbar sprain/strain[.]”); Pet. Ex. 3 at 2153 (noting onset of back
problems in 1966 and that Petitioner “jumped from 35 ft up” when he was in the Marine Corps).
As the Chief Special Master noted, Petitioner’s history of back pain “was significant enough that
an MRI was performed on his back in 2016,” and Petitioner’s back pain was one of the reasons he
saw his PCP on November 1, 2017—the appointment in which Petitioner received the flu vaccine.
Decision at 2 (citing Pet. Ex. 3 at 2180); id. at 11; Pet. Ex. 3 at 2101, 2105. Thus, the Chief Special
Master considered Petitioner’s back pain and articulated a rational basis—founded upon evidence
in Petitioner’s medical records—for his conclusion that Petitioner’s back pain was not related to
his GBS.
That the onset of this back pain occurred within the Table timeframe—specifically on
December 10, 2017, does not assist Petitioner’s claim here. See MFR Mem. at 11 (citing Pet. Ex.
3 at 2156) (“It is important to note that the assessment states “chronic lower back pain with an
inciting even[t] that occurred 10 days ago.” (alteration added and emphasis omitted)). The crux
of the Chief Special Master’s reasoning was not that Petitioner did not experience any back pain
during the Table timeframe. On the contrary, the Chief Special Master recognized that Petitioner
experienced such symptoms and, considering Petitioner’s medical records as a whole, reasonably
attributed them to something other than GBS based on Petitioner’s medical history and the
statements of his treating physicians. Decision at 11 (first citing Pet. Ex. 3 at 2156; and then citing
Pet. Ex. 3 at 2180). For this same reason, Petitioner’s argument that “the scope of his pain is
extensive as the records state ‘across the whole back and now going down the left side of the leg
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to just above the knee on the posterior side’” is unavailing. MFR Mem. at 11 (quoting Pet. Ex. 3
at 2153).
Petitioner references a case study concluding that “low back pain is a common symptom
of GBS,” which can delay diagnosis when it presents as an early symptom of GBS—particularly
when it does not present with the characteristic muscle weakness. Id. at 14 (quoting Ding)
(emphasis omitted). However, as the Chief Special Master noted, Petitioner had a long history of
back pain, and Petitioner’s treating physician associated his back pain with a sprain or strain.
Decision at 11; Pet. Ex. 3 at 2156−58 (“Lower back pain due to sprain/strain”); Pet. Ex. 3 at 2158
(“Exam consistent with DDD [degenerative disc disease] and recent onset of lumbar
sprain/strain[.]”); Pet. Ex. 3 at 2153 (“In marine corp [sic] he jumped from 35 ft up. At that time
he felt a dullness in his back.”); Pet. Ex. 3 at 2153 (“ONSET: first event 1966”); Cucuras, 993
F.2d at 1528 (“Medical records, in general, warrant consideration as trustworthy evidence.”).
Thus, the Chief Special Master weighed the evidence in the medical records against the evidence
in the medical literature and concluded that it was not preponderantly likely that Petitioner’s back
pain was GBS-related. The broad discretion to weigh evidence is “within the purview of [the
special master as] the fact finder.” Porter, 663 F.3d at 1249; see also R.J. ex rel. W.J., 93 F.4th at
1235 (“It is within a special master’s discretion to weigh evidence.”). Particularly in view of the
substantial medical evidence supporting that Petitioner’s back pain was unrelated to his GBS, the
Court declines to “‘second guess’ the special master’s fact-intensive conclusions that are ‘based
upon [his] accumulated expertise in the field.’” Hinton, 2025 WL 763153, at *2 (quoting Hodges,
9 F.3d at 961)).
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* * * * *
In sum, the evidence of symptoms Petitioner points to in the Table timeframe consists only
of Petitioner’s affidavits, his December 13, 2017 report of chronic eye pain (despite that Petitioner
had a history of eye-related issues), back pain “within an inciting even[t]” on December 10, 2017
(which his doctors attributed to a sprain, not GBS), and a suggestion that he may have experienced
dizziness within the Table timeframe. After a review of the record, the Chief Special Master
weighed this evidence, as is within his discretion, drew plausible inferences, and “articulated a
rational basis” for his conclusion that Petitioner’s GBS onset did not occur until January 5, 2018—
well after the Table timeframe closed. Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360);
R.J. ex rel. W.J., 93 F.4th at 1235. The record supports his conclusion. Pet Ex. 3 at 2151 (noting
that Petitioner complained of “stringy mucous discharge [in both eyes] since [the] 1970s”); id. at
2156−58 (attributing lower back pain to “sprain/strain”); id. at 2188−89 (Petitioner reporting
“occasional orthostatic dizziness” roughly a month prior to vaccine administration); id. at 2052
(Petitioner reporting on January 10, 2018, that “he was in his usual state of physical and
psychological health until ‘after Christmas’”). Whether another judge or special master would
have evaluated the evidence differently is of no moment; “the law is settled that neither the Court
of Federal Claims nor the Federal Circuit can substitute its judgment for that of the special master
merely because it might have reached a different conclusion.” Snyder v. Sec’y of Health & Hum.
Servs., 88 Fed. Cl. 706, 718 (2009); Broekelschen v. Sec’y of Health & Hum. Servs., 618 F.3d
1339, 1349 (Fed. Cir. 2010) (quoting Munn, 970 F.2d at 871) (“This court does not ‘reweigh the
factual evidence, or [ ] assess whether the special master correctly evaluated the evidence. And of
course we do not examine the probative value of the evidence or the credibility of the witnesses.
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These are all matters within the purview of the fact finder.’”). Accordingly, the Court finds that
the Chief Special Master’s onset determination was not arbitrary or capricious.
II. The Chief Special Master’s Conclusion That Petitioner Failed to Establish a Table or
Off-Table Claim Was Not Arbitrary or Capricious.
Petitioner contends that the Chief Special Master’s conclusion that Petitioner failed to meet
his burden to prove a Table or off-Table claim is arbitrary and capricious. Mot. at 2; MFR Mem.
at 14–20. The Court holds that the Chief Special Master properly determined that Petitioner did
not carry his burden of proving either his Table claim or his off-Table claim.
A. The Chief Special Master’s Conclusion that Petitioner Did Not Prove His
Table Claim Was Not Arbitrary or Capricious.
Petitioner’s Table claim rises and falls with the Chief Special Master’s onset determination,
as none of the other Table requirements are in dispute. See supra note 12; see generally Mot.;
MFR Mem.; Resp. Thus, for the same reasons the Court concluded above that the Chief Special
Master’s onset determination was not arbitrary and capricious, Petitioner’s argument with respect
to his Table claim fails.
B. The Chief Special Master’s Conclusion that Petitioner Did Not Prove His Off-
Table Claim Was Not Arbitrary or Capricious.
The Court also rejects Petitioner’s alternative argument that Mr. Kindle has proven a
causation-in-fact claim. MFR Mem. at 14. For the reasons explained below, the Chief Special
Master’s conclusion that Petitioner has not established causation-in-fact was not arbitrary or
capricious.
As noted, to prove causation-in-fact under the Vaccine Act for an off-Table claim, a
petitioner must prove by a preponderance of the evidence each of the three Althen prongs: (1) a
medical theory causally connecting the vaccination and the injury; (2) a logical sequence of cause
and effect showing that the vaccination was the reason for the injury; and (3) a showing of a
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proximate temporal relationship between vaccination and injury. Althen, 418 F.3d at 1278. In an
off-Table claim, “the heavy lifting must be done by the petitioner” to prove causation-in-fact, and
this burden is “heavy indeed.” Hodges, 9 F.3d at 961. Failure to prove any one of the Althen
prongs is dispositive. Oliver, 900 F.3d at 1361; Dobrydnev v. Sec’y of Health & Hum. Servs., 566
F. App’x 976, 980 (Fed. Cir. 2014) (“Because petitioners must meet their burden under all three
Althen factors to prevail, a failure to do so on any one of these factors is dispositive.”).
The Chief Special Master properly concluded that Petitioner had not proven his off-Table
claim because the nine-week delay from Petitioner’s vaccination to his symptom onset “is too
lengthy to be considered ‘medically acceptable to infer causation-in-fact.’” Decision at 12
(quoting de Bazan, 539 F.3d at 1352). Relying on his “accumulated expertise in the field,” the
Chief Special Master reasoned that nine weeks exceeded “the longest timeframe (eight weeks)
generally accepted for a similar non-Table claim recognized in the [Vaccine] Program.” Id. at 12
(emphasis in original) (citing Barone, 2014 WL 6834557, at *13); Hodges, 9 F.3d at 961; see also
Hinton, 2025 WL 763153, at *2 (“The Vaccine Act makes clear that we do not ‘second guess’ the
special master’s fact-intensive conclusions that are ‘based upon [his] accumulated expertise in the
field.’” (quoting Hodges, 9 F.3d at 961)). The Chief Special Master ultimately concluded that
“Petitioner has not otherwise persuasively established circumstances in which such an unusually
lengthy post-vaccination onset could still be deemed medically acceptable – especially since
Petitioner’s earlier symptoms are either unrelated to his GBS, or reflect pre-vaccination
conditions.” Decision at 12. The upshot of the Chief Special Master’s analysis was that the nine-
week timeframe, taken together with “symptoms that have not convincingly been demonstrated to
be GBS-specific” was “simply too remote” to infer vaccine causation. Id.
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This conclusion was not arbitrary or capricious. It is well-established “that the proximate
temporal relationship prong requires preponderant proof that the onset of symptoms occurred
within a timeframe for which, given the medical understanding of the disorder’s etiology, it is
medically acceptable to infer causation-in-fact.” de Bazan, 539 F.3d at 1352. It was permissible
and reasonable for the Chief Special Master to rely on his own “accumulated expertise,” as well
as that of other special masters who have also declined to find more than an eight-week delay
between flu vaccination and GBS symptom onset supportive of an inference of causation. Hodges,
9 F.3d at 961 (“Congress assigned to a group of specialists, the Special Masters within the Court
of Federal Claims, the unenviable job of sorting through these painful cases and, based upon their
accumulated expertise in the field, judging the merits of the individual claims.”); Doe v. Sec’y of
Health & Hum. Servs., 76 Fed. Cl. 328, 338–39 (2007) (“One reason that proceedings are more
expeditious in the hands of special masters is that the special masters have the expertise and
experience to know the type of information that is most probative of a claim.”); Simeone v. Sec’y
of Health & Hum. Servs., No. 20-1375V, 2023 WL 5286292, at *7 n.7 (Fed. Cl. Spec. Mstr. Feb.
24, 2023), review denied, 167 Fed. Cl. 389 (2023) (noting that special masters would “be remiss
in ignoring prior cases presenting similar theories or factual circumstances, along with the
reasoning employed in reaching such decisions”); see also Barone, 2014 WL 6834557, at *13;
Aguayo v. Sec’y of Health & Hum. Servs., No. 12-563V, 2013 WL 441013, at *3–4 (Fed. Cl. Spec.
Mstr. Jan. 15, 2013); Corder v. Sec’y of Health & Hum. Servs., No. 08-228V, 2011 WL 2469736,
at *27–29 (Fed. Cl. Spec. Mstr. May 31, 2011); De La Cruz v. Sec’y of Health & Hum. Servs., No.
17-783V, 2018 WL 945834, at *1 (Fed. Cl. Spec. Mstr. Jan. 23, 2013); Chinea, 2019 WL 1873322,
at *29; but see Spayde v. Sec’y of Health & Hum. Servs., No. 16-1499V, 2021 WL 686682, at *18–
19 (Fed. Cl. Spec. Mstr. Jan. 27, 2021) (concluding that 60-day onset satisfied Althen prong
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three).23 As noted, this Court may not “‘second guess’ the special master’s fact-intensive
conclusions that are ‘based upon [his] accumulated expertise in the field.’” Hinton, 2025 WL
763153, at *2 (quoting Hodges, 9 F.3d at 961).
Further, the Chief Special Master did not rely solely on his “accumulated expertise” to
reach his conclusion. Hodges, 9 F.3d at 961. His conclusion was also supported by the record,
given that Petitioner did not file any medical literature supporting that an onset of vaccine-induced
GBS beyond the generally accepted eight-week timeframe was medically appropriate, and that
Petitioner’s treating neurologist posited a different possible cause of his GBS.24 Pet. Ex. 3 at 2048
23 The Court is not aware of any case in which a special master recognized an onset of longer than
60 days post-vaccination. See, e.g., Redzepagic v. Sec’y of Health & Hum. Servs., No. 19-853V,
2025 WL 1147520, at *16 (Fed. Cl. Spec. Mstr. Mar. 19, 2025) (“Decisions in the Vaccine
Program have gone out as far as two months or 60 days for vaccine-caused demyelinating
illness.”). The cases in which special masters have recognized a 60-day latency period involved
records readily distinguishable from the record here. In Spayde, the special master concluded that
prong three was satisfied even though January 12, 2014—the latest probable onset date—was
approximately 60 days after petitioner’s vaccination based on “persuasive testimony based on
medical literature” from the petitioner’s expert. Spayde, 2021 WL 686682, at *18–19 (“While 60
days is four days outside the generally accepted timeframe of eight weeks, it is exceedingly close,
and within a two-month calendar period.”); cf. Cooper v. Sec’y of Health & Hum. Servs., No. 18-
1885V, 2024 WL 1522331, at *18–20 (Fed. Cl. Spec. Mstr. Mar. 12, 2024) (concluding that onset
of GBS 60 days after Prevnar 13 vaccine satisfied Althen prong three). In Cooper, the special
master concluded that a 60-day onset satisfied prong three where petitioner framed his argument
based on “two seminal studies” directly analyzing the onset issue, expert opinions, and “the
admitting physician’s assessment of the vaccine as a pertinent risk factor.” Cooper, 2024 WL
1522331, at *18–20 (noting that 60-day onset is “on the very edge of the entirely undisputed eight-
week latency period”).
24 As described above, the Yale Medicine and Mayo Clinic articles both make several assertions
regarding timing, but none undermine the reasonableness of the Chief Special Master’s conclusion.
See supra Background § I.C. Specifically, the Yale Medicine article notes that “[s]ymptoms can
rapidly worsen in severity over hours or days and early treatment can considerably shorten the
course of the illness,” symptoms “may progress over the course of one to four weeks before
leveling off,” and are usually most severe within four weeks of symptom onset. Yale Medicine at
1, 2, 4. Similarly, the Mayo Clinic article notes that symptoms of weakness and tingling can
“quickly spread” and “worsen rapidly,” and that “[p]eople with Guillain-Barre syndrome usually
experience their most significant weakness within two weeks after symptoms begin.” Mayo Clinic
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(Dr. Bryarly noting that Petitioner’s “respiratory illness may have been the inciting factor” for his
GBS). Said differently, Petitioner requested that the Chief Special Master make a finding that no
other special master had made before, without providing medical literature or other compelling
evidence to support such a finding. The Chief Special Master also “articulated a rational basis”
for declining to do so. Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360); see Decision
at 9–12. When discussing Petitioner’s Table claim, he took care to note that “[w]hen the record is
read in its entirety, the evidence of a purportedly-earlier onset is thin, when compared to evidence
of an onset in early January.” Decision at 11. He supported this conclusion by explaining later in
his analysis that Petitioner had not “convincingly . . . demonstrated” that the symptoms Petitioner
claims occurred “within the well-established timeframe for vaccine-induced GBS” (eye
symptoms, dizziness, back pain, and a cough) were GBS-specific, as those symptoms were
“unrelated to his GBS, or reflect pre-vaccination conditions.”25 Id. at 12; MFR. Mem. at 19; see
at 1, 3, 4. Rather than frustrate the Chief Special Master’s analysis, these articles bolster it, as they
underscore the “acute” nature of GBS. See Decision at 11.
25 Petitioner focuses on two symptoms in particular—his eye symptoms and cough—which he
concedes first occurred outside of the 3−42-day Table timeframe, but contends occurred within an
appropriate timeframe to support an off-Table claim. MFR Mem. at 13, 15−16. First, regarding
Petitioner’s eye symptoms, the Chief Special Master reasonably concluded that those symptoms
were not related to Petitioner’s GBS, so the presence of those symptoms within six to eight weeks
does not support Petitioner’s claim. See supra Discussion § I.B.1. Second, regarding Petitioner’s
cough (which Petitioner posits first occurred on December 22, 2017 or December 25, 2017), the
Chief Special Master noted that respiratory symptoms “do not reflect the kind of neurologic
concerns that would stand as GBS’s onset.” MFR Mem. at 15−16; Decision at 10. This conclusion
was reasonable, particularly because, as the Chief Special Master noted, Petitioner’s neurologist
opined that Petitioner’s upper respiratory infection may have been the inciting factor for his
GBS—which is not tantamount to being a symptom of it. Decision at 4 (citing Pet. Ex. 3 at 2048);
see Cucuras, 993 F.2d at 1528 (“Medical records, in general, warrant consideration as trustworthy
evidence.”). In light of this fact, the abstract that Petitioner cites to support that “[c]ough and
respiratory distress can be the presenting sign of GBS,” (which was not filed separately as medical
literature), does not assist Petitioner’s off-Table claim. MFR Mem. at 16 n.3. To the extent that
Petitioner argues that the other symptoms he identifies in his Motion—i.e., back pain and
dizziness—occurred within a timeframe that could support an off-Table claim, those arguments
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supra Discussion § I.B. Thus, the Chief Special Master rationally explained that the weight of the
evidence supported a finding of onset nine weeks after vaccination—a factual finding plainly
within his purview—and buttressed his conclusion by invoking the generally accepted outer bound
“for a similar non-Table claim in the [Vaccine] Program.” Decision at 12; Kirby, 997 F.3d at 1381
(quoting Lampe, 219 F.3d at 1360); R.J. ex rel. W.J., 93 F.4th at 1235.
The Chief Special Master did not impermissibly impose a “hard and fast deadline . . .
between vaccination and the onset of clinically apparent symptoms of neurologic injury.” Paluck
v. Sec’y of Health & Hum. Servs., 786 F.3d 1373, 1383 (Fed. Cir. 2015). Rather, here, the Chief
Special Master simply recognized that eight weeks is generally the longest timeframe special
masters have found to support a finding of vaccine causation. Accordingly, he concluded that it
was inappropriate to infer causation on the record before him, where Petitioner had failed to proffer
preponderant evidence that “such an unusually lengthy post-vaccination onset” of nine weeks
“could still be deemed medically acceptable.” Decision at 12. Indeed, Petitioner failed to proffer
any persuasive evidence—in the form of medical literature or otherwise—which could
preponderantly prove that his GBS onset occurred within a medically acceptable timeframe to infer
vaccine causation. Absent such preponderant evidence supporting that—based on Petitioner’s
specific circumstances—a longer timeframe is appropriate, it was reasonable for the Chief Special
Master to conclude that the timing prong of Althen had not been met. See Lampe, 219 F.3d at 1366
(“In any event, a special master’s task is to make a factual determination of causation based on the
evidence in a particular case.”).
fail for similar reasons. As explained above, the Chief Special Master reasonably found
Petitioner’s contention that those symptoms marked the onset of his GBS “unpersuasive,” based
on “what is known” about GBS, Petitioner’s medical records evidencing a history of back pain,
and his physician’s belief that his back pain, reported on December 20, 2017, was due to a
“sprain/strain.” Decision at 11; see supra Discussion § I.B.2, 3.
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Petitioner expresses concern that the Chief Special Master did not consider “that GBS does
not present the same way in every Petitioner.” MFR Mem. at 19. This concern is unfounded. The
Chief Special Master did not conclude that GBS could not manifest in the manner in which
Petitioner described; rather, he simply concluded that on record before him, Petitioner did not
“persuasively establish[] circumstances” supporting “such an unusually lengthy post-vaccination
onset.” Decision at 12. In other words, the Chief Special Master concluded that Petitioner did not
present sufficient evidence to support that Petitioner’s GBS onset occurred when and how he
argued that it did. This does not reflect a failure to recognize that GBS manifests differently in
different patients. To the contrary, the Chief Special Master simply required Petitioner to do the
requisite “heavy lifting” to prove causation-in-fact based on his specific circumstances, and
concluded that Petitioner had not done so. Id. at 11–12; Hodges, 9 F.3d at 961; Lampe, 219 F.3d
at 1366 (“In any event, a special master’s task is to make a factual determination of causation based
on the evidence in a particular case.”). Petitioner states that “[i]t is unclear why Mr. Kindle’s GBS
needs to align with the ‘vast majority of cases’ when the scientific reality is that individuals have
variation in vaccine-induced injuries.” MFR Mem. at 20 (quoting Decision at 11). However, the
best reading of the Decision is not that the Chief Special Master imposed such a requirement.
Rather, the Chief Special Master simply concluded that Petitioner had failed to prove that his
particular case deviated from the typical presentation of GBS. Decision at 11.
Lastly, Petitioner argues that “it would be illogical to believe that the day Mr. Kindle
appeared at the VA and could not walk was when his symptoms first started.” MFR Mem. at 16.
But in fact, the QAIs—which set forth the statutory definition of GBS under the Vaccine Act—
contemplate such a rapid onset. See 42 C.F.R. § 100.3(c)(15). Indeed, the QAIs require an
“interval between onset and nadir of weakness between 12 hours and 28 days.” Id.
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§ 100.3(c)(15)(ii)(C). The Chief Special Master’s explanation of the course of Petitioner’s onset—
that it first manifested with a fall on January 5, 2018 and rapidly worsened over the course of the
two following days—plainly fits within this definition and is supported by Petitioner’s own
medical literature. Yale Medicine at 1 (noting that “[s]ymptoms can rapidly worsen in severity
over hours or days”). The Decision reflects that Chief Special Master took care to consider and
carefully analyze Petitioner’s medical records and symptoms, and determined, based on the record
and his “accumulated expertise in the field,” that the onset of Petitioner’s GBS took place over the
course of three days in which Petitioner experienced significant weakness and fell multiple times
as a result. Hinton, 2025 WL 763153, at *2 (“The Vaccine Act makes clear that we do not ‘second
guess’ the special master’s fact-intensive conclusions that are ‘based upon [her] accumulated
expertise in the field.’” (quoting Hodges, 9 F.3d at 961)).
In sum, the Chief Special Master appropriately concluded that Petitioner’s GBS onset
occurred on January 5, 2018—65 days, or roughly nine weeks—after he had received the flu
vaccine. See supra Discussion § I. Further, the Chief Special Master’s conclusion that the
symptoms Petitioner experienced earlier than January 5, 2018, had “not convincingly been
demonstrated to be GBS-specific,” and that Petitioner therefore had not proven a Table claim or
causation-in-fact, was not arbitrary or capricious. Decision at 12. The Chief Special Master
“considered the relevant evidence of record, dr[ew] plausible inferences and articulated a rational
basis for the decision.” Kirby, 997 F.3d at 1381 (quoting Lampe, 219 F.3d at 1360).
The Chief Special Master limited his analysis of Petitioner’s off-Table claim to the timing
prong of Althen (prong three). See Decision at 11−12. This was proper, as failure to prove any
one Althen prong is dispositive. Dobrydnev, 566 F. App’x at 980. Petitioner dedicates much of
his supporting Memorandum to the “logical sequence of cause and effect” prong of Althen (prong
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two), citing medical records which, he argues, reflect that his treating physicians associated his
GBS to his flu vaccine. See MFR Mem. at 15–19; see also Althen, 418 F.3d at 1278. For the
reasons explained above, this Court, in its “role of a reviewing judge,” accepts the Chief Special
Master’s weighing of the evidence with respect to prong three. Munn, 970 F.2d at 869. Thus, the
Court need not reach Petitioner’s prong two arguments. Henkel, 2024 WL 3873569, at *1
(“Because we conclude that the special master’s finding on Althen prong three was not arbitrary
or capricious . . . and because Appellants needed to prevail on all three prongs to have their petition
granted, we affirm the petition’s denial without reaching the prong-two finding.”). 26
26 Even if Petitioner’s arguments as to prong two were relevant, such arguments are nevertheless
unpersuasive. As an initial matter, this Court presumes—as it must—that the Chief Special Master
considered the evidence Petitioner cites, because there is no indication in the Decision to the
contrary. Moriarty, 844 F.3d at 1328 (citing Hazlehurst v. Sec’y of Health & Human Servs., 604
F.3d 1343, 1352 (Fed. Cir. 2010)); see also Decision at 9 (“The following factual findings are
made after a complete and thorough review of the record, including all medical records, affidavits,
and all other additional evidence and filings from the parties.”). Further, the records Petitioner
cites in support of his prong two arguments are unpersuasive. These records generally reflect
Petitioner’s own concerns about a possible connection between his flu vaccine and GBS—and his
reticence to receive vaccines as a result of that belief—or merely note that Petitioner’s GBS
occurred after he received the flu vaccine. MFR Mem. at 17−18 (citing Pet. Ex. 4 at 504, 736,
932, 979, 1018, 1339, 1393); Cedillo, 617 F.3d at 1347−48 (holding that a special master did not
err in failing to afford significant weight to the opinions of treating physicians which “simply
indicat[ed] an awareness of a temporal, not causal, relationship between” the vaccine and injury
(emphasis in original)); cf. Perreira v. Sec’y of Health & Hum. Servs., 33 F.3d 1375, 1377 (Fed.
Cir. 1994) (concluding that special master did not err by “requir[ing] the [expert] opinion to be
more than unsupported speculation”). The other records cited by Petitioner that he contends
reference a possible causal connection between Petitioner’s flu vaccine and GBS were made by
general physicians in 2021 and 2022, years after the onset of Petitioner’s GBS—and, notably, after
this case was filed. MFR. Mem. at 17−18 & n.4 (citing Pet. Ex. 4 at 377, 440, 503, 1392); see
ECF No. 1. In contrast, as the Chief Special Master noted in the Decision, Petitioner’s
contemporaneous medical records reflect that Dr. Bryarly—a neurologist who treated Petitioner’s
GBS—instead suggested that Petitioner’s upper respiratory infection may have been the
underlying cause of his GBS. Decision at 4 (citing Pet. Ex. 3 at 2048) (Dr. Bryarly noting on
January 10, 2018 that Petitioner’s “respiratory illness may have been the inciting factor” for his
GBS)); see also Cucuras, 993 F.2d at 1528 (noting that medical records “warrant consideration as
trustworthy evidence,” in part because they are “generally contemporaneous to the medical
events”); Kirby, 997 F.3d at 1382 (“Cucuras stands for the unremarkable proposition that it was
not erroneous to give greater weight to contemporaneous medical records than to later,
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CONCLUSION
The Court laments the significant health consequences that Petitioner has suffered due to
his illness. While this Court empathizes with Petitioner, for the reasons stated above, the Court
finds that the Chief Special Master’s examination of the record in Mr. Kindle’s case resulted in a
decision that was not arbitrary or capricious. The Chief Special Master’s Decision dismissing Mr.
Kindle’s petition is therefore SUSTAINED, and Petitioner’s Motion for Review (ECF No. 34) is
DENIED. The Clerk of the Court is directed to enter Judgment consistent with this Memorandum
and Order. The parties are directed to CONFER and FILE a Notice by July 31, 2025, attaching
a proposed public version of this sealed Memorandum and Order, identifying any information
subject to redaction pursuant to Vaccine Rule 18(b).
IT IS SO ORDERED.
Eleni M. Roumel
ELENI M. ROUMEL
Judge
contradictory testimony.”). Regardless, it was not necessary for the Chief Special Master to
address Petitioner’s prong two arguments, given the Chief Special Master’s determination—which
this Court concludes is not arbitrary or capricious—that prong three was dispositive in Petitioner’s
case. Henkel, 2024 WL 3873569, at *1.
48