VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-02020
Package ID: USCOURTS-cofc-1_20-vv-02020
Petitioner: Paul Enstrom
Filed: 2021-08-24
Decided: 2023-01-20
Vaccine: influenza
Vaccination date: 2020-01-30
Condition: Guillain Barre Syndrome (GBS)
Outcome: compensated
Award amount USD: 171279

AI-assisted case summary:
Paul Enstrom, a 56-year-old man, filed a petition for compensation under the National Vaccine Injury Compensation Program on December 29, 2020. He alleged that he suffered Guillain-Barré Syndrome (GBS) as a result of an influenza vaccine administered on January 30, 2020. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on August 23, 2021, conceding that Mr. Enstrom was entitled to compensation. The respondent acknowledged that Mr. Enstrom suffered from GBS following the flu vaccine within the Table time period and that there was insufficient evidence to prove an unrelated cause. The respondent also agreed that the claim met the statutory severity requirements, as Mr. Enstrom experienced sequelae of his GBS for more than six months. Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement on September 29, 2021, finding Mr. Enstrom entitled to compensation. The case then proceeded to the damages phase. Petitioner's counsel was Nancy Routh Meyers, and respondent's counsel was Christine Mary Becer. The parties reached an impasse on the appropriate award for pain and suffering, which Chief Special Master Corcoran resolved in a Decision Awarding Damages issued on January 20, 2023. Mr. Enstrom had a non-contributory medical history prior to vaccination. On March 5, 2020, approximately 36 days after vaccination, he presented with progressive numbness in his extremities, weakness, difficulty walking, and back pain. He was hospitalized, where a physical exam documented an abnormal finger-nose test, abnormal gait, weakness, sensory deficits, and diminished reflexes. Early GBS was suspected. By March 7, 2020, his symptoms had continued, and he returned to the emergency room. MRIs of his brain and spine were performed, and a lumbar puncture showed markedly elevated CSF glucose and protein. A neurologist assessed GBS and initiated a five-day course of IVIg. Mr. Enstrom did not experience further progression of weakness or numbness, nor abdominal, respiratory, or autonomic involvement. He was hospitalized for six days, followed by six days of inpatient rehabilitation. He experienced residual effects, including pain, decreased strength, stamina, and balance issues, particularly in his feet. He underwent 16 physical therapy sessions over 24 weeks. Neurology follow-ups indicated slow improvement, with strength and endurance at 60-65% of his baseline by August 2020, along with ongoing sensory symptoms and pain. By December 2021, he reported persistent fatigue and neuropathic pain, which was significantly helped by Lyrica (pregabalin) but not completely controlled. He retired early from his job as a safety coordinator due to these symptoms and the demands of his work. The public decision does not describe the specific mechanism of injury or name any expert witnesses. Chief Special Master Corcoran awarded Mr. Enstrom a total of $171,279.47, consisting of $170,000.00 for actual pain and suffering and $1,279.47 for actual unreimbursed expenses. This award was based on the severity and duration of his GBS, considering his hospitalization, IVIg treatment, rehabilitation, residual symptoms, and impact on his personal and professional life, drawing comparisons to prior GBS cases.

Theory of causation field:
Paul Enstrom, age 56, received an influenza vaccine on January 30, 2020. He developed Guillain-Barré Syndrome (GBS) within approximately 36 days, which is listed on the Vaccine Injury Table. The respondent conceded entitlement, agreeing that the GBS occurred following the flu vaccine within the Table time period and that there was insufficient evidence of an unrelated cause. The case proceeded to damages. Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement on September 29, 2021, finding entitlement. Subsequently, on January 20, 2023, Chief Special Master Corcoran issued a Decision Awarding Damages, awarding Mr. Enstrom $170,000.00 for pain and suffering and $1,279.47 for unreimbursed expenses, totaling $171,279.47. The public text does not specify the mechanism of injury or name any experts. Petitioner's counsel was Nancy Routh Meyers, and respondent's counsel was Christine Mary Becer.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-02020-0
Date issued/filed: 2021-09-29
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 08/24/2021) regarding 20 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-02020-UNJ Document 25 Filed 09/29/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-2020V
UNPUBLISHED
PAUL ENSTROM, Chief Special Master Corcoran
Petitioner, Filed: August 24, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Influenza (Flu) Vaccine;
Guillain-Barre Syndrome (GBS)
Respondent.
Nancy Routh Meyers, Turning Point Litigation, Greensboro, NC, for Petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On December 29, 2020, Paul Enstrom filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleges that he suffered Guillain Barré Syndrome (GBS) as a
result of an influenza (“flu”) vaccination administered on January 30, 2020. Petition at ¶¶
2, 13-14. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On August 23, 2021, Respondent filed his Rule 4(c) report in which he concedes
that Petitioner is entitled to compensation in this case. Respondent’s Rule 4(c) Report at
1. Specifically, Respondent states that medical personnel at DICP have reviewed the
petition and medical records and have concluded that Petitioner suffered from GBS
1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required
to post it on the United States Court of Federal Claims' website in accordance with the E-Government Act
of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government
Services). This means the Ruling will be available to anyone with access to the internet. In accordance
with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other information,
the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I agree that
the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:20-vv-02020-UNJ Document 25 Filed 09/29/21 Page 2 of 2
following a flu vaccine within the Table time period, and there is not preponderant
evidence that Petitioner’s GBS was due to a factor unrelated to the vaccination. Id. at 4.
Respondent further agrees that the claim meets the statutory severity requirements
because Petitioner experienced sequelae of his GBS for more than six months. Id.
In view of Respondent’s position and the evidence of record, I find that
Petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
2

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_20-vv-02020-1
Date issued/filed: 2023-01-20
Pages: 11
Docket text: PUBLIC DECISION (Originally filed: 12/16/2022 ) regarding 40 DECISION of Special Master Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
--------------------------------------------------------------------------------
Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 1 of 11
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-2020V
UNPUBLISHED
PAUL ENSTROM, Chief Special Master Corcoran
Petitioner, Filed: December 16, 2022
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Decision Awarding Damages; Pain
HUMAN SERVICES, and Suffering; Influenza (Flu)
Vaccine; Guillain-Barré syndrome
Respondent. (GBS).
Nancy Routh Meyers, Turning Point Litigation, Greensboro, NC, for Petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON DAMAGES1
On December 29, 2020, Paul Enstrom filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). The case was assigned to the Office of Special Masters’ Special
Processing Unit (the “SPU”). Respondent conceded that Petitioner had suffered Guillain
Barré syndrome (“GBS”) after receipt of an influenza (“flu”) vaccination administered on
January 30, 2020, as listed on the Vaccine Injury Table. However, the parties reached an
impasse on the appropriate award for pain and suffering from that injury, leaving that
issue to my resolution.
1 Because this unpublished opinion contains a reasoned explanation for the action in this case, I am
required to post it on the United States Court of Federal Claims' website in accordance with the E-
Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic
Government Services). This means the opinion will be available to anyone with access to the internet.
In accordance with Vaccine Rule 18(b), petitioner has 14 days to identify and move to redact medical or
other information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon
review, I agree that the identified material fits within this definition, I will redact such material from public
access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 2 of 11
For the reasons set forth below, I find that Petitioner is entitled to $171,279.47
(representing $170,000.00 for actual pain and suffering, plus $1,279.47 for actual
unreimbursed expenses).3
I. Relevant Procedural History
As noted above, Petitioner initiated his claim in December 2020.4 In August 2021,
Respondent conceded entitlement and the case formally moved into the damages phase.
Rule 4(c) Report (ECF No. 19); Entitlement Ruling (ECF No. 20). But even after ten
months they could not reach agreement. ECF Nos. 26-34. On July 27, 2022, Petitioner
filed a Damages Brief, in which he requested an award of $180,000.00 for his “past and
future” pain and suffering. Damages Brief (ECF No. 36). Respondent submitted that a
lower award of $107,500.00 would be appropriate. Response (ECF No. 37). On
September 13, 2022, Petitioner filed a Reply (ECF No. 39). The matter is ripe for
adjudication.
II. Legal Standard
Compensation awarded pursuant to the Vaccine Act shall include “[f]or actual and
projected pain and suffering and emotional distress from the vaccine-related injury, an
award not to exceed $250,000.” Section 15(a)(4). Additionally, a petitioner may recover
“actual unreimbursable expenses incurred before the date of judgment award such
expenses which (i) resulted from the vaccine-related injury for which petitioner seeks
compensation, (ii) were incurred by or on behalf of the person who suffered such injury,
and (iii) were for diagnosis, medical or other remedial care, rehabilitation . . . determined
to be reasonably necessary.” Section 15(a)(1)(B). The petitioner bears the burden of proof
with respect to each element of compensation requested. Brewer v. Sec’y of Health &
Hum. Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18,
1996).
There is no mathematic formula for assigning a monetary value to a person’s pain
and suffering and emotional distress. I.D. v. Sec’y of Health & Hum. Servs., No. 04-1593V,
2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013) (“[a]wards for emotional
distress are inherently subjective and cannot be determined by using a mathematical
formula”); Stansfield v. Sec’y of Health & Hum. Servs., No. 93-0172V, 1996 WL 300594,
3 The parties have stipulated to the out-of-pocket damages component. See Response at n. 1; Reply at 8.
4 Petitioner filed the medical records required by the Vaccine Act alongside his petition in December 2020.
Exhibits (“Exs.”) 1-14. He filed updated medical records (Exs. 15-16) in early 2022, and damages affidavits
from himself and his wife (Exs. 17-18) on July 27, 2022.
2

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 3 of 11
at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the assessment of pain and suffering is
inherently a subjective evaluation”). Factors to be considered when determining an award
for pain and suffering include: 1) awareness of the injury; 2) severity of the injury; and 3)
duration of the suffering. I.D., 2013 WL 2448125, at *9 (quoting McAllister v. Sec’y of
Health & Hum. Servs., No 91-1037V, 1993 WL 777030, at *3 (Fed. Cl. Spec. Mstr. Mar.
26, 1993), vacated and remanded on other grounds, 70 F.3d 1240 (Fed. Cir. 1995)). I
may also consider prior pain and suffering awards to aid my resolution of the appropriate
amount of compensation for pain and suffering in this case. See, e.g., Doe 34 v. Sec’y of
Health & Hum. Servs., 87 Fed. Cl. 758, 768 (2009) (finding that “there is nothing improper
in the chief special master’s decision to refer to damages for pain and suffering awarded
in other cases as an aid in determining the proper amount of damages in this case.”).
And, of course, I may rely on my own experience (along with my predecessor Chief
Special Masters) adjudicating similar claims.5 Hodges v. Sec’y of Health & Hum. Servs.,
9 F.3d 958, 961 (Fed. Cir. 1993).
Although pain and suffering in the past was often determined based on a
continuum, as Respondent argues, that practice was cast into doubt by the Court several
years ago. In Graves, Judge Merow rejected a special master’s approach of awarding
compensation for pain and suffering based on a spectrum from $0.00 to the statutory
$250,000.00 cap. Graves v. Sec’y of Health & Hum. Servs., 109 Fed. Cl. 579 (2013).
Judge Merow maintained that do so resulted in “the forcing of all suffering awards into a
global comparative scale in which the individual petitioner’s suffering is compared to the
most extreme cases and reduced accordingly.” Id. at 590. Instead, Judge Merow
assessed pain and suffering by looking to the record evidence, prior pain and suffering
awards within the Vaccine Program, and a survey of similar injury claims outside of the
Vaccine Program. Id. at 595. Under this alternative approach, the statutory cap merely
cuts off higher pain and suffering awards – it does not shrink the magnitude of all possible
awards as falling within a spectrum that ends at the cap.
III. Relevant Medical History
I have reviewed both parties’ arguments and all submitted evidence. I find the
following to be most relevant to the damages determination. All citations are to the
medical records unless otherwise noted.
5 From July 2014 until September 2015, the SPU was overseen by former Chief Special Master Vowell. For
the next four years, until September 30, 2019, all SPU cases, including the majority of SIRVA claims, were
assigned to former Chief Special Master Dorsey, now Special Master Dorsey. In early October 2019, the
majority of SPU cases were reassigned to me as the current Chief Special Master.
3

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 4 of 11
• Upon receiving the subject vaccine on January 30, 2020, Petitioner was 56 years
old with a non-contributory medical history. See generally Ex. 1.6 He was recorded
to be active, walking several miles a day, and engaged in work around the house.
Id. at 13. He lived with his wife on their cattle ranch in Nucla, Colorado. See Ex. 4
at 14. He was employed full-time as a safety coordinator for a power company.
See Ex. 2 at 7; Ex. 3 at 40.
• On March 5, 2020, Petitioner presented to a chiropractor in Montrose, Colorado
complaining of progressive numbness in his extremities, weakness, difficulty
walking, and back pain. Ex. 2 at 5-9. On the chiropractor’s instructions, that same
day, Petitioner presented to Montrose Memorial Hospital’s emergency room
(“ER”).7 At the hospital, a physical exam documented an abnormal finger-nose
test; abnormal gait; weakness; sensory deficits; diminished reflexes; and bilateral
Babinski signs. Ex. 3 at 41-42. CT scans of the head and neck were unremarkable.
Id. at 57. “Early” GBS was suspected, but a lumbar puncture was not performed
“as it would be very early in the course and may be false negative.” Id. at 45.
Petitioner was sent home with plans to attend an outpatient neurology consultation
the following week, pending an outpatient appointment the following week, absent
any acute worsening or the development of bulbar-type symptoms. Id.
• By March 7, 2020, Petitioner became “concerned… enough” by his continued
symptoms that rather than waiting for the scheduled outpatient neurology
appointment, he returned to the ER. Ex. 3 at 9-13. He underwent MRIs of the brain
as well as the cervical, lumbar, and thoracic spine. Id. at 14, 29-34. The emergency
attending physician determined to proceed with a lumbar puncture and a formal
neurology evaluation, which would take place at St. Mary’s Hospital and Regional
Medical Center in Grand Junction, Colorado. Id. at 14.8 Petitioner was assessed
to be stable. He and his wife wanted to drive themselves, but the providers insisted
on ambulance transfer. Id.
• After admission to St. Mary’s Hospital, Petitioner was documented to have normal
motor tone; normal sensation (but “subjective numbness and tingling”); normal
strength in the upper extremities; slightly decreased (4-) strength in the lower
extremities; trace or absent deep tendon reflexes; and abnormal gait. Ex. 4 at 229.
A lumbar puncture showed “markedly elevated CSF glucose and protein.” Id. at
238, 247, 281. A neurologist, Seth Andrew Kareus, M.D., assessed GBS and
started a five-day course of IVIg. Id. at 231, 241. Per subsequent records,
6 See also Rule 4(c) Report; Damages Brief; Response; and Reply (omitting prior history).
7 Petitioner’s home address in Nucla, Colorado, is approximately 90 miles away from both the chiropractor
and the hospital in Grand Junction, Colorado. Ex. 2 at 7; Ex. 3 at 40. Petitioner avers that no medical
facilities were closer. Brief at n. 1. The medical records also reflect that his wife attended these medical
encounters, and thus, she potentially did the driving.
8 St. Mary’s is approximately 60 miles away from Montrose Hospital, and approximately 105 miles away
from Petitioner’s home.
4

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 5 of 11
Petitioner “did not have any progression of his weakness or numbness after
starting IVIg, never had abdominal, respiratory, or autonomic involvement.” Id. at
246.
• On March 13, 2020, Petitioner was transferred to St. Mary’s inpatient rehabilitation
facility, where he completed the IVIg course. His leg strength and gait did not
worsen or improve. Ex. 4 at 58-59, 245-47.
• Petitioner also noted the recent worsening of chronic neck, shoulder, and back
pain. Ex. 4 at 248; see also id. at 254 (noting “chronic midline low back pain with
bilateral sciatica”). The treaters posited that this could be due to “positioning or
compensation” stemming from GBS. Ex. 4 at 263.
• Petitioner received various pain relief measures including prescription-strength
acetaminophen, oxycodone, Toradol, gabapentin, diclofenac sodium topical gel,
and cyclobenzaprine while at St. Mary’s Hospital and/or inpatient rehabilitation
(which by and large, did not continue after his discharge). Ex. 4 at 77-91.9
• On March 19, 2020, Petitioner was discharged home with instructions to utilize
support when bathing, transferring from a seat, and ambulating around the house.
He would follow up with outpatient neurology and physical therapy (“PT”). Ex. 4 at
53-54. He was also advised to make a “gradual return to work and certainly to
abide by social distancing.” Id. at 67.
• On April 16, 2020, Petitioner presented to Logan McDaneld, M.D., at a neurology
clinic in Grand Junction, Colorado. Ex. 5 at 7.10 No particular symptoms are
recorded, but Petitioner was “stable without noticeable improvement or
progression.” Id. He still had a prescription for acetaminophen to address
headaches and “mild” pain,” and was taking gabapentin 300 mg three times a day.
Id. at 7-8.
• After conducting EMG/NCS testing of the lower extremities, Dr. McDaneld
assessed the GBS subtype of acute inflammatory demyelinating polyneuropathy
(“AIDP”), impacting only the motor nerves, without significant axonal injury. Id. at
10-11. Dr. McDaneld planned a follow-up appointment in 90 days “to ensure that
he is continuing to improve.” Id. at 11.
9 Certain records state that Petitioner tried amitriptyline, but did not find it to be very helpful. See, e.g., Ex.
15 at 9. From my review, the earlier medical records and the parties’ briefing do not verify whether or when
Petitioner received this drug.
10 While Petitioner is described as “return[ing] to the neurology clinic,” there do not appear to be any prior
medical encounters specifically with Dr. MacDaneld. Ex. 5 at 7; see generally Exs. 3-4.
5

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 6 of 11
• At the May 5, 2020, initial outpatient PT evaluation, Petitioner was recorded to
have pain (ranging from 0 – 9/10); decreased strength (rated at 25% of normal),
stamina, and balance; weakness in all extremities, particularly in his forearms;
significant restrictions in ankle dorsal flexion and hamstrings; and difficulty walking
on uneven surfaces, hills, and stairs. Ex. 6 at 4-5. The therapist wrote: “[t]herapy
will be prolonged due to multiple treatment areas and [the] nature of [his]
diagnosis.” Id. at 5. Petitioner attended 16 total PT sessions over 24 weeks.11
• Petitioner’s progress was also recorded at periodic neurology follow-ups, which
were conducted remotely. First, during an August 19, 2020, telephonic encounter,
Petitioner reported that he was “trending toward improvement although it is slow.”
Ex. 8 at 6.12 He had continued numbness and pain in his feet; tingling in his hands;
and issues with coordination. Id. He was “getting stronger slowly over time, but…
still at 60 to 65% of his baseline level of strength & endurance.” Id. Petitioner had
self-discontinued his gabapentin, though the record does not indicate why. Id.
• Subsequent PT sessions reflect that Petitioner had ongoing pain particularly in his
feet. Ex. 9 at 7 (August 7, 2020 – “feeling better at the end of the day but feet still
really hurt”); id. at 9 (September 3, 2020 – “feet are still bothersome”); id. at 11
(September 10, 2020 – “feet are slightly better, looking into orthotics”).
• At the last PT session on October 1, 2020, Petitioner reported that his balance was
better, but he still had a very hard time going uphill. Ex. 9 at 13. He had pain, poor
balance, poor stamina, numb feet, slightly numb hands, and poor grip strength in
his thumbs. Id. The assessment was “continued poor endurance and foot pain due
to neuropathy. Id.
• During the next neurology follow-up – conducted telephonically on November 30,
2020 – Petitioner reported “overall lack of endurance and strength and…
struggl[ing] with ongoing neuropathic pain in his feet.” Ex. 10 at 7. He did not desire
“any type of neuropathic pain medication… due to concern for potential side
effects.” Id. He had “been able to go back to work with adaptation to his issues with
endurance while walking, however is mostly working from home.” Id.; see also Ex.
11 at 2 (December 15, 2020, letter from the neurologist – documenting that
Petitioner reflected “ongoing improvement… left with some residual neurological
deficits”).
11 PT sessions took place on May 5 (the initial evaluation), May 12, May 19, May 26, June 2, June 9, June
16, June 23, June 30, July 21, July 29, August 13, August 20, September 3, September 10, and October
1, 2020. See Ex. 6 at 4-13; Ex. 7 at 19-28; Ex. 9 at 5-14. Respondent’s review appears to inadvertently
omit the PT sessions reflected in Ex. 7. See Response at 3 (stating: “He had five sessions through June
9th… He restarted PT on August 13, 2020, [and had] five additional visits”).
12 These records from SCL Health Medical Group Neurology, encounter date August 19, 2020, was
assigned Exhibit 8, as reflected on the exhibit’s first page and on the exhibit list. However, within the filing,
the bottom of each page is inadvertently Bates-stamped as Ex. 2.
6

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 7 of 11
• On June 1, 2021, Petitioner again reported decreased stamina, and a burning
numbness in his feet that was worse in the evenings. Ex. 14 at 6. The nurse
practitioner suggested trying new medications to treat his neuropathic pain, but
Petitioner was “not keen on the idea.” Id. at 8.
• On December 16, 2021, Petitioner reported sensory deficits in his right forearm.
Ex. 15 at 9. More disruptive was his ever-present fatigue which worsened
throughout the day, and neuropathic pain (typically ranging from 2 – 3/10 upon
waking up, to 6 – 7/10 over the course of a workday and into the evening). Id.
Petitioner described this pain as “burning” and “very uncomfortable numb
sensation,” which was worst in the soles, but also in his feet and up into his knees.
Id. It was aggravated by stress and any activity, including the walking required for
his job. Id. He sometimes used an expandable walking pole to cover significant
distances. Id. He also reported ever-present fatigue which worsened throughout
the day. Id. In light of these symptoms, he was “getting ready to retire, earlier than
he would have like[d].” Id. In discussing this pain, Petitioner reported that “prior
trials of amitriptyline13 [and] gabapentin” had not been very helpful.” Id. He was
prescribed the neuropathic pain medication Lyrica (pregabalin). Id. at 13.
• Finally, on January 26, 2022, Petitioner reported that he had experienced a mild
cognitive fog for the first two weeks of Lyrica, which had since gone away. Ex. 16
at 2. The medication was “significantly helping his neuropathic pain… it is never
completely controlled but is tolerable.” Id. The nurse practitioner recorded that he
would likely have “long-term sequela from his initial episode including ongoing
significant neuropathic pain and significant fatigue,” and that he had “retired early
because he cannot adequately meet the demands of his job.” Id. at 5. He would
follow up in one year, unless he desired an increased dose of Lyrica. Id.
• Petitioner and his wife described the pain and suffering associated with his GBS
in affidavits prepared on July 27, 2022. Exs. 17-18. Of note, “within a few weeks
of being discharged from inpatient rehab,” in or about April 2020, Petitioner
resumed working for the power company – but only on his computer at home, as
for all employees during the early phase of the COVID-19 pandemic. Ex. 17 at ¶
3. Petitioner and all other employees began returning to the office/ field gradually
starting in June 2020 and were mandated to be back full-time by the end of the
year Id. at ¶ 14. Petitioner struggled to maintain his job duties, and decided in June
2021 that he would retire, which became effective six months thereafter in
December 2021. Id. at ¶¶ 15-18. Petitioner now devotes his “limited energy” to the
cattle ranch, but a greater bulk of the responsibilities now fall to his wife and other
family members. Id. at ¶¶ 19-20. The affidavits also describe impacts to his
personal life. Exs. 17-18.
13 As noted above, my review of the file did not locate references to amitriptyline.
7

Case 1:20-vv-02020-UNJ Document 44 Filed 01/20/23 Page 8 of 11
IV. Appropriate Compensation for Petitioner’s Pain and Suffering
In this case, awareness of the injury is not disputed. The record reflects that at all
times, Petitioner was a competent adult with no impairments that impacted his
awareness. Therefore, I analyze principally the severity and duration of his injury.
I discount Respondent’s reference to unspecified cases that he states are
“factually similar” to Mr. Enstrom’s but resolved by way of proffers prepared by
Respondent. Response at 6. As I have previously noted, a proffer represents
Respondent’s assessment of the case’s full value. However, the literal proffer document
does not set forth Respondent’s complete reasoning for that figure, or whether the
petitioner agrees with that reasoning – only that the petitioner has agreed to accept the
figure. A petitioner may choose to accept a proffer for a variety of reasons – such as
desire to avoid the delays associated with further negotiating and/or litigation, or a time-
sensitive personal need for funds. See Reply at 4 and n. 4 (internal citations omitted).
Additionally, when the Court approves a proffer agreed upon by the parties, the omission
of a factual summary serves additional interests of judicial economy and avoiding
unwarranted disclosures of a petitioner’s medical history. See Vaccine Rule 18(b)(2).
Thus (and as I often emphasize), citations to specific publicly-available, formally
adjudicated reasoned decisions remain the most helpful guidance for resolving damages
disputes.
I also note that Respondent’s specific proffer in this case ($107,500.00) would
likely be lower than any recent reasoned awards for GBS actual pain and suffering, based
on my own review (and Respondent has offered no examples of comparable prior awards
from reasoned decisions).14 But GBS is a particularly alarming kind of vaccine injury,
which generally warrants specific recognition in the amount of the pain and suffering
award. Gross v. Sec’y of Health & Human Servs., No. 19-0835V, 2021 WL 2666685, at
*5 (Fed. Cl. Spec. Mstr. Mar. 11, 2021). Respondent’s proffer is not inappropriate solely
based on this reference to past cases. A pain and suffering award is always determined
by a careful review of additional considerations including any hospitalization, invasive
procedures, treatments and/or other medications, rehabilitation, recovery, residual
effects, and personal/ professional life impacts. But overall considerations lead me to
deem Respondent’s proposal too low.
14 A brief review of prior determinations did not reveal any reasoned decisions in which a case involving
GBS as the injury resulted in pain and suffering awards of less than $125,000.00. See, e.g., Castellanos v.
Sec'y of Health & Hum. Servs., No. 19-1710V, 2022 WL 2398812 (Fed. Cl. Spec. Mstr. May 31, 2022
($125,000.00)); see also Sand v. Sec'y of Health & Hum Servs., No. 19-1104V, 2021 WL 4704665 (Fed.
Cl. Spec. Mstr. Aug, 31, 2021) ($130,000.00); Shankar v. Sec'y of Health & Hum. Servs., No. 19-1382V,
2022 WL 2196407 (Fed. Cl. Spec. Mstr. May 5, 2022) ($135,000.00).
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Here, the evidence best supports that Mr. Enstrom experienced the onset of GBS
in early March 2020, followed by a moderate course. He was fortunate to receive a
relatively prompt diagnosis and appropriate treatment with IVIg. The ambulance transfer
and admission to a higher-level hospital were both precautionary measures taken by the
medical providers. Luckily, “he had no further progression of his weakness and
numbness… and never had any abdominal, respiratory, or autonomic involvement of his
GBS.” Brief at 4 (citing Ex. 4 at 245-46). He was in the hospital for six days, followed by
inpatient rehabilitation for a further six days. While I recognize that Petitioner utilized
supportive devices to ambulate around his home and was assisted by his wife, he did not
receive home-based medical care or rehabilitation sessions. At the same time, however,
I give some weight to the fact that at onset, Petitioner and his wife decided to travel
approximately 90 miles to seek urgent medical treatment on two separate occasions
(rather than waiting for a later outpatient evaluation).
The subsequent PT records reflect residual effects through October 1, 2020,
without clearly stating whether he had achieved all goals or why therapy was being
discontinued. The PT course was relatively limited, consisting of 16 sessions (although
more than Respondent’s apparent count of 10 sessions, see Response at 3). The
information in the subsequent neurology records is presumed to be reliable – but
necessarily limited, because the encounters all took place over telephone or video, most
likely because of the distance that Petitioner would be required to travel for an in-person
evaluation and/or recognition of the COVID-19 pandemic. See Ex. 4 at 67 (hospital
discharge summary recommending social distancing).
Those records reflect that by August 2020, Petitioner was somewhat recovered –
reporting 60 – 65% of his baseline level of strength and endurance. Ex. 8 at 6. Despite
Respondent’s argument (Response at 6), that percentage does not necessarily capture
his complete clinical picture – because that same report also reflects ongoing sensory
symptoms and pain. Moreover, any comparison to Petitioner’s pre-GBS baseline is
confounded by changed circumstances – specifically, that Petitioner’s GBS course
coincided with the pandemic, which rather coincidentally, permitted him to work remotely
and avoid the most strenuous physical aspects of his job throughout 2020. See Ex. 10 at
7. This provides a sufficient explanation for the limited medical care (including Petitioner’s
self-discontinuation of gabapentin) and his continued employment throughout 2020,
followed by his decisions to leave that employment and to try another pain medication,
Lyrica, later in 2021. I also recognize the testimonial evidence that Petitioner was less
physically active at his home and cattle ranch – transferring many of his prior
responsibilities to his family members. See Exs. 17-18.
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Petitioner has offered several comparable pain and suffering determinations, and
I find they are helpful benchmarks, if not exactly on point.15 Johnson (awarding
$180,000.00) did involve a similar hospitalization and five-day course of IVIg. However,
the analysis recognized more severe residual effects – including an inability to drive for
several months and long-term incontinence. 2018 WL 5024012, at *7-9. Fedewa (also
awarding $180,000.00) involved a greater number of attempts to seek medical treatment;
“particularly painful… botched” procedures; and longer hospitalization and PT courses.
Additionally, the petitioner experienced “considerable suffering” in being unable to care
for his own children, as well as anxiety and depression necessitating the prescription
medication Wellbutrin for approximately 15 months. 2020 WL 1915138, at *7-9.
Overall, Mr. Enstrom’s circumstances were more similar to that of the petitioner in
Gruba v. Sec'y of Health & Hum. Servs., No. 19-1157V, 2021 WL 1925630 (Fed. Cl. Spec.
Mstr. April 13, 2021) (awarding $165,000.00 for actual pain and suffering, plus $500.00
per year for future pain and suffering). The Gruba petitioner received relatively prompt
diagnosis and treatment of GBS; a relatively uncomplicated in-patient stay (between
hospitalization and in-patient rehab); a limited course of outpatient PT (17 sessions
compared to 16 for Mr. Enstrom); and she eventually decided to discontinue a physically-
demanding job in light of GBS residuals lasting for over two years. I find that Mr. Enstrom
is entitled to a similar award, if slightly higher – of $170,000.00 for actual pain and
suffering.16
Conclusion
Consistent with the above, I award Petitioner a lump sum payment of $171,279.47
(representing $170,000.00 for actual pain and suffering, plus $1,279.47 for actual
unreimbursed expenses). This amount represents compensation for all damages that
15 Citing Fedewa v. Sec’y of Health & Human Servs., No. 17-1808V, 2020 WL 101518 (Fed. Cl. Spec. Mstr.
March 26, 2020) ($180,000.00); Johnson v. Sec’y of Health & Human Servs., No. 16-1356V, 2018 WL
5024012 (Fed. Cl. Spec. Mstr. July 20, 2018) ($180,000.00); Bircheat v. Sec’y of Health & Human Servs.,
No. 19-1088V, 2021 WL 3026880 (Fed. Cl. Spec. Mstr. June 16, 2021) ($170,000.00); Gross v. Sec’y of
Health & Human Servs., No. 19-0835V, 2021 WL 2666685 (Fed. Cl. Spec. Mstr. Mar. 11, 2021)
($160,000.00); Nelson v. Sec’y of Health & Human Servs., No. 17-1747V, 2021 WL 754856 (Fed. Cl. Spec.
Mstr. Jan. 13, 2021) ($155,000.00).
16 This figure also recognizes Mr. Enstrom and his providers’ decision to try an additional neuropathic pain
medication, which constitutes objective evidence of residual effects until at least January 2022. Ms. Gruba
was never prescribed any neuropathic pain medications. However, I decline to award any figure for future
pain and suffering, as was granted in Gruba. 2021 WL 1925630, at *4-5.
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would be available under Section 15(a). The Clerk of the Court is directed to enter
judgment in accordance with this Decision.17
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
17 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
11