VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00098
Package ID: USCOURTS-cofc-1_21-vv-00098
Petitioner: Beth Ruge
Filed: 2021-01-05
Decided: 2025-10-21
Vaccine: influenza
Vaccination date: 2019-10-23
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 20000

AI-assisted case summary:
On January 5, 2021, Beth Ruge filed a petition seeking compensation for a left shoulder injury related to vaccine administration after an influenza vaccination at work on October 23, 2019. She was 38 years old. Respondent disputed entitlement and moved to dismiss, arguing in part that a CVS record listed October 28, 2019 as the vaccination date and that Ms. Ruge had not shown a qualifying SIRVA lasting more than six months.

Chief Special Master Brian H. Corcoran found the record supported the October 23 vaccination date. Ms. Ruge's first emergency-department visit, orthopedic intake forms, and the workplace flu-shot announcement all pointed to October 23, and the decision treated the conflicting CVS entry as less persuasive. The medical story was a mild but persistent left-shoulder injury: pain began within hours of the shot, she pursued early treatment and physical therapy, then had a long gap in formal care during the COVID-19 period while continuing home exercises. She later returned to seek additional medical advice for the same shoulder.

On October 3, 2025, Chief Special Master Corcoran denied respondent's motion to dismiss and found Ms. Ruge entitled to compensation for a Table SIRVA. The damages decision followed on October 21, 2025. Respondent filed a proffer, Ms. Ruge agreed, and the court awarded $20,000.00 for pain and suffering, paid as a lump sum through counsel's IOLTA account. The public damages decision does not award future expenses, lost wages, or future pain and suffering. Ms. Ruge was represented by Jeffrey S. Pop.

Theory of causation field:
Influenza vaccine, October 23, 2019, age 38, causing left SIRVA. COMPENSATED. Respondent moved to dismiss after disputing the vaccine date, severity, and SIRVA criteria; Chief Special Master Corcoran found the October 23 date supported by the emergency-department record, orthopedic intake, and workplace flu-shot materials despite a conflicting CVS date. Onset was within hours, pain was primarily limited to the vaccinated shoulder, and the six-month severity requirement was met despite a COVID-era care gap because she continued home exercises and later returned to seek shoulder care. Entitlement October 3, 2025; damages October 21, 2025. Award $20,000 pain and suffering, paid as a lump sum via counsel IOLTA. Attorney Jeffrey S. Pop; respondent counsel Catherine Elizabeth Stolar.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00098-0
Date issued/filed: 2025-11-10
Pages: 11
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/03/2025) regarding 45 Ruling on Entitlement ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:21-vv-00098-UNJ Document 54 Filed 11/10/25 Page 1 of 11
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-98V
UNPUBLISHED
BETH RUGE, Chief Special Master Corcoran
Petitioner, Filed: October 3, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Catherine Elizabeth Stolar, U.S. Department of Justice, Washington, DC, for
Respondent.
RULING ON ENTITLEMENT1
On January 5, 2021, Beth Ruge filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), alleging that she suffered a Table injury – shoulder injury related to
vaccine administration (“SIRVA”) - as the result of an influenza (“flu”) vaccine received on
October 28, 2019. Petition at 1. The case was assigned to the Special Processing Unit of
the Office of Special Masters (the “SPU”).
For the reasons set forth below, and after holding an expedited hearing on the
disputed issues, I find that Petitioner is entitled to compensation for her SIRVA Table
injury.
1 Because this Ruling contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the 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 (2018).

Case 1:21-vv-00098-UNJ Document 54 Filed 11/10/25 Page 2 of 11
I. Relevant Procedural History
This case was initiated in January 2021. On July 6, 2023, Respondent filed his
Rule 4(c) Report and Motion to Dismiss. ECF No. 36-37. Petitioner was ordered to file a
combined Response to Respondent’s Rule 4 Report/Motion to Dismiss and Motion for
Ruling on the Record addressing whether Petitioner has established that she met the
Act’s severity requirement pursuant to Section 11(c)(1)(D), and otherwise established a
SIRVA Table claim. Petitioner filed her motion and response on October 2, 2023,
Respondent filed a brief in reaction on November 15, 2023, and Petitioner filed a reply
brief on November 22, 2023. ECF Nos. 39, 41-42.
The parties were subsequently notified that I would resolve this dispute via an
expedited hearing, which took place on September 5, 2025. ECF No. 43. After
considering the arguments of both sides and questioning the parties in regard to the
disputed issues at the expedited hearing on September 5, 2025, I issued an oral ruling
finding Petitioner entitled to compensation. This Ruling memorializes those
findings/determinations.
II. Factual Findings and Ruling on Entitlement
A. Legal Standards
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy
evidence. The records contain information supplied to or by health professionals to
facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in
the balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. “Written records which are, themselves, inconsistent, should be
accorded less deference than those which are internally consistent.” Murphy v. Sec’y of
2

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Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25,
1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd
per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as
incorrect the presumption that medical records are accurate and complete as to all the
patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021).
The United States Court of Federal Claims has outlined four possible explanations
for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y
of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health
& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998).
The credibility of the individual offering such fact testimony must also be determined.
Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley
v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v.
Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within
the special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
3

Case 1:21-vv-00098-UNJ Document 54 Filed 11/10/25 Page 4 of 11
In addition to requirements concerning the vaccination received, the duration and
severity of petitioner’s injury, and the lack of other award or settlement,3 a petitioner must
establish that she suffered an injury meeting the Table criteria, in which case causation
is presumed, or an injury shown to be caused-in-fact by the vaccination she received.
Section 11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria
establishing a SIRVA under the accompanying QAI are as follows:
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time-frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
3 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception; suffered the residual effects of his injury for more than six months, died from his injury, or
underwent a surgical intervention during an inpatient hospitalization; and has not filed a civil suit or collected
an award or settlement for her injury. Section 11(c)(1)(A)(B)(D)(E).
4

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(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
B. Factual Findings4
1. Date of Vaccination
A preliminary issue in this case is whether Petitioner received the flu vaccine on
October 23, 2019, as alleged. Respondent correctly points out that the vaccine
administration record from CVS pharmacy states that Petitioner was actually vaccinated
on October 28, 2019. Ex. 2 at 3.
However, the medical record corresponding to Petitioner’s first medical visit (an
emergency department visit) to address her left shoulder pain – which occurred on
October 26, 2019 (and thus two days before the proposed “correct” vaccination date) -
specifically states: “10/23 received influenza vaccine at her work.” Ex. 3 at 22 (emphasis
added). Thereafter, on November 7, 2019, Petitioner was seen by orthopedist, Dr.
McCarroll.5 Her intake forms for that visit document that Petitioner responded to the
inquiry “List Injury Date or Approximate Date Symptoms Began” with “Wed Oct 23, 2019”
and in response to question “Are you being seen as the result of an accident or injury?”
Petitioner checked the “Yes” box and handwrote “injury from flu shot.” Ex. 26 at 7. In
response to “Please tell us how the accident or injury occurred” Petitioner wrote “flu shot
at work.” Id.
Additionally, Petitioner filed a copy of a flu vaccine announcement from her
workplace for “Wednesday, October 23rd.” Ex. 17. The announcement has the CVS logo
on it. Id. Petitioner explains in her supplemental sworn declaration that she received a flu
shot at on October 23, 2019, administered into her left shoulder by CVS pharmacy at her
workplace. Ex. 21. She states that the CVS vaccination record incorrectly provides
October 28, 2019, as the date of vaccination. She explains that Exhibit 17 is a correct
4 I have fully reviewed and considered all medical records and the parties’ filings and briefing in this matter,
however for the purpose of brevity my factual findings do not summarize and/or address all medical records
and other evidence, or each argument put forward by the parties.
5 I observe that Dr. McCarroll’s November 7, 2019 record states: “This 38-year-old female came today
because she got a flu shot in her left shoulder about a day or 2 ago and right after the flu shot that afternoon
again became very painful and that got worse she has difficulty sleeping.” Ex. 4 at 2 (emphasis added).
However, the timing of Petitioner’s vaccination described in this statement most likely is in error as it is
clearly contradicted by Dr. McCarroll’s own intake forms, as well as other evidence that demonstrating
Petitioner received her flu vaccination on October 23, 2018 (not a day or two before her November 7, 2019
visit).
5

Case 1:21-vv-00098-UNJ Document 54 Filed 11/10/25 Page 6 of 11
copy of the “10/23/2019 Flu Shot Announcement Post” provided to her and her coworkers.
Id.
Accordingly, I find that more likely than not that Petitioner received a vaccination
on October 23, 2019, as alleged.
2. Severity
The next issue to be determined in this case is whether Petitioner has satisfied the
Vaccine Act’s “severity requirement,” pursuant to which a petitioner demonstrate that
they:
(i) suffered the residual effects or complications of such illness, disability,
injury, or condition for more than 6 months after the administration of the
vaccine, or (ii) died from the administration of the vaccine, or (iii) suffered
such illness, disability, injury or condition from the vaccine which resulted in
inpatient hospitalization and surgical intervention.
Section 11(c)(1)(D). To do so here, Petitioner would need to establish sequelae from her
alleged SIRVA persisted until at least April 24, 2020 (assuming an onset of October 23,
2019). After a careful review of the record, I find that Petitioner has established that she
more likely than not suffered the sequela of her injury for more than six months.
The medical record in this case demonstrates that Petitioner sought immediate
care for her left shoulder pain, and aggressively treated her left shoulder injury for the
next two months, including: seeking care at the emergency department, receiving
prescription medication, undergoing a left shoulder MRI, obtaining an orthopedic
evaluation, and participating in eight occupational therapy sessions. Ex. 3 at 22-24, Ex. 4
at 2-3, 28, 32. At her discharge from occupational therapy on December 30, 2019, while
Petitioner was noted by her physical therapist to have “full motion,” her left shoulder
external rotation was found on examination to be “AROM 70˚, with pain,” while her right
external rotation was found to be “WNL” – or within normal limits.6 Ex. 4 at 28-30.
Petitioner’s occupational therapist further observed that Petitioner did “still have some low
level pain in her left shoulder, but it is decreasing. She is ready for discharge to a home
program and will call if any problems arise.” Id. at 30. Petitioner was instructed to continue
with her “HEP” (home exercise program) follow-up with her doctor as needed, and to call
with any questions. Id.
6 Normal shoulder ROM for adults ranges from 165 to 180 degrees in flexion, 170 to 180 degrees in
abduction, 90 to 100 degrees in external rotation, and 70 to 90 degrees in internal rotation. Cynthia C.
Norkin and D. Joyce White, MEASUREMENT OF JOINT MOTION: A GUIDE TO GONIOMETRY 72, 80,
84, 88 (F. A. Davis Co., 5th ed. 2016). Petitioner’s flexion, abduction, and internal rotation were noted to be
within normal limits. Ex. 4 at 28-29.
6

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Respondent correctly points out that following her discharge from physical therapy,
Petitioner did not seek or obtain any additional treatment for her shoulder injury, or report
continued shoulder symptoms to a provider, for over a year. Additionally, during this gap
in her shoulder treatment, Petitioner sought treatment from two other providers – her
OB/GYN and an allergy and asthma specialist – and the records from those providers
contain no report of any shoulder pain, or other symptoms.
Petitioner explains in her sworn declaration that after her discharge from
occupational therapy she performed home exercises on a daily basis, and references her
home exercise handout (filed in support of her claim as Exhibit 15). Ex. 21 at 3 (citing Ex.
15). Petitioner states that she saw her OB/GYN on February 28, 2020 for a hemorrhoids
related visit, and on June 4, 2020 for her annual gynecological screening exam. Id. She
explains she did not raise her shoulder concerns at these visits as the appointments were
to address her gynecological concerns. Id. Petitioner further states she was seen by
allergy and asthma specialist on July 8, 2020, due to her allergies and asthma, and did
not report her shoulder pain because it was outside that provider’s specialty. Id. However,
Petitioner states she did discuss her left shoulder pain at her next visit to this specialist
on November 12, 2020, because she was offered a flu shot. Id. Petitioner states she
explained that she “developed left shoulder pain following a flu shot in October of 2019. I
complained of how my left shoulder still hurts from that flu shot. I declined receiving a flu
shot.” Id. (citing Ex. 7 at 3). The medical record corresponding to Petitioner’s November
12, 2020 visit corroborates that she “[d]eferred” a flu shot, but does not document a report
of shoulder pain. Ex. 7 at 3.
Petitioner explains that she “continued to perform my home exercises for my left
shoulder on a regular basis with hopes that my left shoulder pain would improve with
time.” Ex. 21 at 4. However, Petitioner states that she continued to experience left
shoulder pain and decided to consult with her orthopedist, whom she called in early
January of 2021 “due to my ongoing left shoulder pain.” Id. On January 4, 2021, Petitioner
states she received a return call from her orthopedist’s office recommending she see a
shoulder specialist. Id. (citing Exs. 18 – a screenshot of a voicemail message, and Ex. 19
– an audio recording of a message from Dr. McCarroll’s office). Petitioner’s call to Dr.
McCarroll’s office is corroborated by audio of the message she received from “Cara” at
Dr. McCarroll’s office, and a transcript of the audio, stating that “I got your message
regarding your shoulder. I spoke to Dr. McCarroll and he feels you would best benefit
from seeing one of our shoulder specialists.” Exs. 19, 25.
Petitioner further states that “she decided to seek help from a physical therapy and
chiropractic clinic” and scheduled an appointment. Ex. 21 at 4. Petitioner’s medical
records reflect she was seen by chiropractor, Dr. Barkat, on April 29, 2021 –
7

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approximately 16 months after her discharge from physical therapy at the end of 2019.
Ex. 16 at 10. Dr. Barkat’s record notes Petitioner’s “1-2 year history of left shoulder pain
where she presented to Methodist Sports Medicine for left shoulder pain after receiving a
flu shot.” Id. Dr. Barkat reviewed Petitioner’s “MRI findings [from November 2019] for
bursitis and supraspinatus tendon tendinopathy and possible partial tear.” Id. The notes
that Petitioner states that her “left shoulder range of motion has improved over 1.5 years
with several months [of] physical therapy and pain medication. She states symptoms are
aggravated with left arm range of motion and sleeping on her right side [sic].” Id. The
record also states that Petitioner reported “fatigue and weakness in left lower arm and
achy midthoracic pain associated with left shoulder pain.” Ex. 16 at 10. Petitioner and Dr.
Barkat also discussed her long history of cervicothoracic pain (which predated her left
shoulder injury7). Id. No physical examination is documented from this visit. Dr. Barkat
assessed Petitioner with cervical radicular pain and left shoulder pain. Id. at 11. A possible
referral to another doctor for an evaluation of a partial tear in Petitioner’s left shoulder was
discussed, and it was noted that Petitioner “would like to think about treatment.” Id. at 10.
Petitioner returned to see Dr. Barkat on May 24, 2021 for her “left shoulder pain,
history of cervical spine stiffness and intermittent left wrist pinching and tightness.” Ex. 16
at 7. She stated that her left shoulder pain interfered with her “sleep quality” and certain
activities of daily living “such as getting dressed,” and rated “her symptoms between 3
and 4/10.” Id. A physical exam only notes “[r]ight upper trapezius is moderately hypertonic
on palpation” and that her “[l]eft upper trapezius is mildly hypertonic on palpation.” Id. No
additional physical exam findings, such as shoulder range of motion measurements, are
provided. Dr. Barkat did however treat Petitioner’s left shoulder with “5 minutes of H-Wave
muscle stimulation surrounding left shoulder” and “[a]pplied Kinesio tape to [her] left
shoulder in stabilization format.” Id. He also demonstrated the Codman (a shoulder)
exercise. Id. Petitioner did not receive any further shoulder treatment subsequent to this
appointment.
Petitioner has also filed a sworn declaration from her husband, Erik Ruge, dated
October 29, 2021, in support of her claim. Ex. 20. Mr. Ruge recounts that
[s]tarting in about January of 2020, Beth religiously did home exercises
which included her shoulder. She followed the regimen[] provided to her by
her doctors and/or physical therapists. Beth did exercises in the morning
when she got up routinely. If she missed, she would do them at night before
bed. I saw this on many occasions throughout the next year.
7 See Ex. 9 at 7, 30.
8

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Ex. 20 at 1. Mr. Ruge further recalls that in “April or May of 2021, since her arm never
returned to normal,” Petitioner stated she was going to see a chiropractor. Id. He further
recalls that after she was seen by the chiropractor she stated “the chiropractor felt there
was very little that could be done except to continue the exercises. Beth has continued to
do her home exercises.” Id. at 1-2.
I find that Petitioner’s left shoulder pain related to her October 23, 2019 vaccination
likely persisted during the substantial gap in her shoulder treatment between her
discharge from occupational therapy on December 30, 2019, until she was seen by Dr.
Barkat on April 29, 2021. Petitioner’s shoulder injury, as she acknowledges, and as
evidenced by the medical records and her ability to forego formal treatment for her pain,
was very mild. ECF No. 42 at 5. I deem significant the fact that Petitioner’s gap in
treatment commenced in the months just prior to the start of the COVID-19 Pandemic
and continued throughout its first year. During this time period many individuals sought
minimal medical care, and otherwise limited their exposure to the virus. Additionally, the
notation in Petitioner’s occupation therapy discharge record that she was “ready for a
home program” and “instructed” to continue her home exercise program, is consistent
with the declaration testimony of Petitioner and her husband that she subsequently
engaged in at-home shoulder exercises. Ex. 20 at 1; Ex. 21 at 3. I find that the continued
pursuit of a home exercise program was a reasonable choice for someone with a mild
shoulder injury during the Pandemic.
I acknowledge that Petitioner did seek some treatment from other medical reasons
during this time period, but did not report shoulder pain to those providers (although she
could have done so). However, the treatment Petitioner sought was minimal, and I accept
her testimony that she did not report her shoulder pain to treaters with different medical
specialties,8 even if in the past she had at times reported non-gynecological issues to her
OB/GYN (as Respondent asserts).9 Ex. 21 at 3; ECF No. 41 at 2. I further accept
Petitioner’s testimony that when her shoulder pain persisted, she eventually reached out
to her orthopedist in January 2020, as it is well-supported by the audio (and corresponding
transcript) of Petitioner’s return voicemail message from her orthopedist’s office – even if
specific details regarding her shoulder complaints are not contained in the message – it
is clear that Petitioner had reaching out regarding her shoulder. Ex. 19; Ex. 23. I also
8 I reject Respondent’s argument that because an allergy and asthma provider specializes in immunology
it would be expected that she would report shoulder pain to the provider. ECF No. 36 at 11-12. As I
explained at the expedited hearing on September 5, 2025, this argument would carry substantially greater
weight had Petitioner seen an orthopedic provider during this time.
9 Petitioner, however, maintains that she did discuss her shoulder injury and continued shoulder pain with
her allergy and asthma specialist at one of her two relevant visits, as the provider offered her a vaccination
at her November 12, 2020 visit, but which she declined. Ex. 21 at 3. This discussion is not contained within
the medical record, although the record does state that Petitioner “deferred” a flu vaccine at this this visit –
providing some support for Petitioner’s assertion. Ex. 7 at 3.
9

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acknowledge that this contact occurred around the same time as Petitioner filed the
instant claim, but observe that a large number of cases were filed during this time period
as Respondent issued a Notice of Proposed Rulemaking seeking to remove SIRVA and
vasovagal syncope from the Vaccine Injury Table. National Vaccine Injury Compensation
Program: Revisions to the Vaccine Injury Table, 85 FR 43794, 43794-43800 (July 20,
2020).
Finally, Petitioner’s continued sequela of shoulder pain is supported by her April
and May 2021 visits with Dr. Barkat. Dr. Barkat’s records support that Petitioner
complained of continued shoulder pain, which was aggravated by sleeping on her side
and left arm range of motion. Ex. 16 at 10. Dr. Barkat also discusses Petitioner’s “1-2 year
history of left shoulder pain where she presented to Methodist Sports Medicine for left
shoulder pain after receiving a flu shot.” Id. Respondent argues Petitioner’s continued
shoulder symptoms are not supported by objective evidence of an ongoing shoulder joint
injury, such as range of motion or impingement. ECF No. 36 at 11. However, while such
evidence might be helpful (if generally consistent with Petitioner’s pre-gap shoulder
findings) it is not required to demonstrate sequela. (I observe there is no question that
Petitioner had previously objectively demonstrated the necessary reduced range of
motion findings required under the Table to demonstrate a SIRVA.). Moreover, I observe
that Petitioner’s symptoms in 2021 of shoulder pain and complaints that her pain was
aggravated with range of motion and sleeping, are generally similar to her shoulder
complaints following her flu vaccination in 2019.
Accordingly, Petitioner has established that she suffered the sequela of her
October 23, 2019 flu vaccination for more than six months. However, Petitioner’s very
limited treatment course, and substantial gap in treatment, strongly suggests that her
injury was is very mild – a factor that I will take into account in any damages determination.
3. Pain limited to Petitioner’s left shoulder
The final contested issue is whether Petitioner has demonstrated that her pain was
limited to her vaccinated shoulder. 42 C.F.R. § 100.3(c)(10)(iii). Respondent asserts that
“the evidence shows, instead, that she presented with occasional “tingling pain into [the]
left hand/pinky.” ECF No. 36 at 13-14 (citing Ex. 3 at 22). Additionally, I observe that
Petitioner reported to Dr. Barkat “fatigue and weakness in left lower arm and achy
midthoracic pain associated with [her] left shoulder pain.” Ex. 16 at 10.
However, I find that Petitioner’s complaints of pain associated with her vaccination
were primarily related to her left shoulder. Moreover, I have previously found that claims
involving musculoskeletal pain primarily occurring in the shoulder are valid under the
Table even if there are additional allegations of pain extending to adjacent parts of the
10

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body, since the essence of the claim is that a vaccine administered to the shoulder
primarily caused pain there. Cross v. Sec'y of Health & Hum. Servs., No. 19-1958V, 2023
WL 120783, at *7 (Fed. Cl. Spec. Mstr. Jan. 6, 2023).
C. Other Requirements for Entitlement
Petitioner has established all other requirements for a Table SIRVA claim, the
remainder of which are not contested herein.10 42 C.F.R. § 100.3(c)(10). There is no
history of shoulder pain, inflammation, or dysfunction that would explain the post-
vaccination injury. 42 C.F.R. § 100.3(c)(10)(i). Petitioner suffered the onset of her injury
within 48 hours of her vaccination. 42 C.F.R. § 100.3(c)(10)(ii). And there is not
preponderant evidence of another condition that would explain the symptoms. 42 C.F.R.
§ 100.3(c)(10)(iv). However, even if a petitioner has satisfied the requirements of a Table
injury or established causation-in-fact, he or she must also provide preponderant
evidence of the additional requirements of Section 11(c), i.e., receipt of a covered
vaccine, residual effects of injury lasting six months, etc. See generally §
11(c)(1)(A)(B)(D)(E). But those elements are established as discussed herein (severity)
or undisputed in this claim. I therefore find that Petitioner is entitled to compensation in
this case.
Conclusion
Based on the entire record, I find that Petitioner has provided preponderant
evidence satisfying all requirements for a Table SIRVA. Petitioner is entitled to
compensation. Respondent’s Motion to Dismiss is denied. A Damages Order will issue.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
10 See ECF No. 36 at 13, n. 8.
11

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DOCUMENT 2: USCOURTS-cofc-1_21-vv-00098-1
Date issued/filed: 2025-11-24
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 10/21/2025) regarding 48 DECISION Stipulation/Proffer ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-00098-UNJ Document 55 Filed 11/24/25 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0098V
BETH RUGE,
Chief Special Master Corcoran
Petitioner,
v. Filed: October 21, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Catherine Elizabeth Stolar, U.S. Department of Justice, Washington, DC, for
Respondent.
DECISION AWARDING DAMAGES1
On January 5, 2021, Beth Ruge filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), alleging that she suffered a Table injury – shoulder injury related to
vaccine administration (“SIRVA”) - as the result of an influenza (“flu”) vaccine received on
October 28, 2019. Petition at 1. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On October 3, 2024, I issued a ruling on entitlement, finding Petitioner entitled to
compensation for her SIRVA. On October 20, 2025, Respondent filed a proffer on award
of compensation (“Proffer”) indicating Petitioner should be awarded $20,000.00,
representing compensation for her pain and suffering. Proffer at 2. In the Proffer,
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the Decision will be available to anyone with access to the internet. In
accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other
information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I
agree that the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2018).

Case 1:21-vv-00098-UNJ Document 55 Filed 11/24/25 Page 2 of 5
Respondent represented that Petitioner agrees with the proffered award. Id. Based on
the record as a whole, I find that Petitioner is entitled to an award as stated in the Proffer.
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $20,000.00 for her pain and suffering, to be paid through an ACH
deposit to Petitioner’s counsel’s IOLTA account for prompt disbursement to
Petitioner. This amount represents compensation for all damages that would be available
under Section 15(a).
The Clerk of Court is directed to enter judgment in accordance with this decision.3
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
2

Case 1:21-vv-00098-UNJ Document 55 Filed 11/24/25 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
BETH RUGE, )
)
Petitioner, )
) No. 21-98V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND HUMAN )
SERVICES, )
)
Respondent. )
)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION1
On January 5, 2021, Beth Ruge (“petitioner”) filed a petition for compensation under the
National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act” or
“Act”), alleging that she suffered a Shoulder Injury Related to Vaccine Administration
(“SIRVA”), as defined in the Vaccine Injury Table, following administration of an influenza
(“flu”) vaccine she received on October 28, 2019.2 Petition at 1. On October 2, 2023, petitioner
filed a Motion for Ruling on the Record. ECF No. 39. Respondent filed his Response on
November 15, 2023, and petitioner filed a Reply on November 22, 2023. ECF Nos. 41-42. On
October 3, 2025, the Chief Special Master issued a Ruling on Entitlement finding petitioner
1 This Proffer does not include attorneys’ fees and costs, which the parties intend to address after
the Damages Decision is issued.
2 On November 5, 2021, petitioner filed an Amended Petition, clarifying that she received the
vaccine at issue on October 23, 2019. ECF No. 17.

Case 1:21-vv-00098-UNJ Document 55 Filed 11/24/25 Page 4 of 5
entitled to compensation. ECF No. 45. Respondent now proffers the following regarding the
amount of compensation to be awarded.3
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $20,000.00 in pain and suffering.
See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.
This amount represents all elements of compensation to which petitioner is entitled under
42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made
through one lump sum payment as described below and request that the Chief Special Master’s
decision and the Court’s judgment award the following:4
A lump sum payment of $20,000.00 to be paid through an ACH deposit to petitioner’s
counsel’s IOLTA account for prompt disbursement to petitioner, Beth Ruge.
Petitioner is a competent adult. Proof of guardianship is not required in this case.
Respectfully submitted,
BRETT A. SHUMATE
Assistant Attorney General
3 The parties have no objection to the amount of the proffered award of damages. However,
respondent reserves his right, pursuant to 42 U.S.C. § 300aa-12(f), to seek review of the Chief
Special Master’s October 3, 2025 Ruling on Entitlement, finding petitioner entitled to an award
under the Vaccine Act. This right accrues following the issuance of the Damages Decision.
4 Should petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future medical
expenses, future lost earnings, and future pain and suffering.
2

Case 1:21-vv-00098-UNJ Document 55 Filed 11/24/25 Page 5 of 5
C. SALVATORE D’ALESSIO
Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
LARA A. ENGLUND
Assistant Director
Torts Branch, Civil Division
/s/ Catherine E. Stolar
CATHERINE E. STOLAR
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel: (202) 353-3299
Email: catherine.stolar@usdoj.gov
DATED: October 20, 2025
3