VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00163
Package ID: USCOURTS-cofc-1_21-vv-00163
Petitioner: Courtney Lane
Filed: 2021-01-06
Decided: 2025-11-17
Vaccine: influenza
Vaccination date: 2019-10-25
Condition: right shoulder injury related to vaccine administration (SIRVA)
Outcome: entitlement_granted_pending_damages
Award amount USD: 

AI-assisted case summary:
On January 6, 2021, Courtney Lane filed a petition alleging that an influenza vaccination administered in her right deltoid on October 25, 2019 caused a Table shoulder injury related to vaccine administration. She was thirty-nine years old at vaccination.

The case turned on onset. Ms. Lane did not return for in-person medical care until January 16, 2020, but the first treatment record described right arm pain after the flu injection and pain at the right-deltoid injection site from the October flu vaccine. A later orthopedic record stated that pain began a couple of hours after the October 2019 flu shot, which she reported had been administered high in the shoulder. Examination showed tenderness, pain with abduction and forward flexion, positive impingement signs, and reduced supraspinatus strength. MRI showed subscapularis and supraspinatus tendinosis, impingement, and mild subacromial bursitis. On May 15, 2020, she underwent arthroscopic shoulder surgery with distal clavicle resection, debridement, and subacromial decompression. She returned in autumn 2020 with ongoing stiffness and was assessed with SIRVA and frozen shoulder.

Respondent contested only whether pain began within the forty-eight-hour Table window, pointing to the delay in formal treatment and to telephone records that did not fully match Ms. Lane's recollection of several early calls. Special Master Daniel T. Horner found the medical histories consistently placed onset within forty-eight hours and that the telephone note saying the flu-injection arm still hurt supported, rather than defeated, her account. He also found no prior right-shoulder dysfunction, pain and reduced range of motion limited to the vaccinated shoulder, and no other condition explaining the symptoms. On November 17, 2025, he found Ms. Lane entitled to compensation; damages remain pending.

Theory of causation field:
Adult petitioner, age 39; influenza vaccine October 25, 2019; right Table SIRVA. ENTITLEMENT GRANTED, damages pending. First care Jan. 16, 2020, but records said right arm/injection-site pain from October flu shot; orthopedics recorded onset a couple hours after high injection. MRI: tendinosis, impingement, mild subacromial bursitis. May 15, 2020 arthroscopic distal clavicle resection/debridement/subacromial decompression; later SIRVA/frozen shoulder. Respondent challenged onset only. SM Horner found all SIRVA QAIs met November 17, 2025. Petition filed January 6, 2021. Attorney: Paul R. Brazil.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00163-0
Date issued/filed: 2025-12-16
Pages: 10
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/17/2025) regarding 61 Ruling on Entitlement. Signed by Special Master Daniel T. Horner. (ksb) Service on parties made.
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Case 1:21-vv-00163-UNJ Document 63 Filed 12/16/25 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-163V
Filed: November 17, 2025
Special Master Horner
COURTNEY LANE,
Petitioner,
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Paul R. Brazil, Muller Brazil, LLP, Dresher, PA, for petitioner.
Benjamin Patrick Warder, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On January 6, 2021, petitioner filed a petition under the National Childhood
Vaccine Injury Act (“Vaccine Act”), 42 U.S.C. § 300aa-10, et seq. (2012),2 alleging that
she suffered a Table Injury of Shoulder Injury Related to Vaccine Administration
(“SIRVA”) affecting her right shoulder and following an influenza (“flu”) vaccination she
received on October 25, 2019. (ECF No. 1.) On November 21, 2024, petitioner moved
for a ruling on the written record. (ECF No. 59.) For the reasons set forth below, I
conclude that petitioner is entitled to compensation for a Table Injury of SIRVA.
1 Because this document 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 document 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 Within this decision, all citations to § 300aa will be the relevant sections of the Vaccine Act at 42 U.S.C.
§ 300aa-10, et seq.
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Case 1:21-vv-00163-UNJ Document 63 Filed 12/16/25 Page 2 of 10
I. Applicable Statutory Scheme
Under the National Vaccine Injury Compensation Program, compensation
awards are made to individuals who have suffered injuries after receiving vaccines. In
general, to gain an award, a petitioner must make a number of factual demonstrations,
including showing that an individual received a vaccination covered by the statute;
received it in the United States; suffered a serious, long-standing injury; and has
received no previous award or settlement on account of the injury. Finally – and the key
question in most cases under the Program – the petitioner must also establish a causal
link between the vaccination and the injury.
In some cases, the petitioner may simply demonstrate the occurrence of what
has been called a “Table Injury.” That is, it may be shown that the vaccine recipient
suffered an injury of the type enumerated in the “Vaccine Injury Table,” corresponding to
the vaccination in question, within an applicable time period following the vaccination
also specified in the Table. If so, the Table Injury is presumed to have been caused by
the vaccination, and the petitioner is automatically entitled to compensation, unless it is
affirmatively shown that the injury was caused by some factor other than the
vaccination. § 300aa-13(a)(1)(A); § 300aa-11(c)(1)(C)(i); § 300aa-14(a); § 300aa-
13(a)(1)(B).
As relevant here, the Vaccine Injury Table lists a Shoulder Injury Related to
Vaccine Administration or “SIRVA” as a compensable injury if it occurs within 48 hours
of vaccine administration. § 300aa-14(a), amended by, 42 C.F.R. § 100.3. Table Injury
cases are guided by statutory “Qualifications and aids in interpretation” (“QAIs”), which
provide more detailed explanation of what should be considered when determining
whether a petitioner has suffered an injury listed on the Vaccine Injury Table. 42 C.F.R.
§ 100.3(c). To be considered a “Table SIRVA,” petitioner must show that her injury fits
within the following definition:
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 . . . . 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;
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Case 1:21-vv-00163-UNJ Document 63 Filed 12/16/25 Page 3 of 10
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
Alternatively, if no injury falling within the Table can be shown, the petitioner may
still demonstrate entitlement to an award by showing that the vaccine recipient’s injury
was caused-in-fact by the vaccination in question. § 300aa-13(a)(1)(A); § 300aa-
11(c)(1)(C)(ii). To so demonstrate, a petitioner must show that the vaccine was “not
only [the] but-for cause of the injury but also a substantial factor in bringing about the
injury.” Moberly v. Sec’y of Health & Human Servs., 592 F.3d 1315, 1321 (Fed. Cir.
2010) (quoting Shyface v. Sec’y of Health & Human Servs., 165 F.3d 1344, 1352 (Fed.
Cir. 1999)); Pafford v. Sec’y of Health & Human Servs., 451 F.3d 1352, 1355 (Fed. Cir.
2006). In particular, a petitioner must show by preponderant 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 proximate temporal relationship between vaccination and injury in order to
prove causation-in-fact. Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274,
1278 (Fed. Cir. 2005).
For both Table and Non-Table claims, Vaccine Program petitioners must
establish their claim by a “preponderance of the evidence.” § 300aa-13(a). That is, a
petitioner must present evidence sufficient to show “that the existence of a fact is more
probable than its nonexistence.” Moberly, 592 F.3d at 1322 n.2. Proof of medical
certainty is not required. Bunting v. Sec’y of Health & Human Servs., 931 F.2d 867,
872-73 (Fed. Cir. 1991). However, a petitioner may not receive a Vaccine Program
award based solely on his or her assertions; rather, the petition must be supported by
either medical records or by the opinion of a competent physician. § 300aa-13(a)(1).
Once a petitioner has established his or her prima facie case, the burden then shifts to
respondent to prove, also by preponderant evidence, that the alleged injury was caused
by a factor unrelated to vaccination. Althen, 418 F.3d at 1278 (citations omitted);
§ 300aa-13(a)(1)(B).
II. Procedural History
Based on the allegations in the petition, this case was initially assigned to the
Chief Special Master as part of the Special Processing Unit (“SPU”), which is intended
to expedite cases having a high likelihood of informal resolution. (ECF Nos. 8-9.)
Petitioner filed affidavits and medical records marked as Exhibits 1-15. (ECF Nos. 1,
18, 20, 28.) Thereafter the parties attempted informal resolution, but were unable to
reach an agreement. The case was reassigned to the undersigned in June of 2023.
(ECF Nos. 40-41.)
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Petitioner filed additional records marked as Exhibits 16-17 (ECF Nos. 43, 50)
and respondent filed his Rule 4 Report (ECF No. 48). The only issue raised by
respondent was whether petitioner’s shoulder pain first began within 48 hours of
vaccination. (Id. at 17-18.) Thereafter, petitioner filed phone records (ECF No. 56; Ex.
18) and an additional affidavit (ECF No. 58; Ex. 19).
Petitioner was then directed to file a motion for a ruling on the written record “as
to whether petitioner has demonstrated a Table Injury of SIRVA.” (Non-PDF Scheduling
Order, filed Oct. 8, 2024.) Petitioner filed the requisite motion on November 21, 2024.
(ECF No. 59.) Respondent filed a response on December 20, 2024 (ECF No. 60), and
petitioner filed no reply.3
In light of the above, I have determined that the parties have had a full and fair
opportunity to develop the record and that it is appropriate to rule on the existing record.
See Vaccine Rule 8(d); Vaccine Rule 3(b)(2); Kreizenbeck v. Sec’y of Health & Human
Servs., 945 F.3d 1362, 1366 (Fed. Cir. 2020) (noting that “special masters must
determine that the record is comprehensive and fully developed before ruling on the
record”). Accordingly, petitioner’s motion is now ripe for resolution.
III. Summary of Record Evidence
a. Medical Records
Petitioner received the flu vaccination at issue in her right deltoid on October 25,
2019, during an encounter with her primary care provider. (Ex. 1, pp. 17-21.) She was
39 years old at the time and, although respondent notes a number of prior medical
issues, respondent agrees that she did not have any preexisting history of pain, injury,
or dysfunction, affecting her right shoulder. (ECF No. 60, p. 2.)
Petitioner did not return to medical care until January 16, 2020, between two to
three months after vaccination. (ECF No. 1, pp. 13-16.) At that time, she presented to
her primary care provider with chief complaints of (1) “right arm pain P[ost] flu
inj[ection]” and (2) “Pain at injection site R[ight] deltoid from flu vaccine given in
Oct[ober].” (Id. at 13.) It was further noted that petitioner was experiencing some pain
with her lymphedema pump on her arms. (Id.) Under history of present illness,
petitioner “states that ever since she got her flu shot she has had a lot of discomfort of
her right upper arm [and] it hurts to do anything with that or to lay on it.” (Id.) At this
initial encounter, petitioner demonstrated tenderness to palpation on physical exam, but
had normal range of motion. (Id. at 16.)
3 Somewhat confusingly, petitioner titled her motion as a “motion for a ruling on the record regarding
onset,” potentially implying that the relief sought by the motion would be limited to a finding of fact.
However, in the body of her motion and in her prayer for relief, petitioner was explicit in requesting that
she be found entitled to compensation for a Table SIRVA. (ECF No. 59, p. 7.) In response, respondent
acknowledged that the parties had been prompted to brief petitioner’s entitlement to compensation for a
Table SIRVA, discussed the complete requirements for demonstrating a Table SIRVA, and, although he
raised no issue other than timing of onset, asserted that petitioner had failed to meet her overall burden of
proof to demonstrate entitlement to compensation. (ECF No. 60.)
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Petitioner presented for orthopedic care about a month later, on February 19,
2020. (Ex. 2, pp. 32-35.) At that encounter, the history records that petitioner “received
the flu shot in October 2019 and a couple hours later she star[t]ed experiencing pain
that has progressively worsened.” (Id. at 32.) It was further explained that “[i]nitially her
pain was at the injection site (which was administered higher in the shoulder than
normal) but has now moved into the deltoid and radiates into the bicep.” (Id.) Physical
exam indicated in pertinent part:
There is no atrophy noted about the right shoulder. The right shoulder has
tenderness to palpation over supraspinatus tendon, AC joint. The right
shoulder shows pain on range of motion, primarily abduction as well as
forward flexion. There is pain on abduction against resistance, pain over
the leading edge of the acromion. Pain with forward flexion, abduction past
140 degrees. There is pain near the AC joint on the right. Cross arm test
reveals pain directly over the AC joint. There is full internal and external
rotation with 5/5 strength noted with the elbows at the side. Supraspinatus
strength 4/5. A positive Hawkins impingement test is noted. Discomfort
with Speed’s test. Sensation, motor intact.
(Id. at 34-35.) A follow up MRI showed tendinosis of the subscapularis/supraspinatus
tendon, impingement of the acromial humeral space, and mild subacromial bursitis. (Id.
at 41-42.)
On May 15, 2020, petitioner underwent arthroscopic shoulder surgery. (Ex. 3, p.
2-4.) Specifically, she underwent distal clavicle resection, debridement, and
subacromial decompression. (Id. at 2.) Petitioner returned to care in the autumn of
2020. At that time, she complained of ongoing shoulder stiffness even after her
surgery. She was assessed by an orthopedic surgeon as suffering a SIRVA with
additional frozen shoulder. (Ex. 10, pp. 14-16.) Respondent has not cited any medical
encounter in which petitioner provided a history inconsistent with the above. (ECF No.
60, pp. 2-3.)
b. Written Statements and Phone Records
Petitioner averred that her right shoulder pain began the day of her vaccination
and then got progressively worse. (Ex. 19.) She indicated that, prior to presenting for
care on January 16, 2020, she had contacted her primary care provider by telephone
multiple times. (Ex. 12.) Specifically, she recalled calling the office to complain of
shoulder pain about one-week post-vaccination, “[a] few weeks later,” again a “week or
two later,” and a fourth time in December of 2019. (Id.) She was repeatedly told to use
ice and Tylenol, and it was not until the fourth phone call that she was advised to
schedule an appointment. (Id.)
The provider’s telephone encounter records do not document this pattern of calls.
(Ex. 17.) During the relevant period, petitioner called the office on October 29, 2019
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regarding a prescription (Id. at 12), and on November 26, 2019, again regarding her
prescription, but also complaining of an eye infection (Id. at 11). She is first
documented as having called about her alleged shoulder pain on December 16, 2019.
(Id. at 10.) That record states petitioner’s message as “Flu inj[ection] arm still hurts.”
(Id.) She made additional calls on December 17, 2019, December 31, 2019, and
January 13, 2020, that do not appear to be related to her shoulder. (Id. at 6-8.) She
also called a second time regarding her shoulder pain on January 13, 2020. That
message indicates “Site [of] flu inj[ection] still really hurts.” (Id. at 5.)
IV. Party Contentions
Petitioner argues that postponing treatment is not dispositive of when onset of
shoulder pain actually occurred. (ECF No. 59, p. 5 (citing Lang v. Sec’y of Health &
Human Servs., No. 17-995V, 2020 WL 7873272 (Fed. Cl. Spec. Mstr. Dec. 11, 2020);
Forman-Franco v. Sec’y of Health & Human Servs., No. 15-1479V, 2018 WL 1835203
(Fed. Cl. Spec. Mstr. Feb. 21, 2018); Tenneson v. Sec’y of Health & Human Servs., No.
16-1664V, 2018 WL 3083140 (Fed. Cl. Spec. Mstr. Mar. 30, 2018), mot. for rev. denied,
142 Fed. Cl. 329 (2019); Gurney v. Sec’y of Health & Human Servs., No. 17-481V, 2019
WL 2298790 (Fed. Cl. Spec. Mstr. Mar. 19, 2019)).) Moreover, she notes that it is not
unusual that a SIRVA sufferer would not seek immediate care. (Id. at 5-6 (citing Hanna
v. Sec’y of Health & Human Servs., No. 18-1455V, 2021 WL 3486248 (Fed. Cl. Spec.
Mstr. July 15, 2021); Smallwood v. Sec’y of Health & Human Servs., No. 18-0291V,
2020 WL 2954958, at *10 (Fed. Cl. Spec. Mstr. Apr. 29, 2020)).) Instead, petitioner
argues that where a delay in treatment has contributed to dismissal, it has been in
connection with evidence inconsistent with an immediate post-vaccination onset. (Id. at
6 (citing Lavender v. Sec’y of Health & Human Servs., No. 18-1921V, 2021 WL 667187,
at *9-11 (Fed. Cl. Spec. Mstr. Jan. 25, 2021); Small v. Sec’y of Health & Human Servs.,
No. 15-478V, 2019 WL 6463985, at *11 (Fed. Cl. Spec. Mstr. Nov. 1, 2019), mot. for
rev. denied, 2020 WL 918799 (Fed. Cl. Jan. 27, 2020)).)
Petitioner contends that her delay in seeking treatment was not extraordinary,
that the history of onset she provided to her providers wholly supports onset occurring
within 48 hours of vaccination, and there is no evidence inconsistent with an immediate
onset. (ECF No. 59, pp. 6-7.) Petitioner further contends that respondent has not
raised any other issue with her alleged Table SIRVA. (Id. at 7.) She asserts that her
pain and reduced range of motion were limited to her right shoulder and that no other
condition or abnormality was identified to explain her symptoms. Thus, she contends
she should be found entitled to compensation for a Table SIRVA. (Id.)
Respondent contends, however, that there are multiple reasons why the
evidence points away from a 48-hour post-vaccination onset. (ECF No. 60, p. 7.) First,
petitioner’s recollection that she called her medical provider multiple times post-
vaccination is not consistent with the practice’s telephone encounter records. (Id. at 7-
9.) Second, the telephone encounter records are detailed and show that petitioner was
in frequent contact with her medical provider for a variety of issues. (Id. at 9.) Third,
respondent finds the history of onset occurring “hours” after vaccination, as recorded in
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the medical encounter records, to be unpersuasive given the earlier telephone
encounter records. (Id. at 9-10.) Respondent argues that, whereas petitioner argued
that in general SIRVA sufferers often delay care, this would still have been unusual for
her. (Id. at 10-11.) Respondent contends that the onset issue is dispositive and,
though he discusses the overall standard for determining the presence of a Table
SIRVA, does not raise any other issue based on the facts of this case. (Id. at 11-12.)
V. Discussion
a. SIRVA QAI (1) – No history of pain, inflammation or dysfunction of the
affected shoulder
The first SIRVA criterion requires that there be no relevant prior history of
shoulder concerns that could explain the post-vaccination symptoms. Petitioner asserts
that she had no prior history of any right shoulder injury. (ECF No. 59, p. 7.) In his
motion response, respondent likewise acknowledges that “[p]etitioner did not have a
pre-vaccination history of pain, injury, or dysfunction in her right shoulder.” (ECF No.
48, p. 2.) Based on my own review of the record, I reach the same conclusion.
Accordingly, petitioner has demonstrated the first SIRVA criterion by
preponderant evidence.
b. SIRVA QAI (2) – Pain occurs within the specified time-frame (i.e. 48
hours)
The second SIRVA criterion requires that the petitioner experience an onset of
shoulder pain within 48 hours of the vaccination at issue. This is the only element of
petitioner’s prima facie case that is contested by respondent. Importantly, however,
there is no meaningful dispute that petitioner’s treatment records consistently and
explicitly place the onset of her shoulder pain within 48 hours of vaccination. (Ex. 1, p.
13 (reporting pain “ever since” flu vaccination); Ex. 2, p. 32 (reporting pain within hours
of vaccination); see also Ex. 9, p. 15; Ex. 10, p. 14; Ex. 19.) “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 & Human Servs., 993 F.2d 1525, 1528 (Fed. Cir.
1993).
Respondent argues that the medical treatment records should not be viewed as
persuasive because petitioner delayed seeking treatment, which was unusual for her,
and because her later asserted recollection that she telephoned her provider multiple
times prior to her first treatment encounter is inconsistent with the provider’s telephone
records. These arguments are not persuasive. Although respondent is correct that
petitioner’s hindsight recollection regarding the series of telephone calls does not
appear to be entirely accurate, this does not outweigh the contemporaneous treatment
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records. Even taking account of the telephone encounter records maintained by
petitioner’s primary care provider, these records do support petitioner’s recollection that
she made some calls to her provider prior to complaining of shoulder pain at her first
appointment and also ultimately support petitioner’s contention regarding onset.
Specifically, although petitioner did not accurately recall the precise series of telephone
calls she had made, the records still reflect that she first reported her right shoulder pain
to her provider on December 16, 2019, at that time indicating that her arm “still hurts”
from her flu injection. (Ex. 17, p. 10.) This is entirely consistent with the histories she
subsequently provided during her in-office examinations.
I have considered respondent’s contention that petitioner’s own pattern of
initiating telephone encounters for other purposes could imply that she would have been
likely to report any shoulder pain promptly; however, I do not find the telephone
encounter records sufficiently weighty on this point. There is no presumption that
medical records are accurate and complete as to all physical conditions. Kirby v. Sec’y
of Health & Human Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021). Here, the telephone
encounters were explicitly for other specific purposes and, as telephone encounters,
they did not include any opportunity for general examination. Ultimately, absent any
significant evidence contradicting petitioner’s initial treatment record, petitioner does not
bear any specific burden of explaining her pattern of care. E.g., Lang, 2020 WL
7873272, at *11 (noting that “there is no such thing as an ‘appropriate’ time to seek
treatment”).
Accordingly, petitioner has demonstrated the second SIRVA criterion by
preponderant evidence.
c. SIRVA QAI (3) -- Pain and reduced range of motion are limited to the
shoulder in which the intramuscular vaccine was administered
The third SIRVA criterion requires that the post-vaccination pain and reduced
range of motion be limited to the affected shoulder. This requirement encompasses an
affirmative showing that the petitioner’s presentation included a reduction in range of
motion. Bolick v. Sec’y of Health & Human Servs., No. 20-893V, 2023 WL 8187307, at
*6-8 (Fed. Cl. Spec. Mstr. Oct. 19, 2023). Otherwise, as I have previously explained at
greater length in a prior decision that “the gravamen of this requirement is to guard
against compensating claims involving patterns of pain or reduced range of motion
indicative of a contributing etiology beyond the confines of a musculoskeletal injury to
the affected shoulder.” Grossmann v. Sec’y of Health & Human Servs., No. 18-13V,
2022 WL 779666, at *15 (Fed. Cl. Spec. Mstr. Feb. 15, 2022) (citing Werning v. Sec’y of
Health & Human Servs., No. 18-267V, 2020 WL 5051154, at *10 (Fed. Cl. Spec. Mstr.
July 27, 2020).)
Petitioner asserts that her pain and reduced range of motion were limited to her
right shoulder. (ECF No. 59, p. 7.) Respondent has not raised any argument to the
contrary. (ECF No. 60.) Although petitioner did not initially have reduced range of
motion recorded at her first encounter, she did later have a demonstrated reduction in
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motion. (Ex. 10.) Additionally, based on my own review, I note that petitioner did
complain of symptoms radiating down the arm (e.g., id. at 7); however, although other
etiologies for these symptoms were investigated, petitioner’s diagnoses remained
referrable only to the shoulder (id. at 11-16).
Accordingly, there is preponderant evidence that petitioner’s pain and reduced
range of motion were limited to her affected shoulder within the meaning of the third
SIRVA criterion. See Grossmann, 2022 WL 779666, at *15.
d. SIRV QAI (4) – No other condition or abnormality is present that would
explain the patient’s symptoms.
The fourth SIRVA criterion requires that “[n]o 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, and any other neuropathy).” 42
C.F.R. § 100.3(c)(10)(iv). This element of petitioner’s showing “requires consideration
of a petitioner’s medical condition as a whole.” Record v. Sec’y of Health & Human
Servs., No. 21-1312V, 2025 WL 868957, at *6 (Fed. Cl. Feb. 26, 2025). While the
“other condition or abnormality” at issue must qualify as an explanation for the
petitioner’s symptoms, it “need not be a better or more likely explanation.” French v.
Sec’y of Health & Human Servs., No. 20-0862V, 2023 WL 7128178, at *6 (Fed. Cl.
Spec. Mstr. Sep. 27, 2023).
Petitioner asserts that no other condition or abnormality is present that would
explain her symptoms. (ECF No. 59, p. 7.) Respondent has not raised any argument to
the contrary. (ECF No. 60.) Based on my own review of the record, I likewise conclude
that no other condition or abnormality is implicated. In particular, as noted in the
preceding section, petitioner’s symptoms radiating down her arm were investigated for a
potential neurologic cause, but none was found. (Ex. 9, p. 10; Ex. 10, p. 14.)
Accordingly, petitioner has demonstrated the fourth SIRVA criterion by
preponderant evidence.
e. Factor unrelated to vaccination
Pursuant to the Vaccine Act, once petitioner has met her prima facie burden of
demonstrating a Table Injury, respondent may still prove the condition is “due to factors
unrelated to the administration of the vaccine described in the petition.” § 300aa-
13(a)(1)(B). In this case, respondent has not raised any issue as to any factor unrelated
to vaccination.
VI. Conclusion
For the reasons discussed above, and based on consideration of the record as a
whole, the evidence preponderates in favor of a finding that petitioner is entitled to
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compensation for a Table Injury of SIRVA relative to her October 25, 2019 flu
vaccination. A separate damages order will be issued.
IT IS SO ORDERED.
s/Daniel T. Horner
Daniel T. Horner
Special Master
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