B.T. v. HHS - Influenza, ulnar neuropathy (2024)

B.T., a 44-year-old male, filed a petition alleging that he developed ulnar neuropathy in his right upper extremity as a result of an influenza vaccine administered on September 19, 2018. The case proceeded as an off-Table claim, as ulnar neuropathy is not listed on the Vaccine Injury Table.

Petitioner's medical records indicated a history of right arm and shoulder issues prior to vaccination, including an accessory anconeus muscle causing mass effect on the ulnar nerve at the elbow, diagnosed in 2012. Following vaccination, B.T. reported symptoms of bilateral upper extremity paresthesias and pain, which he attributed to misadministration of the vaccine.

He sought treatment from numerous providers, and some noted a potential link to the vaccine. Petitioner's expert, Dr.

Carlo Tornatore, opined that a mis-administered vaccine could have aggravated B.T.'s congenital predisposition, leading to ulnar neuropathy through a "double crush syndrome" mechanism. Respondent's expert, Dr.

Brian Callaghan, argued that B.T.'s ulnar neuropathy was caused by compression at the elbow, a condition likely exacerbated by his pre-existing anatomical abnormality, and that vaccine causation was unlikely given the timing and nature of the symptoms. The court denied entitlement, finding that while the theory of vaccine-induced ulnar neuropathy was plausible (Althen prong one), Petitioner failed to establish a logical sequence of cause and effect (Althen prong two) or a medically acceptable temporal relationship (Althen prong three).

The court noted that B.T.'s pre-existing condition and the lack of immediate post-vaccination complaints, coupled with the localization of injury to the elbow rather than above it, undermined the claim of vaccine causation. The court also considered a "significant aggravation" claim under the Loving test but found it similarly unsupported by the evidence.