VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-01312
Package ID: USCOURTS-cofc-1_21-vv-01312
Petitioner: William Record
Filed: 2021-04-29
Decided: 2025-08-19
Vaccine: Hepatitis A and B
Vaccination date: 2018-04-30
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 7500

AI-assisted case summary:
On April 29, 2021, William Record filed a petition under the National Vaccine Injury Compensation Program, alleging that he suffered a shoulder injury related to vaccine administration (SIRVA) in both shoulders as a result of receiving Hepatitis A and B vaccines on April 30, 2018. He also claimed that these injuries had residual effects lasting more than six months. Mr. Record testified that he felt the vaccines were administered too high in his shoulders and experienced pain and limited range of motion within 48 hours. His symptoms later spread down his arms, leading to diagnoses of carpal tunnel syndrome (CTS) and possible reactive arthritis. He underwent surgery for CTS and was treated with methotrexate. The initial entitlement decision, issued by Chief Special Master Brian H. Corcoran on September 3, 2024, denied his claim, finding that his symptoms were not shoulder-specific, that his CTS was unrelated to SIRVA, and that the six-month severity requirement was not met. The decision noted that while Petitioner met some elements of a Table SIRVA claim, the predominance of his symptoms in his hands and wrists, the uncharacteristic CTS surgeries, and the alternative explanation of reactive arthritis were inconsistent with a Table SIRVA. The Special Master also found that the record did not establish that any initial pain was severe enough to meet the Act's foundational severity requirement, and that SIRVA and CTS are unrelated conditions. Petitioner appealed this decision. On March 20, 2025, Judge Stephen S. Schwartz issued an opinion and order, finding that the Chief Special Master's decision lacked sufficient explanation for meaningful review. The court remanded the case for further proceedings, specifically noting that the decision did not adequately explain why the SIRVA Qualifications and Aids to Interpretation (QAIs) 3 and 4 were unmet, nor did it sufficiently address the six-month severity requirement, potentially conflating persistence with intensity. Subsequently, on August 19, 2025, Chief Special Master Corcoran issued a decision awarding damages based on a stipulation between the parties. The stipulation awarded Mr. Record a lump sum of $7,500.00, to be paid through an ACH deposit to his counsel's IOLTA account for prompt disbursement. This amount represented compensation for all damages available under Section 15(a) of the Act.

Theory of causation field:
William Record, born January 28, 1957, received Hepatitis A and B vaccines on April 30, 2018. He alleged a Shoulder Injury Related to Vaccine Administration (SIRVA), a Table injury, and also a non-Table injury. Petitioner's expert, Dr. Ava Stanczak, opined that the vaccines were misadministered, causing SIRVA, and that subsequent inflammation led to nerve compression and carpal tunnel syndrome (CTS). Respondent's expert, Dr. Geoffrey D. Abrams, opined that Petitioner's symptoms were not consistent with SIRVA and were not vaccine-caused, disputing the link between SIRVA and CTS. The Chief Special Master initially denied entitlement, finding Petitioner's symptoms were not shoulder-specific, his CTS was unrelated to SIRVA, and the six-month severity requirement was not met. The Special Master found SIRVA and CTS to be unrelated conditions and credited Dr. Abrams's opinion over Dr. Stanczak's. The Court of Federal Claims remanded for further explanation regarding the SIRVA QAIs and the severity requirement. Ultimately, the parties entered into a stipulation to settle the case. The Special Master awarded William Record $7,500.00 in compensation on August 19, 2025, for all damages available under Section 15(a) of the Act.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-01312-0
Date issued/filed: 2025-02-05
Pages: 20
Docket text: PUBLIC DECISION (Originally filed: 09/03/2024) regarding 60 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (mva) Service on parties made.
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Case 1:21-vv-01312-SSS Document 69 Filed 02/05/25 Page 1 of 20
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-1312V
* * * * * * * * * * * * * * * * * * * * * * * * *
WILLIAM RECORD, * Chief Special Master Corcoran
*
Petitioner, *
* Filed: September 3, 2024
v. *
*
SECRETARY OF HEALTH AND *
HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Brian Arnold, Brian R. Arnold & Assoc., Richardson, TX, for Petitioner.
Zoe Wade, U.S. Department of Justice, Washington, DC, for Respondent.
ENTITLEMENT DECISION1
On April 29, 2021, William Record (initially as a pro se litigant) filed a petition for
compensation under the National Vaccine Injury Compensation Program (the “Program”).2
Petition (ECF No. 1) at 1. Petitioner alleges that he suffered from a shoulder injury related to
vaccine administration (“SIRVA,” a Table claim), as a result of Hepatitis A (“Hep A”) and B
(“Hep B”) vaccines he received on April 30, 2018, and/or that these vaccines caused some other
constellation of injuries. Id. The matter went to trial on March 13, 2024. Now, having reviewed
the record, trial testimony, expert reports, and other briefing, I find Petitioner is not entitled to
compensation, for the reasons set forth below.
1 Under Vaccine Rule 18(b), each party has fourteen (14) days within which to request redaction “of any information
furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or
confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly
unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the whole Decision will be available to the public
in its present form. Id.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660,
100 Stat. 3758, codified as amended at 42 U.S.C. §§ 300aa-10 through 34 (2012) [hereinafter “Vaccine Act” or “the
Act”]. Individual section references hereafter will be to § 300aa of the Act (but will omit that statutory prefix).

Case 1:21-vv-01312-SSS Document 69 Filed 02/05/25 Page 2 of 20
I. Factual Background
Vaccination and Treatment through August 2018
Petitioner was born on January 28, 1957, and had a medical history significant for (among
other things) spinal stenosis, sciatica, and bilateral carpal tunnel syndrome (“CTS”). Ex. 2 at 8, 10,
18–20.
On April 26, 2018, Petitioner visited registered pharmacist Lori Luyk in preparation for an
upcoming trip to Brazil. Ex. 2 at 16. Ms. Luyk recommended that Petitioner make a pre-travel
immunizations appointment to receive Hep A, Hep B, and yellow fever vaccines. Id. On April 30,
2018, Petitioner received the Hep A and Hep B vaccines, and further consented to receive the
European yellow fever vaccine.3 (only the Hep A and B vaccines are at issue in this case). There
is no record evidence of any immediate vaccine reaction.
More than two months later, on June 14, 2018, Petitioner went to his primary care physician
Dr. Robert Beeson complaining of bilateral shoulder pain for one month (which would place onset
in mid-May). Ex. 3 at 3. Petitioner specifically reported pain with lifting his arms and rolling onto
his shoulders, adding that the pain was worse in the morning but improved throughout the day,
and claiming his symptoms began after being vaccinated in April. Id. Upon examination, Petitioner
demonstrated pain with abduction, external rotation, and internal rotation of the shoulders. Id. Dr.
Beeson’s assessment was bilateral shoulder pain and lumbar radiculopathy, and he recommended
physical therapy (“PT”), which Petitioner declined, and further laboratory testing.4 Id.
On July 12, 2018, Petitioner returned to Dr. Beeson complaining of persistent bilateral
shoulder pain. Ex. 3 at 5. Petitioner also raised a new complaint of bilateral wrist and hand pain
(left more than right), with numbness in the first four fingers along with swelling (although he did
not identify precisely when these new symptoms began). Id. Petitioner’s previous lumbar radicular
pain was seen as improved, and he exhibited positive results on Phalen’s testing.5 Id. Dr. Beeson’s
assessment was bilateral CTS. Id. He recommended prednisone and referred Petitioner for
additional testing.
3 Ms. Luyk reviewed with Petitioner that the yellow fever vaccine approved for use in the United States was currently
unavailable, and that he would be required to sign a consent form to receive the European yellow fever vaccine, which
has not yet been approved by the FDA. Ex. 2 at 20.
4 Petitioner’s lab results revealed mildly elevated C-reactive protein, which in Dr. Beeson’s view was not high enough
to indicate polymyalgia rheumatica. Ex. 2 at 25.
5 “Phalen test” is where “the size of the carpal tunnel is reduced by holding the affected hand with the wrist fully
flexed or extended for 30 to 60 seconds, or by placing a sphygmomanometer cuff on the involved arm and inflating
to a point between diastolic and systolic pressure; appearance of numbness or paresthesias indicates carpal tunnel
syndrome.” Phalen test, Dorland’s Medical Dictionary Online,
https://www.dorlandsonline.com/dorland/definition?id=112848 (last visited Sept. 3, 2024).
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Petitioner thereafter saw neurologist Dr. Peter Bergman on July 30, 2018, for an evaluation
of his hand numbness and to undergo EMG6 and NCS7 testing. Ex. 3 at 7. Testing results revealed
bilateral severe median neuropathy at the wrist, with active denervation of the abductor pollicis
brevis (“APB”) muscle present on the left. Id.
Treatment in Second Half of 2018 and Suspicion of Different Explanations
On August 10, 2018, Petitioner visited family medicine specialist Dr. Emily Masterson for
ongoing bilateral shoulder pain and hand swelling, with the former identified to have begun
approximately twenty-four hours after Petitioner’s April receipt of the Hep A and Hep B vaccines,
and the latter developing “the end of June to July.” Ex. 3 at 12. Dr. Masterson noted Petitioner’s
assertion that the prednisone he had taken had reduced the shoulder pain but not helped with his
hand issues. Id.
Upon examination, Petitioner exhibited a painful arc bilaterally, decreased internal rotation
bilaterally, negative empty can test bilaterally, and mild impingement signs on the left side but
with none on the right. Ex. 3 at 12. It was proposed that Petitioner’s CTS pain was likely secondary
to swelling from a possible vaccine reaction, although Dr. Masterson allowed that Petitioner may
have had some mild pre-existing CTS. Id. at 13. She also proposed the possibility of reactive
arthritis, and did not rule out a vaccine reaction. Id. Dr. Masterson referred Petitioner to
orthopedics, rheumatology, and immunology/allergy, for further consultation. Id.
Dr. Masterson initially conferred with an in-network rheumatologist, Dr. Matthew Husa.
See generally Ex. 2 at 60–61, 66. Dr. Husa disclaimed expertise to comment on vaccine causation,
however, referring Dr. Masterson to allergy/immunology. Id. at 66. Otherwise, he proposed testing
relevant to rheumatologic conditions, and characterized the attempt to identify an explanation for
Mr. Record’s presentation to come down to either some form of “atypical reaction” to his
vaccinations or “just an odd occurrence of inflammatory arthritis.” Id. at 60.
Next, on August 20, 2018, Petitioner saw allergy and immunology specialist Dr. Jatinder
Aulakh. Ex. 3 at 14. Dr. Aulakh reviewed Petitioner’s prior lab results and noted that Petitioner
showed signs of elevated C-reactive protein and total complement (biomarkers for active
inflammation), but deemed the rest of the findings normal. Id. Dr. Aulakh further noted a family
history of arthritis, and observed some synovial thickening over Petitioner’s metacarpophalangeal
6 “Electromyography” is defined as “an electrodiagnostic technique for recording the extracellular activity (action
potentials and evoked potentials) of skeletal muscles at rest, during voluntary contractions, and during electrical
stimulation; performed using any of a variety of surface electrodes, needles electrodes, and devices for amplifying,
transmitting, and recording the signals.” Electromyography, Dorland’s Medical Dictionary Online,
https://www.dorlandsonline.com/dorland/definition?id=15854&searchterm=electromyography (last visited Sept. 3,
2024).
7 Nerve Conduction Studies “involve eliciting nerve action potentials at sites along a peripheral nerve and recording
the response from another site along the nerve or from a muscle innervated by that nerve.” R. O’Bryan & J. Kincaid,
Nerve Conduction Studies: Basic Concepts and Patterns of Abnormalities, 39 Neurol Clin. (2021) (available at
https://pubmed.ncbi.nlm.nih.gov/34602218/) (last visited Sept. 3, 2024).
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(“MCP”) joints. Id. His assessment was possible reactive arthritis, but noted that “[a]t this time[,]
suspicion of seronegative rheumatoid arthritis is higher.” Id. Dr. Aulakh ordered additional
immunological work-up. Id. at 16.
On August 23, 2018, Petitioner saw rheumatologist Dr. Tyson Hagen for an evaluation of
his shoulder, wrist, and hand pain and stiffness. Ex. 3 at 18. Petitioner again reported shoulder pain
beginning the day after his April vaccinations, adding that it had worsened significantly over the
next nine days, moving down to his elbows over the course of several weeks. Id. Petitioner also
noted that he had previously experienced sciatica, plus hip and buttock pain the week prior to
receiving the vaccinations in question, but that the pain resolved quickly. Id. at 19. Petitioner stated
that he began experiencing symptoms in his hands in early July, and since then had completed two
courses of prednisone. Id.
Dr. Hagen’s assessment included inflammatory polyarthritis and bilateral CTS, but noted
that “[i]t is not clear at this time if this is just a reactive arthritis from the vaccinations or if this is
an onset of a more chronic inflammatory condition.” Ex. 3 at 20. Dr. Hagen also considered
polymyalgia rheumatica, seronegative rheumatoid arthritis, and other seronegative inflammatory
polyarthritis as diagnostic possibilities. Id. He further documented that “[Petitioner] had pre-
existing carpal tunnel syndrome in both hands. The inflammation of the wrists seems to have
exacerbated his carpal tunnel symptoms.” Id. Dr. Hagen advised Petitioner to continue wearing his
CTS braces and to return in three months or soon if necessary. Id. at 20–21.
On August 27, 2018, Petitioner saw orthopedist Dr. Sean Haney for a consultation. Ex. 3
at 23. During examination, Petitioner exhibited 180 degrees of forward flexion, 85 degrees of
external rotation, internal rotation to L1, and 5/5 cuff strength. Id. Dr. Haney documented
Petitioner’s bilateral shoulder pain as multifactorial, noting that “[h]e clearly has an element of
reactive arthritis.” Id. Dr. Haney recommended PT and prednisone, and discussed the possibility
of surgical release for his CTS. Id. at 24. Petitioner elected to proceed with surgery, and on October
16, 2018, Petitioner underwent carpal tunnel release of his left hand. Ex. 3 at 24; Ex. 2 at 114.
Subsequent Treatment
Petitioner returned to see Dr. Hagen for a follow-up appointment on October 29, 2018. Ex.
3 at 26. He now reported improved symptoms from his CTS release ten days prior, with his left
forearm pain now gone, although his MCP joints were still swollen. Id. Dr. Hagen stated that
“[Petitioner] has some active inflammatory arthritis” and recommended repeat labs and to start
Methotrexate (a rheumatic drug) in four weeks if the lab results were sufficient. Id. at 27. On
December 14, 2018, Petitioner underwent carpal tunnel release of his right hand. Ex. 2 at 151.
Petitioner had an orthopedic follow-up appointment on February 14, 2019, at which time
he reported that he was no longer having symptoms at night, his sensation was gradually
improving, and that it had been recommended for him to return to activity as tolerated. Ex. 3 at 28.
Six days later, on February 20, 2019, Petitioner saw Dr. Hagen. Id. at 29. He reported that he still
4

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had swelling in his MCP joints, but was otherwise tolerating the Methotrexate well. Id. Dr. Hagen
recommend increasing Petitioner’s dosage in order to get better control of the inflammation. Id.
The filed records indicate that Petitioner saw Dr. Hagen on three other occasions, with his
last documented visit occurring on February 13, 2020. Ex. 2 at 211. At that time, Dr. Hagen
observed no synovitis on examination and noted that Petitioner was tolerating his methotrexate
well and there had been no major flares of joint pain or swelling since his last visit. Id. Petitioner
reported some intermittent soreness in his shoulders and some mildly decreased sensation in his
left thumb, index and middle fingers that was stable. Id. No further records have been filed in this
case.
II. Witness Testimony
A. Fact Witnesses8
1. William Record – Petitioner offered testimony at the hearing. Tr. at 9–39.
At the time of vaccination, Petitioner was working for a medical supply company in Colorado. Id.
at 11. He confirmed receipt of the Hep A and B vaccines (along with a vaccine not covered in the
Program) in Colorado on April 30, 2018—with one administered in each arm. Id. at 10. He was at
that time planning a trip to South America for his daughter’s wedding. Id. at 11. Petitioner had no
pre-vaccination history of shoulder injury, and felt well the day of vaccination. Id. at 11–12.
A nurse practitioner was responsible for administering the vaccines, and Petitioner recalled
sensing that they were given too high in his shoulder. Tr. at 13–14. He did not, however, feel more
than some soreness immediately after, consistent with what he expected from a vaccination. Id. at
14. However, the soreness sensation grew by the day after, and he also began to experience
problems with moving his arm and discomfort during sleep. Id. at 15–16.
Petitioner thereafter travelled abroad as originally planned, but continued to notice issues
with pain and arm movement. Tr. at 17–18. He took some over-the-counter anti-inflammatory
medications, which provided limited relief, but did not seek medical treatment. Id. at 18. By the
time of his return to the U.S., Petitioner was still assuming the problem was transient in nature, but
started to notice his symptoms “migrate a little bit down my arm,” leading him to call his medical
provider for an in-person treatment (set for mid-June). Id. at 19. There, Petitioner reported his
severe pain and the range of motion limitations he was experiencing, but he was told to self-
medicate with more anti-inflammatories, and to return for more care if improvement was not
observed. Id. at 20–21.
8 Petitioner also offered an affidavit from his stepdaughter, Paige Nicole Lopez. See generally Ex. 13 (ECF No. 52-
1). However, Ms. Lopez did not testify at trial—and because the subjects she addresses in her witness statement were
adequately covered at hearing, and are otherwise not dispositive of the case. I do not summarize the contents of that
statement.
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A month later, Petitioner returned to his medical treater in mid-July, and was now feeling
worse, with pain “down through my elbows and was in my wrists and going into my hands,” plus
growing hand numbness and swelling. Tr. at 22. He also recalled experiencing ongoing shoulder
pain and swelling. Id. Although Petitioner did not sense that his treater was taking seriously his
condition, he was prescribed a steroid and some sleeping medication. Id. at 22–23. Petitioner
deemed the steroid effective in reducing his swelling/inflammation, although his hand and finger
symptoms were making it difficult for him to type at work. Id. at 23–24.
Petitioner opted for a different treater (Dr. Masterson) in August, and she continued steroid
treatment while also recommending that he see rheumatology and neurology specialists. Tr. at 24–
25. He subsequently went to Dr. Hagen, who recommended a different medication from a steroid.
Id. at 26. By this point, Petitioner was having increased difficulties with arm movement and use
of his hands for fine motor actions like buttoning his clothes. Id. at 27. But as the record discussed
above reveals, Petitioner had been diagnosed with CTS, and he recalled being told by a treater that
“severe inflammation and swelling” had caused the nerve blockage resulting in his CTS symptoms.
Id. at 28. He also testified being told that his shoulder inflammation and problems “had to have
been” associated with his CTS, since the problems had “moved right down my arms.” Id.
Petitioner noted the CTS-related surgeries he had underwent, acknowledging that they
improved his hand sensation and use despite the prior nerve damage. Tr. at 29. His shoulders are
also improved since the fall of 2018, noting in particular the range of motion improvements,
although he does still occasionally experience pain. Id. at 29–30. But Petitioner stressed he had
never experienced CTS prior to his April 2018 vaccinations. Id. at 30. And his post-vaccination
symptoms had impacted his ability to work that summer into the fall, as well as his pursuit of a
variety of outdoor activities he enjoyed. Id. at 30–32. It is Petitioner’s belief that the
misadministration of the Hep A and B vaccines resulted in the injuries that followed. Id. at 32–33.
On cross-examination, Petitioner acknowledged receiving the Hep A and B vaccines in the
past without incident. Tr. at 35–36. He clarified that he had reported to Dr. Hagen in August 2018
that his soreness post-vaccination had not become painful until nine days later, but added that he
viewed this as a progression in the degree of pain, rather than a difference between soreness and
outright pain. Id. at 39. Petitioner also noted that he had reported to a treater in the summer of 2018
that he was experiencing morning stiffness that would dissipate as the day went on. Id. at 37–38.
Today, he has continued treatment with no specialist akin to those he saw that summer, other than
a rheumatologist, and continues medication prescribed for rheumatologic conditions. Id. at 38.
2. Dawn Record – Mrs. Record, the Petitioner’s wife, offered brief testimony
in support of the claim. Tr. at 67–78. She also received vaccines at the same time as Mr. Record
(and at the same location), in advance of their planned international travel. Id. at 68. She recalled
him informing her the same day that he had received the vaccines at too high a place on his
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shoulder, and that he felt immediate soreness and subsequent pain. Id. at 69, 70, 77. He also
displayed range of motion limits during their travel. Id. at 72.
Prior to this incident, Petitioner had been in good health, with no evident issues in his arms.
Tr. at 69–70. But Mrs. Record observed Petitioner to continue to experience worsening of
symptoms after their trip, and eventually it was recommended that he pursue specialized
evaluations. Id. at 72–73. She was also present at Petitioner’s visit to Dr. Su, who proposed that
Petitioner’s CTS-hand symptoms could reflect inflammation that had begun in his shoulders. Id.
at 75. Over the time of his injury, Petitioner found it increasingly difficult to work or engage in
pursuits he enjoyed. Id. at 75–76. But in the time since Petitioner’s hand surgeries and receipt of
different medications, he has experienced improvement. Id. at 76–77.
B. Petitioner’s Expert – Dr. Ava Stanczak
Dr. Stanczak, an osteopathic physician, offered two written reports and testified on behalf
of Petitioner. Report, dated Aug. 5, 2022, filed as Ex. 11 (ECF No. 33-1) (“Stanczak First Rep.”);
Report, dated Feb. 22, 2023, filed as Ex. 12 (ECF No. 43-1) (“Stanczak Supp. Rep.”). Dr. Stanczak
proposed that Petitioner suffered a shoulder injury bilaterally after receipt of the Hep A and Hep
B vaccines. Stanczak First Rep. at 1.
Dr. Stanczak attended North Texas State University for her undergraduate degree, and
Texas College of Osteopathic Medicine for her doctor of osteopathy. See Curriculum Vitae, filed
Dec. 8, 2022 (ECF No. 40-1) (“Stanczak CV”) at 1; Tr. at 41–42. She then completed an internship
in Pediatrics, followed by her residency in Pediatrics at Children’s Medical Center in Dallas Texas.
Id. She is currently the Associate Dean of Primary Care at Kansas College of Osteopathic
Medicine. Id. at 3. Dr. Stanczak is board certified by the American Board of Osteopathic Pediatrics,
as well as board certified in Urgent Care Medicine. Id. at 1. Dr. Stanczak acknowledged, however,
that her focus is not on treatment of vaccine injuries or SIRVAs. Tr. at 62.9
Dr. Stanczak began her testimony by stressing how the mechanics of vaccine
administration could cause injury. Tr. at 45–46. If not properly administered into the deltoid
muscle, a vaccine’s antigenic components could enter the bursal space in a joint, producing a
significant inflammatory reaction. Id. at 46, 49, 50–52 (discussing literature specific to SIRVA).
The record in this case suggested to Dr. Stanczak that Petitioner had been given the Hep A and B
9 There was also some dispute between the parties as to the degree or nature of Dr. Stanczak’s expertise as applied to
the issues disputed in this action. Tr. at 103–04. As I noted during the trial, however, while I deemed Dr. Stanczak
competent to testify in this case generally, I do not accept her as a “SIRVA expert” specifically. This only means,
however, that opinions she offered about the nature of SIRVA and its purported association with CTS did not gain
heft simply due to the fact she supplied them, since she has no demonstrated special knowledge of SIRVA. Id. at 104–
05. I otherwise have considered carefully her opinion, and took it into account in reaching my decision.
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vaccines too high in his shoulder, consistent with a SIRVA injury. Id. at 46, 48–49.10 And
Petitioner’s pain had likely begun in the timeframe defined by the Table. Id. at 50.11 She thus
concluded that the record supported the conclusion that Petitioner experienced a SIRVA. Id. at 53.
Dr. Stanczak also endeavored to establish that Petitioner’s non-shoulder symptoms and
injuries were associated with his purported SIRVA. She sketched out a theory in which vaccination
could cause an “acute inflammatory response,” leading to cytokine production and downstream
symptoms indicative of excessive inflammation, like swelling, pain, and nerve compression. Tr.
at 53–54. Nerves in the shoulder branch down into the arm, and could result in CTS due to
inflammation and damage beginning in the shoulder. Id. at 55, 57–58. Indeed, one such nerve (the
median nerve) is connected with CTS. Id. at 66–67. Dr. Stanczak derived this opinion in part from
record evidence suggesting Petitioner’s treaters had proposed such a connection. Id. at 56. She also
opined that Petitioner’s treatment delay had exacerbated his subsequent CTS. Id. at 58–59.
On cross, Dr. Stanczak acknowledged that her conclusion that the covered vaccines were
misadministered was derived not from a medical record but from Petitioner’s testimonial
recollection of his vaccinations. Tr. at 63. She further admitted that the opinion offered to establish
a mechanistic association between Petitioner’s SIRVA and his subsequent CTS was largely not
found in her written reports. Id. at 64. The only independent evidence she could offer for this
alleged association was in an article specific to SIRVA. See S. Atanasoff et al., Shoulder Injury
Related to Vaccine Administration (SIRVA), 28 Vaccine 8049 (2010), filed as Ex. 12.1 (ECF No.
43-2) (“Atanasoff”).
Dr. Stanczak was also recalled for Petitioner’s rebuttal case. See generally Tr. at 105–06.
She maintained that she had referenced some independent literature involving CTS and its
association with SIRVA. Id. at 105; see M. Bodor & E. Montalvo, Vaccine-Related Shoulder
Dysfunction, 25 Vaccine 585 (2009), filed as Ex. 12.3 (ECF No. 43-4) (“Bodor & Montalvo”). She
also reiterated her view that the record supported Petitioner’s SIRVA claim allegations, and that
she properly took into account the Petitioner’s personal contentions (along with other fact
witnesses like Mrs. Record) in reaching the opinions she espoused. Tr. at 105–06.
10 Although Petitioner received a non-covered vaccine (yellow fever) at the time he also received the Hep A and B
vaccines, Dr. Stanczak proposed it unlikely the yellow fever vaccine had been mis-administered, since the record
showed it was a vaccine administered subcutaneously, with no risk it might have been introduced into the wrong place
on the arm. Tr. at 47.
11 Dr. Stancak was also asked some conclusory questions about Petitioner’s success in meeting other SIRVA elements
(Tr. at 50, 52–53, 60–61), but I do not summarize those responses since such vouching is not persuasive, or the proper
role of an expert.
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C. Respondent’s Expert – Dr. Geoffrey D. Abrams
Dr. Abrams, a board-certified orthopedic surgeon, offered one written report and testified
on behalf of Respondent. Report, dated Nov. 6, 2022, filed as Ex. A (ECF No. 38-1) (“Abrams
Rep.”). He opined that Petitioner’s shoulder symptoms following receipt of the relevant vaccines
are not consistent with that of a SIRVA injury, and were not otherwise vaccine-caused (including
Petitioner’ CTS). Id. at 6.
Dr. Abrams attended Stanford University for his undergraduate degree, and the University
of California, San Diego for his medical degree. See Curriculum Vitae, filed as Ex. B (ECF No.
38-9) (“Abrams CV”) at 1. He then completed a surgical internship followed by his residency at
Stanford University Hospital and Clinics. Id. Thereafter, Dr. Abrams completed a fellowship in
Orthopedic Sports Medicine at Rush University Medical Center. Id. He is currently an Associate
Professor of Orthopedic Surgery at Stanford University School of Medicine, as well as the Director
of the Lacob Family Sports Medicine Center at Stanford University. Id.; Abrams Rep. at 1. Dr.
Abrams also serves as Team Physician for numerous professional and collegiate sports teams in
the San Francisco Bay Area. Abrams CV at 32–33; Abrams Rep. at 1. He has a surgical practice
that focuses on orthopedic conditions of the shoulder, and he has also published extensively on
shoulder and other musculoskeletal pathology. Abrams Rep. at 1.
Dr. Abrams started his testimony with an explanation for how SIRVA injuries are theorized
to occur (consistent with Dr. Stanczak’s opinion). Tr. at 81–82. He characterized SIRVA as
featuring not only the elements relevant to the Table claim (such as immediate pain and range of
motion limits) but also “bone bruising, swelling in the subacromial bursa space, as well as
occasional rotator cuff problems,” with bursitis, tendinitis, and capsulitis as common diagnoses
connected to a SIRVA. Id. at 82, 83. But SIRVA is often comorbid with preexisting but benign
deficits that only manifest after the initial SIRVA pain, like tears or arthritic conditions. Id. at 82–
84. It also is characterized by shoulder-specific inflammation that does not migrate down the arm
or elsewhere. Id. at 88–89.
Petitioner’s description of his injury course, Dr. Abrams contended, was not consistent
with the acute nature of a SIRVA. Dr. Abrams understood Petitioner to have experienced a gradual
onset of pain over time, with some intermittent improvement, and he deemed that “atypical” of a
SIRVA. Tr. at 85. He also maintained that range of motion issues would be immediately associated
with initial vaccine administration—such that Petitioner’s lack of reported range of motion limits
in mid-June 2018 (as opposed to pain with motion) was also not SIRVA-like. Id. at 86–87.
Moreover, Petitioner reported the most treatment success with methotrexate—an
immunosuppressant drug not commonly used in the treatment of SIRVA injuries (although it is
used for inflammation associated with rheumatic conditions). Id. at 87–88, 101–02. (On cross-
examination, however, Dr. Abrams allowed that Petitioner had testified to experiencing more
traditional SIRVA-associated symptoms, even if Dr. Abrams interpreted the record as inconsistent
with the injury. Tr. at 100).
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In addition, Dr. Abrams noted the extent to which a large number of Petitioner’s post-
vaccination complaints were not shoulder-specific. For example, Petitioner had noted he had sleep
difficulties due to forearm pain, which was not characteristic of SIRVA. Tr. at 89. Dr. Abrams also
disputed that wrist pain could ever be a SIRVA symptom. Id. at 90. The same, he maintained, was
true of CTS itself, not something thought to have any relationship with SIRVA. Id.
Dr. Abrams particularly disputed Dr. Stanczak’s argument that CTS could be the
downstream result of shoulder inflammation, noting that authority offered by the Petitioner for this
contention did not address CTS. Tr. at 91; See generally Atanasoff, Bodor & Montalvo. He
similarly denied that the inflammation associated with a SIRVA could ever become severe enough
to cause median nerve compression at that situs that would then result in downstream wrist harm.
Tr. at 92. Anatomically, he maintained, inflammation in the bursa would not be expected to spread
down the arm in the manner proposed in Dr. Stanczak’s theory. Tr. at 92–94. To illustrate the
point, Dr. Abrams used a visual aid of nerves in the shoulder and bursal region. Id. at 95–96. In
fact, Dr. Abrams argued, if inflammation in the median nerve starting at the shoulder could spread
down the arm, one would expect inflammation all the way down throughout the arm—but
Petitioner’s EMG/NCS test results did not confirm the presence of that universal degree of nerve-
related dysfunction. Id. at 96–98.
III. Procedural History
After the case’s initiation, the matter was assigned to a different special master before being
reassigned to me in August 2021. Respondent filed his Rule 4(c) Report contesting Petitioner’s
right to compensation on February 28, 2022 (ECF No. 29). On August 26, 2022, Petitioner filed
an amended petition asserting a SIRVA Table claim. See Amended Petition, dated Aug. 26, 2022
(ECF No. 35). The process of obtaining expert reports began, with the final report from Dr.
Stanczak filed in April 2023. The parties submitted pre-hearing submissions, and then a one-day
Entitlement Hearing occurred on March 13, 2024. The matter is now fully ripe for resolution.
IV. Applicable Law
A. Petitioner’s Overall Burden in Vaccine Program Cases
To receive compensation in the Vaccine Program, a petitioner must prove either: (1) that
he suffered a “Table Injury”—i.e., an injury falling within the Vaccine Injury Table—
corresponding to one of the vaccinations in question within a statutorily prescribed period of time
or, in the alternative, (2) that his illnesses were actually caused by a vaccine (a “Non-Table
Injury”). See Sections 13(a)(1)(A), 11(c)(1), and 14(a), as amended by 42 C.F.R. § 100.3; §
11(c)(1)(C)(ii)(I); see also Moberly, 592 F.3d at 1321; Capizzano v. Sec’y of Health & Hum. Servs.,
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440 F.3d 1317, 1320 (Fed. Cir. 2006).12 Petitioner asserts a Table SIRVA claim, in addition to a
non-Table claim based on the same facts.
For both Table and Non-Table claims, Vaccine Program petitioners bear a “preponderance
of the evidence” burden of proof. Section 13(1)(a). That is, a petitioner must offer evidence that
leads the “trier of fact to believe that the existence of a fact is more probable than its nonexistence
before [he] may find in favor of the party who has the burden to persuade the judge of the fact’s
existence.” Moberly, 592 F.3d at 1322 n.2; see also Snowbank Enter. v. United States, 6 Cl. Ct.
476, 486 (1984) (mere conjecture or speculation is insufficient under a preponderance standard).
Proof of medical certainty is not required. Bunting v. Sec’y of Health & Hum. Servs., 931 F.2d 867,
873 (Fed. Cir. 1991). In particular, a petitioner must demonstrate that the vaccine was “not only
[the] but-for cause of the injury but also a substantial factor in bringing about the injury.” Moberly,
592 F.3d at 1321 (quoting Shyface, 165 F.3d at 1352–53); Pafford v. Sec’y of Health & Hum.
Servs., 451 F.3d 1352, 1355 (Fed. Cir. 2006). A petitioner may not receive a Vaccine Program
award based solely on his assertions; rather, the petition must be supported by either medical
records or by the opinion of a competent physician. Section 13(a)(1).
In attempting to establish entitlement to a Vaccine Program award of compensation for a
Non-Table claim, a petitioner must satisfy all three of the elements established by the Federal
Circuit in Althen v. Sec'y of Health & Hum. Servs., 418 F.3d 1274, 1278 (Fed. Cir. 2005): “(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.”
Each of the Althen prongs requires a different showing. Under Althen prong one, petitioners
must provide a “reputable medical theory,” demonstrating that the vaccine received can cause the
type of injury alleged. Pafford, 451 F.3d at 1355–56 (citations omitted). To satisfy this prong, a
petitioner’s theory must be based on a “sound and reliable medical or scientific explanation.”
Knudsen v. Sec’y of Health & Hum. Servs., 35 F.3d 543, 548 (Fed. Cir. 1994). Such a theory must
only be “legally probable, not medically or scientifically certain.” Id. at 549.
Petitioners may satisfy the first Althen prong without resort to medical literature,
epidemiological studies, demonstration of a specific mechanism, or a generally accepted medical
theory. Andreu, 569 F.3d at 1378–79 (citing Capizzano, 440 F.3d at 1325–26). Special masters,
despite their expertise, are not empowered by statute to conclusively resolve what are essentially
thorny scientific and medical questions, and thus scientific evidence offered to establish Althen
12 Decisions of special masters (some of which I reference in this ruling) constitute persuasive but not binding
authority. Hanlon v. Sec’y of Health & Hum. Servs., 40 Fed. Cl. 625, 630 (1998). By contrast, Federal Circuit rulings
concerning legal issues are binding on special masters. Guillory v. Sec’y of Health & Hum. Servs., 59 Fed. Cl. 121,
124 (2003), aff’d 104 F. Appx. 712 (Fed. Cir. 2004); see also Spooner v. Sec’y of Health & Hum. Servs., No. 13-159V,
2014 WL 504728, at *7 n.12 (Fed. Cl. Spec. Mstr. Jan. 16, 2014).
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prong one is viewed “not through the lens of the laboratorian, but instead from the vantage point
of the Vaccine Act’s preponderant evidence standard.” Id. at 1380. Accordingly, special masters
must take care not to increase the burden placed on petitioners in offering a scientific theory linking
vaccine to injury. Contreras, 121 Fed. Cl. at 245.
In discussing the evidentiary standard applicable to the first Althen prong, the Federal
Circuit has consistently rejected the contention that it can be satisfied merely by establishing the
proposed causal theory’s scientific or medical plausibility. See Kalajdzic v. Sec’y of Health &
Hum. Servs., No. 2023-1321, 2024 WL 3064398, at *2 (Fed. Cir. June 20, 2024) (arguments “for
a less than preponderance standard” deemed “plainly inconsistent with our precedent” (citing
Moberly, 592 F.3d at 1322)); Boatmon v. Sec’y of Health & Hum. Servs., 941 F.3d 1351, 1359
(Fed. Cir. 2019); see also Howard v. Sec'y of Health & Hum. Servs., 2023 WL 4117370, at *4
(Fed. Cl. May 18, 2023) (“[t]he standard has been preponderance for nearly four decades”), aff’d,
2024 WL 2873301 (Fed. Cir. June 7, 2024) (unpublished). And petitioners always have the
ultimate burden of establishing their overall Vaccine Act claim with preponderant evidence. W.C.
v. Sec’y of Health & Hum. Servs., 704 F.3d 1352, 1356 (Fed. Cir. 2013) (citations omitted); Tarsell
v. United States, 133 Fed. Cl. 782, 793 (2017) (noting that Moberly “addresses the petitioner’s
overall burden of proving causation-in-fact under the Vaccine Act” by a preponderance standard).
The second Althen prong requires proof of a logical sequence of cause and effect, usually
supported by facts derived from a petitioner’s medical records. Althen, 418 F.3d at 1278; Andreu,
569 F.3d at 1375–77; Capizzano, 440 F.3d at 1326; Grant v. Sec’y of Health & Hum. Servs., 956
F.2d 1144, 1148 (Fed. Cir. 1992). In establishing that a vaccine “did cause” injury, the opinions
and views of the injured party’s treating physicians are entitled to some weight. Andreu, 569 F.3d
at 1367; Capizzano, 440 F.3d at 1326 (“medical records and medical opinion testimony are favored
in vaccine cases, as treating physicians are likely to be in the best position to determine whether a
‘logical sequence of cause and effect show[s] that the vaccination was the reason for the injury’”)
(quoting Althen, 418 F.3d at 1280). Medical records are generally viewed as particularly
trustworthy evidence, since they are created contemporaneously with the treatment of the patient.
Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
Medical records and statements of a treating physician, however, do not per se bind the
special master to adopt the conclusions of such an individual, even if they must be considered and
carefully evaluated. Section 13(b)(1) (providing that “[a]ny such diagnosis, conclusion, judgment,
test result, report, or summary shall not be binding on the special master or court”); Snyder v. Sec’y
of Health & Hum. Servs., 88 Fed. Cl. 706, 746 n.67 (2009) (“there is nothing . . . that mandates
that the testimony of a treating physician is sacrosanct—that it must be accepted in its entirety and
cannot be rebutted”). As with expert testimony offered to establish a theory of causation, the
opinions or diagnoses of treating physicians are only as trustworthy as the reasonableness of their
suppositions or bases. The views of treating physicians should be weighed against other, contrary
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evidence also present in the record—including conflicting opinions among such individuals.
Hibbard v. Sec’y of Health & Hum. Servs., 100 Fed. Cl. 742, 749 (2011) (not arbitrary or capricious
for special master to weigh competing treating physicians’ conclusions against each other), aff’d,
698 F.3d 1355 (Fed. Cir. 2012); Veryzer v. Sec’y of Dept. of Health & Hum. Servs., No. 06-522V,
2011 WL 1935813, at *17 (Fed. Cl. Spec. Mstr. Apr. 29, 2011), mot. for review den’d, 100 Fed.
Cl. 344, 356 (2011), aff’d without opinion, 475 F. Appx. 765 (Fed. Cir. 2012).
The third Althen prong requires establishing a “proximate temporal relationship” between
the vaccination and the injury alleged. Althen, 418 F.3d at 1281. That term has been equated to the
phrase “medically-acceptable temporal relationship.” Id. A petitioner must offer “preponderant
proof that the onset of symptoms occurred within a timeframe which, given the medical
understanding of the disorder’s etiology, it is medically acceptable to infer causation.” de Bazan v.
Sec’y of Health & Hum. Servs., 539 F.3d 1347, 1352 (Fed. Cir. 2008). The explanation for what is
a medically acceptable timeframe must align with the theory of how the relevant vaccine can cause
an injury (Althen prong one’s requirement). Id. at 1352; Shapiro v. Sec’y of Health & Hum. Servs.,
101 Fed. Cl. 532, 542 (2011), recons. den’d after remand, 105 Fed. Cl. 353 (2012), aff’d mem.,
503 F. Appx. 952 (Fed. Cir. 2013); Koehn v. Sec’y of Health & Hum. Servs., No. 11-355V, 2013
WL 3214877 (Fed. Cl. Spec. Mstr. May 30, 2013), mot. for rev. den’d (Fed. Cl. Dec. 3, 2013),
aff’d, 773 F.3d 1239 (Fed. Cir. 2014).
B. Legal Standards Governing Factual Determinations
The process for making determinations in Vaccine Program cases regarding factual issues
begins with consideration of the medical records. Section 11(c)(2). The special master is required
to consider “all [ ] relevant medical and scientific evidence contained in the record,” including
“any diagnosis, conclusion, medical judgment, or autopsy or coroner's report which is contained
in the record regarding the nature, causation, and aggravation of the petitioner's illness, disability,
injury, condition, or death,” as well as the “results of any diagnostic or evaluative test which are
contained in the record and the summaries and conclusions.” Section 13(b)(1)(A). The special
master is then required to weigh the evidence presented, including contemporaneous medical
records and testimony. See Burns v. Sec'y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir.
1993) (determining that it is within the special master's discretion to determine whether to afford
greater weight to contemporaneous medical records than to other evidence, such as oral testimony
surrounding the events in question that was given at a later date, provided that such determination
is evidenced by a rational determination).
As noted by the Federal Circuit, “[m]edical records, in general, warrant consideration as
trustworthy evidence.” Cucuras, 993 F.2d at 1528; Doe/70 v. Sec'y of Health & Hum. Servs., 95
Fed. Cl. 598, 608 (2010) (“[g]iven the inconsistencies between petitioner's testimony and his
contemporaneous medical records, the special master's decision to rely on petitioner's medical
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records was rational and consistent with applicable law”), aff'd, Rickett v. Sec'y of Health & Hum.
Servs., 468 F. App’x 952 (Fed. Cir. 2011) (non-precedential opinion). A series of linked
propositions explains why such records deserve some weight: (i) sick people visit medical
professionals; (ii) sick people attempt to honestly report their health problems to those
professionals; and (iii) medical professionals record what they are told or observe when examining
their patients in as accurate a manner as possible, so that they are aware of enough relevant facts
to make appropriate treatment decisions. Sanchez v. Sec'y of Health & Hum. Servs., No. 11–685V,
2013 WL 1880825, at *2 (Fed. Cl. Spec. Mstr. Apr. 10, 2013); Cucuras v. Sec'y of Health & Hum.
Servs., 26 Cl. Ct. 537, 543 (1992), aff'd, 993 F.2d at 1525 (Fed. Cir. 1993) (“[i]t strains reason to
conclude that petitioners would fail to accurately report the onset of their daughter's symptoms”).
Accordingly, if the medical records are clear, consistent, and complete, then 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). Indeed, contemporaneous medical records
are often found to be deserving of greater evidentiary weight than oral testimony—especially
where such testimony conflicts with the record evidence. Cucuras, 993 F.2d at 1528; see also
Murphy v. Sec'y of Health & Hum. Servs., 23 Cl. Ct. 726, 733 (1991), aff'd per curiam, 968 F.2d
1226 (Fed. Cir. 1992), cert. den'd, Murphy v. Sullivan, 506 U.S. 974 (1992) (citing United States
v. United States Gypsum Co., 333 U.S. 364, 396 (1947) (“[i]t has generally been held that oral
testimony which is in conflict with contemporaneous documents is entitled to little evidentiary
weight.”)).
However, the Federal Circuit has also noted that there is no formal “presumption” that
records are accurate or superior on their face to other forms of evidence. Kirby v. Sec’y of Health
& Hum. Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021). There are certainly situations in which
compelling oral or written testimony (provided in the form of an affidavit or declaration) may be
more persuasive than written records, such as where records are deemed to be incomplete or
inaccurate. Campbell v. Sec'y of Health & Hum. Servs., 69 Fed. Cl. 775, 779 (2006) (“like any
norm based upon common sense and experience, this rule should not be treated as an absolute and
must yield where the factual predicates for its application are weak or lacking”); Lowrie, 2005 WL
6117475, at *19 (“[w]ritten records which are, themselves, inconsistent, should be accorded less
deference than those which are internally consistent”) (quoting Murphy, 23 Cl. Ct. at 733)).
Ultimately, a determination regarding a witness's credibility is needed when determining the
weight that such testimony should be afforded. Andreu, 569 F.3d at 1379; Bradley v. Sec'y of
Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
When witness testimony is offered to overcome the presumption of accuracy afforded to
contemporaneous medical records, such testimony must be “consistent, clear, cogent, and
compelling.” Sanchez, 2013 WL 1880825, at *3 (citing Blutstein v. Sec'y of Health & Hum. Servs.,
No. 90–2808V, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). In determining the
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accuracy and completeness of medical records, the Court of Federal Claims has listed 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 1334 (Fed. Cir. 2014). In making
a determination regarding whether to afford greater weight to contemporaneous medical records
or other evidence, such as testimony at hearing, there must be evidence that this decision was the
result of a rational determination. Burns, 3 F.3d at 417.
C. Analysis of Expert Testimony
Establishing a sound and reliable medical theory often requires a petitioner to present
expert testimony in support of his claim. Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357,
1361 (Fed. Cir. 2000). Vaccine Program expert testimony is usually evaluated according to the
factors for analyzing scientific reliability set forth in Daubert v. Merrell Dow Pharm., Inc., 509
U.S. 579, 594–96 (1993). See Cedillo v. Sec’y of Health & Hum. Servs., 617 F.3d 1328, 1339 (Fed.
Cir. 2010) (citing Terran v. Sec’y of Health & Hum. Servs., 195 F.3d 1302, 1316 (Fed. Cir. 1999).
Under Daubert, the factors for analyzing the reliability of testimony are:
(1) whether a theory or technique can be (and has been) tested; (2) whether the theory or
technique has been subjected to peer review and publication; (3) whether there is a known
or potential rate of error and whether there are standards for controlling the error; and (4)
whether the theory or technique enjoys general acceptance within a relevant scientific
community.
Terran, 195 F.3d at 1316 n.2 (citing Daubert, 509 U.S. at 592–95).
In the Vaccine Program the Daubert factors play a slightly different role than they do when
applied in other federal judicial settings, like the district courts. Typically, Daubert factors are
employed by judges (in the performance of their evidentiary gatekeeper roles) to exclude evidence
that is unreliable or could confuse a jury. By contrast, in Vaccine Program cases these factors are
used in the weighing of the reliability of scientific evidence proffered. Davis v. Sec'y of Health &
Hum. Servs., 94 Fed. Cl. 53, 66–67 (2010) (“uniquely in this Circuit, the Daubert factors have been
employed also as an acceptable evidentiary-gauging tool with respect to persuasiveness of expert
testimony already admitted”). The flexible use of the Daubert factors to evaluate the
persuasiveness and reliability of expert testimony has routinely been upheld. See, e.g., Snyder, 88
Fed. Cl. at 742–45. In this matter (as in numerous other Vaccine Program cases), Daubert has not
been employed at the threshold, to determine what evidence should be admitted, but instead to
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determine whether expert testimony offered is reliable and/or persuasive.
Respondent frequently offers one or more experts in order to rebut a petitioner’s case.
Where both sides offer expert testimony, a special master's decision may be “based on the
credibility of the experts and the relative persuasiveness of their competing theories.” Broekelschen
v. Sec'y of Health & Hum. Servs., 618 F.3d 1339, 1347 (Fed. Cir. 2010) (citing Lampe, 219 F.3d
at 1362). However, nothing requires the acceptance of an expert's conclusion “connected to
existing data only by the ipse dixit of the expert,” especially if “there is simply too great an
analytical gap between the data and the opinion proffered.” Snyder, 88 Fed. Cl. at 743 (quoting
Gen. Elec. Co. v. Joiner, 522 U.S. 146 (1997)); see also Isaac v. Sec'y of Health & Hum. Servs.,
No. 08–601V, 2012 WL 3609993, at *17 (Fed. Cl. Spec. Mstr. July 30, 2012), mot. for review
den'd, 108 Fed. Cl. 743 (2013), aff'd, 540 F. App’x. 999 (Fed. Cir. 2013) (citing Cedillo, 617 F.3d
at 1339). Weighing the relative persuasiveness of competing expert testimony, based on a
particular expert's credibility, is part of the overall reliability analysis to which special masters
must subject expert testimony in Vaccine Program cases. Moberly, 592 F.3d at 1325–26
(“[a]ssessments as to the reliability of expert testimony often turn on credibility determinations”);
see also Porter v. Sec'y of Health & Hum. Servs., 663 F.3d 1242, 1250 (Fed. Cir. 2011) (“this court
has unambiguously explained that special masters are expected to consider the credibility of expert
witnesses in evaluating petitions for compensation under the Vaccine Act”).
D. Consideration of Medical Literature
Both parties filed numerous items of medical and scientific literature in this case, but not
all such items factor into the outcome of this decision. While I have reviewed all the medical
literature submitted in this case, I discuss only those articles that are most relevant to my
determination and/or are central to Petitioner’s case—just as I have not exhaustively discussed
every individual medical record filed. Moriarty v. Sec’y of Health & Hum. Servs., No. 2015–5072,
2016 WL 1358616, at *5 (Fed. Cir. Apr. 6, 2016) (“[w]e generally presume that a special master
considered the relevant record evidence even though he does not explicitly reference such evidence
in his decision”) (citation omitted); see also Paterek v. Sec’y of Health & Hum. Servs., 527 F.
App’x 875, 884 (Fed. Cir. 2013) (“[f]inding certain information not relevant does not lead to—and
likely undermines—the conclusion that it was not considered”).
ANALYSIS
I. Petitioner Cannot Preponderantly Establish a Table SIRVA Claim
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 pain from the vaccine administration manifests within 48 hours.
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42 C.F. R. § 100.3(a)(XIV)(B). Additional relevant criteria establishing a SIRVA under the
accompanying Qualifications and Aids to Interpretation (“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
(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).
Here, Petitioner can substantiate some elements of a Table SIRVA. For example, the record
establishes his onset of pain as occurring within 48 hours of vaccination—based on a combination
of record proof and witness contentions. In addition, Mr. Record reported range of motion limits,
even if not consistently. And he had no demonstrated prior history of shoulder pain (as opposed to
CTS).
However, other aspects of the record are inconsistent with a Table SIRVA. The largest
deficiency with the claim is the fact that Petitioner eventually reported pain and other symptoms
not characteristic of SIRVA, affecting his hands and wrists in particular. Indeed, these issues
eventually predominated his treatment. Thus, by the late summer/early fall of 2018, Petitioner was
predominantly receiving rheumatologic care for his complaints, and medications more specific to
such treatment. The CTS-oriented surgical procedures he underwent are also wholly
uncharacteristic of SIRVA. Thus, the record overall does not establish that Petitioner’s complaints
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were shoulder-specific, even if initially they appeared to be. And an alternative explanation—
reactive arthritis—was proposed by several treaters, and never ruled out, nor was SIRVA itself
embraced as the most likely diagnostic explanation for what Petitioner experienced.
My conclusion remains even if I ignored all the CTS-oriented treatment the Petitioner
received, and focused only on SIRVA-specific elements. This is because a Table claim is subject
to the same requirement of proof of six months severity that any Program claim must meet. Song
v. Sec’y of Health & Hum. Servs., 31 Fed. Cl. 61, 65 (1994), aff’d, 41 F.3d 1520 (Fed. Cir. 1994)
(unpublished); Crabbe v. Sec’y of Health & Hum. Servs., No. 10-762V, 2011 WL 4436724, at *1
(Fed. Cl. Spec. Mstr. Aug. 26, 2011). And the evidence in this case does not preponderate in favor
of a finding of severity.
Assuming that Petitioner’s pain onset began the day of, or even one day after the April 30,
2018 vaccinations, the record does not show that his shoulder-specific concerns continued through
the end of October 2018. On the contrary—by that time, his entire focus was on CTS, for which
he was seeing a rheumatologist, Dr. Hagen. And his treatments were all aimed at remedying those
symptoms. Thus, this case does not present circumstances common to SIRVAs, where a person
either (in the worst case) undergoes arthroscopic surgery, obtains steroid shots to minimize pain,
or otherwise engages in extensive physical therapy. This record does not establish that any initial
pain Petitioner might have experienced due to vaccine misadministration was severe enough to
meet the Act’s foundational severity requirement. Wagner v. Sec’y of Health & Hum. Servs., No.
17-1388V, 2019 WL 3297509, at *5 (Fed. Cl. Spec. Mstr. May 8, 2019) (finding that “[w]hile
even mild symptoms that do not require medical care may satisfy the severity requirement, ongoing
medical treatment for conditions unrelated to the alleged vaccine injury do not”) (emphasis in
original).
In so determining, I find unpersuasive Petitioner’s strained effort to connect his
documented CTS issues with any SIRVA-like symptoms he experienced post-vaccination—and
thus the ongoing nature of his CTS diagnosis and treatment is not a SIRVA-related sequelae that
could meet the severity requirement, even after his shoulder complaints had ceased. SIRVA and
CTS are simply unrelated conditions. And as Dr. Abrams established, it is highly unlikely that
SIRVA-associated inflammation would both “spread” down the arm and also be capable of causing
the symptoms associated with, or leading to, CTS. By contrast, Dr. Stanczak was unpersuasive on
this issue, and lacked a sufficient personal background in treating or studying either condition (let
alone their relationship) to offer a reliable opinion on the topic. In addition, no other independent
evidence was referenced suggesting CTS and SIRVA could be related as alleged herein. And it is
undisputed that Petitioner had experienced CTS prior to vaccination in any event.
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II. Petitioner Cannot Establish a Causation-in-Fact Claim
The same facts and findings set forth above lead me to conclude that no causation-in-fact
claim would be viable. Because Petitioner cannot establish that his SIRVA persisted for more than
six months, any causation claim would involve a finding that the Hep A and B vaccines caused
him to experience CTS. But the record does not support this determination, in several regards.
As noted, Dr. Stanczak did not credibly establish that a SIRVA could morph into CTS, or
worsen13 a preexisting case of it. In addition, the Althen prongs were not at all met on a theory that
the Hep A and/or B vaccines can cause CTS in the first place. Dr. Stanczak also did not offer a
reliable theory that these vaccines (or even any covered vaccine) could worsen CTS. Rather, the
entirety of her theory relied on connecting the SIRVA to CTS, but she did not persuasively
establish this (for the reasons previously discussed).
The record similarly does not support the conclusion that these vaccines likely “did cause”
Petitioner’s CTS. While some treaters, like Dr. Masterson (in reaction to Petitioner’s reports to
them) allowed for a possibility of a vaccine reaction, that conclusion was not later accepted or
deemed likely. Petitioner’s history at most suggests an initial SIRVA-like reaction that later waned,
with his preexisting CTS flaring up independently and concurrently—but coincidental to
vaccination. Nor has Petitioner established his CTS began, or worsened, in a medically acceptable
timeframe measured from the date of vaccination. The record suggests Petitioner first complained
of wrist or hand-associated issues in mid-July 2018, or two and one-half months after vaccination
at the end of April. At best, based on his own testimony, he first felt post-vaccination hand
symptoms like swelling at the end of June—two months after the vaccinations. But no reliable
13 Petitioner has not formally alleged a significant aggravation claim based on the six-prong test set in Loving v. Sec’y
of Health & Hum. Servs., 86 Fed. Cl. 135, 144 (2009). The Loving test’s elements require establishing:
(1) The person’s condition prior to administration of the vaccine, (2) the person’s current condition (or the
condition following the vaccination if that is also pertinent), (3) whether the person’s current condition
constitutes a ‘significant aggravation’ of the person’s condition prior to vaccination, (4) a medical theory
causally connecting such a significantly worsened condition to the vaccination, (5) a logical sequence of
cause and effect showing that the vaccination was the reason for the significant aggravation, and (6) a
showing of proximate temporal relationship between the vaccination and the significant aggravation.
Loving, 86 Fed. Cl. at 144.
In Sharpe v. Sec’y of Health & Hum. Servs., 964 F.3d 1072 (Fed. Cir. 2020), the Federal Circuit further elaborated on
the Loving framework. Under Prong (3) of the Loving test, the Petitioner need not demonstrate an expected outcome,
but merely that her current-post vaccination condition was worse than pre-vaccination. Sharpe, 964 F.3d at 1081. And
a claimant may make out a prima facie case of significant aggravation overall without eliminating a preexisting
condition as the potential cause of her significantly aggravated injury (although the Circuit’s recasting of the
significant aggravation standard sill permits Respondent to attempt to establish alternative cause, where a petitioner’s
showing is enough to make out a prima facie case and thereby shift the burden of proof to Respondent). Id. at 1083.
19

Case 1:21-vv-01312-SSS Document 69 Filed 02/05/25 Page 20 of 20
evidence has been offered in this case supporting a timeframe of two or more months after
vaccination as medically acceptable.
CONCLUSION
Petitioner has not carried his burden of proof, and therefore the claim is dismissed. In the
absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of the Court SHALL
ENTER JUDGMENT in accordance with the terms of this Decision. 14
IT IS SO ORDERED.
s/ Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
14 Pursuant to Vaccine Rule 11(a), the parties may expedite entry of judgment if (jointly or separately) they file notices
renouncing their right to seek review.
20

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DOCUMENT 2: USCOURTS-cofc-1_21-vv-01312-1
Date issued/filed: 2025-03-20
Pages: 9
Docket text: JUDGE VACCINE REPORTED OPINION AND ORDER (PUBLIC VERSION) reissuing 72 Opinion and Order on 61 Motion for Review. Signed by Judge Stephen S. Schwartz. (cmc) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-01312-SSS Document 73 Filed 03/20/25 Page 1 of 9
In the United States Court of Federal Claims
No. 21-1312V
(Filed Under Seal: February 26, 2025)
(Reissued: March 20, 2025)
FOR PUBLICATION
*************************************
WILLIAM RECORD, *
*
Petitioner, *
*
v. *
*
SECRETARY OF HEALTH AND *
HUMAN SERVICES, *
*
Respondent. *
*
*************************************
Brian Robert Arnold, Brian R. Arnold & Associates, Richardson, TX, for
Petitioner.
Jay Travis Williamson, Trial Attorney, Torts Branch, Civil Division, United
States Department of Justice, Washington, D.C., for Respondent. With him on the
briefs were Brian M. Boynton, Principal Acting Assistant Attorney General, C.
Salvatore D’Alessio, Director, Heather L. Pearlman, Deputy Director, and Lara A.
Englund, Assistant Director, Torts Branch, Civil Division, United States Department
of Justice, Washington, D.C.
OPINION AND ORDER
Petitioner William Record sought relief under the National Childhood Vaccine
Injury Act of 1986, 42 U.S.C. §§ 300aa-10 to -34 (“Vaccine Act”), for an alleged
bilateral shoulder injury related to vaccine administration (“SIRVA”). SIRVA, as
discussed below, is a “Table” injury subject to simplified proof of causation. 42 C.F.R.
§§ 100.3(a)(VIII), 100.3(a)(XIII), 100.3(c)(10). But the Chief Special Master found that
the Petitioner had not demonstrated a Table injury, and so denied recovery. See
Entitlement Decision (“Entitlement Dec.”) (ECF 60). Petitioner filed a motion for
review, which has been fully briefed and argued.1 I conclude that aspects of the
 This Opinion was issued under seal on February 26, 2025. The parties were directed to propose
redactions by March 12, 2025. No proposed redactions were submitted. The Court hereby releases
publicly the Opinion and Order of February 26 in full.
1 Petitioner’s Mot. for Review (“Pet.’s Mot.”) (ECF 61); Respondent’s Resp. to Mot. for Review (“Resp.’s
Br.”) (ECF 64).

Case 1:21-vv-01312-SSS Document 73 Filed 03/20/25 Page 2 of 9
Entitlement Decision are not explained with enough detail for meaningful review.
Thus, I REMAND for further proceedings.2
BACKGROUND
I. The Vaccine Act
To obtain compensation under the Vaccine Act, a petitioner must prove that a
vaccine caused an injury. Althen v. Sec’y of Health & Hum. Servs., 418 F.3d 1274,
1278 (Fed. Cir. 2005). There are two ways to show that a vaccine caused a given
medical condition: (1) “through a statutorily-prescribed presumption of causation
upon a showing that the injury falls under the Vaccine Injury Table (‘Table injury’),”
id. (citing 42 U.S.C. § 300aa-14(a)), or (2) by establishing causation in fact “where the
complained-of injury is not listed in the Vaccine Injury Table (‘off-Table injury’),” id.
(citing 42 U.S.C. §§ 300aa-13(a)(1), 300aa-11(c)(1)(C)(ii)(I)).
The presumption of causation for Table injuries applies when petitioners
receive covered vaccines and then experience specified injuries within specified time
periods.3 For many injuries listed as possible Table injuries, the Table includes
“Qualifications and Aids to Interpretation” (“QAIs”) that define the injury and explain
how the existence of the injury should be established. See 42 C.F.R. § 100.3(c). If a
petitioner “can establish that [he] received a listed vaccine and experienced such
symptoms or injuries within the specified timeframes, [he] has met [his] prima facie
burden to prove that the vaccine caused [his] injuries.” de Bazan v. Sec’y of Health &
Hum. Servs., 539 F.3d 1347, 1351 (Fed. Cir. 2008).
For both Table and off-Table injuries, to receive compensation, a Petitioner
must demonstrate that he “suffered the residual effects or complications of [the
alleged injury] for more than 6 months after the administration of the vaccine.” 42
U.S.C. § 300aa-11(c)(1)(D)(i).
Petitioner has alleged that he sustained SIRVA in both arms after receiving
vaccinations for Hepatitis A and B.4 Am. Pet. at 2 (ECF 35). SIRVA is a Table injury
2 This Court has jurisdiction. See 42 U.S.C. §§ 300aa-11(c), 300aa-12, 300aa-16(a). Petitioner timely
moved for review. See 42 U.S.C. § 300aa-12(e)(1).
3 That distinguishes Table cases from off-Table cases, in which a petitioner must prove causation in
fact by preponderance of the evidence. Trinnaman v. Sec’y of Health & Hum. Servs., 171 Fed. Cl. 317,
322 (2024); see, e.g., Hibbard v. Sec’y of Health & Hum. Servs., 698 F.3d 1355, 1366 (Fed. Cir. 2012);
Althen, 418 F.3d at 1278.
4 Petitioner has also alleged, in the alternative, a causation-in-fact claim. Am. Pet. at 5 (ECF 35).
Petitioner’s theory of causation was that the administration of his vaccines caused SIRVA, which in
turn led to all the other symptoms that he experienced. Pet.’s Pre-Hearing Br. at 11–17 (ECF 47); Tr.
at 32, 59–61 (ECF 59); Pet.’s Mot. at 7–9. Because that medical theory overlaps with some aspects of
Petitioner’s Table claim, and because I remand for additional development of the Table claim, I need
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for those vaccines when experienced within 48 hours of vaccination. See 42 C.F.R.
§§ 100.3(a)(VIII)(B), 100.3(a)(XIII)(B). The QAIs for SIRVA are as follows:
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. ... 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; [“QAI 1”]
(ii) Pain occurs within the specified time-frame; [“QAI 2”]
(iii) Pain and reduced range of motion are limited to the shoulder in
which the intramuscular vaccine was administered; [“QAI 3”] 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). [“QAI
4”]
42 C.F.R. § 100.3(c)(10)(i)–(iv).
This Court may set aside a special master’s conclusions as “arbitrary,
capricious, an abuse of discretion, or otherwise not in accordance with law[.]” 42
U.S.C. § 300aa-12(e)(2)(B). “Fact findings are reviewed ... under the arbitrary and
capricious standard; legal questions under the ‘not in accordance with law’ standard;
and discretionary rulings under the abuse of discretion standard.” Munn v. Sec’y of
Dep’t of Health & Hum. Servs., 970 F.2d 863, 870 n.10 (Fed. Cir. 1992). A special
master must explain his reasoning thoroughly enough to enable meaningful review
by the appellate court. Goodwin v. Sec’y of Health & Hum. Servs., No. 19-503, 2024
WL 4758470, at *1 (Fed. Cl. Oct. 10, 2024). When this Court finds error, it may either
substitute its own findings and conclusions or remand for additional proceedings. 42
U.S.C. § 300aa-12(e)(2)(B)–(C).
II. Procedural and Factual History
Petitioner received the Hepatitis A and Hepatitis B vaccines, one in each
shoulder, on April 30, 2018.5 Pet.’s Ex. 1 at 1–2 (ECF 19-1); Entitlement Dec. at 2.
Petitioner testified that he immediately felt both vaccinations were given “too high”
not reach Petitioner’s off-Table theories. If the Chief Special Master wishes to provide further
explanation of his resolution of the off-Table claim on remand, he may do so.
5 Petitioner also received a vaccination against yellow fever on the same date, Pet.’s Ex. 1 at 1–3 (ECF
19-1), but that vaccination is not at issue in this case. Pet.’s Mot. at 1–2; Entitlement Dec. at 2.
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in the shoulder. Entitlement Dec. at 5; see Tr. at 14 (ECF 59); Pet.’s Ex. 10 at 2 (ECF
32-2). He also testified that he developed pain and movement limitations in both
shoulders within 48 hours. Tr. at 14–16; Entitlement Dec. at 5, 17.
The pain worsened during a period of international travel and began to spread
down his arms, see Entitlement Dec. at 5, so Petitioner sought medical attention in
June. Id. at 2; Pet.’s Ex. 2 at 24–27 (ECF 20-1).6 At his appointment, Petitioner
reported both pain and restricted movement, and placed the onset of pain at the time
of the vaccination. Pet.’s Ex. 2 at 25; Entitlement Dec. at 2, 5, 17. His providers at the
time suggested physical therapy, which he declined. Pet.’s Ex. 2 at 26; Pet.’s Ex. 3 at
3 (ECF 21-1); Entitlement Dec. at 2.7
He returned a month later, with continued shoulder pain and additional wrist
and hand pain. Pet.’s Ex. 3 at 5; Entitlement Dec. at 2. Petitioner was diagnosed with
carpal tunnel syndrome and wrist neuropathy. Pet.’s Ex. 2 at 37; Pet.’s Ex. 3 at 5, 7;
Entitlement Dec. at 2–3.8
Petitioner’s pain continued. In an August visit, he again complained of
bilateral shoulder pain and hand swelling. Pet.’s Ex. 3 at 12–13; Entitlement Dec. at
3. The doctor suggested possible “reactive arthritis,” and hypothesized that the carpal
tunnel pain was secondary to possible vaccine-related swelling. Pet.’s Ex. 3 at 13; see
Entitlement Dec. at 3. Subsequent treating physicians continued to note the
potentially reactive nature of his swelling. Pet.’s Ex. 3 at 14, 20.
Petitioner underwent surgery for carpal tunnel syndrome in October and
December 2018, Entitlement Dec. at 4, which he testified improved his symptoms. Id.
at 6. He also began treatment with methotrexate, a rheumatic medicine. Id. at 4–5,
9; Pet.’s Ex. 2 at 135–36; Pet.’s Ex. 3 at 29–32.
By February 2020, Petitioner was experiencing only “intermittent soreness in
his shoulders and some mildly decreased sensation in his left thumb, index and
6 Most pages of Petitioner’s Exhibit 2 contain three different sets of page numbering. See, e.g., Pet.’s
Ex. 2 at 24 (numbered as 18, 24, and 25). The Chief Special Master used the numbering stamped in
red at the bottom of the exhibit page, rather than the pagination of the underlying document or the
ECF pagination. For consistency and ease of reference, I do so as well throughout this opinion.
7 As with Exhibit 2, I follow the Chief Special Master in using the exhibit pagination rather than the
ECF pagination.
8 The record is inconsistent as to whether Petitioner had carpal tunnel syndrome before his
vaccination. The Chief Special Master considered it “undisputed that Petitioner had experienced
[carpal tunnel syndrome] prior to vaccination.” Entitlement Dec. at 18. But Petitioner in fact
specifically denied that he had been treated for or diagnosed with carpal tunnel syndrome before
vaccination. Tr. at 30; Entitlement Dec. at 6. Whatever the true facts of Petitioner’s carpal tunnel
syndrome might be, they do not appear to be “undisputed.” Entitlement Dec. at 18. The Chief Special
Master may revisit the issue on remand.
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middle fingers that was stable.” Entitlement Dec. at 5. According to Petitioner’s
hearing testimony, his only ongoing treatment is rheumatologic. Id. at 6; Tr. at 38.
But although his shoulders have improved, he testified that he continued to
experience pain as late as the hearing before the Chief Special Master in March 2024.
Entitlement Dec. at 6; Tr. at 29–30.
The Chief Special Master considered the record and found that Petitioner had
not demonstrated a Table SIRVA injury. Entitlement Dec. at 17–18. He determined
that the first two QAIs were met because Petitioner had no relevant history of
shoulder pain and the alleged injury occurred within 48 hours of vaccination. Id. at
17. But he found that Petitioner did not satisfy QAI 3 or QAI 4. Id. at 17–18.
The Petitioner argued, based on the medical record and expert testimony, that
his carpal tunnel syndrome symptoms were caused by SIRVA-related inflammation.9
Pet.’s Resp. to Resp.’s Pre-Hearing Mem. at 4–5 (ECF 51). But the Chief Special
Master rejected that argument:
However, other aspects of the record are inconsistent with a Table
SIRVA. The largest deficiency with the claim is the fact that Petitioner
eventually reported pain and other symptoms not characteristic of
SIRVA, affecting his hands and wrists in particular. Indeed, these issues
eventually predominated his treatment. Thus, by the late summer/early
fall of 2018, Petitioner was predominantly receiving rheumatologic care
for his complaints, and medications more specific to such treatment. The
[carpal tunnel syndrome]-oriented surgical procedures he underwent
are also wholly uncharacteristic of SIRVA. Thus, the record overall does
not establish that Petitioner’s complaints were shoulder-specific, even if
initially they appeared to be. And an alternative explanation — reactive
arthritis — was proposed by several treaters, and never ruled out, nor
was SIRVA itself embraced as the most likely diagnostic explanation for
what Petitioner experienced.
Entitlement Dec. at 17–18.
In addition to that relatively terse explanation, the Chief Special Master
rejected Petitioner’s claim that his shoulder pain was connected to his hand and wrist
pain. Id. at 18. He found that “SIRVA and CTS are simply unrelated conditions,” and
credited the government’s expert’s view that SIRVA is “highly unlikely” to spread to
9 The Petition also mentions a theory that Petitioner’s vaccination aggravated pre-existing medical
conditions. Am. Pet. at 5. But the Chief Special Master explained that Petitioner failed to formally
develop that argument, Entitlement Dec. at 19 n.13, and Petitioner did not present an aggravation
theory in his motion for review. I therefore agree with the Chief Special Master that to the extent
Petitioner wished to present aggravation as grounds for recovery, he failed to preserve it. RCFC App.
B, Rule 24.
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a patient’s wrists and hands. Id. He acknowledged the contrary view of Petitioner’s
expert, but found her unpersuasive and “lack[ing] a sufficient personal background
in treating or studying either condition (let alone their relationship) to offer a reliable
opinion on the topic.” Id.
The Chief Special Master further explained that his conclusion remained the
same “even if [he] ignored all the [carpal tunnel syndrome]-oriented treatment that
the Petitioner received, and focused only on SIRVA-specific elements,” id., because
the record as a whole did not show that any shoulder-specific pain persisted for the
required six-months:
Assuming that Petitioner’s pain onset began the day of, or even one day
after the April 30, 2018 vaccinations, the record does not show that his
shoulder-specific concerns continued through the end of October 2018.
On the contrary — by that time, his entire focus was on CTS, for which
he was seeing a rheumatologist, Dr. Hagen. And his treatments were all
aimed at remedying those symptoms. Thus, this case does not present
circumstances common to SIRVAs, where a person either (in the worst
case) undergoes arthroscopic surgery, obtains steroid shots to minimize
pain, or otherwise engages in extensive physical therapy. This record
does not establish that any initial pain Petitioner might have
experienced due to vaccine misadministration was severe enough to
meet the Act’s foundational severity requirement.
Id.
DISCUSSION
Petitioner argues mainly that the Chief Special Master failed to adequately
consider the possibility that his shoulder and wrist pain were unrelated. Oral Arg.
Tr. at 21 (ECF 71); see Pet.’s Mot. at 8. As Petitioner points out, QAI 3 and QAI 4
could be met even if a SIRVA patient coincidentally suffered unrelated carpal tunnel
syndrome. See Rodgers v. Sec’y of Health & Hum. Servs., No. 18-0559V, 2021 WL
4772097, at *8 (Fed. Cl. Sept. 9, 2021). Petitioner also argues that the Chief Special
Master erred in finding the Vaccine Act’s six-month severity requirement unmet.
Pet.’s Mot. at 6. I agree that it is difficult to understand why the Chief Special Master
considered those requirements unsatisfied in Petitioner’s case, and so I remand for
additional explanation.
1. The SIRVA QAIs
At the threshold, the government questions whether Petitioner has even
preserved an argument that he experienced SIRVA unrelated to his other conditions.
Resp.’s Br. at 11; Oral Arg. Tr. at 51. Petitioner does appear to have focused his
argument before the Chief Special Master on the theory that all his pain was
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connected to the vaccines.10 But there is no question that Petitioner alleged a SIRVA
injury, Am. Pet. at 2; see also 42 U.S.C. §§ 300aa-11(c)(1)(C)(i), even if the scope of
the symptoms attributable to that injury is in dispute. The Chief Special Master
accordingly considered the possibility that Petitioner’s shoulder pain could be
analyzed as distinct from his hand and wrist pain. Entitlement Dec. at 18. That is
enough to present the issue for this Court’s review. See Suffolk Techs., LLC v. AOL
Inc., 752 F.3d 1358, 1364 n.2 (Fed. Cir. 2014) (explaining that once the lower court
“recognized, considered, and ruled on the issue,” the argument was not forfeited on
appeal) (citing Hollmer v. Harari, 681 F.3d 1351, 1356 n.3 (Fed. Cir. 2012) (in turn
citing Lebron v. Nat’l R.R. Passenger Corp., 513 U.S. 374, 379 (1995))). I may therefore
review the Chief Special Master’s conclusion that Petitioner failed to show that his
shoulder pain, considered in isolation, constituted a SIRVA Table injury.
The main problem with the Entitlement Decision is that it does not explain the
Chief Special Master’s reasoning in enough detail for my review. The essential
reasoning appears in a single paragraph (reproduced above) making two points about
Petitioner’s treatment: (1) his treatments were ultimately rheumatologic and carpal
tunnel–related, and (2) during the course of his treatment, the alternative
explanation of “reactive arthritis” was “never ruled out” while SIRVA was not
“embraced as the most likely diagnostic explanation.” Entitlement Dec. at 17–18. But
it does not follow from either of those points that QAI 3 and QAI 4 are unmet.
As for QAI 3, Petitioner was obligated to show “[p]ain and reduced range of
motion are limited to the shoulder in which the intramuscular vaccine was
administered[.]” 42 C.F.R. § 100.3(c)(10)(iii). As mentioned, though, there is no
dispute that a petitioner can satisfy QAI 3 even if he is treated for other pain,
elsewhere in his body, caused by some other condition. Rodgers, 2021 WL 4772097,
at *8. Given the acknowledged possibility that Petitioner’s shoulder pain appeared
coincidentally with other conditions, the Entitlement Decision should have
considered whether some of the pain was shoulder-specific.
As for QAI 4, the question is whether any “other condition or abnormality is
present that would explain the patient’s symptoms[.]” 42 C.F.R. § 100.3(c)(10)(iv); see,
e.g., Lang v. Sec’y of Health & Hum. Servs., No. 17-995V, 2020 WL 7873272, at *12–
13 (Fed. Cl. Dec. 11, 2020). That requires consideration of a petitioner’s medical
10 The Chief Special Master, as mentioned, rejected that theory based mainly on his findings that
SIRVA is distinct from Petitioner’s other conditions and that the government’s expert was more
credible than Petitioner’s. Entitlement Dec. at 18. Petitioner has presented little if any contrary
argument, and so has not shown that the Chief Special Master’s conclusion was arbitrary or capricious.
But even that part of the Entitlement Decision distinguishes Petitioner’s carpal tunnel syndrome from
his “SIRVA-like symptoms,” id., and so underscores that shoulder-specific concerns should be analyzed
as such even if other concerns are set aside.
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condition as a whole. See, e.g., Durham v. Sec’y of Health & Hum. Servs., No. 17-
1899V, 2023 WL 3196229, at *14 (Fed. Cl. May 2, 2023). Although the Entitlement
Decision mentions the possibility of reactive arthritis, it does not actually conclude
that reactive arthritis is “present,” nor that it would “explain” Petitioner’s symptoms
as a whole — only that it was not “ruled out.” Entitlement Dec. at 18; see 42 C.F.R. §
100.3(c)(10)(iv). Finding that an alternative explanation for Petitioner’s condition is
possible does not respond to the terms of the QAI and thus cannot be enough to find
that the Table criteria are unmet.
To be clear, I do not find that the Chief Special Master was wrong on the facts
or that Petitioner has a Table injury. The point, rather, is that to survive arbitrary
and capricious review, “a decision-maker must ‘provide a reasoned explanation for
[his] action.’” Goodwin, 2024 WL 4758470, at *3 (quoting Dep’t of Homeland Sec. v.
Regents of the Univ. of Cal., 591 U.S. 1, 35 (2020)). That requires not only that the
decision maker “consider[] the relevant evidence of record [and] draw[] plausible
inferences,” but that the decision maker “articulate[] a rational basis for the decision.”
Hines ex rel. Sevier v. Sec’y of Dep’t of Health & Hum. Servs., 940 F.2d 1518, 1528
(Fed. Cir. 1991). Where a special master’s decision does not articulate an explanation
that logically connects specific facts to the terms of the Table, there is not enough for
this Court’s review, and remand is appropriate. McClendon v. Sec’y of Dep’t of Health
& Hum. Servs., 23 Cl. Ct. 191, 196–97 (1991); see also Goodwin, 2024 WL 4758470 at
*2 (quoting Dixon v. Sec’y of Health & Hum. Servs., 61 Fed. Cl. 1, 8 (2004) (itself
quoting Motor Vehicle Mfrs. Ass’n v. State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43
(1983))).
2. The Six-Month Severity Requirement
The Chief Special Master concluded in the alternative that “even if [he] ignored
all the [carpal tunnel syndrome]-oriented treatment the Petitioner received, and
focused only on SIRVA-specific elements,” Petitioner did not satisfy the Vaccine Act’s
six-month severity requirement. Entitlement Dec. at 18. I remand for reconsideration
of that conclusion as well.
The Chief Special Master found that “the record does not show that
[Petitioner’s] shoulder-specific concerns continued through the end of October 2018,”
six months after the vaccination. Entitlement Dec. at 18. Findings of fact by special
masters are reviewed with great deference. Porter v. Sec’y of Health & Hum. Servs.,
663 F.3d 1242, 1249 (Fed. Cir. 2011); Munn, 970 F.2d at 870. But the Chief Special
Master’s specific factual findings conflict with that conclusion. Petitioner in fact
testified that he experienced intermittent pain as late as the 2024 hearing in this
case. See Tr. at 29–30; Entitlement Dec. at 6. The Entitlement Decision never says
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that Petitioner was not credible in that regard. That makes it hard to understand a
finding that, even “focus[ing] only on SIRVA-specific elements” of Petitioner’s claim,
“his shoulder-specific concerns” were over by the fall of 2018. Entitlement Dec. at 18.
It is possible that the Chief Special Master meant that Petitioner’s pain was
not intense enough to satisfy the severity requirement. See id. (concluding that the
record “does not establish that any initial pain Petitioner might have experienced due
to vaccine misadministration was severe enough to meet the Act’s foundational
severity requirement”). But that would have been a legal error. The Vaccine Act’s
severity requirement goes only to the persistence of pain, not its intensity, and is met
so long as Petitioner can show that he “suffered the residual effects or complications
of [the alleged injury] for more than 6 months after the administration of the
vaccine[.]” 42 U.S.C. § 300aa-11(c)(1)(D)(i); see Wright v. Sec’y of Health & Hum.
Servs., 22 F.4th 999, 1002 (Fed. Cir. 2022); Wagner v. Sec’y of Health & Hum. Servs.,
No. 17-1388V, 2019 WL 3297509, at *5 (Fed. Cl. May 8, 2019); see also Oral Arg. Tr.
at 40. If Petitioner’s shoulder-specific symptoms lasted more than six months, the
severity requirement would be met even if the symptoms did not require ongoing
medical treatment.
I do not find that Petitioner met the severity requirement. Rather, because the
Entitlement Decision’s conclusion about the severity of Petitioner’s injury rests on an
unexplained finding that could rest in turn on factual or legal error, I remand for
additional consideration.
CONCLUSION
For the foregoing reasons, the Petitioner’s motion for review (ECF 61) is
GRANTED and the Entitlement Decision (ECF 60) is VACATED. The case is
REMANDED to the Chief Special Master. The Chief Special Master shall issue a
new entitlement decision within ninety days of this decision. See 42 U.S.C. § 300aa-
12(e)(2)(C); RCFC App. B, Rule 28(b).
Respondent’s motion to strike (ECF 66) Petitioner’s Supplemental Motion
(ECF 65) is GRANTED for the reasons stated on the record at the hearing. Oral Arg.
Tr. at 4–6.
IT IS SO ORDERED.
s/ Stephen S. Schwartz
STEPHEN S. SCHWARTZ
Judge
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DOCUMENT 3: USCOURTS-cofc-1_21-vv-01312-2
Date issued/filed: 2025-08-19
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 07/01/2025) regarding 78 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (mva) Service on parties made.
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In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-1312V
* * * * * * * * * * * * * * * * * * * * * * * * *
*
WILLIAM RECORD, * Chief Special Master Corcoran
*
Petitioner, * Filed: July 1, 2025
*
v. *
*
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Brian Robert Arnold, Brian R. Arnold & Associates, Richardson, TX, for Petitioner.
Jay Travis Williamson, U.S. Dep’t of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On April 29, 2021, William Record filed a petition seeking compensation under the
National Vaccine Injury Compensation Program (“Vaccine Program”).2 Petition, dated April 29,
2021 (ECF No. 1) (“Pet.”). Petitioner alleges that he suffered from a shoulder injury related to
vaccine administration (“SIRVA”) in both his left and right shoulder as a result of his receipt of
the Hepatitis A (“Hep A”) and Hepatitis B (“Hep B”) vaccines on April 30, 2018. Pet. at 1.
Moreover, Petitioner alleges that he experienced residual effects of this injury for more than six
months. Id.
Respondent denies that the Hep A and Hep B vaccines caused Petitioner to suffer SIRVA,
or any other injury or condition. Nonetheless, both parties, while maintaining their above-stated
positions, agreed in a stipulation that the issues before them could be settled, and that a decision
1 Under Vaccine Rule 18(b), each party has fourteen (14) days within which to request redaction “of any information
furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or
confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly
unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the whole Decision will be available to the public
in its present form. Id.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660,
100 Stat. 3758, codified as amended at 42 U.S.C. §§ 300aa-10 through 34 (2012) (“Vaccine Act” or “the Act”).
Individual section references hereafter will be to § 300aa of the Act (but will omit that statutory prefix).

Case 1:21-vv-01312-SSS Document 80 Filed 08/19/25 Page 2 of 8
should be entered awarding Petitioner compensation. Stipulation, dated June 30, 2025 (ECF No.
77) (“Stipulation”).
I have reviewed the file, and based upon that review, I conclude that the parties’ stipulation
(as attached hereto) is reasonable. I therefore adopt it as my decision in awarding damages on the
terms set forth therein.
The stipulation awards:
• A lump sum of $7,500.00 to be paid through an ACH deposit to petitioner’s counsel’s
IOLTA account for prompt disbursement to petitioner.
Stipulation at ¶ 10. These amounts represent compensation for all damages that would be available
under Section 15(a) of the Act.
I approve a Vaccine Program award in the requested amount set forth above to be made to
Petitioner. In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of
the Court is directed to enter judgment herewith.3
IT IS SO ORDERED.
/s/ Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 Pursuant to Vaccine Rule 11(a), the parties may expedite entry of judgment by each filing (either jointly or separately)
a notice renouncing their right to seek review.

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