VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-01423
Package ID: USCOURTS-cofc-1_21-vv-01423
Petitioner: STEPHEN RINEHART
Filed: 2021-02-02
Decided: 2026-03-09
Vaccine: influenza
Vaccination date: 2020-09-30
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: entitlement_granted_pending_damages
Award amount USD: 

AI-assisted case summary:
Stephen Rinehart filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) resulting from an influenza vaccine received on September 30, 2020. He experienced pain and decreased range of motion in his right shoulder, which he sought treatment for starting in December 2020. The medical records contained some inconsistencies regarding the exact onset of pain, but overall indicated pain present since vaccination, limited range of motion, and positive orthopedic tests. Petitioner underwent physical therapy and received a cortisone injection, reporting improvement in range of motion but persistent pain. He stopped formal treatment in March 2021, just over five months after vaccination, due to accepting a job offer after a period of unemployment. The court found that the record preponderantly established that Petitioner likely experienced residual effects of his injury for more than six months, suffered the onset of shoulder pain within 48 hours of vaccination, and that no other condition explained his symptoms. The court also found that all requirements for a Table SIRVA and statutory entitlement were met. Therefore, Stephen Rinehart was found entitled to compensation, with damages to be determined.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-01423-0
Date issued/filed: 2026-03-09
Pages: 13
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/02/2026) regarding 54 Ruling on Entitlement, Order on Motion for Ruling on the Record Signed by Chief Special Master Brian H. Corcoran. (ppa) Service on parties made.
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Case 1:21-vv-01423-UNJ Document 56 Filed 03/09/26 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-1423V
STEPHEN RINEHART, Chief Special Master Corcoran
Petitioner, Filed: February 2, 2026
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jonathan Joseph Svitak, Shannon Law Group, P.C., Woodridge, IL, for Petitioner.
Ryan Pohlman Miller, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On June 2, 2021, Stephen Rinehart filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleges that he suffered a shoulder injury related to vaccine
administration (“SIRVA”) resulting from an influenza (“flu”) vaccine received on
September 30, 2020. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
1 Because this Ruling contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the Ruling will be available to anyone with access to the internet. In accordance
with Vaccine Rule 18(b), petitioner has 14 days to identify and move to redact medical or other information,
the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I find the
identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C.
§ 300aa (2018).

Case 1:21-vv-01423-UNJ Document 56 Filed 03/09/26 Page 2 of 13
Respondent argued that Petitioner is not entitled to compensation (ECF No. 38),
and the parties have now fully briefed the claim (ECF Nos. 48, 52, 53). For the reasons
set forth below, I find that record evidence preponderantly establishes that Petitioner likely
experienced residual effects of his injury for more than six months, suffered the onset of
shoulder pain within 48 hours of vaccination, demonstrated that another condition would
not explain his post-vaccination symptoms, and satisfied the remaining requirements for
a Table SIRVA, and therefore is entitled to compensation.
I. Relevant Factual History
A. Medical Records
Petitioner received a flu vaccine in his right deltoid on September 30, 2020. Ex. 9
at 5. Two and a half months later (December 18, 2020), he saw orthopedist Vincent Key,
M.D., for right shoulder pain. Ex. 3 at 7. The record of this visit contains varying
descriptions of the onset of Petitioner’s pain, describing it as “right shoulder pain that’s
been present for 1-2 months,” stating that “he did have a flu shot and has noticed pain in
his shoulder ever since,” and documenting that “PT STATES THAT IT STARTED AFTER
FLU SHOT X1 MOS, PT STATES THAT PAIN GETTING WORSE SINCE THE SHOT.”
Id. The record adds that Petitioner “works loading pallets and has experienced difficulty
doing this” (Id.), although Petitioner maintains that this is incorrect and he was not working
at this time.3 ECF No. 48 at *33.
On examination, Dr. Key determined that Petitioner exhibited a “global decrease
in active and passive range of motion,” with positive results on the Neer, Hawkins, and
cross arm tests. Ex. 3 at 8. A right shoulder x-ray showed mild acromioclavicular joint
arthritis but was otherwise normal. Id. Dr. Key assessed Petitioner with right shoulder
adhesive capsulitis; he recommended physical therapy (“PT”) and referred Petitioner to
another specialist for a cortisone injection. Id. Three days later (December 21, 2020),
Petitioner saw sports medicine specialist David Smith, M.D., who administered a right
shoulder cortisone injection. Id. at 31.
On December 23, 2020, Petitioner underwent a PT evaluation of his right shoulder.
Ex. 2 at 8. The record of this evaluation indicates an onset date of September 29, 2020 -
- one day before vaccination - and states that the shoulder pain occurred “following a
reaction to a flu shot on 9/21/20,” misstating the date of vaccination. Id. Petitioner rated
his pain seven out of ten, ranging between two at best and ten at worst. Id. His pain was
3 Petitioner cites several declarations in support of his claim that he was not working during this time period
ECF No. 48 at *33. However, the testimony he cites concerns his layoff in September 2020 and his return
to his former employer in March 2021, and does not address his employment status in December 2020.
2

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worse in the evening and kept him up at night. Id. Petitioner continued PT until March 9,
2021.
Petitioner followed up with Dr. Key on February 1, 2021, four months after
vaccination. Ex. 3 at 46. He reported significant improvement in his symptoms following
the cortisone injection and PT. Id. He continued to experience pain from time to time with
certain maneuvers, but overall was happy with his improved range of motion and pain. Id.
On examination, Dr. Key found that he exhibited improved internal rotation, but continued
to have positive Neer and Hawkins signs. Id.
At a February 3, 2021 PT session, Petitioner reported a “roughly 65% recovery
since start of therapy.” Ex. 2 at 32. He was able to raise his hand above his head with
less difficulty, and felt his range of motion had greatly improved. Id. He continued to report
trouble reaching behind his back, and occasionally felt pain with reaching out and lifting.
Id. At a March 2, 2021 PT session, Petitioner reported that he was sore after “moving a
lot of boxes over the weekend.” Ex. 34 at 10.
On March 9, 2021, Petitioner attended his final PT session. Ex. 2 at 37-42.
Petitioner stated that “he has made [an] excellent recovery and is ready to be discharged
to continue with HEP [home exercise program] independently.” Id. at 37. Petitioner
reported excellent progress in right shoulder strength and range of motion, and was able
to lift his arm overhead and behind his back “much better” and sleep without pain. Id.
Petitioner planned to continue working on range of motion in external rotation at home.
Id. Petitioner’s reported pain levels remained the same as at the start of care: seven out
of ten at the time of the appointment, ranging from two at best to ten at worst. Id. The
therapist stated that Petitioner had shown excellent effort and “has met all goals for
therapy” – despite the fact that one of the therapy goals was to decrease his pain to less
than two out of ten, which the record suggests had not occurred. Id. at 38.
Petitioner subsequently saw his cardiologist on March 23, 2021, for an “[a]cute
visit.” Ex. 7 at 172. He underwent an electrocardiogram and echocardiogram two days
later. Ex. 6 at 19, 26. Neither record mentions shoulder pain. Petitioner received COVID-
19 vaccines in his left deltoid on March 31 and April 21, 2021. Ex. 37 at 2-3. Petitioner’s
cardiologist ordered labs, which were drawn on October 12, 2021; unsurprisingly, the lab
record does not list any shoulder complaints.4 Ex. 6 at 52. Petitioner received a flu vaccine
4 Respondent asserts that Petitioner also saw his cardiologist without mentioning shoulder pain on May 13,
2021. ECF No. 52 at *7. However, the cited record (Ex. 6 at 67) is a May 13, 2020 record – over four months
before vaccination. Even if Petitioner did see his cardiologist without seeking care for his shoulder on May
13, 2021, this would have little relevance to the question whether Petitioner was still experiencing residual
effects of his injury at that time, given that it would not be expected for a patient to seek shoulder treatment
from a cardiologist.
3

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in his right deltoid on October 14, 2021, and a COVID-19 vaccine in his right deltoid on
December 26, 2021. Ex. 4 at 6; Ex. 6 at 48.
B. Testimonial Statements
Petitioner filed three declarations5 in support of his claim.6 Exs. 1, 11, 35. He states
that during the administration of the vaccine at issue in this case, he felt more pain than
previous vaccinations, and noticed that the injection site was higher than usual. Ex. 1 at
¶ 7. He experienced pain and soreness at the injection site immediately after vaccination.
Id. at ¶ 8. Thereafter, his pain steadily worsened. Id.
Initially, Petitioner thought the pain would resolve with time and movement. Ex. 1
at ¶ 9. Instead, the pain worsened and his shoulder became stiff, with decreased range
of motion. Id. Because the pain persisted, he sought medical treatment. Id. at ¶ 10. PT
improved his range of motion, but his pain persisted. Id. at ¶ 12.
Petitioner signed his initial declaration on April 28, 2021 – just over six months after
vaccination. Ex. 1. In it, he states that “[s]ince the time the vaccine was administered, I
have consistently experienced right shoulder pain and decreased range of motion.” Id. at
¶ 13. He states that he has not sought medical care with the urgency or frequency he
otherwise would have due to the COVID-19 Pandemic and because he was laid off on
September 30, 2020 (the day of vaccination) due to the Pandemic, affecting his health
insurance. Id.
In his declaration signed on August 15, 2024, Petitioner states that his pain
remains two out of ten at best, and is usually three to four, sometimes increasing to ten
out of ten. Ex. 35 at ¶ 15. Pain interferes with normal daily activities and hobbies. Id. at
¶ 16.
Petitioner explains that when he stopped PT in March 2021, his pain continued to
range between “one out of ten at best and eleven out of ten at worst.” Ex. 11 at ¶ 34.
However, his overall pain was improved in that he experienced intense spikes of pain less
frequently, and his pain stayed at lower levels more often. Id. He never followed up with
Dr. Key after his February 2021 appointment because the cortisone injection had not
helped and he did not think there was much else Dr. Key could do to help him. Id. at ¶ 35.
5 Although Petitioner labeled Exhibit 1 and 35, as well as the remaining testimonial statements, as affidavits,
they are not notarized. Nonetheless, they are acceptable as declarations sworn under penalty of perjury.
28 U.S.C. § 1746.
6 Petitioner’s initial declaration, ECF No. 7, is not labeled with an exhibit number, but a later-filed exhibit list
identifies it as Exhibit 1. Additionally, this declaration appears to be missing the fourth page. Petitioner also
filed a declaration on January 9, 2023, ECF No. 23, which was later stricken. Scheduling Order and Order
Striking, issued April 29, 2024 (ECF No. 39).
4

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At the time he stopped PT, his range of motion had improved, but he was “still in a lot of
pain going past that range of motion.” Id. at ¶ 37.
Petitioner explains that he stopped PT in early March 2021 not because either he
or the therapist determined that he no longer needed therapy. Ex. 11 at ¶ 37. Instead,
stopping therapy was “entirely due to” his former employer offering him a job that he
“could not refuse.” Id. Petitioner explains that from his layoff on September 30, 2020 until
March 2021, he was “in a constant search for a new job.” Id. at ¶ 38. He spent hours
every day looking and applying for jobs, with no response. Id. Pandemic-related
restrictions had “crushed the job market” in his industry. Id. He thinks his age (62 at the
time) was also a factor. Id. Additionally, he worked as a driver, which requires passing a
Department of Transportation (“DOT”) medical examination. Id. at ¶ 39. His DOT card
had expired in late 2020, and at the time he could not raise his arm above his head and
shoulder – a requirement of the DOT examination – due to his SIRVA. Id. This limited the
jobs for which he was qualified. Id.
On March 1, 2021, his former employer called to offer him a position as warehouse
manager. Ex. 11 at ¶ 40. Taking the job meant he would not be able to continue PT, but
he felt he had to take the job or he may never work again. Id. By this time, he had improved
enough to pass the DOT examination. Id. at ¶ 43.
Petitioner states that as of March 9, 2021, when he stopped PT, he was “still
suffering serious right shoulder SIRVA symptoms,” including pain and limited range of
motion. Ex. 11 at ¶ 41. He wanted to continue PT, and thinks it would have improved his
condition. Id. He continued to experience “near-constant excruciating pain” until around
mid-September 2021. Id. at ¶ 48. At that time, he noticed his pain gradually improving. Id.
at ¶ 49.
Petitioner explains that he has not allowed his injury to deter him from getting
vaccines. Ex. 11 at ¶ 51. However, he now shows the vaccine administrator, and often
draws on his shoulder, where he wants it placed. Id. at ¶ 52.
Dr. Key submitted a signed statement dated April 26, 2021 on Petitioner’s behalf.
Ex. 10 at 3. Dr. Key states that after vaccination, Petitioner developed acute shoulder
pain that “could have been an inflammatory response” and “could have caused some of
his shoulder pain.” Id.
Petitioner submitted a declaration from a co-worker, Matt Love. Ex. 16. Mr. Love
states that when Petitioner returned to their company in March 2021, he saw Petitioner
at least once a week. Id. at ¶ 7. At that time, it was “visibly obvious that he was working
in pain.” Id. at ¶ 8. Mr. Love saw Petitioner grimace or wince when handling items, and
sometimes reach out to pick something up but have to pull back. Id. Mr. Love noticed that
Petitioner often worked one-handed. Id. Mr. Love states that Petitioner continued to
5

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demonstrate signs of pain for a significant period of time, at least a few months after he
returned to work. Id. at ¶ 11.
Gary Breeden, another co-worker of Petitioner, submitted a declaration on his
behalf. Ex. 18. Mr. Breeden states that within days of Petitioner returning to work, he saw
Petitioner using only his non-injured arm and it was “evident that Stephen’s shoulder was
hurting.” Id. at ¶ 7. He observed Petitioner rubbing his shoulder, and having difficulty
reaching up to take something off of a shelf. Id. Mr. Breeden and other co-workers
sometimes saw Petitioner struggling to lift or reach for something and helped him, and
Petitioner sometimes asked for help. Id. at ¶ 8. Mr. Breeden states that Petitioner’s
shoulder had not fully recovered when Mr. Breeden retired in October 2023. Id. at ¶ 11.
II. The Parties’ Arguments
A. Severity
Petitioner asserts that his SIRVA symptoms have persisted to the present date,
over 43 months. Petitioner’s Motion for Ruling on the Record, filed Nov. 15, 2024, at *37-
44 (ECF No. 48) (“Mot.”). When he concluded PT, although his range of motion and
strength had improved, his pain levels remained the same as they had been at his
evaluation. Mot. at *38. He stopped PT due to accepting a job and financial
considerations, not because he was fully recovered. Id. at *39. Petitioner asserts that he
did tell his cardiologist about his shoulder pain, in response to questions about his
physical activity. Id. at *40. However, he did not seek treatment for his shoulder pain from
his cardiologist, and otherwise that “it is not necessarily surprising that the cardiologist
failed to record Stephen’s SIRVA symptoms.” Id.
When Petitioner returned to work in mid-March 2021 he remained impaired, and
used creative techniques to move and lift boxes. Mot. at *37. His co-workers also helped
him from time to time. Id. Petitioner objects to Respondent’s assertion that the medical
record evidence contradicts the testimonial evidence. Id. at *41. And Petitioner points out
that the PT records themselves are inconsistent, stating that he satisfied all therapy goals
despite the fact that pain reduction was one of his goals and the records demonstrate no
improvement in pain. Id. at *43.
Respondent argues that Petitioner has not satisfied the statutory severity
requirement, and thus is not entitled to compensation. Respondent’s Response, filed Jan.
9, 2025, at *10-14 (ECF No. 52) (“Resp.”). Respondent emphasizes that Petitioner’s last
treatment for shoulder pain occurred five months and nine days after vaccination, at which
time he was discharged from PT. Resp. at *10-14. At that time, Petitioner reported
“excellent progress” and his therapist noted that he had met all therapy goals. Id. And he
infers that Petitioner appears to have been “well enough to do strenuous activity using his
shoulder” by late February 2021: on March 2nd he reported being sore from moving boxes
over the weekend. Id. at *11-12.
6

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Respondent adds that Petitioner received medical care and treatment on at least
eight occasions in the nine months after vaccination – although the care he lists includes
only encounters to receive vaccines and see a cardiologist. Resp. at *12. And Petitioner
received two vaccines in his right – injured – arm in October and December 2021, which
Respondent emphasizes further suggests that his pain had resolved. Id. at *12-13.
Respondent cites an “apparent conflict” between contemporaneous medical records
(establishing that Petitioner treated his injury for less than six months, after which he did
not seek further treatment and received two vaccines in his affected shoulder) and later
testimonial statements (asserting continuing symptoms after he stopped formal
treatment), and asserts that the medical records should be given greater weight. Id. at
*13.
B. Onset
Petitioner asserts that his pain began immediately after vaccine administration on
September 30, 2020. Mot. at *27. Although the record of his first treatment in December
2020 contains a vague description of onset, Petitioner asserts that “it is unambiguous that
the pain started with [my] flu shot.” Id. The PT evaluation similarly states that his pain had
been present since vaccination. Id. Petitioner states that two of his daughters are nurses,
and he and his wife consulted with them on the date of vaccination about his shoulder
pain. Id. at *30. He delayed seeking formal care due to the Pandemic and a belief that his
symptoms would resolve on their own. Id. at *31.
Respondent argues that Petitioner cannot establish Table onset because he did
not seek care until two months and 18 days after vaccination, at which time he reported
a one to two month history of pain. Resp. at *15. Although this treatment record also
states that Petitioner had received a vaccine and had pain in his shoulder ever since,
Respondent asserts that “[t]his description is vague, and does not preponderantly place
the onset of petitioner’s injury” within 48 hours. Id. Respondent states that the “date of
vaccination is a very clear marker and definitive date,” but rather than reporting that date
Petitioner “reported a vague timeline of one to two months.” Id. Respondent adds that this
“vague onset” would place the start of Petitioner’s symptoms either 18 days after
vaccination or a month and 18 days after vaccination – both of which are well outside the
Table timeframe. Id. In Respondent’s view, Petitioner’s “ambiguous” report of pain “ever
since” vaccination is not sufficient to establish that his pain began within 48 hours. Id.
C. Whether Another Condition Would Explain Post-Vaccination
Symptoms
Respondent notes that Petitioner’s x-ray showed acromioclavicular joint arthritis,
and therefore asserts that “it is possible there was an alternate cause for his shoulder
pain.” Resp. at *16. Respondent does not further develop this argument or cite additional
evidence suggesting arthritis caused Petitioner’s pain.
7

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Petitioner asserts that prior to vaccination, he was fit and active, with no shoulder
impairment. Mot. at *36. After vaccination, he experienced immediate pain and difficulty
with normal activities of daily living. Id. Petitioner views Respondent’s suggestion that
arthritis may have caused his shoulder pain as unsupported. Petitioner asserts that “Dr.
Key’s opinion directly contradicts such speculation, as Dr. Key stated that the ‘minimal
acromioclavicular arthrosis’ would not explain Stephen’s SIRVA symptoms” – although
this statement goes far beyond the cited evidence: Petitioner does not cite any opinion or
statement of Dr. Key to this effect, but only the x-ray report and Petitioner’s declaration
stating that Dr. Key told him there was no reason for the pain reflected in the x-ray. Id.
(citing Ex. 3 at 28, Ex. 11 at ¶ 31).
III. Legal Standards
Before compensation can be awarded under the Vaccine Act, a petitioner must
preponderantly demonstrate all matters required under Section 11(c)(1), including the
factual circumstances surrounding his or her claim. Section 13(a)(1)(A). In making this
determination, the special master or court should consider the record as a whole. Section
13(a)(1). Petitioner’s allegations must be supported by medical records or by medical
opinion. Id.
To resolve factual issues, the special master must weigh the evidence presented,
which may include contemporaneous medical records and testimony. See Burns v. Sec'y
of Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (explaining that a special
master must decide what weight to give evidence including oral testimony and
contemporaneous medical records). “Medical records, in general, warrant consideration
as trustworthy evidence. The records contain information supplied to or by health
professionals to facilitate diagnosis and treatment of medical conditions. With proper
treatment hanging in the balance, accuracy has an extra premium. These records are
also generally contemporaneous to the medical events.” Cucuras v. Sec’y of Health &
Human Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
To overcome the presumptive accuracy of medical records testimony, a petitioner
may present testimony which is “consistent, clear, cogent, and compelling.” Sanchez v.
Sec'y of Health & Human Servs., No. 11-685V, 2013 WL 1880825, at *3 (Fed. Cl. Spec.
Mstr. Apr. 10, 2013) (citing Blutstein v. Sec'y of Health & Human Servs., No. 90-2808V,
1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The Federal Circuit has
“reject[ed] as incorrect the presumption that medical records are accurate and complete
as to all the patient’s physical conditions.” Kirby v. Sec’y of Health & Human Servs., 997
F.3d 1378, 1383 (Fed. Cir. 2021) (explaining that a patient may not report every ailment,
or a physician may enter information incorrectly or not record everything he or she
observes).
8

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In addition to requirements concerning the vaccination received and the lack of
other award or settlement,7 a petitioner must establish that he or she suffered an injury
meeting the Table criteria, in which case causation is presumed, or an injury shown to be
caused-in-fact by the vaccination he or she received. Section 11(c)(1)(C). The Vaccine
Act further includes a “severity requirement,” pursuant to which a petitioner demonstrate
that they:
(i) suffered the residual effects or complications of such illness, disability,
injury, or condition for more than 6 months after the administration of the
vaccine, or (ii) died from the administration of the vaccine, or (iii) suffered
such illness, disability, injury or condition from the vaccine which resulted in
inpatient hospitalization and surgical intervention.
Section 11(c)(1)(D).
“[T]he fact that a petitioner has been discharged from medical care does not
necessarily indicate that there are no remaining or residual effects from her alleged
injury.” Morine v. Sec’y of Health & Human Servs., No. 17-1013, 2019 WL 978825, at *4
(Fed. Cl. Spec. Mstr. Jan. 23, 2019); see also Herren v. Sec’y of Health & Human Servs.,
No. 13-1000V, 2014 WL 3889070, at *3 (Fed. Cl. Spec. Mstr. July 18, 2014) (“a discharge
from medical care does not necessarily indicate there are no residual effects”). “A
treatment gap . . . does not automatically mean severity cannot be established.” Law v.
Sec’y of Health & Human Servs., No. 21-0699V, 2023 WL 2641502, at *5 (Fed. Cl. Spec.
Mstr. Feb. 23, 2023) (finding severity requirement met where petitioner sought care for
under three months and had met physical therapy goals but still lacked full range of motion
and experienced difficulty with certain activities, then returned to care nearly five months
later reporting stiffness and continuing restrictions in motion); see also Peeples v. Sec’y
of Health & Human Servs., No. 20-0634V, 2022 WL 2387749 (Fed. Cl. Spec. Mstr. May
26, 2022) (finding severity requirement met where the petitioner sought care for four
months, followed by fifteen-month gap); Silvestri v. Sec’y of Health & Human Servs., No.
19-1045V, 2021 WL 4205313 (Fed. Cl. Spec. Mstr. Aug. 16, 2021) (finding severity
requirement satisfied where petitioner did not seek additional treatment after the five-
month mark.
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria
7 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception and has not filed a civil suit or collected an award or settlement for his or her injury. Section
11(c)(1)(A)(B)(E).
9

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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).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
IV. Ruling on Entitlement
A. Severity
The record supports a finding that Petitioner likely experienced residual effects of
his injury for more than six months. Petitioner treated his shoulder injury until over five
10

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months after his pain began. A month prior to his last PT session, Petitioner reported 65%
progress. Although he stopped formal treatment just before the six-month mark, the last
treatment record does not indicate that his condition had fully resolved. Rather, it shows
that his pain levels remained unchanged. Although the record states that all therapy goals
had been met, one of his goals was pain of less than two out of ten – which the record
itself did not show had been met.– meaning that his condition had not fully resolved. Thus,
his symptoms likely persisted until at least the end of March 2021, which satisfies the
statutory severity requirement.
Petitioner has convincingly explained that he stopped treatment not because his
condition had resolved, but because he was offered a job following months of
unsuccessful job searching after a layoff. And even if I were to infer that Petitioner’s
receipt of two vaccines in his right arm in late 2021 meant that his condition had likely
resolved by that time, that would not suggest that it had resolved months before that.8 I
also give some weight to the fact that Petitioner’s first sworn witness statement was
prepared in April 2021, the month right after both the arrival of the severity deadline and
his last PT treatment. It is reasonable to infer that Petitioner at that time was likely still
experiencing sequelae of his injury, as he then alleged, and Respondent has offered no
reason to doubt the truthfulness of this witness contention.
B. Onset
The record supports a finding that Petitioner’s shoulder pain likely began within 48
hours of vaccination. Although Petitioner did not seek formal medical treatment for
approximately two and a half months, I have previously stated that a treatment delay of
this length does not, by itself, raise serious concerns about onset. Tully v. Sec’y of Health
& Human Servs., No. 21-1998V, 2024 WL 4533515 (Fed. Cl. Spec. Mstr. Sept. 20, 2024)
(finding onset occurred within 48 hours although claimant did not seek care for two and a
half months); Diaz v. Sec’y of Health & Human Servs., 20-1003V, 2023 WL 8440873, at
*6 (Fed. Cl. Spec. Mstr. Nov. 1, 2023) (finding onset was within 48 hours where the
petitioner delayed seeking care for over three months after vaccination); Buck v. Sec’y of
Health & Human Servs., No. 19-1301V, 2023 WL 6213423, at *7 (Fed. Cl. Spec. Mstr.
Aug. 23, 2023) (finding onset of pain occurred within 48 hours where the petitioner did
not seek care for over three months and noting that a delay in seeking care is relevant to
onset, but not dispositive).
Respondent argues that the medical record of Petitioner’s first treatment “does not
preponderantly place the onset” of Petitioner’s injury within 48 hours. Resp. at *15.
However, the Vaccine Act does not require that a particular medical record
8 The record does not support Petitioner’s claim that his injury persisted for 43 months. The record shows
that he stopped treatment just over five months after vaccination. It is reasonable to infer that his condition
resolved shortly thereafter.
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preponderantly establish Table onset; rather, a preponderance of the evidence as a whole
must support such a finding. Section 13(b)(2).
Respondent also takes issue with the fact that Petitioner described onset vaguely,
rather than specifically stating that his pain began on the date of vaccination. However,
there is no requirement that a medical record reflect that a claimant specified a precise
onset date. And it is not uncommon for patients to describe the duration of their pain in
weeks or months, rather than providing a specific date of onset. See Roberson v. Sec’y
of Health & Human Servs., No. 21-2309V, 2025 WL 605724, at *7 (Fed. Cl. Spec. Mstr.
Jan. 24, 2025) (finding onset within 48 hours where claimant sought care 23 days after
vaccination reporting pain that had been present for ‘two or three weeks,’ noting that many
people speak in colloquial terms when seeking medical care).
The record of Petitioner’s first visit states that his pain had been present for one to
two months, but elaborated that the pain had been present ever since vaccination. Ex. 3
at 7. Similarly, at his PT evaluation, he stated his pain began after vaccination, although
he misremembered the precise date the vaccine was received. Ex. 2 at 8. And Petitioner
has offered supporting testimonial evidence.
I do not view the medical records and testimonial evidence as being in conflict.
Rather, the medical records shed some light on the question of onset, but are themselves
somewhat incongruous.9 The testimonial evidence provides additional details consistent
with the medical records. All of this evidence in its totality supports a favorable onset
finding.
C. Petitioner’s Arthritis Would Not Explain His Post-Vaccination
Symptoms
The record does not support a finding that Petitioner’s arthritis would likely explain
his post-vaccination symptoms. Although Petitioner’s x-ray showed arthrosis, the report
described it as “[m]inimal.” Ex. 3 at 28. Petitioner’s minimal arthritis presumably was
present before vaccination, as it is degenerative. But there is no evidence to suggest that
Petitioner suffered right shoulder pain before vaccination. And Petitioner’s treaters did not
attribute his pain to arthritis.
D. Factual Findings Regarding QAI Criteria for Table SIRVA and Other
Entitlement Requirements
Respondent does not contest the remaining statutory and SIRVA requirements,
and I find that they are preponderantly satisfied. Petitioner’s shoulder ROM was limited,
9 The record of the December 18, 2020 appointment states on, on a single page, that the pain was present
“for 1-2 months,” after a flu shot “X1 MONTHS,” and “ever since” his flu vaccination. Ex. 3 at 7. This record
could be read to support a one-month onset, onset between one and two months, or onset on the date of
vaccination.
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his symptoms were limited to his shoulder, and the record does not contain preponderant
evidence that Petitioner had a history of right shoulder pain that would explain his post-
vaccination symptoms. Ex 3 at 8; Ex. 7 at 196, 204.
Petitioner received a covered vaccine in the United States. Ex. 9 at 5. And he
states that he has not filed any action, resolved a claim for damages, or received
compensation in the form of an award or settlement for his vaccine-related injury. Ex. 11
at ¶¶ 66, 67. Thus, Petitioner is entitled to compensation.
Conclusion
Based on my review of the record as a whole, I find that it is more likely than not
that Petitioner’s shoulder pain began within 48 hours of vaccination, persisted for more
than six months, and no other condition would explain his post-vaccination symptoms. I
also find that all SIRVA Table requirements are preponderantly met, as are all statutory
requirements for entitlement. Therefore, Petitioner’s motion for a ruling on the record that
he is entitled to compensation is GRANTED.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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