VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-01720
Package ID: USCOURTS-cofc-1_21-vv-01720
Petitioner: Yvette Moyler
Filed: 2021-08-18
Decided: 2025-09-18
Vaccine: Tdap
Vaccination date: 2019-09-09
Condition: brachial neuritis
Outcome: dismissed
Award amount USD: 

AI-assisted case summary:
Yvette Moyler filed a petition alleging that a Tdap vaccine administered on September 9, 2019, caused her to develop brachial neuritis (BN), a condition listed on the Vaccine Injury Table. She claimed her symptoms persisted for more than six months, meeting the severity requirement for compensation. The initial medical records showed pain at the injection site within two weeks of vaccination, described as a "toothache," with tenderness but normal range of motion. Treatment at that time involved home care like cold compresses and Tylenol. Ms. Moyler did not seek further medical evaluation for her arm for approximately nine months, during which time she had appointments for pre-existing conditions like diabetes and hypertension but did not report shoulder pain. She then began a new job requiring significant lifting, which she stated exacerbated her symptoms. Upon returning to medical care in June 2020, her reported symptoms included swelling, burning pain radiating to her neck, hand swelling, and tingling, which differed from her initial complaints. The special master found that Ms. Moyler failed to establish the required six-month severity of injury, noting the significant gap in treatment and the differing symptomology before and after that gap. The court reviewed the special master's decision, finding it was not arbitrary or capricious. The court affirmed the dismissal, concluding that the special master reasonably determined that Ms. Moyler's later symptoms were likely due to a new injury from her physically demanding job rather than a continuation of the vaccine-related injury, and that the initial symptoms did not meet the six-month duration requirement.

Theory of causation field:
Tdap vaccine on September 9, 2019, adult exact age not stated, alleged to cause Table brachial neuritis with onset about 12 days later. DISMISSED. Petitioner Yvette Moyler had early injection-site/arm complaints but a long treatment gap before later, different symptoms after beginning physically demanding work. Chief Special Master Corcoran found the six-month severity requirement was not met and dismissed the petition on March 12, 2025. Judge Molly R. Silfen affirmed on September 18, 2025. No injury compensation awarded.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-01720-0
Date issued/filed: 2025-04-11
Pages: 14
Docket text: PUBLIC DECISION (Originally filed: 03/12/2025) regarding 45 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 1 of 14
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-1720V
YVETTE MOYLER, Chief Special Master Corcoran
Petitioner,
v. Filed: March 12, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Thomas Joseph O’Connell, Abramson & O’Connell, LLC, Columbus, OH, for Petitioner.
Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent.
DISMISSAL DECISION1
On August 18, 2021, Yvette Moyler 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 as a result of a tetanus-diphtheria-acellular
pertussis (“Tdap”) vaccine received on September 9, 2019, she suffered from brachial
neuritis (“BN”) as defined on the Vaccine Injury Table (the “Table”). Pet., ECF No. 1. The
case was assigned to the Special Processing Unit (“SPU”) of the Office of Special
Masters.
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the Decision will be available to anyone with access to the internet. In
accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other
information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I
agree that the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 2 of 14
For the foregoing reasons, I find that Petitioner has provided insufficient proof of
severity of injury, as required for all Vaccine Act claims. See Section 11(c)(1)(D)(i).3
Petitioner’s claim is thus DISMISSED.
I. Relevant Procedural History
Along with the filing of her petition, medical records, and affidavits, Petitioner filed
a preliminary expert report plus medical literature exhibits. See ECF No. 1; see also ECF
Nos. 20-27.4 At a May 2022 initial status conference, I noted that (among other things)
there was a potential issue regarding Petitioner’s ability to satisfy the six-month severity
requirement – and ordered Petitioner to file additional medical records and/or affidavits to
overcome this issue. ECF No. 20 at 2. In response, Petitioner submitted three additional
affidavits – two authored by friends of Petitioner’s and the third authored by Petitioner
herself. ECF No. 25. The parties thereafter made an effort to informally resolve this case
but were ultimately unsuccessful. See ECF Nos. 31-37.
Respondent filed his Rule 4(c) Report defending this case in June 2023. ECF No.
39. Among other things,5 Respondent contended that Petitioner had not established the
existence of residual effects of the alleged injury for more than six months after the
September 9, 2019 vaccination. Respondent’s Report at 8 (citing Section 11(c)(1)(D)(i)).
This is due to the existence of a substantial temporal gap in the medical records during
which Petitioner did not report ongoing symptoms. Id. at 8-9. Respondent argued the
record actually suggests that Petitioner’s symptoms resolved a few weeks post
vaccination – supported by the fact that she had four intervening medical visits without
reporting continued shoulder/arm pain during the gap in care. Id. at 9. More so, during the
gap in care Petitioner started a new job requiring additional lifting and carrying, which she
believed exacerbated her pain, leading her to seek further care. Id. Finally, Respondent
contended that Petitioner’s reported symptoms were different immediately post
vaccination than they were following the nine-month gap. Id.
3 Petitioner does not allege, nor would the evidence support, either alternative for establishing the severity
requirement: that the alleged injury resulted in death, or “inpatient hospitalization and surgical intervention.”
Section 11(c)(1)(D)(ii), (iii). Rather, this case turns on Petitioner’s inability to prove six months of post-onset
sequelae.
4 Due to several filing errors (Exs. 1-18, ECF Nos. 1, 8, 12) the exhibits were stricken from the record and
re-filed in June 2022. See ECF Nos. 20-27.
5 Respondent also argued Petitioner cannot establish a Table BN claim as none of her treating physicians
diagnosed her with BN and because she has multiple other conditions or abnormalities present that could
explain her post-vaccination symptoms (i.e., carpal tunnel syndrome, uncontrolled insulin-dependent
diabetes mellitus, and breast cancer). Respondent’s Report at 11-12 (emphasis added).
2

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After a review of the record and Respondent’s arguments, I issued an Order to
Show Cause, again affording Petitioner an opportunity to submit any additional evidence
to remedy the deficiencies in the record related to the statutory six-month severity
requirement. ECF No. 40. But I warned Petitioner that my ultimate severity analysis would
start with the medical record documentation, albeit supplemented by declarations or
affidavits. Id. at 4.
In response, Petitioner submitted medical records (outside the pertinent gap in
treatment bearing on severity) and supplemental affidavits. ECF Nos. 41-43. She also
filed a supplemental expert report and medical literature, along with another expert report
from a spine and sport medicine specialist. ECF No. 42. Having reviewed Petitioner’s
additional evidence, Respondent filed a status report stating his intention to continue
defending this matter and requesting to file his own expert reports. ECF No. 44. The issue
of severity is now ripe for adjudication.
II. Contemporaneous Medical Records
Petitioner’s pre-vaccination medical history is relevant for type II diabetes mellitus,
hypertension, and carpal tunnel syndrome (“CTS”) in her left wrist. See generally Exs. 2-
3; Ex. 15.
Petitioner received the subject Tdap vaccination in her left deltoid on September
9, 2019. Ex. 2 at 113. She then sought care for shoulder-related complaints on September
21, 2019 (at an urgent care facility), and again two days later, on September 23, 2019
(with the internal medicine specialist/primary care physician (“PCP”) who administered
the subject vaccination). Ex. 4 at 3-4; Ex. 2 at 117. During Petitioner’s September 23rd
appointment, she reported that she had developed left upper extremity (“UE”) pain at the
site of her vaccination. Ex. 2 at 117-18. She described the pain as a “toothache.” Id. at
118. A physical examination showed normal range of motion (“ROM”) but tenderness
over the left deltoid. Id. at 120. The PCP felt that Petitioner suffered a “[l]ikely localized
reaction following administration of her Tdap vaccination[,]” and recommended cold
compresses and Tylenol. Id. at 118, 122.
On September 25, 2019, Petitioner underwent a left shoulder ultrasound, and it
yielded normal results (it did not contain evidence of fluid collection or abscess “to account
for [Petitioner’s] pain and swelling of the left upper arm”). Ex. 2 at 131-32. Five days later,
on September 30, 2019, Petitioner called her PCP’s office to review the results of her
ultrasound. Id. at 127. During that call, Petitioner stated that she “continue[d] to have arm
pain after injection” and that she could now barely lift her arm. Id. The PCP told Petitioner
to continue with cold compresses, Tylenol, and to keep her arm mobile. Id. Petitioner did
not return to care for her left shoulder/arm soon thereafter.
3

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Rather, Petitioner only returned to care for left UE symptoms approximately nine
months later, on June 14, 2020. Ex. 2 at 138. However, during this gap in treatment she
had in-person follow-up visits with her PCP on December 2, 2019 (for diabetes,
hypertension, and a headache) and March 2, 2020 (for diabetes). Ex. 18 at 80-90, 93-
108. More so, on April 9 and May 21, 2020, Petitioner had telemedicine follow-up visits
with her PCP, again for her pre-existing diabetes and hypertension. Id. at 63-66, 73-76.
Petitioner did not complain of shoulder symptoms at any of these four visits.
Petitioner then went to the emergency room (“ER”) on June 14, 2020, reporting left
arm and neck swelling present “ever since she got a tetanus shot in September.” Ex. 2 at
138. She described “localized swelling to her left shoulder [that would] sometimes go to
her upper arm and into her neck.” Id. Petitioner also noted that she “got a new position at
a memory care unit where she [was] doing a lot of lifting [and] carrying [and] she feels the
swelling and burning pain [had] gotten worse.” Id. She reported that the swelling and
burning pain “stop[ped] before it g[ot] to the elbow” but was present in the trapezius and
neck. Id. A physical examination was consistent with mild swelling in the left deltoid/outer
arm and tenderness in the trapezius muscle. Id. at 141. An x-ray of the left shoulder was
“unremarkable.” Id. The treater felt that Petitioner had a “blood clot” which “might be from
overuse,” and he advised her to wear a sling and to take anti-inflammatories and/or
muscle relaxers. Id.
The next day (June 15, 2020), petitioner called her PCP’s office, informing the
treater of her ER visit the previous night and stating that her “left arm is swollen and in
pain.” Ex. 2 at 133. She also reported neck pain “toward the back” and “a tingling
sensation on [her] fingers.” Id. Petitioner stated that the “[s]welling in [her] arm and neck
did not happen until after [her] Tetanus shot.” Id. Petitioner was seen in-person later that
day and reiterated her complaints of “chronic left shoulder pain, left fingertip
numbness/tingling and left hand swelling since having a tetanus shot in Sep[tember]
2019.” Id. at 145. She had normal ROM and strength on examination, but tenderness
over the left deltoid. Id. at 147. The assessment included chronic left shoulder pain with
an “[u]nclear etiology, possibly [osteoarthritis (“OA”)]” or an inflammatory process. Id. at
145. Petitioner was told to continue taking Flexeril and she received a prescription for
Naproxen; an MRI was also ordered. Id.
Petitioner followed up with her PCP on June 22, 2020, complaining of chronic left
shoulder pain “present since 9/2019, which she attribute[d] to an immunization she
received in the left deltoid.” Ex. 2 at 155. She stated her pain was “[w]orse since starting
new job.” Id. She described the pain as “burning” and “primarily over the left shoulder and
deltoid area, although sometimes this radiate[d] into the hand.” Id. Her ROM was also
“severely limited due to pain” and she experienced “intermittent swelling.” Id. The
4

Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 5 of 14
assessment included “[c]hronic pain/swelling after an immunization in 9/2019. Worsening
x2 months since starting new job. Etiology unclear but seems neuropathic, possibly
referred pain from CTS. Possible tendonitis vs. radiculopathy. No clear trauma.” Id.
On June 24, 2020, another physician at Petitioner’s PCP’s office reviewed
Petitioner’s recent history and treatment plan. Ex. 2 at 150. The physician noted that
Petitioner’s left shoulder pain “[b]egan after getting injection for Tdap vaccine” and that
her shoulder x-ray showed “chronic degen[eration], but no acute process.” Id. The treater
opined that “[g]iven the neuropathy, [it was] concerning that this process [was] actually
cervical radiculopathy and not her shoulder.” Id. Petitioner requested an MRI of her
shoulder and the physician “discussed with [her] that [he would] rather image her cervical
spine based on her history, but since she want[ed her] shoulder imaged, [the] decision
was made to image both” the neck and shoulder. Id.
An August 8, 2020 MRI of the left shoulder revealed “diffuse muscle edema and
likely changes related to denervation edema.” Ex. 2 at 165. The impression was that this
was from an “uncertain etiology.” Id. The findings were also consistent with severe
tendinopathy of the supraspinatus and infraspinatus tendons and moderate tendinopathy
of the subscapularis with no focal rotator cuff tear. Id. There was suspicion for a grade 1
muscle strain based on patchy muscle edema in the supraspinatus tendon; mild bursitis;
and moderate tendinopathy involving the biceps tendon. Id.
Petitioner saw an orthopedic surgeon on September 3, 2020, for a chief complaint
of pain in the left shoulder. Ex. 2 at 167. Petitioner reported that her “burning” shoulder
pain and swelling began “after an immunization injection in 9/2019[,]” and that it has “not
resolved since.” Id. at 168, 171. She also reported associated numbness, tingling,
weakness, and limited function. Id. at 168. The orthopedist noted that Petitioner was “an
uncontrolled diabetic.” Id. An examination showed full active and passive ROM and slight
swelling and tenderness in the distal upper arm. Id. at 171. The orthopedist was “unable
to replicate her pain with impingement testing or of the rotator cuff[;] this is not the pain
that she feels.” Id. An EMG was recommended. Id.
During a September 4, 2020 telemedicine follow up with her PCP, Petitioner
reported continued “burning” left shoulder pain, swelling in her arm, and hand numbness.
Ex. 2 at 175. The PCP reiterated the belief that Petitioner’s left shoulder pain had an
“[u]nclear etiology but appears neuropathic in nature, after Tdap immunization in 9/2019.”
Id. Petitioner was prescribed gabapentin and referred to a neurologist. Id.
5

Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 6 of 14
Petitioner underwent an EMG of the left UE6 on September 23, 2020. Ex. 2 at 180.
The EMG was considered “abnormal” with findings “consistent with a moderately severe,
left median entrapment neuropathy across the carpal tunnel without significant axonal
involvement.” Id. Petitioner’s PCP reviewed the findings with her and explained they were
“consistent with [CTS], but did not reveal any other findings that would explain her
symptoms in the shoulder region.” Id. at 178. The PCP told Petitioner that a cervical MRI
should still be completed “as there may be a radicular component of pain.” Id. Petitioner
expressed “deep frustration” and that she was “being ignored.” Id. Specifically, Petitioner
explained that
[t]he vaccination [] started this entire cascade of pain and testing was in the
lower arm near the elbow, and that she had an obvious bulge, which ha[d]
been present since the vaccination . . . . She [] has pain only at the area of
the bulge, and not at the shoulder at this time, and this is where the pain
has always been located.
Id. The PCP noted that Petitioner “was told that on evaluation of her prior clinic notes,
there was no note of a bulge.” Id. Petitioner was instructed to obtain an in-person
evaluation of this bulge. Id. Petitioner did not attend an in-person evaluation.
During a November 24, 2020 telemedicine visit with her PCP, Petitioner, among
other things, complained of a “bulge in her forearm that [wa]s in pain.” Ex. 18 at 27. She
described shooting pain in her shoulder and down to her hand, plus hand swelling. Id.
The PCP felt that Petitioner should “[c]onsider small fiber neuropathy” as a potential
diagnosis and stated she may need a skin biopsy to confirm as much. Id.
Petitioner began physical therapy (“PT”) for her left shoulder pain on December 7,
2020. Ex. 31 at 8. She described her history stating she received the Tdap vaccine in
September 2019 and went to the ER two days later with pain and swelling plus “burning
nagging toothache pain” with shakiness and numbness in the arm and hand. Id. at 10.
She also described neck pain, beginning “around the same time as the injection that still
remains.” Id. The physical therapist noted that Petitioner’s symptoms were “consistent
with left UE radiculopathy possibly in C6-C7 dermatome pattern from left 1st rib
depression, poor posture[,] and brachial plexus tension.” Id. at 8. She attended seven
additional PT appointments before discontinuing PT on January 19, 2021. See id. at 13-
45.
6 This EMG does not appear to have tested the infraspinatus or supraspinatus tendons of the left
subscapular nerve. Ex. 2 at 181.
6

Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 7 of 14
On January 8, 2021, Petitioner followed up with her PCP, who still felt that her
shoulder pain had an unclear etiology “though [it] appear[ed] neuropathic in nature.” Ex.
18 at 6. A May 6, 20217 repeat EMG of the left UE showed severe isolated involvement
of the left suprascapular nerve and moderate left CTS. Ex. 6 at 2. It did not show any
evidence of cervical radiculopathy, brachial plexopathy, myopathy, or polyneuropathy.
See id.
III. Affidavits
Through affidavits (some specifically drafted after my Order to Show Cause
highlighting the specific deficiencies in the record related to severity), Petitioner maintains
that she can establish the Act’s six-month requirement. She attests that during her
September 23 and 30, 2019 visits,8 her PCP “did not instruct [her] to return for further
evaluation or treatment.” Ex. 22 ¶¶ 7-8. As a result, between September 30, 2019, and
June 14, 2020, she “did not seek any further medical evaluation of [her] left arm pain” -
despite persistent pain - because “it was [her] impression from the communications with
the office of [her PCP] that there was no other treatment that could be provided for [her]
complaints.” Id. ¶¶ 9-10. Petitioner explains that she “hoped that the pain would go away
but it did not.” Id. ¶ 9. Following her September 30, 2019 visit, she contends that the “most
severe” pain that made it “unbearable to lift [her] arm continued for about one month.” Ex.
33 ¶ 10. She then had ongoing difficulties with reaching for a shelf or behind her back,
lifting heavy items, or sleeping. Id.
Petitioner addresses her position at an assisted living facility and explains that she
began this position “[o]n or about May 1, 2020.” Ex. 22 ¶ 11. She attests that she already
had pain in her left arm and shoulder when she began working at this facility, but she took
the job due to employment and financial concerns. Ex. 33 ¶¶ 16, 21. The duties included
“assisting residents with transfers in and out of wheelchairs, beds, and showers[,]
cleaning, laundry, lifting food trays and trash removal.” Ex. 22 ¶ 11. Petitioner states that
the lifting made her arm pain worse, which prompted her to go to the ER on June 14,
2020, and seek additional shoulder and neck treatment thereafter. Id. ¶¶ 11-12; Ex. 33 ¶
17. Due to her ongoing pain, Petitioner stopped working at this facility on July 4, 2020.
Ex. 22 ¶ 13. She claims that she did not “suffer any new injury to [her] left arm or shoulder
during the time she worked at” this facility. Ex. 33 ¶ 21. Rather, “by the summer of 2020”
it became clear to Petitioner that her symptoms “that began after [] the vaccine the
7 During the time between Petitioner’s last follow-up visit with her PCP for left shoulder symptoms in January
2021 and her May 2021 EMG, Petitioner had been diagnosed with, and began treatment for, breast cancer.
See, e.g., Ex. 25 at 17, 333-49; Ex. 26 at 6; Ex. 27 at 16-21, 43-45; Ex. 28 at 28, 124. Such treatment
extended through June 2022. See generally Exs. 29-30.
8 The contact with Petitioner’s treater regarding ongoing shoulder pain on September 30, 2019, appears to
have been a phone call, not an in-person visit. Ex. 2 at 127.
7

Case 1:21-vv-01720-MRS Document 49 Filed 04/11/25 Page 8 of 14
previous September were not only continuing but would get much worse” if she continued
to use her arm in this employment. Id. ¶ 22.
Petitioner also provides more context for some of the entries in her medical
records. For instance, Petitioner explains that when she described her pain at her
September 23, 2019 visit as a “toothache,” she was “trying to describe an intense, burning
type of pain” and the “best comparison that came to mind was intense pain [she had]
previously experienced during dental procedures.” Ex. 33 ¶ 7. Additionally, she states she
did not mention left shoulder complaints at her PCP visits during the gap in treatment
because these appointments were regular follow ups and at that time, she was “no longer
experiencing the worst pain . . . where [she] could barely lift [her] arm.” Id. ¶¶ 14-15.
Petitioner’s friend authored an affidavit on her behalf and attests that Petitioner
complained to her of pain in her upper left arm, “includ[ing] the time period of September
30, 2019 to June 14, 2020.” Ex. 23 ¶ 7. This friend explains that she would take her mother
to Petitioner’s house “in the fall of 2019” – during which time Petitioner told the friend of
ongoing shoulder pain. Ex. 34 ¶ 3. The friend’s mother passed away on April 11, 2020,
and “between the time [Petitioner] received her vaccine injection in September 2019 and
[her] mother’s death on April 11, 2020,” Petitioner told her of continued upper left arm
pain. Id. ¶ 4. Another friend of Petitioner’s attests that Petitioner complained to her of
ongoing pain following her September 2019 visits and “throughout 2020.” Ex. 24 ¶¶ 5-7.
Petitioner’s daughter authored an affidavit on her mother’s behalf (also in response
to my Order to Show Cause) and states that “[d]uring spring break of 2020[,]” on March
16, 2020, she moved home with Petitioner – who “was still having pain in her left arm and
shoulder.” Ex. 35 ¶¶ 5-6. She also states that Petitioner’s pain became “worse because
of the type of work she had to do” with her job at the assisted living facility (beginning in
May 2020). Id. ¶ 8.
IV. Petitioner’s Experts’ Arguments
Petitioner was warned on several occasions not to retain a medical expert, life care
planner, or other expert without consulting with Respondent and obtaining leave from me,
with reimbursement of those costs risked if she acted otherwise. See, e.g., ECF No. 17
(SPU Initial Order, issued on April 15, 2022); ECF No. 20 (Scheduling Order, issued
following an initial status conference on May 26, 2022); ECF No. 32 (Scheduling Order,
issued on November 4, 2022). Despite such warnings (and failing to consult with
Respondent and/or the court), Petitioner has submitted expert reports from two
physicians, which consist of the experts’ answers to various questions posed by
8

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Petitioner’s counsel. I will consider the arguments made by Petitioner’s experts to the
extent that they relate to the specific issue of severity.
First, Petitioner submitted an expert report from Dr. Scott Lipson (and
corresponding medical literature), which was authored in August 2021 following a
telemedicine visit with Petitioner. Ex. 7. Dr. Lipson specializes in neurophysiology. Id. at
1. He did not address Petitioner’s lengthy gap in treatment but contended that Petitioner’s
left shoulder pain “continued through May 2021,” or through the time of her repeat EMG
that month. Id. at 10. Dr. Lipson argued that Petitioner’s clinical presentation and
diagnostic findings were consistent with “isolated suprascapular neuropathy as the
manifestation of her [BN]” – which caused atrophy of the supraspinatus and infraspinatus
nerves and severe denervating changes. Id. at 10-11. Dr. Lipson concluded that the “most
obvious cause” of Petitioner’s shoulder symptoms was “post-vaccine [BN].” Id. at 12.
In a supplemental report (drafted in response to my Order to Show Cause), Dr.
Lipson homed in on the severity issue at hand. He was not surprised by Petitioner’s
reported “worsening pain” in June 2020, after using her left arm more at a new job. Ex.
36 at 2. He opined this “exacerbation” was “entirely consistent with her known
suprascapular neuropathy” – which is characterized by the most severe pain at the
beginning of the disorder, followed by the pain becoming more neuropathic then
musculoskeletal. Id. at 2-3. To him, this did not suggest “the development of a new cause
for shoulder pain” but is instead consistent with her course of BN. Id. Additionally, Dr.
Lipson asserted that because Petitioner’s PCP did not suggest or diagnose
“suprascapular mononeuropathy/[BN]” – a diagnosis he claimed is often missed by PCPs
– or order any additional diagnostic tests beyond an ultrasound, Petitioner chose not to
return to care after September 2019. Id. at 3.
Second, Petitioner submitted an expert report from Dr. Joseph Feinberg, a
specialist in neuromuscular and electrodiagnostic medicine. Ex. 40 at 1. Dr. Feinberg
opined that Petitioner had “chronic and recurrent pain that has persisted for well beyond
six months from the time she first reported symptoms on 9/21/19.” Id. at 2. He further
opined that her complaints “in September of 2019, June of 2020, and thereafter were
caused by the Tdap vaccine.” Id. He contended that Petitioner’s presentation was classic
of BN “secondary to a vaccination and there is no other plausible explanation for her
symptoms and diagnostic [] findings.” Id. Dr. Feinberg argued that Petitioner’s first EMG
(performed in September 2023) did not test the suprascapular nerve and was thus
“inadequate[,]” which is why the correct diagnosis was not made until her repeat EMG in
May 2021. Id. at 1.
9

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V. Applicable Legal Standard
Petitioners carry the burden of establishing the matters required in the petition by
a preponderance of the evidence. Section 13(a)(1)(A). One such requirement is
“documentation demonstrating that [the petitioner]9 ... suffered the residual effects or
complications of such [vaccine-related] illness, disability, injury, or condition for more than
6 months after the administration of the vaccine.” Section 11(c)(1)(D)(i); see also Black v.
Sec’y of Health & Hum. Servs., 33 Fed. Cl. 546, 550 (1995) (reasoning that the “potential
petitioner” must not only make a prima facie case, but clear a jurisdictional threshold, by
“submitting supporting documentation which reasonably demonstrates that a special
master has jurisdiction to hear the merits of the case”), aff’d, 93 F.3d 781 (Fed. Cir. 1996)
(internal citations omitted).
Congress has stated that the severity requirement was designed “to limit the
availability of the compensation system to those individuals who are seriously injured from
taking a vaccine.” H.R. REP. 100-391(I), at 699 (1987), reprinted in 1987 U.S.C.C.A.N.
2313–1, 2313–373, cited in Cloer v. Sec’y of Health & Hum. Servs., 654 F.3d 1322, 1335
(Fed. Cir. 2011), cert. denied, 132 S.Ct. 1908 (2012); Wright v. Sec’y of Health & Hum.
Servs., 22 F.4th 999, 1002 (Fed. Cir. 2022).
The Act prohibits finding a petition requirement “based on the claims of a petitioner
alone, unsubstantiated by medical records or by medical opinion.” Section 13(a)(1).
Medical records must be considered, see Section 13(b)(1), and are generally afforded
substantial weight. Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed.
Cir. 1993). Murphy v. Sec’y of Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4
(Fed. Cl. Spec. Mstr. April 25, 1991), quoted with approval in decision denying review, 23
Cl. Ct. 726, 733 (1991), aff'd per curiam, 968 F.2d 1226 (Fed.Cir.1992)). However, the
Federal Circuit has recently “reject[ed] as incorrect the presumption that medical records
are accurate and complete as to all the patient’s physical conditions.” Kirby v. Sec’y of
Health & Hum. Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021).
It is thus certainly the case that factual matters required to prove elements of a
Vaccine Act claim may be established by a mix of witness statements and record proof,
with the special master required to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La Londe
v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184 (2013) (citing Section 12(d)(3);
Vaccine Rule 8), aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
9 Or other vaccinee, e.g., a minor or other person who is unable to represent his or her own interests, on
behalf of whom the claim is brought.
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VI. Analysis
I note preliminarily that Petitioner not only had opportunity to prepare her claim
prior to filing, but was repeatedly put on notice over the subsequent duration of the case
that severity was an issue to be addressed. Yet even after Respondent submitted his
formal position in his Rule 4(c) Report (resulting in an Order to Show Cause), Petitioner
has not submitted additional evidence or established why additional time is merited to
obtain such evidence. Petitioner has thus now had a “full and fair opportunity” to support
her position. Vaccine Rule 3(b). Based upon that existing record (and despite
Respondent’s request for responsive expert reports), I find dismissal is warranted.
Assuming arguendo10 that Petitioner’s initial post-vaccination complaints and
symptoms were, in fact, consistent with BN as alleged, the filed medical records suggests
that her injury was initially severe upon onset but improved over time, and thus did not
require much formal medical treatment to resolve. Indeed, after her September 25, 2019
ultrasound, which did not find anything to “account for [her] pain and swelling of the left
upper arm,” she was told to use home treatments, like cold compresses and Tylenol as
needed. Ex. 2 at 127, 131-32. There was thus some medical expectation that treatment
of the injury might not be needed for a substantial period of time – which would have been
only three weeks after vaccination.
In addition, the record does not corroborate Petitioner’s severity assertions in other
regards. She discontinued treatment for her shoulder injury the same month as her
subject vaccination, and there is no subsequent medical record proof that the injury
demanded any additional medical evaluation for approximately nine months. Indeed, the
records do not show a single follow-up visit for evaluation of her shoulder symptoms
between September 30, 2019, and June 14, 2020 (in comparison to the records showing
ongoing care for pre-existing ailments with the same PCP who administered the subject
vaccination, and with whom she previously sought shoulder/arm related treatment prior
to the gap in care).
Petitioner, however, maintains that following her September 2019 visits with her
PCP, her physician “did not instruct [her] to return for further evaluation or treatment.” Ex.
22 ¶¶ 7-8. She thus believed that “there was no other treatment that could be provided
for [her] complaints.” Id. ¶¶ 9-10. She also attests that she did not complain of shoulder-
related complaints at intervening PCP visits because these appointments were regular
10 There appears to also be a dispute among the parties regarding whether Petitioner’s initial post-
vaccination symptoms and diagnostic findings were consistent with a Table BN injury and/or whether she
was, in fact, ever diagnosed with BN by any of her treaters. See Respondent’s Report at 11-13; see also
Exs. 36, 40. In light of severity being a dispositive issue, however, I do not address diagnosis.
11

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follow ups, and at that time she was “no longer experiencing the worst pain . . . where
[she] could barely lift [her] arm.” Ex. 33 ¶¶ 10, 14-15. She again was hopeful the pain
would subside, and believed “there was no other treatment that could be provided.” Id.
While there is some reason to credit such arguments, they are ultimately
unpersuasive given the totality of evidence. Petitioner’s contention, for example, that
medical providers did not propose much in the way of treatment for her shoulder pain
after September 2019 does have record support. But at the same time, Petitioner had
several in-person and telehealth visits with her PCP (the same person who provided her
initial UE treatment – and thus would have been already aware of her vaccine-related
complaints) during the subsequent treatment gap. Accordingly, she had ample
opportunity to mention such problems, had they continued to linger as alleged, and
despite earlier suggestions that only limited, conservative treatment was possible.
Petitioner further points to record evidence establishing that beginning from when
she returned to care on June 14, 2020 (nine months after treatment cessation), she
consistently associated her ongoing pain to her earlier vaccination. See, e.g., Ex. 2 at 138
(a June 14, 2020 note stating Petitioner presented for arm pain “ever since she got a
tetanus shot in September”); Ex. 2 at 145 (a June 15, 2020 follow up for “chronic left
shoulder pain since tetanus shot in Sep[.] 2019.”); Ex. 2 at 155 (a June 22, 2020 note
showing a complaint of “[c]hronic pain/swelling after an immunization in 9/2019.”); Ex. 2
at 168 (a September 3, 2020 note stating her pain “began after an immunization injection
in 9/2019.”); Ex. 18 at 7 (a January 8, 2021 note stating Petitioner “continues to have L
shoulder/arm pain. Developed after onset of tdap [sic] vaccination in 9/2019.”).
In many cases (especially where the treatment gap was shorter, or featured less
intervening opportunities to obtain follow-up care for a purported vaccine injury), the
foregoing might be sufficient to satisfy severity. But here, there is a competing factor
established by the record. For in May 2020, Petitioner began a job at an assisted living
facility requiring substantial lifting and carrying elderly patients to and from beds,
wheelchairs, and showers. Not only does this suggest that her vaccine-related symptoms
(to the extent they existed at the time) were mild enough to take on this kind of work (even
with financial concerns), but Petitioner also expressly admitted to medical providers that
this job exacerbated her shoulder symptoms. See, e.g., Ex. 2 at 138 (a June 14, 2020 ER
report that her new job made her pain worse); Ex. 2 at 155 (a June 22, 2020 report of
“[w]orsening [pain and swelling] x2 months since starting new job.”); Ex. 22 ¶¶ 11-12 (her
first affidavit stating that the lifting required from her new job made her arm pain worse,
which prompted her to go to the ER on June 14, 2020, and seek additional shoulder and
neck treatment). While an argument could be made that the physical labor associated
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with the new job merely exacerbated the prior vaccine injury, this record leans more in
favor of the conclusion that the new position caused an entirely different injury.
In fact, the medical records show that Petitioner’s complaints and physical
examination findings differed pre and post gap in treatment. Thus, in September 2019
Petitioner complained of left UE pain, and her September 23, 2019 examination showed
tenderness at her myofascial trigger point but no edema; diminished ROM was likewise
not observed. Ex. 2 at 120. But when Petitioner returned to care in June 2020 following
the gap in treatment and thereafter, she consistently reported a different constellation of
symptoms - pain into the neck, swelling in the upper left limb (and left hand),
numbness/tingling that radiated into her left hand/fingers, and exhibited limited ROM.
See, e.g., Ex. 2 at 138, 145, 155, 168; Ex. 18 at 7, 26-27. She also began complaining of
weakness in the left arm and a bulge in her forearm. Ex. 18 at 7, 27. While Petitioner’s
pre-gap medical records are indeed limited, it is apparent that she experienced differing
symptoms (in terms of type and location) in September 2019 than in June 2020 and
beyond, and thereby further casting doubt on her contentions that the vaccine-related
complaints were related to or consistent with her June 2020 concerns.
Even more persuasive on this point is the fact that Petitioner’s treaters suspected
different etiologies of her symptoms immediately post-vaccination than they did for the
symptoms she displayed after the nine-month treatment gap. At Petitioner’s September
23, 2019 visit, for instance, her PCP assessed her with a “[l]ikely localized reaction
following administration of her Tdap vaccination in her left upper extremity.” Ex. 2 at 117-
18. By contrast, when Petitioner visited the ER in June 2020 after the gap in care, the ER
physician speculated that Petitioner’s symptoms were caused by a blood clot formed from
overuse with her new job. Id. at 141. And when Petitioner followed up with her PCP on
June 15, 2020 (the same treater who knew Petitioner’s recent history and previously
assessed a localized vaccine reaction), that PCP opined that the cause of her ongoing
symptomology had an “[u]nclear etiology” and was “possibly OA” or an inflammatory
process. Id. at 145. Later that month, on June 22, 2020, her PCP posited a neuropathic
etiology, possibly referred pain from CTS, or tendonitis versus radiculopathy as possible
explanations for her pain. Id. at 155. As a result, the PCP urged Petitioner to undergo
MRIs of the neck and shoulder, but Petitioner insisted her symptoms were rooted in her
shoulder. Id. at 150. Such evidence supports the conclusion that Petitioner was
experiencing a manifestation of distinguishable symptoms and/or conditions following the
conclusion of her initial vaccine-related care.
I also do not find that the witness statements supplied by Petitioner can overcome
the existing medical record discussed above, even if they merit some weight. Thus, a
third party affidavit obtained from one of Petitioner’s acquaintances attests to encounters
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with Petitioner when she would mention ongoing shoulder pain during the pertinent gap
in care, and even provides a rationale for the recollection (that the timeframe sticks in the
individual’s head due to a personal family loss at the time). See generally Ex. 34. Yet this
affidavit (and most of the other supplemental and/or fact affidavits), was authored for the
purposes of litigation, after the filing of the instant claim, and even after the issuance of
my Order to Show Cause. And it cannot fully rebut the absence of evidence of UE
complaints in the timeframe, despite many opportunities to raise the issue with treaters.
The same can be said of Petitioner’s expert reports. The timing of these reports
provides some grounds for giving them slightly less weight; two of the three expert reports
were submitted over two years after the initiation of the instant claim, and following the
issuance of my Order to Show Cause. Far more importantly, however, none of Petitioner’s
expert reports specifically address what occurred during the relevant gap in care - and
with that, what if any of Petitioner’s vaccine-related symptoms were ongoing between
September 2019 and June 2020. This was something that an expert could well have
provided useful commentary upon, especially since the record clearly establishes that
Petitioner could have raised UE concerns during the treatment gap. Given Petitioner’s
limited post-vaccination care prior to the gap, some contextual medical explanation was
needed, but these reports did not provide it. I therefore do not give the reports significant
weight in resolving severity.
CONCLUSION
Petitioner has presented insufficient proof to establish the six-month severity
requirement. Section 11(c)(1)(D). Therefore, she is ineligible to pursue compensation
under the Program. In the absence of a timely-filed motion for review (see Appendix B to
the Rules of the Court), the Clerk of Court shall enter judgment in accordance with this
Decision.11
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
11 Pursuant to Vaccine Rule 11(a), the parties may expedite entry of judgment by filing a joint notice
renouncing their right to seek review.
14

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_21-vv-01720-1
Date issued/filed: 2025-09-18
Pages: 17
Docket text: REPORTED JUDGE VACCINE ORDER/OPINION. Public version of 51. Signed by Judge Molly R. Silfen. (rf) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-01720-MRS Document 53 Filed 09/18/25 Page 1 of 17
In the United States Court of Federal Claims
YVETTE MOYLER,
Petitioner,
No. 21-1720
v.
Filed under seal: September 3, 2025
Reissued: September 18, 2025
THE UNITED STATES,
Respondent.
Thomas J. O’Connell, Abramson & O’Connell, LLC, Columbus, OH, for petitioner.
Alexa Roggenkamp, Civil Division, United States Department of Justice, Washington, DC, for
respondent.
OPINION AND ORDER
Denying Ms. Moyler’s motion for review
Yvette Moyler filed a petition under the National Childhood Vaccine Injury Act of 1986,
seeking compensation for a shoulder injury that she alleges resulted from a tetanus-diphtheria-
acellular pertussis (“Tdap”) vaccine.1 She argues that the special master’s decision was arbitrary
and capricious because the special master (1) did not adequately consider all record evidence when
assessing the severity of her injury; (2) made an implausible inference when concluding that her
symptoms resulted from a different injury; (3) required her to satisfy a heightened burden of proof
and failed to consider witness statements; and (4) abused his discretion by denying an evidentiary
hearing.
1 This opinion was originally issued under seal on September 3, 2025. The parties had no proposed
redactions. The court reissues the opinion publicly.
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The special master’s findings were not arbitrary, capricious, or an abuse of discretion. He
considered the evidence, made plausible inferences, articulated his reasoning, and reached a rea-
sonable conclusion. The court therefore will deny Ms. Moyler’s motion for review and affirm the
special master’s decision.
I. Background
A. Ms. Moyler’s medical history
On September 9, 2019, Ms. Moyler received a Tdap vaccine in her left arm, in the deltoid
muscle. ECF No. 25-3 at 4; ECF No. 22-2 at 113. Since before the vaccination, Ms. Moyler had
type II diabetes and hypertension. See ECF No. 22-2 at 2-72; ECF No. 22-3 at 4-36.
Two weeks after the vaccination, on September 21, Ms. Moyler visited an urgent care cen-
ter and reported “pain at the injection site from Tdap.” ECF No. 22-4 at 3. The doctor prescribed
pain medication and instructed her to follow up with her doctor in two days. Id. On September 23,
Ms. Moyler followed up with her primary-care physician. ECF No. 22-2 at 117. She reported pain
at the site of her Tdap injection, which she described as a “toothache” that gradually worsened
throughout the day. Id. at 118. She stated that she was having trouble completing daily activities
and sleeping on her left side due to the pain. Id. A physical examination showed tenderness over
the left deltoid but a normal range of motion. Id. at 120. The physician noted that Ms. Moyler was
“likely [experiencing a] localized reaction following administration of her Tdap vaccination” and
advised her to use cold compresses and Tylenol to manage the pain. Id. at 118, 122.
Two days later, Ms. Moyler underwent an upper left arm ultrasound, which found no fluid
collection or abscess. ECF No. 22-2 at 131. Ms. Moyler called her primary-care physician’s office
five days later and reported that she was still experiencing arm pain and could “barely lift [her]
arm.” Id. at 127. A nurse advised her to continue using a cold compress, taking Tylenol, and mov-
ing her arm. Id.
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Ms. Moyler did not return to her primary-care physician for care for her left upper arm
until about nine months later in June 2020. Id. at 133. During that nine-month period, she had four
appointments, in December 2019 and March, April, and May 2020, with an internal-medicine phy-
sician. In those appointments, she addressed her diabetes and hypertension but not her arm pain.
ECF No. 22-18 at 61-108. Ms. Moyler alleges that she continued experiencing pain in her upper
left arm throughout that nine-month period, although the most severe pain subsided after one
month. ECF No. 42-3 at 3-4. She continued to take Tylenol and took Ibuprofen during that time.
According to Ms. Moyler, she was under the impression that there was no other treatment that
could be provided for her ongoing symptoms. Id.
In May 2020, Ms. Moyler began a new job at an assisted living facility where she “as-
sist[ed] residents with transfers, cleaning, laundry, lifting food trays, and trash removal.” ECF No.
42-3 at 5. She alleges that the pain in her left arm got worse with the increased activity required
by her job, and she also started experiencing muscular pain near her neck. Id. at 5.
On June 14, 2020, Ms. Moyler visited the emergency room to seek treatment for swelling
in her left shoulder, upper arm, and neck. ECF No. 22-5 at 5. The emergency room physician found
swelling in her upper arm and trapezius muscle, placed her arm in a sling, and recommended that
she take anti-inflammatories and muscle relaxers. Id. at 7-8. The next day, Ms. Moyler called her
primary-care physician’s office to report that she had visited the emergency room the night before
and that her left arm and neck were swollen and in pain. She stated that the swelling began after
her Tdap vaccination, and that she was also waking up with a tingling sensation in her fingers.
ECF No. 22-2 at 133. Later that day, she visited her primary-care physician’s office and reported
the same symptoms. Id. at 145. The physician noted an unclear etiology that was “possibly [oste-
oarthritis], unlikely infection or [deep vein thrombosis] or trauma / injury” and ordered an MRI of
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her left shoulder and an x-ray of her cervical spine. Id. A week later, Ms. Moyler visited her pri-
mary-care physician’s office again and met with a different doctor. Id. at 155. She again reported
chronic left arm and shoulder pain and swelling since her Tdap vaccination, which she stated had
gotten worse after starting her new job. Id. That physician also noted an “unclear” etiology, that
the pain “seems neuropathic,” and that all her workup thus far, including an ultrasound and x-ray,
had been “negative.” Id.
In the meantime, Ms. Moyler alleges that it was getting more difficult to do her job at the
assisted living facility, and the pain ultimately prevented her from working. ECF No. 42-3 at 5.
Ms. Moyler alleges that, as a result, she left her job in July 2020. Id.
Ms. Moyler underwent an MRI on August 8, 2020. ECF No. 22-2 at 162. Two days later,
her primary-care physician called her to discuss the MRI results, which showed “diffuse muscle
edema” throughout her infraspinatus and supraspinatus muscles from an unknown etiology, tendi-
nopathy, and a possible grade 1 muscle strain. Id. at 161, 165. The physician recommended an
EMG study and referred her to Dr. Bryce Fincham, an orthopedist. Id. at 161, 166-167. The next
month, Mr. Moyler had an appointment with Dr. Fincham; she reported burning pain, numbness,
tingling, and weakness in her left shoulder. Id. at 167-68. Like her primary-care physician, Dr.
Fincham also recommended an EMG nerve conduction study of her upper left arm. Id. at 171. Ms.
Moyler underwent the EMG study on September 23, which showed carpal tunnel syndrome but
no other issues. Id. at 179-80. The EMG did not test the infraspinatus and supraspinatus muscles,
which were the muscles that the MRI had found to be abnormal. ECF No. 42-6 at 4 (expert report
by Dr. Scott Lipson).
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Ms. Moyler continued taking medication for her pain in the meantime and participated in
physical therapy in December 2020 and January 2021, but neither relieved the pain. ECF No. 42-
3 at 6-7.
In May 2021, Ms. Moyler underwent another EMG study, this time testing the left infrasp-
inatus and supraspinatus muscles. ECF No. 22-6. The EMG found a “severe, isolated involvement
of the left suprascapular nerve.” Id. at 2. On August 2, 2021, Ms. Moyler had an appointment with
neurological specialist Dr. Scott Lipson. ECF No. 22-7 at 2. Dr. Lipson examined the back of Ms.
Moyler’s left shoulder, which revealed atrophy of the left supraspinatus and infraspinatus muscles
and loss of strength in those muscles. Id. at 6-7. Dr. Lipson photographed Ms. Moyler’s back
during his examination. Id. at 6. After reviewing Ms. Moyler’s medical records, Dr. Lipson con-
cluded that Ms. Moyler suffered from severe post-vaccine brachial neuritis. Id. at 10-12. Dr. Jo-
seph Feinberg, a physiatrist who treats brachial plexus and traumatic nerve injuries, reached the
same conclusion after reviewing Ms. Moyler’s medical records. ECF No. 42-10.
B. The procedural background of this case
On August 18, 2021, Ms. Moyler filed a petition with the Office of Special Masters in this
court alleging that she has brachial neuritis or suprascapular neuropathy directly caused by the
Tdap vaccine she received in September 2019 and that her symptoms have persisted for more than
six months. ECF No. 1 at 3-4 [¶¶17-19]. On May 25, 2022, the special master held a status con-
ference, where he discussed the statutory requirement that a petitioner show six months of post-
vaccination symptoms and encouraged Ms. Moyler to file additional medical records or supple-
mental affidavits to show that she satisfied the requirement. ECF No. 20 at 2 (citing 42 U.S.C.
§ 300aa-11(c)(1)(D)(i)). Ms. Moyler filed additional exhibits, including affidavits from herself and
her daughter, as well as affidavits from two friends. EFC Nos. 25-4, 25-5, 25-6, 42-3, 42-4, 42-5.
Ms. Moyler also filed Dr. Lipson’s photo of her back, which she alleges demonstrated the severity
5

Case 1:21-vv-01720-MRS Document 53 Filed 09/18/25 Page 6 of 17
of her condition. ECF No. 22-7 at 6. The parties spent time trying to reach an informal resolution
but were unsuccessful. ECF No. 37. The government then filed a report under rule 4(c) of the Rules
of the Court of Federal Claims, arguing that Ms. Moyler had not provided sufficient evidence to
meet the Vaccine Act’s severity requirement. ECF No. 39 at 8-10.
The special master concluded that Ms. Moyler did not satisfy the six-month severity re-
quirement and dismissed Ms. Moyler’s case. ECF No. 49.2 The special master explained that Ms.
Moyler’s medical records suggest that the injury was initially severe but improved over time. Id.
at 11. He noted that Ms. Moyler discontinued treatment for her shoulder within a month after her
vaccination and did not have a follow-up evaluation or any mention of her shoulder in her medical
records until about nine months later, creating a gap in medical records between September 30,
2019, and June 14, 2020. Id. The special master also noted Ms. Moyler’s new job at an assisted
living facility as a competing factor that, she stated, exacerbated her symptoms, and that her symp-
toms were mild enough at that time to take the job. Id. at 11-12.
When reviewing her medical records, the special master also found that Ms. Moyler’s
symptoms differed before and after the gap in treatment. According to the special master, her
symptoms in September 2019 were tenderness but no edema; her symptoms in June 2020 were
neck pain, swelling in the left upper arm and hand, numbness and tingling in her left hand and
fingers, and weakness in her left arm. ECF No. 49 at 13. The special master also pointed out that
before the treatment gap, in September 2019, Ms. Moyler’s primary-care physician attributed the
symptoms to “a likely localized reaction following administration of the Tdap vaccination in her
left upper extremity.” Nine months later, other physicians thought her pain might be from a blood
2 The special master initially released his opinion under seal at ECF No. 45. He later released a
public version of his opinion, ECF No. 49.
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clot from overuse, an inflammatory process, or a neuropathic etiology. Id. at 13. The special master
also determined that the expert reports and affidavits Ms. Moyler submitted could not overcome
the existing medical records and gap in care. Id. at 13-14.
Ms. Moyler seeks review of the special master’s decision dismissing her case. ECF No. 47.
She argues that the special master’s decision was arbitrary and capricious, that he failed to consider
all the evidence presented, and that his conclusion that her symptoms were caused by a separate
workplace injury is not plausible. Id. at 1-2. She also argues that the special master abused his
discretion by denying an evidentiary hearing. Id. at 24-25.
II. Discussion
This court has jurisdiction to review a special master’s decision under the Vaccine Act.
42 U.S.C. § 300aa-12(e). On a motion for review, this court may uphold or set aside the special
master’s findings of fact and conclusions of law or remand the petition to the special master for
further action. 42 U.S.C. § 300aa-12(e)(2); accord Vaccine Rule 27.
This court reviews the decision of a special master to determine whether it is arbitrary,
capricious, an abuse of discretion, or otherwise not in accordance with law. 42 U.S.C. § 300aa-
12(e)(2)(B); Masias v. Secretary of Health and Human Services, 634 F.3d 1283, 1287 (Fed. Cir.
2011); accord Vaccine Rule 27. That standard is “well understood to be the most deferential pos-
sible.” Munn v. Secretary of Health and Human Services, 970 F.2d 863, 870 (Fed. Cir. 1992).
“If the special master has considered the relevant evidence of record, drawn plausible in-
ferences and articulated a rational basis for the decision, reversible error will be extremely difficult
to demonstrate.” Hines v. Secretary of Health and Human Services, 940 F.2d 1518, 1528 (Fed.
Cir. 1991); see White v. Secretary of Health and Human Services, No. 24-1372, ECF No. 37 at 5
(Fed. Cir. Aug. 27, 2025). This court, like the Federal Circuit, does “not reweigh the factual evi-
dence, assess whether the special master correctly evaluated the evidence, or examine the probative
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value of the evidence or the credibility of the witnesses—these are all matters within the purview
of the fact finder.” Porter v. Secretary of Health and Human Services, 663 F.3d 1242, 1249 (Fed.
Cir. 2011); see Munn, 970 F.2d at 871-72 (explaining that the Federal Circuit and this court apply
the same standard).
This court reviews discretionary rulings, including case management decisions, for abuse
of discretion. Munn, 970 F.2d at 870 n.10. That review “will rarely come into play except where
the special master excludes evidence.” Id. The court gives “no deference to the … Special Master’s
determinations of law,” reviewing legal questions de novo. Carson v. Secretary of Health and
Human Services, 727 F.3d 1365, 1368 (Fed. Cir. 2013).
Under the Vaccine Act, a petitioner seeking compensation for injuries caused by a covered
vaccine can prove entitlement to compensation in one of two ways. For so-called table injuries, a
petitioner may recover when an injury or condition listed in the vaccine injury table (42 U.S.C.
§ 300aa-14(a)) begins to manifest itself within the time specified in the table for the vaccine in
question. Hines, 940 F.2d at 1524; see 42 U.S.C. § 300aa-11(c)(1)(C)(i). Causation in those cases
is presumed. Hines, 940 F.2d at 1524. For off-table injuries, which are not listed in the table or
occur outside the timeframe specified in the table, the petitioner must prove actual causation. Id.
at 1524-25; 42 U.S.C. § 300aa-11(c)(1)(C)(ii). For both table and off-table injuries, the petitioner
must prove, by a preponderance of the evidence, entitlement to compensation. Id. at
1525; 42 U.S.C. § 300aa–13(a)(1)(A).
In table injury cases, as long as the claim is “within the timetable and specifications of a
Table injury [then] the statute does the heavy lifting—causation is conclusively presumed.”
Hodges v. Secretary of Department of Health and Human Services, 9 F.3d 958, 961 (Fed. Cir.
8

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1993); see White, No. 24-1372, ECF No. 37 at 5. According to the vaccine injury table, the symp-
toms for brachial neuritis must appear within two to 28 days after administration of the Tdap vac-
cine. 42 C.F.R. § 100.3. Here, Ms. Moyler also bears the burden to prove, by a preponderance of
the evidence, that she suffered from brachial neuritis for more than six months after receiving her
Tdap vaccine. 42 U.S.C. § 300aa-13(a)(1)(A); 42 U.S.C. § 300aa-11(c)(1)(D)(ⅰ). That includes
providing “documentation demonstrating that [she] … suffered the residual effects or complica-
tions … for more than 6 months after the administration of the vaccine.” 42 U.S.C. § 300aa-
11(c)(1)(D)(ⅰ). A case may be dismissed for failure to meet the six-month severity requirement.
See, e.g., Felix v. Secretary of Health and Human Services, 172 Fed. Cl. 626, 633-34 (2024).
A. The special master’s decision was not arbitrary or capricious
In Vaccine Act cases, this court must uphold a special master’s factual finding “as not
being arbitrary or capricious” if the finding is “based on evidence in the record that is not wholly
implausible.” Cedillo v. Secretary of Health and Human Services, 617 F.3d 1328, 1338 (Fed. Cir.
2010) (cleaned up). That standard is similar to, and even more deferential than, the substantial
evidence standard a court of appeals applies to its review of the factfinding of an administrative
agency. “Substantial evidence is … such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938).
A “finding may be supported by substantial evidence even if two inconsistent conclusions can be
drawn from the evidence.” Citigroup Inc. v. Capital City Bank Group, Inc., 637 F.3d 1344, 1349
(Fed. Cir. 2011). Both the substantial evidence and the arbitrary and capricious standards of review
require the court to uphold a factual determination unless the evidence cannot reasonably be inter-
preted in a way that supports the determination. See Shoes by Firebug LLC v. Stride Rite Children’s
Group, LLC, 962 F.3d 1362, 1371 (Fed. Cir. 2020) (explaining that, when the lower tribunal was
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presented with two alternative theories, the reviewing court’s “task is not to determine which the-
ory [it] find[s] more compelling” or “to second-guess the [tribunal’s] assessment of the evidence”
(quotation marks omitted)).
1. The special master’s decision was not arbitrary or capricious in
finding that Ms. Moyler’s symptoms came from a different in-
jury
Ms. Moyler argues that the special master’s inference that her symptoms came from a
workplace injury was implausible. ECF No. 47 at 16. She asserts that the record does not indicate
that she suffered a different injury to her arm and shoulder while working and points out that there
are no incident reports from her employer, no worker’s compensation claims on file, and no med-
ical records indicating a new injury. Id. Ms. Moyler also argues that no medical evidence can
connect her work activities to her muscle atrophy and nerve damage. Id. She adds that the expert
reports she submitted found that her symptoms were caused by brachial neuritis from her Tdap
vaccination, not from a different injury, and that brachial neuritis is often missed, delayed, or mis-
diagnosed. Id. at 17 (citing ECF No. 22-7 at 11-2; ECF No. 42-6 at 3-4; ECF No. 42-10 at 2).
The government responds that the special master’s conclusion that Ms. Moyler’s initial
symptoms were unrelated to her later symptoms is reasonable. ECF No. 50 at 10. According to the
government, the special master reasonably evaluated the evidence and medical records, which im-
ply that Ms. Moyler’s pain was initially severe but improved over time and that there was a sig-
nificant gap in treatment. Id. at 14-15. The government also notes that the special master found
that Ms. Moyler’s new job may have exacerbated her shoulder pain and that her symptoms after
the gap in treatment were different from her symptoms before. Id. The government argues that the
special master “properly afforded little weight to” Ms. Moyler’s expert reports, which did not ad-
dress the gap in treatment or fully diagnose Ms. Moyler’s symptoms. Id. at 16-17.
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When a special master considers the relevant evidence of record, draws plausible infer-
ences, and articulates a rational basis for his decision, the court must uphold his decision. Hines,
940 F.2d at 1528. The special master’s decision does not have to be the only possible conclusion.
It must only be a conclusion that a reasonable mind could reach based on the totality of the evi-
dence; that is, it must not be wholly implausible. Cedillo, 617 F.3d at 1338; Citigroup, 637 F.3d
at 1349. This court must uphold the special master’s factual determinations even if it would have
reached a different factual conclusion had it been the one conducting the evidentiary review.
Citigroup, 637 F.3d at 1349; Shoes by Firebug, 962 F.3d at 1371.
Here, the special master reviewed Ms. Moyler’s medical record. He noted that Ms. Moyler
stopped receiving treatment for her upper left arm “the same month” she received the vaccine. He
also noted that Ms. Moyler did not seek treatment for her symptoms for nine months, and only
after she started a new, more demanding job. ECF No. 49 at 11. The special master explained that
during those nine months, Ms. Moyler had four doctors’ appointments for other medical issues but
did not mention anything related to her upper left arm or shoulder. Id. at 12. After reviewing the
records from Ms. Moyler’s appointments, the special master distinguished Ms. Moyler’s symp-
toms in June 2020 from those that began in September 2019. Id. at 12-13. The special master noted
that Ms. Moyler’s June 2020 symptoms were different from those she alleged in September 2019;
in September 2019 her symptoms indicated a myofascial trigger point on her left deltoid but no
edema, while in June 2020 her symptoms included swelling, burning pain that spread to her trape-
zius and neck, left hand swelling, fingertip numbness, and tingling. Id.; ECF No. 22-2 at 131-132,
138, 145, 155, 168; ECF No. 22-18 at 7.
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The special master considered the fact that Ms. Moyler’s later symptoms appeared a month
after she started new and more physically demanding work activities, and that they were distin-
guishable by type and location from her September 2019 symptoms. ECF No. 49 at 12-13. The
special master appropriately considered the evidence, including Ms. Moyler’s medical records,
providers’ different theories regarding her symptoms, and work activities. He clearly articulated
his conclusion that her new job caused a different injury and that her initial symptoms did not last
six months. Id. at 12-13; see Hines, 940 F.2d at 1528; Cedillo, 617 F.3d at 1338; Citigroup, 637
F.3d at 1349.
There are legitimate reasons to be skeptical of the special master’s conclusion. First, he
stated that Ms. Moyler visited the same primary care provider who initially treated her post-vaccine
symptoms four times during that nine-month period. ECF No. 49 at 12. The special master appears
to have been mistaken, as she visited different providers during that period. ECF No. 22-18. When
visiting a different provider for a different reason, it is not apparent that a patient would necessarily
raise a concern about an unrelated injury for which she had already seen a different provider. Sec-
ond, the special master also expressed concern that Ms. Moyler was willing to take on a new job,
with more physical demands, undercutting her argument that she was already injured from the
vaccine. ECF No. 49 at 12. But there are many reasons a person might take a new job, not least
the need for pay and healthcare, even if it might exacerbate an existing injury. That said, the con-
clusion that the new job caused a new injury is plausible. Although there is another plausible—
potentially even more plausible—explanation that Ms. Moyler’s symptoms began in September
2019 and continued through June 2020 and after, potentially with symptoms morphing over time,
the court cannot second guess the special master’s weighing of the evidence to reach the conclusion
he did.
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Ms. Moyler also suggests that the six-month severity requirement could still be met if it
started when she got the August 2020 MRI. ECF No. 47 at 15. She argues that the “relevant inquiry
is whether any residual effect or complication lasts for more than six months, regardless of the
time of onset.” Id. But to prove entitlement for a table injury, a petitioner must have developed the
post-vaccination symptoms within the time specified in the table for the vaccine in question. Hines,
940 F.2d at 1524; see 42 U.S.C. § 300aa-11(c)(1)(C)(i). For the Tdap vaccine, the symptoms for
brachial neuritis must appear within two to 28 days after vaccination. 42 C.F.R. § 100.3. Thus, the
six months began when Ms. Moyler reported symptoms in that 28-day window.
The special master’s decision not to afford weight to Ms. Moyler’s expert reports was like-
wise not arbitrary or capricious. The special master noted that Ms. Moyler’s expert reports did not
“address what occurred during the relevant gap in care [and] … what if any of [Ms. Moyler’s]
vaccine-related symptoms were ongoing between September 2019 and June 2020.” ECF No. 49 at
14; see ECF Nos. 22-7, 42-10. Without information on the severity of Ms. Moyler’s injury, it was
reasonable for the special master to determine, without finding the expert reports not credible, that
the expert reports did not provide adequate evidence to support a conclusion that Ms. Moyler was
suffering from the same injury she received in September 2019.
It was also reasonable for the special master to find that Ms. Moyler’s friends’ and daugh-
ter’s affidavits did not rebut her nine-month treatment gap. See Cucuras v. Secretary of Depart-
ment of Health & Human Services, 993 F.2d 1525, 1528 (Fed. Cir. 1993) (affirming the special
master’s decision to prioritize and rely on medical records over testimony). Ms. Moyler argues
that the special master imposed a standard of proof closer to beyond a reasonable doubt than pre-
ponderance of the evidence. ECF No. 47 at 23-24. But the special master explained that the affi-
davits and expert reports were just not enough to overcome, by a preponderance of the evidence,
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the existing medical records and to rebut the treatment gap. See ECF No. 49 at 10, 13-14; Cucuras,
993 F.2d at 1528. That conclusion based on a weighing of the record evidence is not one the court
can second guess.
2. The special master appropriately addressed, considered and
weighed the evidence presented
Ms. Moyler argues that the special master failed to consider the totality of the evidence in
his severity analysis and that that failure constitutes error. ECF No. 47 at 10-15 (citing Moriarty
v. Secretary of Health and Human Services, 844 F.3d 1322, 1328 (Fed. Cir. 2016)). Specifically,
she argues that the special master did not consider her MRI and EMG test results and the photos
of her back because he did not discuss them in his severity analysis. ECF No. 47 at 12. She also
argues that the special master discounted her expert reports, did not address their credibility, and
dismissed them for not addressing the nine-month gap in treatment. Id. at 13.
The government responds that the special master is presumed to have considered all evi-
dence in the record, even if he does not explicitly reference it in his decision. ECF No. 50 at 12
(citing Moriarty v. Secretary of Health and Human Services, 844 F.3d 1322, 1328 (Fed. Cir.
2016)). The government points out that the special master did discuss Ms. Moyler’s test results in
the background section of his decision, but that the disputed tests took place after Ms. Moyler
started her new job, and the special master found those results to be unrelated to the symptoms she
was experiencing immediately after the vaccine. ECF No. 50 at 12 (citing ECF No. 49 at 5, 7, 9).
The government argues that the real issue is whether Ms. Moyler’s symptoms were part of her
initial incident after the vaccine or from a new injury. Id.
Generally, “even if the special master had made no explicit reference to the evidence,” the
court presumes that he considered the totality of the evidence. Hazlehurst v. Secretary of Health
and Human Services, 604 F.3d 1343, 1352 (Fed. Cir. 2010); see Medtronic, Inc. v. Daig Corp.,
14

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789 F.2d 903, 906 (Fed. Cir. 1986) (“We presume that a fact finder reviews all the evidence pre-
sented unless he explicitly expresses otherwise.”). Here, the special master discussed most evi-
dence presented, including Ms. Moyler’s medical records, test results, affidavits, and expert re-
ports. ECF No. 49 at 3-9. While the special master limited his discussion of some of the evidence
to the background section of his decision, and did not address other pieces of evidence—the pic-
tures of Ms. Moyler’s back—that was within his authority. See, e.g., Gonzalez v. Secretary of
Health & Human Services, 173 Fed. Cl. 728, 735 (2024) (upholding the special master’s factual
findings even though his decision did not expressly discuss the petitioner’s affidavit); Simanski v.
Secretary of Health & Human Services, 115 Fed. Cl. 407, 436 (2009), aff’d, 601 F. App’x 982
(Fed. Cir. 2015) (“[A] Special Master is not required to discuss every piece of evidence or testi-
mony in [his] decision.” (cleaned up)). After considering the totality of the evidence, the special
master appropriately determined that Ms. Moyler’s post-vaccine symptoms did not persist for at
least six months and instead that her current symptoms resulted from new work activities. ECF
No. 49 at 11-14.
B. The special master did not abuse his discretion by deciding not to con-
duct an evidentiary hearing
Ms. Moyler argues that the special master’s decision not to hold an evidentiary hearing was
arbitrary, capricious, and an abuse of discretion. ECF No. 47 at 24. She argues that Vaccine Rules
3(b) and 8(c) counsel in favor of holding an evidentiary hearing when testimony reasonably might
address apparent tension between medical records and later recorded recollections. Id. (citing
Campbell v. Secretary of Health & Human Services, 69 Fed. Cl. 775, 778 (2006)). According to
Ms. Moyler, her silence regarding her left arm and shoulder symptoms during her medical appoint-
ments in the nine months before June 2020 does not provide a basis for presuming that her medical
15

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records addressed every symptom she was experiencing. Id. She also argues that there was a com-
pelling need for the special master to conduct an evidentiary hearing to evaluate the credibility of
the witnesses who corroborated her ongoing symptoms during those nine months. Id. at 24-25.
The government responds that hearings are not required by the Vaccine Act and that special mas-
ters can rule on the record when each party has already had a full and fair opportunity to present
its case. ECF No. 50 at 17.
“Special masters have wide discretion in determining whether to conduct an evidentiary
hearing.” Kreizenbeck v. Secretary of Health and Human Services, 945 F.3d 1362, 1365 (Fed. Cir.
2020); see 42 U.S.C. § 300aa-12(d)(3)(B)(v) (the special master “may conduct such hearings as
may be reasonable and necessary”); Vaccine Rule 8(d) (“The special master may decide a case on
the basis of written submissions without conducting an evidentiary hearing.”). In Campbell, which
Ms. Moyler relies on for her argument, the special master rejected the petitioners’ witness affida-
vits and expert reports and sua sponte added articles to the record without giving the petitioners
any opportunity to respond to them. Campbell, 69 Fed. Cl. at 779. Here, Ms. Moyler submitted
witness affidavits and expert reports, all of which the special master reviewed. See ECF No. 49 at
13-14. In considering the affidavits and expert reports, the special master concluded that, although
they merited “some weight,” they did not rebut the treatment gap in the medical records. Id. As
discussed, that conclusion was not arbitrary or capricious. Cucuras, 993 F.2d at 1528; Cedillo, 617
F.3d at 1338. Although an evidentiary hearing would have been a reasonable choice, especially
when choosing to discount some evidence based on its timing or inferred motives, the special
master was within his discretion not to conduct an evidentiary hearing.
III. Conclusion
This court denies Ms. Moyler’s motion for review and affirms the special master’s deci-
sion. The clerk of the court shall enter judgment accordingly.
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IT IS SO ORDERED.
/s/ Molly R. Silfen
MOLLY R. SILFEN
Judge
17

================================================================================
DOCUMENT 3: USCOURTS-cofc-1_21-vv-01720-2
Date issued/filed: 2025-09-18
Pages: 17
Docket text: JUDGE VACCINE REPORTED OPINION (PUBLIC VERSION) re: 51 Order on Motion for Review, Judge Vaccine Order/Opinion (**RE-DOCKETED 53 FOR POSTING TO THE COURT'S WEBSITE**) Signed by Judge Molly R. Silfen. (tjk) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-01720-MRS Document 55 Filed 09/18/25 Page 1 of 17
In the United States Court of Federal Claims
YVETTE MOYLER,
Petitioner,
No. 21-1720
v.
Filed under seal: September 3, 2025
Reissued: September 18, 2025
THE UNITED STATES,
Respondent.
Thomas J. O’Connell, Abramson & O’Connell, LLC, Columbus, OH, for petitioner.
Alexa Roggenkamp, Civil Division, United States Department of Justice, Washington, DC, for
respondent.
OPINION AND ORDER
Denying Ms. Moyler’s motion for review
Yvette Moyler filed a petition under the National Childhood Vaccine Injury Act of 1986,
seeking compensation for a shoulder injury that she alleges resulted from a tetanus-diphtheria-
acellular pertussis (“Tdap”) vaccine.1 She argues that the special master’s decision was arbitrary
and capricious because the special master (1) did not adequately consider all record evidence when
assessing the severity of her injury; (2) made an implausible inference when concluding that her
symptoms resulted from a different injury; (3) required her to satisfy a heightened burden of proof
and failed to consider witness statements; and (4) abused his discretion by denying an evidentiary
hearing.
1 This opinion was originally issued under seal on September 3, 2025. The parties had no proposed
redactions. The court reissues the opinion publicly.
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The special master’s findings were not arbitrary, capricious, or an abuse of discretion. He
considered the evidence, made plausible inferences, articulated his reasoning, and reached a rea-
sonable conclusion. The court therefore will deny Ms. Moyler’s motion for review and affirm the
special master’s decision.
I. Background
A. Ms. Moyler’s medical history
On September 9, 2019, Ms. Moyler received a Tdap vaccine in her left arm, in the deltoid
muscle. ECF No. 25-3 at 4; ECF No. 22-2 at 113. Since before the vaccination, Ms. Moyler had
type II diabetes and hypertension. See ECF No. 22-2 at 2-72; ECF No. 22-3 at 4-36.
Two weeks after the vaccination, on September 21, Ms. Moyler visited an urgent care cen-
ter and reported “pain at the injection site from Tdap.” ECF No. 22-4 at 3. The doctor prescribed
pain medication and instructed her to follow up with her doctor in two days. Id. On September 23,
Ms. Moyler followed up with her primary-care physician. ECF No. 22-2 at 117. She reported pain
at the site of her Tdap injection, which she described as a “toothache” that gradually worsened
throughout the day. Id. at 118. She stated that she was having trouble completing daily activities
and sleeping on her left side due to the pain. Id. A physical examination showed tenderness over
the left deltoid but a normal range of motion. Id. at 120. The physician noted that Ms. Moyler was
“likely [experiencing a] localized reaction following administration of her Tdap vaccination” and
advised her to use cold compresses and Tylenol to manage the pain. Id. at 118, 122.
Two days later, Ms. Moyler underwent an upper left arm ultrasound, which found no fluid
collection or abscess. ECF No. 22-2 at 131. Ms. Moyler called her primary-care physician’s office
five days later and reported that she was still experiencing arm pain and could “barely lift [her]
arm.” Id. at 127. A nurse advised her to continue using a cold compress, taking Tylenol, and mov-
ing her arm. Id.
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Ms. Moyler did not return to her primary-care physician for care for her left upper arm
until about nine months later in June 2020. Id. at 133. During that nine-month period, she had four
appointments, in December 2019 and March, April, and May 2020, with an internal-medicine phy-
sician. In those appointments, she addressed her diabetes and hypertension but not her arm pain.
ECF No. 22-18 at 61-108. Ms. Moyler alleges that she continued experiencing pain in her upper
left arm throughout that nine-month period, although the most severe pain subsided after one
month. ECF No. 42-3 at 3-4. She continued to take Tylenol and took Ibuprofen during that time.
According to Ms. Moyler, she was under the impression that there was no other treatment that
could be provided for her ongoing symptoms. Id.
In May 2020, Ms. Moyler began a new job at an assisted living facility where she “as-
sist[ed] residents with transfers, cleaning, laundry, lifting food trays, and trash removal.” ECF No.
42-3 at 5. She alleges that the pain in her left arm got worse with the increased activity required
by her job, and she also started experiencing muscular pain near her neck. Id. at 5.
On June 14, 2020, Ms. Moyler visited the emergency room to seek treatment for swelling
in her left shoulder, upper arm, and neck. ECF No. 22-5 at 5. The emergency room physician found
swelling in her upper arm and trapezius muscle, placed her arm in a sling, and recommended that
she take anti-inflammatories and muscle relaxers. Id. at 7-8. The next day, Ms. Moyler called her
primary-care physician’s office to report that she had visited the emergency room the night before
and that her left arm and neck were swollen and in pain. She stated that the swelling began after
her Tdap vaccination, and that she was also waking up with a tingling sensation in her fingers.
ECF No. 22-2 at 133. Later that day, she visited her primary-care physician’s office and reported
the same symptoms. Id. at 145. The physician noted an unclear etiology that was “possibly [oste-
oarthritis], unlikely infection or [deep vein thrombosis] or trauma / injury” and ordered an MRI of
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her left shoulder and an x-ray of her cervical spine. Id. A week later, Ms. Moyler visited her pri-
mary-care physician’s office again and met with a different doctor. Id. at 155. She again reported
chronic left arm and shoulder pain and swelling since her Tdap vaccination, which she stated had
gotten worse after starting her new job. Id. That physician also noted an “unclear” etiology, that
the pain “seems neuropathic,” and that all her workup thus far, including an ultrasound and x-ray,
had been “negative.” Id.
In the meantime, Ms. Moyler alleges that it was getting more difficult to do her job at the
assisted living facility, and the pain ultimately prevented her from working. ECF No. 42-3 at 5.
Ms. Moyler alleges that, as a result, she left her job in July 2020. Id.
Ms. Moyler underwent an MRI on August 8, 2020. ECF No. 22-2 at 162. Two days later,
her primary-care physician called her to discuss the MRI results, which showed “diffuse muscle
edema” throughout her infraspinatus and supraspinatus muscles from an unknown etiology, tendi-
nopathy, and a possible grade 1 muscle strain. Id. at 161, 165. The physician recommended an
EMG study and referred her to Dr. Bryce Fincham, an orthopedist. Id. at 161, 166-167. The next
month, Mr. Moyler had an appointment with Dr. Fincham; she reported burning pain, numbness,
tingling, and weakness in her left shoulder. Id. at 167-68. Like her primary-care physician, Dr.
Fincham also recommended an EMG nerve conduction study of her upper left arm. Id. at 171. Ms.
Moyler underwent the EMG study on September 23, which showed carpal tunnel syndrome but
no other issues. Id. at 179-80. The EMG did not test the infraspinatus and supraspinatus muscles,
which were the muscles that the MRI had found to be abnormal. ECF No. 42-6 at 4 (expert report
by Dr. Scott Lipson).
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Ms. Moyler continued taking medication for her pain in the meantime and participated in
physical therapy in December 2020 and January 2021, but neither relieved the pain. ECF No. 42-
3 at 6-7.
In May 2021, Ms. Moyler underwent another EMG study, this time testing the left infrasp-
inatus and supraspinatus muscles. ECF No. 22-6. The EMG found a “severe, isolated involvement
of the left suprascapular nerve.” Id. at 2. On August 2, 2021, Ms. Moyler had an appointment with
neurological specialist Dr. Scott Lipson. ECF No. 22-7 at 2. Dr. Lipson examined the back of Ms.
Moyler’s left shoulder, which revealed atrophy of the left supraspinatus and infraspinatus muscles
and loss of strength in those muscles. Id. at 6-7. Dr. Lipson photographed Ms. Moyler’s back
during his examination. Id. at 6. After reviewing Ms. Moyler’s medical records, Dr. Lipson con-
cluded that Ms. Moyler suffered from severe post-vaccine brachial neuritis. Id. at 10-12. Dr. Jo-
seph Feinberg, a physiatrist who treats brachial plexus and traumatic nerve injuries, reached the
same conclusion after reviewing Ms. Moyler’s medical records. ECF No. 42-10.
B. The procedural background of this case
On August 18, 2021, Ms. Moyler filed a petition with the Office of Special Masters in this
court alleging that she has brachial neuritis or suprascapular neuropathy directly caused by the
Tdap vaccine she received in September 2019 and that her symptoms have persisted for more than
six months. ECF No. 1 at 3-4 [¶¶17-19]. On May 25, 2022, the special master held a status con-
ference, where he discussed the statutory requirement that a petitioner show six months of post-
vaccination symptoms and encouraged Ms. Moyler to file additional medical records or supple-
mental affidavits to show that she satisfied the requirement. ECF No. 20 at 2 (citing 42 U.S.C.
§ 300aa-11(c)(1)(D)(i)). Ms. Moyler filed additional exhibits, including affidavits from herself and
her daughter, as well as affidavits from two friends. EFC Nos. 25-4, 25-5, 25-6, 42-3, 42-4, 42-5.
Ms. Moyler also filed Dr. Lipson’s photo of her back, which she alleges demonstrated the severity
5

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of her condition. ECF No. 22-7 at 6. The parties spent time trying to reach an informal resolution
but were unsuccessful. ECF No. 37. The government then filed a report under rule 4(c) of the Rules
of the Court of Federal Claims, arguing that Ms. Moyler had not provided sufficient evidence to
meet the Vaccine Act’s severity requirement. ECF No. 39 at 8-10.
The special master concluded that Ms. Moyler did not satisfy the six-month severity re-
quirement and dismissed Ms. Moyler’s case. ECF No. 49.2 The special master explained that Ms.
Moyler’s medical records suggest that the injury was initially severe but improved over time. Id.
at 11. He noted that Ms. Moyler discontinued treatment for her shoulder within a month after her
vaccination and did not have a follow-up evaluation or any mention of her shoulder in her medical
records until about nine months later, creating a gap in medical records between September 30,
2019, and June 14, 2020. Id. The special master also noted Ms. Moyler’s new job at an assisted
living facility as a competing factor that, she stated, exacerbated her symptoms, and that her symp-
toms were mild enough at that time to take the job. Id. at 11-12.
When reviewing her medical records, the special master also found that Ms. Moyler’s
symptoms differed before and after the gap in treatment. According to the special master, her
symptoms in September 2019 were tenderness but no edema; her symptoms in June 2020 were
neck pain, swelling in the left upper arm and hand, numbness and tingling in her left hand and
fingers, and weakness in her left arm. ECF No. 49 at 13. The special master also pointed out that
before the treatment gap, in September 2019, Ms. Moyler’s primary-care physician attributed the
symptoms to “a likely localized reaction following administration of the Tdap vaccination in her
left upper extremity.” Nine months later, other physicians thought her pain might be from a blood
2 The special master initially released his opinion under seal at ECF No. 45. He later released a
public version of his opinion, ECF No. 49.
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clot from overuse, an inflammatory process, or a neuropathic etiology. Id. at 13. The special master
also determined that the expert reports and affidavits Ms. Moyler submitted could not overcome
the existing medical records and gap in care. Id. at 13-14.
Ms. Moyler seeks review of the special master’s decision dismissing her case. ECF No. 47.
She argues that the special master’s decision was arbitrary and capricious, that he failed to consider
all the evidence presented, and that his conclusion that her symptoms were caused by a separate
workplace injury is not plausible. Id. at 1-2. She also argues that the special master abused his
discretion by denying an evidentiary hearing. Id. at 24-25.
II. Discussion
This court has jurisdiction to review a special master’s decision under the Vaccine Act.
42 U.S.C. § 300aa-12(e). On a motion for review, this court may uphold or set aside the special
master’s findings of fact and conclusions of law or remand the petition to the special master for
further action. 42 U.S.C. § 300aa-12(e)(2); accord Vaccine Rule 27.
This court reviews the decision of a special master to determine whether it is arbitrary,
capricious, an abuse of discretion, or otherwise not in accordance with law. 42 U.S.C. § 300aa-
12(e)(2)(B); Masias v. Secretary of Health and Human Services, 634 F.3d 1283, 1287 (Fed. Cir.
2011); accord Vaccine Rule 27. That standard is “well understood to be the most deferential pos-
sible.” Munn v. Secretary of Health and Human Services, 970 F.2d 863, 870 (Fed. Cir. 1992).
“If the special master has considered the relevant evidence of record, drawn plausible in-
ferences and articulated a rational basis for the decision, reversible error will be extremely difficult
to demonstrate.” Hines v. Secretary of Health and Human Services, 940 F.2d 1518, 1528 (Fed.
Cir. 1991); see White v. Secretary of Health and Human Services, No. 24-1372, ECF No. 37 at 5
(Fed. Cir. Aug. 27, 2025). This court, like the Federal Circuit, does “not reweigh the factual evi-
dence, assess whether the special master correctly evaluated the evidence, or examine the probative
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value of the evidence or the credibility of the witnesses—these are all matters within the purview
of the fact finder.” Porter v. Secretary of Health and Human Services, 663 F.3d 1242, 1249 (Fed.
Cir. 2011); see Munn, 970 F.2d at 871-72 (explaining that the Federal Circuit and this court apply
the same standard).
This court reviews discretionary rulings, including case management decisions, for abuse
of discretion. Munn, 970 F.2d at 870 n.10. That review “will rarely come into play except where
the special master excludes evidence.” Id. The court gives “no deference to the … Special Master’s
determinations of law,” reviewing legal questions de novo. Carson v. Secretary of Health and
Human Services, 727 F.3d 1365, 1368 (Fed. Cir. 2013).
Under the Vaccine Act, a petitioner seeking compensation for injuries caused by a covered
vaccine can prove entitlement to compensation in one of two ways. For so-called table injuries, a
petitioner may recover when an injury or condition listed in the vaccine injury table (42 U.S.C.
§ 300aa-14(a)) begins to manifest itself within the time specified in the table for the vaccine in
question. Hines, 940 F.2d at 1524; see 42 U.S.C. § 300aa-11(c)(1)(C)(i). Causation in those cases
is presumed. Hines, 940 F.2d at 1524. For off-table injuries, which are not listed in the table or
occur outside the timeframe specified in the table, the petitioner must prove actual causation. Id.
at 1524-25; 42 U.S.C. § 300aa-11(c)(1)(C)(ii). For both table and off-table injuries, the petitioner
must prove, by a preponderance of the evidence, entitlement to compensation. Id. at
1525; 42 U.S.C. § 300aa–13(a)(1)(A).
In table injury cases, as long as the claim is “within the timetable and specifications of a
Table injury [then] the statute does the heavy lifting—causation is conclusively presumed.”
Hodges v. Secretary of Department of Health and Human Services, 9 F.3d 958, 961 (Fed. Cir.
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1993); see White, No. 24-1372, ECF No. 37 at 5. According to the vaccine injury table, the symp-
toms for brachial neuritis must appear within two to 28 days after administration of the Tdap vac-
cine. 42 C.F.R. § 100.3. Here, Ms. Moyler also bears the burden to prove, by a preponderance of
the evidence, that she suffered from brachial neuritis for more than six months after receiving her
Tdap vaccine. 42 U.S.C. § 300aa-13(a)(1)(A); 42 U.S.C. § 300aa-11(c)(1)(D)(ⅰ). That includes
providing “documentation demonstrating that [she] … suffered the residual effects or complica-
tions … for more than 6 months after the administration of the vaccine.” 42 U.S.C. § 300aa-
11(c)(1)(D)(ⅰ). A case may be dismissed for failure to meet the six-month severity requirement.
See, e.g., Felix v. Secretary of Health and Human Services, 172 Fed. Cl. 626, 633-34 (2024).
A. The special master’s decision was not arbitrary or capricious
In Vaccine Act cases, this court must uphold a special master’s factual finding “as not
being arbitrary or capricious” if the finding is “based on evidence in the record that is not wholly
implausible.” Cedillo v. Secretary of Health and Human Services, 617 F.3d 1328, 1338 (Fed. Cir.
2010) (cleaned up). That standard is similar to, and even more deferential than, the substantial
evidence standard a court of appeals applies to its review of the factfinding of an administrative
agency. “Substantial evidence is … such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938).
A “finding may be supported by substantial evidence even if two inconsistent conclusions can be
drawn from the evidence.” Citigroup Inc. v. Capital City Bank Group, Inc., 637 F.3d 1344, 1349
(Fed. Cir. 2011). Both the substantial evidence and the arbitrary and capricious standards of review
require the court to uphold a factual determination unless the evidence cannot reasonably be inter-
preted in a way that supports the determination. See Shoes by Firebug LLC v. Stride Rite Children’s
Group, LLC, 962 F.3d 1362, 1371 (Fed. Cir. 2020) (explaining that, when the lower tribunal was
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presented with two alternative theories, the reviewing court’s “task is not to determine which the-
ory [it] find[s] more compelling” or “to second-guess the [tribunal’s] assessment of the evidence”
(quotation marks omitted)).
1. The special master’s decision was not arbitrary or capricious in
finding that Ms. Moyler’s symptoms came from a different in-
jury
Ms. Moyler argues that the special master’s inference that her symptoms came from a
workplace injury was implausible. ECF No. 47 at 16. She asserts that the record does not indicate
that she suffered a different injury to her arm and shoulder while working and points out that there
are no incident reports from her employer, no worker’s compensation claims on file, and no med-
ical records indicating a new injury. Id. Ms. Moyler also argues that no medical evidence can
connect her work activities to her muscle atrophy and nerve damage. Id. She adds that the expert
reports she submitted found that her symptoms were caused by brachial neuritis from her Tdap
vaccination, not from a different injury, and that brachial neuritis is often missed, delayed, or mis-
diagnosed. Id. at 17 (citing ECF No. 22-7 at 11-2; ECF No. 42-6 at 3-4; ECF No. 42-10 at 2).
The government responds that the special master’s conclusion that Ms. Moyler’s initial
symptoms were unrelated to her later symptoms is reasonable. ECF No. 50 at 10. According to the
government, the special master reasonably evaluated the evidence and medical records, which im-
ply that Ms. Moyler’s pain was initially severe but improved over time and that there was a sig-
nificant gap in treatment. Id. at 14-15. The government also notes that the special master found
that Ms. Moyler’s new job may have exacerbated her shoulder pain and that her symptoms after
the gap in treatment were different from her symptoms before. Id. The government argues that the
special master “properly afforded little weight to” Ms. Moyler’s expert reports, which did not ad-
dress the gap in treatment or fully diagnose Ms. Moyler’s symptoms. Id. at 16-17.
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When a special master considers the relevant evidence of record, draws plausible infer-
ences, and articulates a rational basis for his decision, the court must uphold his decision. Hines,
940 F.2d at 1528. The special master’s decision does not have to be the only possible conclusion.
It must only be a conclusion that a reasonable mind could reach based on the totality of the evi-
dence; that is, it must not be wholly implausible. Cedillo, 617 F.3d at 1338; Citigroup, 637 F.3d
at 1349. This court must uphold the special master’s factual determinations even if it would have
reached a different factual conclusion had it been the one conducting the evidentiary review.
Citigroup, 637 F.3d at 1349; Shoes by Firebug, 962 F.3d at 1371.
Here, the special master reviewed Ms. Moyler’s medical record. He noted that Ms. Moyler
stopped receiving treatment for her upper left arm “the same month” she received the vaccine. He
also noted that Ms. Moyler did not seek treatment for her symptoms for nine months, and only
after she started a new, more demanding job. ECF No. 49 at 11. The special master explained that
during those nine months, Ms. Moyler had four doctors’ appointments for other medical issues but
did not mention anything related to her upper left arm or shoulder. Id. at 12. After reviewing the
records from Ms. Moyler’s appointments, the special master distinguished Ms. Moyler’s symp-
toms in June 2020 from those that began in September 2019. Id. at 12-13. The special master noted
that Ms. Moyler’s June 2020 symptoms were different from those she alleged in September 2019;
in September 2019 her symptoms indicated a myofascial trigger point on her left deltoid but no
edema, while in June 2020 her symptoms included swelling, burning pain that spread to her trape-
zius and neck, left hand swelling, fingertip numbness, and tingling. Id.; ECF No. 22-2 at 131-132,
138, 145, 155, 168; ECF No. 22-18 at 7.
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The special master considered the fact that Ms. Moyler’s later symptoms appeared a month
after she started new and more physically demanding work activities, and that they were distin-
guishable by type and location from her September 2019 symptoms. ECF No. 49 at 12-13. The
special master appropriately considered the evidence, including Ms. Moyler’s medical records,
providers’ different theories regarding her symptoms, and work activities. He clearly articulated
his conclusion that her new job caused a different injury and that her initial symptoms did not last
six months. Id. at 12-13; see Hines, 940 F.2d at 1528; Cedillo, 617 F.3d at 1338; Citigroup, 637
F.3d at 1349.
There are legitimate reasons to be skeptical of the special master’s conclusion. First, he
stated that Ms. Moyler visited the same primary care provider who initially treated her post-vaccine
symptoms four times during that nine-month period. ECF No. 49 at 12. The special master appears
to have been mistaken, as she visited different providers during that period. ECF No. 22-18. When
visiting a different provider for a different reason, it is not apparent that a patient would necessarily
raise a concern about an unrelated injury for which she had already seen a different provider. Sec-
ond, the special master also expressed concern that Ms. Moyler was willing to take on a new job,
with more physical demands, undercutting her argument that she was already injured from the
vaccine. ECF No. 49 at 12. But there are many reasons a person might take a new job, not least
the need for pay and healthcare, even if it might exacerbate an existing injury. That said, the con-
clusion that the new job caused a new injury is plausible. Although there is another plausible—
potentially even more plausible—explanation that Ms. Moyler’s symptoms began in September
2019 and continued through June 2020 and after, potentially with symptoms morphing over time,
the court cannot second guess the special master’s weighing of the evidence to reach the conclusion
he did.
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Ms. Moyler also suggests that the six-month severity requirement could still be met if it
started when she got the August 2020 MRI. ECF No. 47 at 15. She argues that the “relevant inquiry
is whether any residual effect or complication lasts for more than six months, regardless of the
time of onset.” Id. But to prove entitlement for a table injury, a petitioner must have developed the
post-vaccination symptoms within the time specified in the table for the vaccine in question. Hines,
940 F.2d at 1524; see 42 U.S.C. § 300aa-11(c)(1)(C)(i). For the Tdap vaccine, the symptoms for
brachial neuritis must appear within two to 28 days after vaccination. 42 C.F.R. § 100.3. Thus, the
six months began when Ms. Moyler reported symptoms in that 28-day window.
The special master’s decision not to afford weight to Ms. Moyler’s expert reports was like-
wise not arbitrary or capricious. The special master noted that Ms. Moyler’s expert reports did not
“address what occurred during the relevant gap in care [and] … what if any of [Ms. Moyler’s]
vaccine-related symptoms were ongoing between September 2019 and June 2020.” ECF No. 49 at
14; see ECF Nos. 22-7, 42-10. Without information on the severity of Ms. Moyler’s injury, it was
reasonable for the special master to determine, without finding the expert reports not credible, that
the expert reports did not provide adequate evidence to support a conclusion that Ms. Moyler was
suffering from the same injury she received in September 2019.
It was also reasonable for the special master to find that Ms. Moyler’s friends’ and daugh-
ter’s affidavits did not rebut her nine-month treatment gap. See Cucuras v. Secretary of Depart-
ment of Health & Human Services, 993 F.2d 1525, 1528 (Fed. Cir. 1993) (affirming the special
master’s decision to prioritize and rely on medical records over testimony). Ms. Moyler argues
that the special master imposed a standard of proof closer to beyond a reasonable doubt than pre-
ponderance of the evidence. ECF No. 47 at 23-24. But the special master explained that the affi-
davits and expert reports were just not enough to overcome, by a preponderance of the evidence,
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the existing medical records and to rebut the treatment gap. See ECF No. 49 at 10, 13-14; Cucuras,
993 F.2d at 1528. That conclusion based on a weighing of the record evidence is not one the court
can second guess.
2. The special master appropriately addressed, considered and
weighed the evidence presented
Ms. Moyler argues that the special master failed to consider the totality of the evidence in
his severity analysis and that that failure constitutes error. ECF No. 47 at 10-15 (citing Moriarty
v. Secretary of Health and Human Services, 844 F.3d 1322, 1328 (Fed. Cir. 2016)). Specifically,
she argues that the special master did not consider her MRI and EMG test results and the photos
of her back because he did not discuss them in his severity analysis. ECF No. 47 at 12. She also
argues that the special master discounted her expert reports, did not address their credibility, and
dismissed them for not addressing the nine-month gap in treatment. Id. at 13.
The government responds that the special master is presumed to have considered all evi-
dence in the record, even if he does not explicitly reference it in his decision. ECF No. 50 at 12
(citing Moriarty v. Secretary of Health and Human Services, 844 F.3d 1322, 1328 (Fed. Cir.
2016)). The government points out that the special master did discuss Ms. Moyler’s test results in
the background section of his decision, but that the disputed tests took place after Ms. Moyler
started her new job, and the special master found those results to be unrelated to the symptoms she
was experiencing immediately after the vaccine. ECF No. 50 at 12 (citing ECF No. 49 at 5, 7, 9).
The government argues that the real issue is whether Ms. Moyler’s symptoms were part of her
initial incident after the vaccine or from a new injury. Id.
Generally, “even if the special master had made no explicit reference to the evidence,” the
court presumes that he considered the totality of the evidence. Hazlehurst v. Secretary of Health
and Human Services, 604 F.3d 1343, 1352 (Fed. Cir. 2010); see Medtronic, Inc. v. Daig Corp.,
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789 F.2d 903, 906 (Fed. Cir. 1986) (“We presume that a fact finder reviews all the evidence pre-
sented unless he explicitly expresses otherwise.”). Here, the special master discussed most evi-
dence presented, including Ms. Moyler’s medical records, test results, affidavits, and expert re-
ports. ECF No. 49 at 3-9. While the special master limited his discussion of some of the evidence
to the background section of his decision, and did not address other pieces of evidence—the pic-
tures of Ms. Moyler’s back—that was within his authority. See, e.g., Gonzalez v. Secretary of
Health & Human Services, 173 Fed. Cl. 728, 735 (2024) (upholding the special master’s factual
findings even though his decision did not expressly discuss the petitioner’s affidavit); Simanski v.
Secretary of Health & Human Services, 115 Fed. Cl. 407, 436 (2009), aff’d, 601 F. App’x 982
(Fed. Cir. 2015) (“[A] Special Master is not required to discuss every piece of evidence or testi-
mony in [his] decision.” (cleaned up)). After considering the totality of the evidence, the special
master appropriately determined that Ms. Moyler’s post-vaccine symptoms did not persist for at
least six months and instead that her current symptoms resulted from new work activities. ECF
No. 49 at 11-14.
B. The special master did not abuse his discretion by deciding not to con-
duct an evidentiary hearing
Ms. Moyler argues that the special master’s decision not to hold an evidentiary hearing was
arbitrary, capricious, and an abuse of discretion. ECF No. 47 at 24. She argues that Vaccine Rules
3(b) and 8(c) counsel in favor of holding an evidentiary hearing when testimony reasonably might
address apparent tension between medical records and later recorded recollections. Id. (citing
Campbell v. Secretary of Health & Human Services, 69 Fed. Cl. 775, 778 (2006)). According to
Ms. Moyler, her silence regarding her left arm and shoulder symptoms during her medical appoint-
ments in the nine months before June 2020 does not provide a basis for presuming that her medical
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records addressed every symptom she was experiencing. Id. She also argues that there was a com-
pelling need for the special master to conduct an evidentiary hearing to evaluate the credibility of
the witnesses who corroborated her ongoing symptoms during those nine months. Id. at 24-25.
The government responds that hearings are not required by the Vaccine Act and that special mas-
ters can rule on the record when each party has already had a full and fair opportunity to present
its case. ECF No. 50 at 17.
“Special masters have wide discretion in determining whether to conduct an evidentiary
hearing.” Kreizenbeck v. Secretary of Health and Human Services, 945 F.3d 1362, 1365 (Fed. Cir.
2020); see 42 U.S.C. § 300aa-12(d)(3)(B)(v) (the special master “may conduct such hearings as
may be reasonable and necessary”); Vaccine Rule 8(d) (“The special master may decide a case on
the basis of written submissions without conducting an evidentiary hearing.”). In Campbell, which
Ms. Moyler relies on for her argument, the special master rejected the petitioners’ witness affida-
vits and expert reports and sua sponte added articles to the record without giving the petitioners
any opportunity to respond to them. Campbell, 69 Fed. Cl. at 779. Here, Ms. Moyler submitted
witness affidavits and expert reports, all of which the special master reviewed. See ECF No. 49 at
13-14. In considering the affidavits and expert reports, the special master concluded that, although
they merited “some weight,” they did not rebut the treatment gap in the medical records. Id. As
discussed, that conclusion was not arbitrary or capricious. Cucuras, 993 F.2d at 1528; Cedillo, 617
F.3d at 1338. Although an evidentiary hearing would have been a reasonable choice, especially
when choosing to discount some evidence based on its timing or inferred motives, the special
master was within his discretion not to conduct an evidentiary hearing.
III. Conclusion
This court denies Ms. Moyler’s motion for review and affirms the special master’s deci-
sion. The clerk of the court shall enter judgment accordingly.
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IT IS SO ORDERED.
/s/ Molly R. Silfen
MOLLY R. SILFEN
Judge
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