VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-02044 Package ID: USCOURTS-cofc-1_21-vv-02044 Petitioner: Margaret Achanzar Filed: 2021-10-20 Decided: 2024-11-25 Vaccine: human papillomavirus (HPV) Vaccination date: 2019-10-21 Condition: SIRVA and/or axillary nerve mononeuropathy/significant aggravation of shoulder injury Outcome: pending Award amount USD: AI-assisted case summary: On October 20, 2021, Margaret Achanzar filed a petition alleging injury after an HPV vaccination administered on October 21, 2019. Her theory evolved during the case. By July 2023, she alleged a Table SIRVA and, in the alternative, axillary nerve mononeuropathy or significant aggravation of a shoulder injury caused-in-fact by the vaccination. Respondent opposed compensation, disputing the SIRVA requirements for onset, reduced range of motion, the six-month severity element, and the absence of another explanation for the symptoms. Ms. Achanzar maintained that the injection injured her left shoulder and that a neurologic injury helped explain why the case did not fit neatly into the Table SIRVA framework. On November 25, 2024, Chief Special Master Brian H. Corcoran dismissed only the Table SIRVA claim. He concluded that Ms. Achanzar could not establish the regulatory requirements for Table SIRVA, including persistence of a qualifying musculoskeletal injury for six months and the absence of confounding neurologic abnormalities. But he also found the off-Table axillary-nerve/significant-aggravation theory tenable and reassigned the case for further development. Special Master Thomas L. Gowen later awarded interim attorney's fees and costs on February 27, 2026; that interim fee award was not injury compensation and the merits remained unresolved in the reviewed public decisions. Theory of causation field: HPV vaccine on October 21, 2019, allegedly causing left shoulder injury/SIRVA and alternatively axillary nerve mononeuropathy or significant aggravation; TABLE SIRVA DISMISSED, off-Table causation-in-fact theory pending. Respondent disputed onset, reduced ROM, severity, and lack of alternative explanation. Chief SM Corcoran found Table SIRVA requirements unmet because neurologic features and six-month musculoskeletal persistence defeated the Table claim, but allowed off-Table axillary-nerve theory to continue. No injury compensation in reviewed public record; February 27, 2026 award was interim attorney fees/costs. Petition filed October 20, 2021; Table ruling November 25, 2024. Attorneys: Phyllis Widman / Muller Brazil. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_21-vv-02044-0 Date issued/filed: 2025-01-08 Pages: 14 Docket text: PUBLIC DECISION (Originally filed: 11/25/2024) regarding 57 DECISION of Special Master,, Order Reassigning Case Special Master, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made. -------------------------------------------------------------------------------- Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 1 of 14 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 21-2044V MARGARET ACHANZAR, Chief Special Master Corcoran Petitioner, v. Filed: November 25, 2024 SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Phyllis Widman, Widman Law Firm, LLC, Linwood, NJ, for Petitioner. Naseem Kourosh, U.S. Department of Justice, Washington, DC, for Respondent. DECISION DISMISSING TABLE SIRVA CLAIM AND ORDER OF REASSIGNMENT1 Margaret Achanzar seeks compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine Act”) for injuries following her receipt of a human papillomavirus (“HPV”) vaccine which she received on October 21, 2019. I hereby conclude that she has not established a shoulder injury related to vaccine administration (“SIRVA”) corresponding to a listing on the Vaccine Injury Table (“the Table”), see 42 C.F.R. § 100.3(c)(10). Her Table SIRVA claim must therefore be DISMISSED, and the matter is transferred out of the Special Processing Unit (the “SPU”) and reassigned randomly to a Special Master for further proceedings. 1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required to post it on the United States Court of Federal Claims' website in accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services). This means the Ruling will be available to anyone with access to the internet. In accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I 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-02044-UNJ Document 59 Filed 01/08/25 Page 2 of 14 I. Procedural History Petitioner originally alleged “a left shoulder injury (SIRVA) and/or significan[t] aggravat[ion]… in the alternative, [a] shoulder injury that was caused-in-fact by the vaccination.” Petition filed Oct. 20, 2021 (ECF No. 1). Respondent did not invite any settlement discussions. In formally opposing compensation, Respondent disputed the threshold severity requirement, as well as the Table SIRVA requirements for onset, reduced ROM, and lack of an alternative explanation for Petitioner’s symptoms. See generally Rule 4(c) Report filed Mar. 24, 2023 (ECF No. 33) at 12 – 14. Petitioner maintained that her claim should proceed – but revised her injury allegation to SIRVA “and/or axillary nerve mononeuropathy,” Amended Petition filed July 12, 2023 (ECF No. 43) at Preamble; see also Brief filed July 13, 2023 (ECF No. 46); Response filed Aug. 23, 2023 (ECF No. 47); Reply filed Sept. 6, 2023 (ECF No. 48). The parties were encouraged to explore informal resolution centering on Petitioner’s showing of an axillary nerve injury persisting for over six months post- vaccination, but not a Table SIRVA. Scheduling Order filed Aug. 12, 2024 (ECF No. 50) (memorializing status conference). Petitioner requested to pursue “concurrent” claims for a Table SIRVA and a nerve injury (despite my warning that those seemed to be incompatible), and she conveyed a settlement demand to Respondent. Status Report filed Sept. 23, 2024 (ECF No. 54).3 However, Respondent declined to enter into settlement discussions, and requested that the case proceed on a litigation track. Status Report filed Oct. 29, 2024 (ECF No. 56). The matter is ripe for adjudication. II. Authority Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a preponderance of the evidence, the matters required in the petition by Vaccine Act Section 11(c)(1). Compensation may not be awarded “based on the claims of a petitioner alone, unsubstantiated by medical records or by medical opinion.” Section 13(a)(1). A special master must consider, but is not bound by, any diagnosis, conclusion, judgment, test result, report, or summary concerning the nature, causation, and aggravation of 3 Petitioner also mentioned “talk[ing] with her expert.” Status Report filed Sept. 12, 2024 (ECF No. 51). She was “reminded that the parties should not retain a medical expert, life care planner, or other expert without consulting each other and the Chief Special Master. Engaging experts is not routine in SPU cases and may not be found to be a reasonable cost depending on the circumstances of the case.” Scheduling Order filed Sept. 20, 2024 (Non-PDF), citing SPU Initial Order filed June 10, 2022 (ECF No. 15) at 1. 2 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 3 of 14 petitioner’s injury or illness that is contained in a medical record. Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy evidence. The records contain information supplied to or by health professionals to facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in the balance, accuracy has an extra premium. These records are also generally contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993). Accordingly, where medical records are clear, consistent, and complete, they should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03- 1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule does not always apply. In Lowrie, the special master wrote that “written records which are, themselves, inconsistent, should be accorded less deference than those which are internally consistent.” Lowrie, 2005 WL 6117475, at *19. The United States Court of Federal Claims has recognized that “medical records may be incomplete or inaccurate.” Camery v. Sec’y of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998). The Court later outlined four possible explanations for inconsistencies between contemporaneously created medical records and later testimony: (1) a person’s failure to recount to the medical professional everything that happened during the relevant time period; (2) the medical professional’s failure to document everything reported to her or him; (3) a person’s faulty recollection of the events when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013), aff’d, 746 F.3d 1335 (Fed. Cir. 2014). The Court has also said that medical records may be outweighed by testimony that is given later in time that is “consistent, clear, cogent, and compelling.” Camery, 42 Fed. Cl. at 391 (citing Blutstein v. Sec’y of Health & Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The credibility of the individual offering such testimony must also be determined. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993). The special master is obligated to fully consider and compare the medical records, testimony, and all other “relevant and reliable evidence contained in the record.” La Londe, 110 Fed. Cl. at 204 (citing § 12(d)(3); Vaccine Rule 8); see also Burns v. Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within the special master’s discretion to determine whether to afford greater weight to medical records or to other evidence, such as oral testimony surrounding the events in question that was given at a later date, provided that such determination is rational). 3 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 4 of 14 A potential petitioner must demonstrate that he or she “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)4; see also Black v. Sec’y of Health & Human 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 & Human Servs., 654 F.3d 1322, 1335 (Fed. Cir. 2011), cert. denied, 132 S.Ct. 1908 (2012); Wright v. Sec’y of Health & Human Servs., 22 F.4th 999, 1002 (Fed. Cir. 2022). Beyond severity and other requirements concerning the vaccination received, and the lack of other award or settlement, see Section 11(c)(1)(A), (B), (D), and (E), a petitioner must establish that he or she either suffered an injury meeting the Table criteria, in which case causation is presumed, or an injury shown to be caused-in-fact by the vaccination she received. Section 11(c)(1)(C). The most recent version of the Table, which can be found at 42 C.F.R. § 100.3, identifies the vaccines covered under the Program, the corresponding injuries, and the time period in which the particular injuries must occur after vaccination. Section 14(a). Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48 hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria establishing a SIRVA under the accompanying QAI are as follows: Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests as shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm. These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder resulting in an inflammatory reaction. SIRVA is caused by an injury to the musculoskeletal structures of the shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological 4 Section 11(c)(1)(D) presents two alternative grounds for eligibility to compensation if a petitioner does not meet the six months threshold: (ii) death from the vaccine, and (iii) inpatient hospitalization and surgical intervention. Neither alternative is alleged or implicated in this claim. 4 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 5 of 14 injury and abnormalities on neurological examination or nerve conduction studies (NCS) and/or electromyographic (EMG) studies would not support SIRVA as a diagnosis (even if the condition causing the neurological abnormality is not known). A vaccine recipient shall be considered to have suffered SIRVA if such recipient manifests all of the following: (i) No history of pain, inflammation or dysfunction of the affected shoulder prior to intramuscular vaccine administration that would explain the alleged signs, symptoms, examination findings, and/or diagnostic studies occurring after vaccine injection; (ii) Pain occurs within the specified time frame; (iii) Pain and reduced range of motion are limited to the shoulder in which the intramuscular vaccine was administered; and (iv) No other condition or abnormality is present that would explain the patient’s symptoms (e.g., NCS/EMG or clinical evidence of radiculopathy, brachial neuritis, mononeuropathies, or any other neuropathy). 42 C.F.R. § 100.3(c)(10) (2017). If, the petitioner’s injury does not fit within a Table listing, the petitioner must prove that the administered vaccine was the cause in fact of the injury. Section 11(c)(1)(C)(ii) and (iii). In such circumstances, petitioner asserts a “non-Table or [an] off-Table” claim and to prevail, petitioner must prove the claim by preponderant evidence. Section 13(a)(1)(A). This standard is “one of . . . simple preponderance, or ‘more probable than not’ causation.” Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274, 1279-80 (Fed. Cir. 2005) (referencing Hellebrand v. Sec’y of Health & Human Servs., 999 F.2d 1565, 1572-73 (Fed. Cir. 1993). The Federal Circuit has held that to establish an off-Table injury, petitioners must “prove . . . that the vaccine was not only a but-for cause of the injury but also a substantial factor in bringing about the injury.” Shyface v. Sec’y of Health & Human Servs., 165 F.3d 1344, 1351 (Fed. Cir 1999). The received vaccine, however, need not be the predominant cause of the injury. Id. 5 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 6 of 14 III. Contemporaneous Evidence • Petitioner had a preexisting diagnosis of Ehlers-Danlos syndrome,5 and repeated exam findings of hypermobility. See, e.g., Ex. 18 at 3 – 5; Ex. 9 at 5 – 6; Ex. 3 at 2 – 3; Ex. 3 at 5 – 6; id. at 7 – 9. Born in 2003, she was a high school student on the swim team and color guard. See, e.g., Ex. 15 at 6; Ex. 3 at 2 – 3. • Petitioner received the at-issue vaccine in her left arm on October 21, 2019, at her pediatrics office in New Jersey. Ex. 1 at 1; Ex. 15 at 4; Ex. 19 at 3. • Petitioner did not mention the vaccine or any shoulder/arm complaints at a gynecological appointment fifteen days post-vaccination. Ex. 5 at 188 – 91. • But twenty-nine (29) days post-vaccination, on November 19, 2019, Petitioner sought an initial orthopedics evaluation for “[l]eft shoulder pain which began about 4 weeks ago. She denies any specific history of trauma… She does participate in the color guard and has been swimming over the past week with exacerbation of symptoms.” Ex. 3 at 2. The pain was persistent despite taking ibuprofen and “working with the athletic trainer at school.” Id. at 3. On exam, the left shoulder had full range of motion (“ROM “), but pain on extremes; hypermobility; instability; and “grossly intact” sensation. Id. at 3. A labral tear was suspected. Id. Petitioner declined x-rays due to concerns about radiation. Id. At a December 3, 2019, follow- up appointment, the orthopedist reviewed that an MRI arthrogram did not show labral or rotator cuff tearing. Id. at 7 – 9. • At a November 26, 2019 physical therapy (“PT”) initial evaluation, Petitioner reported an onset in “mid-September,” denied trauma, but acknowledged “participating in color guard at the time.” Ex. 3 at 5. The pain currently rated 3/10, and she was only kicking during swim team practice. Id. The physical therapist documented normal passive ROM with pain at extremes and 4/5 strength; did not offer any specific assessment, and instructed Petitioner on home exercises. Id. at 5 – 6.6 5 Ehlers-Danlos syndrome is defined as: “A group of inherited disorders of connective tissue… Prominent manifestations include hyperextensible skin and joints, easy bruisability, and friability of tissues with bleeding and poor wound healing… Called also cutis hyperelastica.” Dorland’s Medical Dictionary Online, https://www.dorlandsonline.com/dorland/definition?id=110561 (hereinafter “Dorland’s Online”) (last accessed Nov. 21, 2024). 6 No further records of formal PT sessions have been filed. See generally Ex. 3, 18; but see Ex. 12 at 2, 5 (December 10, 2019, physiatry record stating that Petitioner had completed about 4 PT sessions, which she should continue”); id. at 7 (December 18th record stating that Petitioner should discontinue PT as of that date). 6 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 7 of 14 • Around this time, Petitioner’s mother learned about SIRVA from internet research, see Ex. 23 at ¶ 18, and/or an acquaintance, Ex. 12 at 2. She contacted Marko Bodor, M.D., who “stated that it is possible that [Petitioner] may have SIRVA”,7 and referred her to a physiatrist at the Rutgers – State University of New Jersey medical school and health system. Ex. 12 at 2. • At the December 10, 20198 physiatry initial evaluation, Petitioner reported that the HPV vaccine had been administered “towards the back of the left shoulder with the needle pointing downwards,” and was followed by initial discomfort, which “persisted and worsened over the next two weeks.” Ex. 12 at 2.9 The exam findings included trace reflexes (1+) in both upper limbs; decreased sensation to light touch/ pinprick at the left deltoid – corresponding to the axillary nerve; and decreased active ROM and a positive crossed adduction sign in the left shoulder. Id. at 3. An ultrasound found “subacromial, sub-deltoid bursa fluid collection anterior to [left] deltoid head.” Id. at 5. The physiatrist endorsed: “Left shoulder pain immediately s/p IM deltoid muscle vaccination thus SIRVA.” Id. at 5 – 6 (noting that SIRVA was first proposed by Bodor and Montalvo). The physiatrist’s more specific diagnoses in Petitioner’s case were “subacromial subdeltoid bursitis10 [and…] axillary nerve mononeuropathy.” Id. 5. The physiatrist planned a subacromial bursa aspiration and steroid injection, noting “If the symptoms persist, consider a procedure targeting the left axillary nerve.” Id. at 6. • The physiatrist performed the subacromial bursa aspiration and steroid injection on December 18, 2019. Ex. 12 at 7 – 8. At a follow-up 16 days later, Petitioner reported that those procedures were painful and “did not provide significant relief,” and her pain was increased following New Year’s Eve festivities. Id. at 9. A repeat ultrasound found “mild to moderate effusion11 in the subacromial subdeltoid bursa.” Id. at 10. The physiatrist administered a second steroid injection. Id. at 11. 7 There are no medical records or other evidence or allegation that Dr. Bodor, who is based in California, evaluated Petitioner, who was living in New Jersey in 2019. 8 Petitioner incorrectly recalls establishing with the physiatrist on December 12, 2019. Ex. 2 at ¶ 11. 9 Both parties cite copies of the physiatry records which do not include the physical exam findings. See Rule 4(c) Report at 3 – 4 and Brief at 3 – 4, citing Ex. 4 at 4 – 11. 10 Bursitis is defined as inflammation of a bursa, which is “a sac or saclike cavity filled with a viscid fluid and situated at places in the tissues at which friction would otherwise develop.” Dorland’s Online. 11 Effusion is defined as “the escape of fluid into a part or tissue.” Dorland’s Online. 7 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 8 of 14 • At a January 23, 2020 pediatrics appointment, Petitioner reported the post- vaccination immediate onset of acute left shoulder pain, which the physiatrist had diagnosed as bursitis and SIRVA. Ex. 7 at 5. An exam found normal active and passive ROM and strength, but decreased sensation on the superior/ lateral shoulder/ deltoid; Petitioner reported that the area “felt weird” with light touch. Id. at 6. The pediatrician did not offer any new diagnoses or treatment – stating that that Petitioner should follow her specialist’s recommendations. Id. at 6.12 • Three months and thirteen (13) days post-vaccination, on February 3, 2020, Petitioner reported “0% relief” despite the steroid injections and rest; she “continued to have 8/10 achy pain with associated intermittent ‘electrical sensation’ sharp throbbing pain over the anterior and posterior left shoulder.” Ex. 12 at 12.13 On a repeat ultrasound, three views were negative for bursitis or effusion, compared to only one view finding “equivocal” effusion. Id. at 13. The physiatrist believed that bursitis “may not be [Petitioner’s] primary pain generator.” Id. Instead, based on the clinical history, exam findings of decreased sensation, and “100%” pain relief from the nerve block, Petitioner’s ongoing condition was “probably due to axillary nerve mononeuropathy.” Petitioner was instructed not to resume PT, not to engage in physical activities such as swimming and softball, and call to schedule a pulsed radiofrequency ablation (“RFA”)14 of the left axillary nerve. Id. • At a February 27, 2020 neurology initial evaluation,15 Petitioner recounted that an improperly-administered HPV vaccine had caused her injury, which involved “pain, numbness, weakness in the left arm.” Ex. 6 at 2. A neurological exam was apparently normal (including sensation “within normal limits”). Id. at 2 – 3. 12 The pediatrician may have notified the Vaccine Adverse Reporting System (“VAERS”) of Petitioner’s injury in January 2020, see Ex. 7 at 5; Ex. 22 at 8, but that report has not been filed. 13 Of note, the exam findings are identical in the December 2019 physiatry initial evaluation and the February 2020 follow-up – raising the possibility that those were carried forward in the electronic medical records. Compare Ex. 12 at 3, id. at 14. 14 The Cleveland Clinic explains: “During a radiofrequency ablation [RFA] procedure, a small hollow needle is inserted into the targeted nerve that is causing pain. An electrode is inserted into the top of the needle, which sends the radio waves through the needle to the targeted nerve. The heat causes a lesion that prevents the nerve from sending pain signals to your brain.” Cleveland Clinic, Radiofrequency Ablation for Pain Management, https://my.clevelandclinic.org/health/treatments/17411-radiofrequency-ablation (last accessed Nov. 21, 2024). Additionally, “pain relief following a nerve block injection[…] tells your provider that that particular nerve is the source of your pain and is an appropriate target for RFA.” Id. 15 See also Ex. 15 at 16 and Ex. 6 at 2 – 3 (reflecting that Petitioner’s pediatrician had arranged the referral to the neurologist). 8 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 9 of 14 Regardless, the neurologist endorsed that the vaccine had “directly injured the left axillary nerve due to swelling,” for which Petitioner would “continue to follow up with her physiatrist.” Id. at 3. • In a March 3, 2020 VAERS report, Petitioner’s mother wrote: “Feb. 3rd nerve block confirmed that pain is coming from nerve in shoulder. [The] physiatrist recommended ablation. [Petitioner] has been in pain every day since the shot was given. Never a day less than 2 – 3/10 pain scale, and about 2 -3 days per week of pain over 7/10 pain scale.” Ex. 22 at 8. • However, there are no recorded complaints, exam findings, or treatment for a left shoulder injury over the next thirteen (13) months – despite intervening medical encounters. o Specifically at a November 5, 2020 pediatrics annual evaluation, Petitioner was noted to be exercising, swimming, walking, and playing football – but the same record notes a 7-pound weight increase “due to decreased activity and exercise.” Ex. 7 at 9. The medical record does not address the presence or absence of any left shoulder injury. Id. at 10. Her mother requested “1 vaccine at a time d/t previous bursitis from HPV vaccine in 10/2019,” and did not consent to the 2nd HPV vaccine dose Id. Accordingly, Petitioner received a Menactra vaccine, in her right arm. Id. o Petitioner’s left arm was used for administration of vaccines on February 25, and April 2, 2021. Ex. 7 at 14, 16. She attended pediatric appointments for unrelated concerns on April 5, April 26, July 13, and October 8, 2021, as well as January 27, 2022. Id. at 18 – 32. The pediatric records do not address the presence or absence of a left shoulder injury – but they reflect Petitioner’s requests for referrals to an epidemiologist, id. at 23, and to “immunology – reason: HPV vaccine reaction,” id. at 26. • At an April 4, 2022, telemedicine physiatry appointment, Petitioner reported a “similar” but “worsened” left shoulder injury in the last two months (“February 2022… further in March 2022”). Ex. 12 at 16. Her pain rated 5 – 6/10. Ex. 12 at 16. She had been “active and working out and believe[d] multiple factors contribute[d] to the exacerbation.” Id. • At an April 20, 2022 in-person physiatry evaluation, on exam, the left shoulder had normal ROM, reflexes, and strength; the only abnormal finding was decreased 9 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 10 of 14 sensation at the left axillary nerve. Ex. 12 at 18.16 An ultrasound’s findings were normal (with “no evidence of impingement,” “no atrophy teres minor”). Id. at 18 – 19. The physiatrist administered another axillary nerve block injection, which delivered “significant improvement of the achy quality pain.” Id. at 19 – 20. However, the nerve block “unmasked” a different “stabbing” pain. Ex. 12 at 21 – 23. The physiatrist considered that this new pain “may be associated with possible impingement,” but that was not corroborated by a limited ultrasound performed on April 26, 2022. Id. at 24. In May 2022, the physiatrist prescribed gabapentin, and administered a steroid injection to the subacromial bursa. Id. at 25 – 28. • At a May 16, 2022 telemedicine physiatry follow-up, Petitioner reported 85% improvement from the recent steroid injection, and “good relief” from gabapentin. Ex. 12 at 29. She described only “a small pinch in her left shoulder” constituting an “impairment.” Id. The physiatrist assessed that Petitioner had experienced a “transient delayed exacerbation status post axillary nerve block 04/20/22.” Id. at 30. He referred Petitioner for PT. Id. • At the June 17, 2022, PT initial evaluation, Petitioner reported that the 2019 vaccination had caused left shoulder bursitis and impingement. Ex. 13 at 8. She currently had “sharp pain in the posterior shoulder then an ache that radiates down the arm… some N [numbness?] in the L hand with long periods of positioning. Agg. with reaching, lifting.” Id. She was “work[ing] as a bartender – must lift kegs, repetitively use hands…” Id. She also had neck pain and hypermobile joints. Id. at 8, 11 – 13. On exam, the left shoulder had normal ROM with the possible exception of passive flexion and abduction (“catch around 95 but reaches full 180/180 degrees”). Id. at 9. The therapist’s assessments were left shoulder pain and cervical radiculopathy. Id. at 13. After 12 sessions concluding on July 29, 2022, Petitioner’s pain had improved. There does not appear to be a repeat physical examination or a discharge summary. Ex. 13 at 14 – 38; Ex. 16 at 1 – 52. • Physiatry follow-up encounters took place via telemedicine on June 27, July 11, July 25, and September 26, 2022. See generally Ex. 17. The last encounter’s record confirms that Petitioner was “now able to lift things with her shoulder, reach overhead, and has had significant improvement.” Id. at 8. Her current pain rated 1 – 2/10. Id. At The physiatrist maintained that Petitioner’s left shoulder pain was “consistent with SIRVA… and transient delayed exacerbation status post axillary nerve block 4/20/22.” Id. at 9. She had “two pain subtypes”; the first was axillary nerve pain which had been temporarily relieved by the nerve block, currently 16 April 20, 2022, was the physiatrist’s final physical examination of Petitioner’s left shoulder. All subsequent encounters were either focused on therapeutic procedures or conducted via telemedicine. 10 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 11 of 14 managed with gabapentin, and currently rated 2/10. Id. The second pain subtype was “mechanical mainly lateral pain with abduction,” which was “unmasked” by the April 2022 nerve block. Id. Petitioner’s description of this second pain subtype, and the significant relief from the May 2022 were suggestive of subacromial impingement but that was not confirmed on the ultrasound. Id. At the final encounter in September 2022, the physiatrist recorded that Petitioner had decreased pain and increased strength; she would try to take gabapentin less often, and she could return for another steroid injection if her pain worsened. Id. There are no further medical records. IV. Affidavits • In November 2021, Petitioner recalled: “[The physiatrist] recommended a procedure that would burn the nerve away, but I have not had this procedure done because I am very young and it is very risky. For the last two years since receiving the HPV vaccine, I have been in pain every single day. The nerve-blocking experience on February 3, 2020, is the only time since receiving the HPV vaccine that I have been pain-free. That brief period of pain relief made me realize just how much pain I have been living with for the last two years.” Ex. 2 at ¶¶ 12 – 16. • In July 2022, Petitioner alleged that the vaccine had caused a neuropathy. “Over time, the muscle controlled by that nerve has grown weak and I can’t move my arm properly causing the shoulder joint bones to bang together when I raise my arm. The doctor [which?] said this is called an impingement.” Ex. 14 at ¶ 16. • In July 2023, Petitioner maintained that her left shoulder injury persisted over time; despite believing that was caused by the HPV vaccine (potentially a misadministration), she believed that vaccines overall were effective, and thus received others, including two in her still-injured left arm in 2021. Ex. 24 at ¶¶ 27 – 29. Petitioner also stated that her physiatrist “recently informed me that at this point, I may have developed a shoulder impingement issue from not using my shoulder due to my injury; this is causing a new type of pain in my left shoulder.” Id. at ¶¶ 32 – 33. • Also in July 2023, her mother offered similar recollections – including of the physiatrist’s advice to rest the shoulder; Petitioner’s decision to forego surgery due to potential side effects and lack of recovery; Petitioner’s adherence to home exercises; and her experience of “daily pain for years.” See generally Ex. 23. 11 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 12 of 14 V. Findings of Fact A. Table SIRVA Claim A Table SIRVA is not viable given the facts of this matter. First, Petitioner cannot show that her bursitis or any related musculoskeletal injury resembling SIRVA persisted for at least six months post-onset, as is required for all Program claims. Section 11(c)(1)(D)(i). Respondent’s objection on this threshold issue is reasonable, particularly in light of the over two-year gap in documentation of any left shoulder injury, despite intervening primary care encounters. It would have been helpful for Petitioner to argue more specifically about the duration of each alleged injury. See generally Brief at 10 – 12, Reply at 5 – 7. After I provided my preliminary assessment that there was stronger evidence of an ongoing nerve injury than any ongoing musculoskeletal injury, see Scheduling Order (ECF No. 50), Petitioner cited only to the initial assessments of bursitis (within three months post-vaccination), not to any later records. Status Report (ECF No. 53), citing Ex. 7 at 5. The medical records support the conclusion that initially after the vaccination, Petitioner was identified to have bursitis. The bursal fluid was aspirated in December 2019, and a February 2020 repeat ultrasound suggested that condition was at least substantially resolved (given that three views were negative for bursitis or effusion, compared to only one view finding “equivocal” effusion). Ex. 12 at 13. Also in February 2020, the physiatrist emphasized that two steroid injections had provided “0% relief,” and he believed that bursitis “may not be [Petitioner’s] primary pain generator.” Id. at 20. However, although the bursitis diagnosis was carried forward in subsequent electronic medical records, it was eventually deleted by the physiatrist. Compare Ex. 12 at 27 and 28. Neither did the physiatrist endorse that any ongoing bursitis caused the suspected “impingement” documented in 2022. There is thus insufficient evidence to conclude that Petitioner’s initial bursitis or any related musculoskeletal injury persisted for over six months post-vaccination. This is not cured by the physiatrist’s continued use of the term SIRVA – since whether the injury meets the legal definition is a matter to be determined herein. A second deficiency with the Table claim is Petitioner’s inability to eliminate any “other condition or abnormality… that would explain [her] symptoms (e.g., NCS/EMG or clinical evidence of radiculopathy, brachial neuritis, mononeuropathies, or any other neuropathy).” 42 C.F.R. § 100.3(c)(10)(iv). As the Table specifically states, “SIRVA is 12 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 13 of 14 caused by an injury to the musculoskeletal structures of the shoulder (e.g., tendons, ligaments, bursae, etc.). SIRVA is not a neurological injury and abnormalities on neurological examination or nerve conduction studies (NCS) and/or electromyographic (EMG) studies would not support SIRVA as a diagnosis (even if the condition causing the neurological abnormality is not known).” 42 C.F.R. § 100.3(c)(10) at Preamble. Respondent argues that Petitioner cannot meet this element, highlighting the physiatrist’s focus shifting away from bursitis, and towards the axillary nerve injury. Rule 4(c) Report at 15 – 16. And in fact, the record reveals that the nerve injury is much more prominent in the medical records (both in 2019 – 2020, and in 2022). While it could be alleged on this record that the vaccination caused SIRVA-oriented inflammation in and around the bursa which secondarily caused a nerve injury (see Ex. 6 at 3 (neurologist’s concern that the vaccination “directly injured the left axillary nerve due to swelling”)), that has not been articulated by Petitioner – and would require further development, through medical experts on both sides. But how both a SIRVA and non-Table claim are viable has been inadequately explained by Petitioner – and she has failed to disentangle the alleged musculoskeletal and neurological injuries, sufficient to save the Table “side” of this claim. “Claims involving shoulder pathology in the presence of significant and potentially confounding neurologic signs and symptoms are better addressed on a causation-in-fact basis.” Durham v. Sec’y of Health & Hum. Servs., No. 17-1899V, 2023 WL 3196229 at *14 (Fed. Cl. Spec. Mstr. Apr. 7, 2023).17 B. Causation Claim Severity As noted, a non-Table claim can be articulated based on the record evidence. Arguably, the vaccination was also followed by an axillary nerve injury which involved both pain and decreased sensation. The physiatrist believed that this was Petitioner’s “primary pain generator.” That was relieved only temporarily by a nerve block, so the physiatrist recommended ablation surgery. That injury was confirmed by a neurologist on February 27, 2020, and described in the mother’s VAERS report five days later. This claim likely would meet the severity requirement (unlike the Table claim). There is no evidence, or argument from Respondent, that this injury would have resolved within the next seven weeks. See also, e.g., Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378 (Fed. Cir. 2021) (affirming that a radial nerve injury persisted for more than six months post-vaccination). To the contrary, when Petitioner eventually returned to the physiatrist in 2022, he recorded that the injury had “worsened,” again found decreased 17 Because Petitioner has failed to establish the Table SIRVA requirement at 42 C.F.R. § 100.3(c)(10)(iv), it is unnecessary to address the additional disputed requirements, id. at § (c)(10)(ii) (onset of shoulder pain within 48 hours post-vaccination); id. at § (c)(10)(iii) (requiring limited ROM). 13 Case 1:21-vv-02044-UNJ Document 59 Filed 01/08/25 Page 14 of 14 sensation along the axillary nerve, maintained the same diagnosis, and relieved the pain with another axillary nerve block injection and gabapentin. Petitioner and her mother have also explained that that in early 2020, they were concerned about the ablation surgery’s risks and likelihood of success, and instead continued with rest over-the-counter pain medications. This explanation is acceptable – especially when focusing on the spring and summer of 2020, when the COVID-19 Pandemic emerged.18 The primary care records not addressing the shoulder begin in November 2020, Ex. 7 at 9 – 10, and they are focused on other concerns. Accord Kirby, 997 F.3d at 1383 (holding that medical records were “silent about the existence of any lingering symptoms [but] also silent about the nonexistence of such symptoms”). Petitioner’s explanation that she believed the HPV vaccine was improperly administered, but she was willing to receive additional vaccines and alternated between arms, is also a reasonable explanation. Moreover, when Petitioner finally returned in April 2022, the physiatrist endorsed that Petitioner’s injury had “worsened,” and found similar pain and decreased sensation at the deltoid, suggesting an axillary nerve injury, which was relieved by another axillary nerve block and gabapentin. See, e.g., Ex. 12 at 18 – 19; Ex. 17 at 9. For the foregoing reasons, there is preponderant evidence of an axillary nerve injury persisting for over six months, and indeed through September 2022.19 VI. Conclusion and Order of Reassignment Petitioner cannot meet the elements of a Table SIRVA claim, and it is therefore DISMISSED. But a causation-in-fact claim is tenable under the circumstances. To that end, and pursuant to Vaccine Rule 3(d), the above-captioned case is hereby transferred out of SPU and reassigned randomly to a Special Master by the Clerk’s Office. Further proceedings will be determined by the assigned Special Master. IT IS SO ORDERED. s/Brian H. Corcoran Brian H. Corcoran Chief Special Master 18 See, e.g., Centers for Disease Control and Prevention, CDC Museum COVID-19 Timeline, https://www.cdc.gov/museum/timeline/covid19.html (last accessed Nov. 21, 2024) (describing the national emergency declaration, and preventative measures taken throughout the United States, beginning in March 2020). 19 At the same time, the significant gap, despite ample opportunity to at least complain of an ongoing shoulder injury, suggests that the injury was less significant. See also Reply at 6 (stating that Petitioner had other “emergent priorities” in 2021). 14 ================================================================================ DOCUMENT 2: USCOURTS-cofc-1_21-vv-02044-cl-extra-11298561 Date issued/filed: 2026-03-30 Pages: 1 Docket text: Supplementary opinion from CourtListener cluster 10831324 -------------------------------------------------------------------------------- In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS Filed: February 27, 2026 * * * * * * * * * * * * * MARGARET ACHANZAR, * * Petitioner, * No. 21-2044V * v. * Special Master Gowen * SECRETARY OF HEALTH * AND HUMAN SERVICES, * * Respondent. * * * * * * * * * * * * * * Bridget C. McCullough, Muller Brazil, LLP, Dresher, PA, for petitioner. Naseem Kourosh, U.S. Department of Justice, Washington, D.C., for respondent. DECISION ON INTERIM ATTORNEYS’ FEES AND COSTS1 On September 17, 2024, Margaret Achanzar (“petitioner”) filed a motion for interim attorneys’ fees and costs related to this matter that were incurred between October 13, 2021, and September 11, 2024. Interim Fees Motion (“Int. Mot.”) (ECF No. 52). Petitioner requested that her attorney, Ms. Phyllis Widman,2 be awarded interim attorneys’ fees in the amount of $32,467.00 and costs in the amount of $988.98,3 for a total interim award of $33,455.98. Int. Mot. at 1, 8-15. 1 Pursuant to the E-Government Act of 2002, see 44 U.S.C. § 3501 note (2012), because this opinion contains a reasoned explanation for the action in this case, I am required to post it on the website of the United States Court of Federal Claims. The court’s website is at http://www.uscfc.uscourts.gov/aggregator/sources/7. This means the opinion will be available to anyone with access to the Internet. Before the opinion is posted on the court’s website, each party has 14 days to file a motion requesting redaction “of any information furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule 18(b). “An objecting party must provide the court with a proposed redacted version of the decision.” Id. If neither party files a motion for redaction within 14 days, the opinion will be posted on the court’s website without any changes. Id. 2 The court has since granted petitioner’s motion to substitute Ms. Bridget C. McCullough in place of Ms. Widman as the lead attorney. Clerk’s Notice Granting Motion to Substitute Attorney; see also Consented Motion to Substitute (ECF No. 60). 3 Petitioner stated that “[p]etitioner is owed $988.98 in costs.” Int. Mot. at 1. However, the supporting documentation reflects that the majority of these expenses were paid for by Widman Law Firm LLC. Id. at 18-29. Respondent noted that “$586.98 in costs was incurred by petitioner’s counsel, not by petitioner [and], while there is no provided documentation for the $402.00 filing fee listed in petitioner’s [Interim Fees Motion], the docket in this case indicates that the petition was filed by petitioner’s counsel, not pro se by petitioner.” Respondent’s Response at 4 (ECF No. 54) (citation modified). For the purposes of this decision, I construe petitioner’s request for costs as a request for attorneys’ costs and evaluate them accordingly. On September 25, 2024, respondent filed a response arguing that petitioner had not made the showing necessary to justify an award of interim fees and costs, asserting that petitioner failed to identify or explain the nature of undue hardship; further, respondent pointed to “several instances in which petitioner’s counsel billed for tasks of an administrative nature” at an inappropriate rate. Respondent’s (“Resp’t”) Response at 3-4, 6 (ECF No. 54). Petitioner filed a reply on October 2, 2024, maintaining that denial of the motion would impose undue hardship and asserting that petitioner’s counsel billed appropriately. Petitioner’s (“Pet’r”) Reply (ECF No. 55). For the reasons discussed below, I GRANT petitioner’s motion for attorneys’ fees and costs and award a total of $31,832.63. I. Procedural History On October 20, 2021, petitioner filed her claim in the National Vaccine Injury Compensation Program.4 Petition (ECF No. 1). Petitioner alleges that as a result of receiving the Human Papillomavirus (HPV) vaccine on October 21, 2019, she suffered “a left shoulder injury (SIRVA) and/or significan[t] aggravat[ion] [of] a condition….” Petition at Preamble. Following completion of pre-assignment review, the matter was assigned to the Special Processing Unit (“SPU”) on June 10, 2022. SPU Initial Order (ECF No. 15). After respondent filed a Rule 4(c) report opposing compensation, (ECF No.33), petitioner amended her Petition on July 12, 2023, to allege a Table SIRVA injury and/or axillary nerve mononeuropathy and/or a significant aggravated shoulder injury caused-in-fact by the vaccination. Amended Petition (ECF No. 43) at Preamble and ¶¶ 13, 16; see also Pet’r Reply Brief (“Br.”) (ECF No. 48) at 7-8 (providing that the off-Table claim is “in the alternative to her on-Table claim”). In a status report filed September 23, 2024, petitioner indicated her intent to proceed on concurrent Table and non-Table theories. (ECF No. 53). On November 25, 2024, the Chief Special Master dismissed petitioner’s Table SIRVA claim, finding that petitioner could not establish the regulatory requirements for a Table SIRVA injury, including the persistence of a qualifying musculoskeletal injury for six months and the absence of confounding neurological abnormalities. Dismissal of Table Claim at 12-13 (ECF No. 57). However, the Chief Special Master determined that a causation-in-fact claim based on an alleged axillary nerve injury was tenable under the record and that the severity requirement would likely be satisfied. Id. at 13-14. The case was therefore transferred out of SPU and was reassigned to the undersigned for further proceedings. Notice of Reassignment (ECF No. 58). Accordingly, what began as a streamlined Table injury claim has evolved into a causation-in-fact matter that likely requires further case development. At the time petitioner 4 The National Vaccine Injury Compensation Program is set forth in Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755, codified as amended, 42 U.S.C. §§ 300aa-10 to 34 (2012) (hereinafter “Vaccine Act” or “the Act”). Hereinafter, individual section references will be to 42 U.S.C. § 300aa of the Act. 2 filed the instant motion, the case had already been pending for well over two years, and the record reflects that more than $30,000.00 in attorneys’ fees and costs had been incurred. Approximately seventeen months thereafter, Ms. McCullough was recognized as petitioner’s attorney of record, underscoring that this litigation has continued well beyond its initial SPU posture. Given the extended pendency of these proceedings and the expenses accrued prior to the change in representation, addressing the pending request of interim fees and costs is appropriate for resolution. II. Entitlement to attorneys’ fees and costs a. Legal standard The Vaccine Act provides that reasonable attorneys’ fees and costs “shall be awarded” for a petition that results in compensation. § 15(e)(1)(A)-(B). Even when compensation is not awarded, reasonable attorneys’ fees and costs “may” be awarded “if the special master or court determines that the petition was brought in good faith and there was a reasonable basis for which the claim was brought.” § 15(e)(1). The Federal Circuit has reasoned that in formulating this standard, Congress intended “to ensure that vaccine injury claimants have readily available a competent bar to prosecute their claims.” Cloer v. Sec’y of Health & Human Servs., 675 F.3d 1358, 1362 (Fed. Cir. 2012). Petitioners act in “good faith” if they filed their claims with an honest belief that a vaccine injury occurred. Turner v. Sec’y of Health & Human Servs., No. 99-544V, 2007 WL 4410030, at *5 (Fed. Cl. Spec. Mstr. Nov. 30, 2007). In this case, the records reveal that medical service providers assessed petitioner’s left shoulder pathology and associated it with her HPV vaccination. See, e.g., Pet’r Ex. 6 at 2-3 (ECF No. 11-2); Pet’r Ex. 12 at 12-5 (ECF No. 19-1). Notwithstanding a subsequent gap in medical records, which coincided with the emergence of the COVID-19 pandemic, a treating provider deemed the left shoulder pain not to have resolved as of early 2022, well beyond the six-month severity period. Pet’r Ex. 12 at 30. Thus, petitioner has satisfied the good faith requirement. To receive an award of fees and costs, a petitioner must also demonstrate the claim was brought with a reasonable basis through objective evidence supporting the claim for which the petition was brought. Simmons v. Sec’y of Health & Human Servs., 875 F.3d 632, 635 (Fed. Cir. 2017) (citing § 15(e)(1)); see also, Chuisano v. Sec’y of Health & Human Servs., 116 Fed. Cl. 276, 286 (Fed. Cl. 2014) (citing McKellar v. Sec’y of Health & Human Servs., 101 Fed Cl. 297, 303 (Fed. Cl. 2011)). To establish a reasonable basis for attorneys’ fees, the petitioner need not prove a likelihood of success. Woods v. Sec’y of Health & Human Servs., No. 10-377V, 2012 WL 401485, at *5-7 (Fed. Cl. Spec. Mstr. Aug. 23, 2012) (citing Turner v. Sec'y of HHS, No. 99- 544V, 2007 WL 4410030, at *6 (Fed. Cl. Spec. Mstr. Nov. 30, 2007)). Instead, the special master considers the totality of the circumstances and evaluates the objective evidence, which may fall short of a preponderance, but must rise above a “mere scintilla” of evidence. Cottingham v. Sec’y of Health & Human Servs., 971 F.3d 1337, 1344-46 (Fed. Cir. 2020). Here, petitioner has filed more than a mere scintilla of objective medical evidence. The medical records document post-vaccination left shoulder pathology. See, e.g., Pet’r Ex. 3 at 2; 3 Pet’r Ex. 12 at 3-5. By February 2020, petitioner’s treating providers entertained a diagnosis of a suspected left axillary nerve injury. Pet’r Ex. 12 at 15; Pet’r Ex. 6 at 2-3. Following a gap in the treatment records, her treating physiatrist maintained the same diagnosis requiring medication management in 2022, well beyond the six-month post-vaccination period. Pet’r Ex. 12 16-17. Additionally, the Chief Special Master expressly determined that petitioner’s causation-in-fact theory was tenable under the circumstances, warranting transfer out of SPU for further adjudication. Dismissal of Table Claim at 14. Thus, while this evidence may not establish entitlement by a preponderance, it satisfies the reasonable basis requirement for the purposes of awarding interim attorneys’ fees and costs. I therefore find that the petition was brought in good faith and with a reasonable basis. b. Interim awards The Vaccine Act permits interim attorneys’ fees and costs. Avera v. Sec’y of Health & Human Servs., 515 F.3d 1343, 1352 (Fed. Cir. 2008); Shaw v. Sec’y of Health & Human Servs., 609 F.3d 1372 (Fed. Cir. 2010). In Shaw, the Federal Circuit held that it was proper to grant an interim award when “the claimant establishes that the cost of litigation has imposed an undue hardship.” 609 F.3d at 1375. In Avera, the Federal Circuit stated that “[i]nterim fees are particularly appropriate in cases where proceedings are protracted and costly experts must be retained.” 515 F.3d at 1352. I do not routinely grant interim fee applications. I generally defer ruling on an interim fee application if: the case has been pending for less than eighteen months (measured from the date of filing); the amount of fees requested is less than $30,000; and/ or the aggregate amount of expert costs is less than $15,000. If any one of these conditions exists, I generally defer ruling until these thresholds are met or until an entitlement hearing has occurred. These are, however, only informal requirements, and there are ultimately many factors bearing on the merit of an interim fee application. I evaluate each one on its own merits. Petitioner’s claim has been pending since October 20, 2021. Though interim fee requests are generally disfavored in SPU matters absent extraordinary circumstances, the procedural posture of this case has materially changed since petitioner filed the instant motion. See generally, SPU Initial Order at § F. Further, the requested attorneys’ fees and costs exceed $30,000.00. As the case has been partially briefed and will now proceed as a causation-in-fact case potentially requiring expert development, and as Ms. Widman is no longer petitioner’s attorney, it appears that the cost of litigation imposes an undue hardship to counsel. Accordingly, I find that an award of interim attorneys’ fees and costs is appropriate at this time. III. Reasonable Attorneys’ Fees and Costs a. Legal Standard As stated above, the Vaccine Act only authorizes “reasonable” attorneys’ fees and costs. The Federal Circuit has approved use of the lodestar approach to determine reasonable attorneys’ fees and costs under the Vaccine Act. Avera, 515 F.3d at 1349. Using the lodestar approach, a court first determines “an initial estimate of a reasonable attorneys’ fee by ‘multiplying the number of hours reasonably expended on the litigation times a reasonable hourly rate.’” Id. at 4 1347-58 (quoting Blum v. Stenson, 465 U.S. 886, 888 (1984)). Then, the court may make an upward or downward departure from the initial calculation of the fee award based on other specific findings. Avera, 515 F.3d at 1348. Although not explicitly stated in the statute, the requirement that only reasonable amounts be awarded applies to costs as well as to fees. See Perreira v. Sec’y of Health & Human Servs., 27 Fed. Cl. 29, 34 (1992), aff’d, 33 F.3d 1375 (Fed. Cir. 1994). Special masters have “wide latitude in determining the reasonableness of both attorneys’ fees and costs.” Hines v. Sec’y of Health & Human Servs., 22 Cl. Ct. 750, 753 (1991). They may look to their experience and judgment to reduce the number of hours billed to a level they find reasonable for the work performed. Saxton v. Sec’y of Health & Human Servs., 3 F.3d 1517, 1521 (Fed. Cir. 1993). A line-by-line evaluation of the billing records is not required. Wasson v. Sec’y of Health & Human Servs., 24 Cl. Ct. 482, 483 (1991), aff’d in relevant part, 988 F.2d 131 (Fed. Cir. 1993) (per curiam). The petitioner “bears the burden of establishing the hours expended, the rates charged, and the expenses incurred.” Wasson, 24 Cl. Ct. at 484. Adequate proof of the claimed fees and costs should be presented when the motion is filed. Id. at 484, n.1. Counsel “should make a good faith effort to exclude from a fee request hours that are excessive, redundant, or otherwise unnecessary, just as a lawyer in private practice ethically is obligated to exclude such hours from his fee submission.” Hensley v. Eckerhart, 461 U.S. 424, 434 (1983). b. Hourly rate The interim fee decision in McCulloch provides a framework for consideration of appropriate ranges for attorneys’ fees based upon an individual’s experience. McCulloch v. Sec’y of Health & Human Servs., No. 09-293V, 2015 WL 5634323 (Fed. Cl. Spec. Mstr. Sept. 1, 2015), motion for recons. denied, 2015 WL 6181910 (Fed. Cl. Spec. Mstr. Sept. 21, 2015). The Court has since updated the McCulloch rates. The Attorneys Forum Hourly Rate Fee Schedules for 2021-2024 (“Fee Schedules”) can be accessed online, https://www.uscfc.uscourts.gov/osm- attorneys-forum-hourly-rate-fee-schedules (last accessed Feb. 27, 2026). Petitioner is requesting that her former lead attorney, Ms. Widman and staff be reimbursed for work performed on her case from October 2021 through September 2024. Review of the billing records shows that Ms. Widman billed $375.00 per hour for work completed in 2021; $400.00 per hour for work completed in 2022; $420.00 per hour for work completed in 2023; and $480.00 per hour for work completed in 2024. Int. Mot. at 8-15. Petitioner is also requesting fees for “C.G.,”5 who billed at an hourly rate of either $175.00 or 5 “C.G.” is not identified in either the Interim Fee Motion or Petitioner’s Reply. However, another special master has previously encountered “CG” in billing records filed in a separate matter in which Ms. Widman represented a different petitioner. In that case, the special master determined that “CG” referred to Ms. Carolyn T. Griffin, Esq., an admitted Vaccine Program practitioner. Williams v. Sec’y of Health & Human Servs., No.18-1860V, 2025 WL 755057, at *2 (Fed. Cl. Spec. Mstr. Feb. 11, 2025). Additionally, in a contemporaneous attorneys’ fees decision involving Ms. Widman as the counsel of record for the petitioner, a special master noted that “Ms. Griffin billed either $175 or $275 per hour, depending on whether her work was designated as paralegal or attorney work, for work performed in 2022 through 2024.” Kinney v. Sec’y of Health & Human Servs., No. 18-1522V, 2025 WL 1305394, at *2 (Fed. Cl. Spec. Mstr. Apr. 11, 2025). Accordingly, based on these prior determinations under similar 5 $275.00, for tasks classified as paralegal or attorney work respectfully, which were performed in 2023 and 2024. Id. at 12-15. These rates are consistent with what has been awarded to counsel, associates, and paralegals in the past and are in line with the approved rates contained in the Fee Schedules. In previous matters, however, Ms. Widman has been awarded a lower hourly rate of $450.00 for work performed in 2024 as opposed to the requested rate herein. See, e.g., Argueta v. Sec’y of Health & Human Servs., No. 24-0072V, 2026 WL 496801, at *2 (Fed. Cl. Jan. 20, 2026); Archer v. Sec’y of Health & Human Servs., No. 23-1907V, 2025 WL 3679027, at *2 (Fed. Cl. Nov. 17, 2025); Vacca v. Sec’y of Health & Human Servs., No. 23-1883V, 2025 WL 3681315, at *2 (Fed. Cl. Nov. 17, 2025). In other matters still, special masters have applied Ms. Widman’s requested hourly rate of $480.00 for work completed in 2024. See, e.g., Jenkins v. Sec’y of Health & Human Servs., No. 18-1946V, 2025 WL 2218830, at *3 (Fed. Cl. July 11, 2025); Dryer-Minnerly v. Sec’y of Health & Human Servs., No. 23-1809V, 2025 WL 3900642, at *4 (Fed. Cl. Nov. 19, 2025); Carchietta v. Sec’y of Health & Human Servs., No. 21-2338V, 2025 WL 2651101, at *3 (Fed. Cl. Aug. 20, 2025). In Adams v. Sec’y of Health & Human Servs., Ms. Widman included a brief explanation indicating that her requested rate of $480.00 per hour for 2024 work is near the lower end of the allowable rates for her corresponding years of experience in practice and in the Vaccine Program as provided by the Fee Schedules.6 No. 19-929V, 2025 WL 1891970, at *4 (Fed. Cl. Spec. Mstr. June 13, 2025). Given that the requested rate has been previously awarded and that it is close to the lower end of the relevant tier, I conclude that the requested hourly rates, including the rate for work completed in 2024, are reasonable and appropriate. c. Hours Expended As previously noted, a line-by-line evaluation of the fee application is not required and will not be performed. Wasson, 24 Cl. Ct. at 484. Rather, I may rely on my experience to evaluate the reasonableness of hours expended. Id. Just as “[t]rial courts routinely use their prior experience to reduce hourly rates and the number of hours claimed in attorney fee requests …. [v]accine program special masters are also entitled to use their prior experience in reviewing fee applications.” Saxton, 3 F.3d at 1521. While respondent has indicated that diminished resources generally prevent respondent from providing detailed objections to requests for attorneys’ fees and costs, respondent did identify certain billing entries, asserting that they were improperly included. Resp’t Response at 5-6. Specifically, respondent objected to “extensive review of correspondence with medical providers and drafting and reviewing exhibit lists” as non-attorney work. Id. at 6; see also Int. Mot. at 8-9. Respondent stated that “billing for administrative tasks is not appropriate and billing for paralegal work at an attorney rate is not appropriate.” Resp’t Response at 6 (citing to circumstances, I interpret “C.G.” to refer to Ms. Carolyn Griffin. Going forward, counsel is advised to review all updated Vaccine Rules and the accompanying Guidelines, as there have been several substantive changes made in recent years, and to follow the Vaccine Rules and Guidelines. 6 See generally Vaccine Guidelines Section X(3)(B)(a)(a) (advising that a request for an award of attorney’s fees at an hourly rate not previously awarded must be substantiated by an affidavit of the attorney). 6 Mostovoy v. Sec’y of Health & Human Servs., No. 02-10, 2016 WL 720969, *5 (Fed. Cl. Spec. Mstr. Feb. 4, 2016). Indeed, “[t]asks that can be completed by a paralegal or a legal assistant should not be billed at an attorney’s rate.” Riggins v. Sec’y of Health & Human Servs., No. 99- 382V, 2009 WL 3319818, at *21 (Fed. Cl. Spec. Mstr. June 15, 2009). Having reviewed the submitted billing statement, I have noted a few issues, when taken together, warrant a reduction to the overall billed hours. First, there are multiple entries in the submitted billing records which are for clerical or administrative tasks. For instance, there are entries for drafting exhibit lists, filing documents in CM/ECF, and reviewing ECF notifications. See Int. Mot. at 35 at 8-10. While these tasks were completed by Ms. Widman, in the Vaccine Program, this type of administrative work “should be considered as normal overhead office costs included within the attorneys’ fee rates.” Rochester v. U.S., 18 Cl. Ct. 379, 387 (1989); Dingle v. Sec'y of Health & Human Servs., No. 08-579V, 2014 WL 630473, at *4 (Fed. Cl. Spec. Mstr. Jan. 24, 2014). “[B]illing for clerical and other secretarial work is not permitted in the Vaccine Program.” Mostovoy, 2016 WL 720969, at *5 (citing Rochester, 18 Cl. Ct. at 387). Special masters can reduce a fee request sua sponte, without providing petitioners notice and opportunity to respond. See Sabella v. Sec’y of Health & Human Servs., 86 Fed. Cl. 201, 208-09 (2009). In this case, the work billed by counsel reflects disallowed billing for administrative tasks, warranting an overall reduction of 5% to counsel’s fees. This results in a reduction of $1,623.35. Accordingly, Petitioner’s attorney, Ms. Widman, is entitled to interim attorneys’ fees of $30,843.65. d. Attorneys’ Costs Like attorneys’ fees, costs incurred by counsel or by petitioner must be reasonable to be reimbursed in the Program. Perreira, 27 Fed. Cl. Ct. 29, 34. Here, petitioner is requesting a total of $988.98 in costs. Int. Mot. at 1. Specifically, petitioner provided documentation demonstrating that the requested sum includes a filing fee and the costs incurred when obtaining medical records. Id. at 18-31. Such expenses are routinely reimbursed in the Program. Accordingly, petitioner shall be awarded the full amount requested for costs. IV. Conclusion By the time petitioner filed the instant motion, the case had been pending for more than two years. Significant work has been performed, and additional litigation remains necessary before a final resolution can be reached. Additionally, Ms. Widman is no longer petitioner’s lead counsel. Under these circumstances, an interim award is warranted. Respondent argues that petitioner failed to articulate the nature of any undue hardship. The duration of the litigation, the accumulation of uncompensated attorneys’ fees and costs, and the foreseeable need for continued litigation under a new lead attorney support the appropriateness of interim fees in this case, albeit with a minor reduction. 7 In accordance with the foregoing, I hereby GRANT petitioner’s motion for interim attorneys’ fees and costs and find that petitioner is entitled to a reimbursement of interim attorneys’ fees and costs as follows: Attorneys’ Fees Requested $32,467.00 (Adjustment to Attorneys’ Fees) (-$1,623.35) Attorneys’ Fees Awarded $30,843.65 Attorneys’ Costs Awarded $988.98 Total Interim Attorneys’ Fees and Costs $31,832.63 Accordingly, a lump sum in the amount of $31,832.63, representing reimbursement for petitioner’s interim attorneys’ fees and costs, to be paid in the form of an ACH deposit to petitioner’s counsel’s IOLTA account for prompt disbursement. In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of the Court SHALL ENTER JUDGMENT in accordance herewith.7 IT IS SO ORDERED. s/Thomas L. Gowen Thomas L. Gowen Special Master 7 Entry of judgment is expedited by each party’s filing notice renouncing the right to seek review. Vaccine Rule 11(a). 8