VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-02215
Package ID: USCOURTS-cofc-1_21-vv-02215
Petitioner: Romeo Allas
Filed: 2021-11-24
Decided: 2025-04-28
Vaccine: influenza
Vaccination date: 2020-09-06
Condition: Guillain-Barré syndrome
Outcome: compensated
Award amount USD: 165000

AI-assisted case summary:
Romeo Allas, a 75-year-old individual, filed a petition for compensation under the National Vaccine Injury Compensation Program on November 24, 2021. He alleged that an influenza vaccine received on September 6, 2020, caused him to develop Guillain-Barré syndrome (GBS). The respondent is the Secretary of Health and Human Services. An entitlement hearing was held on April 24, 2024, and Chief Special Master Brian H. Corcoran issued a ruling on October 9, 2024, finding Mr. Allas entitled to compensation. The parties were unable to agree on damages, leading to a subsequent damages decision by Chief Special Master Corcoran on March 25, 2025.

Mr. Allas had a medical history including diabetes, chronic low back pain, hypertension, and hyperlipidemia, among other conditions. On September 6, 2020, he received an influenza vaccine. Two days later, on September 8, 2020, he emailed his primary care provider complaining of persistent muscular and joint pain, which he had been self-treating for three days without relief. He also reported pain traveling from his back to his legs. His provider suggested pain medication. On September 9, 2020, Mr. Allas had a telehealth appointment reporting severe back pain traveling to both legs, difficulty sleeping, and pain when walking, noting his current medications were not working. His provider diagnosed chronic low back pain and prescribed medication and referred him to physical therapy. On the evening of September 12, 2020, Mr. Allas presented to an emergency department with a sudden inability to walk, reporting a history of chronic low back pain and recent knee surgery. His physical and neurological exams were normal, though reflexes were not tested. He was transferred to another hospital due to his inability to walk, generalized weakness, and an indeterminate troponin level. At the second hospital, he reported three days of lower extremity weakness and back pain, multiple near falls, worsening lower back pain, and an inability to walk with his walker. Examination revealed lower lumbar tenderness, mild spinal tenderness, a swollen right knee, decreased lower extremity strength, and diminished reflexes. A lumbar puncture showed high cerebrospinal fluid protein, and an MRI of his lumbar spine showed no compression. A neurologist initially considered GBS but noted atypical asymmetry and CSF white blood cell count. The next day, another neurologist diagnosed GBS and right leg weakness, noting an acute onset of lower extremity weakness and mild numbness following the flu shot. Mr. Allas began a four-day course of IVIG and inpatient physical therapy. His condition improved, and an EMG and nerve conduction study showed findings consistent with GBS and right median neuropathy. He was discharged home for outpatient physical therapy. Over the next several months, he underwent extensive physical and occupational therapy. By March 2021, he had made significant gains and could ambulate with a one-handed device. By October 2021, his strength had returned to baseline, and he no longer required assistance walking, though he used a cane for safety. His family members testified about his prior minimal chronic back pain and the significant decline in his health following the vaccination, including his inability to walk and need for assistance with daily activities. Petitioner's expert, Dr. Steven N. Sykes, opined that the flu vaccine more likely than not caused Mr. Allas's GBS, distinguishing his post-vaccination symptoms from his prior chronic back pain. Respondent's expert, Dr. Marcello Matiello, opined that Mr. Allas's GBS symptoms likely preceded the vaccination. The Special Master found that the evidence preponderated in favor of Mr. Allas's GBS onset occurring within the Table timeframe, distinguishing his pre-vaccination back pain from his GBS symptoms. The Special Master determined Mr. Allas was entitled to compensation.

In the damages decision, the parties disputed the amount for actual pain and suffering. Petitioner sought $175,000.00, while Respondent argued for $100,000.00. Petitioner highlighted his moderate GBS injury, hospitalization, IVIG treatment, extensive physical and occupational therapy, and periods of being bedridden and homebound. He cited comparable cases with awards ranging from $165,000.00 to $180,000.00. Respondent argued Mr. Allas suffered a mostly mild injury with a short hospitalization and recovery, and that his pre-existing comorbidities should be considered. He cited comparable cases with awards from $92,500.00 to $135,000.00. Chief Special Master Corcoran awarded Mr. Allas $165,000.00 for actual pain and suffering, finding his injury moderately severe and distinguishing it from less severe GBS cases. He noted that while Mr. Allas had pre-existing conditions, they did not diminish the impact of the GBS injury. The award was based on the severity and duration of his symptoms, his hospitalization, treatment course, and recovery, and was benchmarked against similar cases, including one not cited by the parties.

Theory of causation field:
Romeo Allas, age 75, received an influenza vaccine on September 6, 2020. He subsequently developed Guillain-Barré syndrome (GBS). Petitioner alleged the vaccine caused his GBS. The Special Master found that Petitioner's GBS onset occurred within the Table timeframe (3-42 days post-vaccination), determining that his symptoms of weakness and inability to walk, which began around September 9-10, 2020, were distinguishable from his pre-existing chronic back pain. Petitioner's expert, Dr. Steven N. Sykes, opined that the vaccine caused the GBS. Respondent's expert, Dr. Marcello Matiello, opined that the onset preceded the vaccine. The Special Master found Petitioner's evidence more persuasive, concluding the vaccine was a substantial factor in causing the GBS. The Special Master awarded $165,000.00 for actual pain and suffering. Petitioner's counsel was Jeffrey S. Pop & Assoc. Respondent's counsel was U.S. Dep’t of Justice. Chief Special Master Brian H. Corcoran issued the entitlement ruling on October 9, 2024, and the damages decision on March 25, 2025.

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_21-vv-02215-0
Date issued/filed: 2024-11-05
Pages: 22
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/09/2024) regarding 48 Ruling on Entitlement. Signed by Chief Special Master Brian H. Corcoran. (mva) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 1 of 22
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-2215V
* * * * * * * * * * * * * * * * * * * * * * * * *
ROMEO ALLAS, * Chief Special Master Corcoran
*
Petitioner, * Filed: October 9, 2024
*
v. *
*
SECRETARY OF HEALTH AND *
HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Alexandra B. Pop, Jeffrey S. Pop & Assoc., Beverly Hills, CA, for Petitioner.
Rachelle P. Bishop, U.S. Dep’t of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On November 24, 2021, Romeo Allas filed a petition for compensation under the National
Vaccine Injury Compensation Program (the “Vaccine Program”). 2 Petitioner alleges his receipt of
an influenza (“flu”) vaccine on September 6, 2020, caused him to suffer Guillain-Barré syndrome
(“GBS”). Petition (ECF No. 1) at 1. Although such matters are often the subject of easily-resolved
Table claims, the question herein of whether onset was Table-consistent presented a reasonable
dispute that required expert input and other fact testimony.
An entitlement hearing in the matter was held in Washington, D.C. on April 24, 2024.
Having reviewed the record, all expert reports, the medical records, and associated literature, I
hereby find that Petitioner is entitled to an award of compensation.
1
Under Vaccine Rule 18(b), each party has fourteen (14) days within which to request redaction “of any information
furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or
confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly
unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the whole Ruling will be available to the public in
its present form. Id.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660,
100 Stat. 3758, codified as amended at 42 U.S.C. §§ 300aa-10 through 34 (2012) [hereinafter “Vaccine Act” or “the
Act”]. Individual section references hereafter will be to § 300aa of the Act (but will omit that statutory prefix).

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 2 of 22
I. Fact History
Pre-Vaccination History
Petitioner’s medical history included diabetes, chronic low back pain, osteoarthrosis in
both knees, osteopenia, bilateral plantar fasciitis and gout, sleep-related leg cramps, hypertension,
hyperlipidemia, labyrinthitis, and vertigo. Ex. 3 at 69; Ex. 4 at 10, 15, 163–65, 1597, 1599; see
also Ex. 6; Ex. 10.
Vaccination and Relevant Hospitalization
On September 6, 2020, Petitioner (then 75 years old) received a flu vaccine at Kaiser
Permanente in Woodland Hills, CA. Ex. 2 at 2. Two days later, on September 8, 2020, Petitioner
emailed his primary care provider James Ramos, M.D., complaining of persistent “muscular and
joint pain,” for which he had been self-treating with an over-the-counter non-steroidal anti-
inflammatory drug “for the past three days 3 times a day,” but which had not helped his pain. Ex.
4 at 1092. (Based on this representation, the pain reported at this time pre-dated vaccination—
although its relationship to Petitioner’s alleged GBS injury is disputed). Petitioner also reported
that he was experiencing a “nagging and persistent pain” that “travel[ed] from [his] back to [his]
legs.” Id. Dr. Ramos proposed a medication plan of Tylenol with codeine and prednisone for pain
relief. Id.
On September 9, 2020, Petitioner saw Dr. Ramos for a telehealth appointment. Ex. 4 at
1096. The record from this encounter describes Petitioner’s complaints as “severe back pain
traveling to both legs; difficulty sleeping; sxs x 3 days; painful when walking.” Id. And it identifies
“back pain” as the primary concern prompting the telehealth visit, adding that Petitioner deemed
the medicines he had been receiving to not be working. Id. at 1096–97. Based on Petitioner’s
reporting, Dr. Ramos noted two separate diagnoses at this visit: “chronic low back pain>3 months”
and “back pain.” Id. at 1097. Dr. Ramos recommended that Petitioner ice the affected areas,
referred him to physical therapy (“PT”), and prescribed Tylenol with codeine and a Medrol
Dosepak. Id.
Three days later (the late evening of September 12, 2020), Mr. Allas went to the Henry
Mayo Newall Hospital emergency department in Valencia, CA, complaining of a sudden inability
to walk. Ex. 3 at 69, 70, 74. In explaining his concerns to treaters, Petitioner reported “a history of
chronic low back pain,” but also that he had undergone knee surgery in December 2019, and since
then had experienced “gradually worsening bilateral knee pain.” Id. at 69. And he reported
“associated general weakness without any focal weakness, loss of sensation, headache, vision
changes, neck pain, or any new or changing back pain.” Id.
Petitioner’s physical examination was normal, as well as his neurologic exam (although
treaters did not test his reflexes at this time). Ex. 3 at 71. Petitioner’s lab results indicated abnormal
2

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 3 of 22
levels of troponin3 (a protein biomarker for heart attack), although this finding was deemed
“indeterminate.” Id. at 74. Treater John C. Meher, M.D., suspected “acute on chronic exacerbation
of chronic bilateral knee pain,” but further noted that Petitioner “repeatedly describe[d] generalized
weakness . . . [as] the reason [he] cannot walk.” Id. Nevertheless, Dr. Meher also stated that because
of a lack of “focal neurologic complaints” and the normal neurologic exam findings, he felt it was
reasonable to defer a full neurologic exam at that time. Id.
Petitioner was subsequently transferred to Kaiser Permanente’s Panorama City Hospital
for further evaluation and monitoring due to his inability to walk, reported generalized weakness,
and “indeterminate troponin with multiple cardiac risk factors.” Ex. 3 at 74. The next day,
Petitioner was evaluated by a new set of treaters, at which time he reported “3 days of lower
extremity weakness and back pain,” multiple instances where he ha[d] nearly fallen,” “worsening
lower back pain,” and that he “was unable to walk with his walker.” Ex. 4 at 1597. He also noted
that although his “knees have been hurting chronically,” at his baseline three days ago he had the
ability to ambulate without any problems. Id. (This would place onset of walking issues after
September 10th, which was itself four days post-vaccination).
Upon examination, Petitioner demonstrated diffuse lower lumbar tenderness, mild midline
tenderness of the spine, a swollen right knee, 2/5 lower extremity strength at hip flexion, 4/5
strength at plantar and dorsiflexion, reflexes 1+ bilaterally at knee, and an inability to take more
than three steps with his walker. Ex. 4 at 1602. A lumbar puncture revealed high cerebrospinal
fluid (“CSF”) protein level of 140, normal white blood cell count of 8-11, and glucose of 169. Id.
at 1622, 1624, 1655. And an MRI of Petitioner’s lumbar spine region revealed no spinal cord
compression. Id. at 1608. Diagnoses included weakness of bilateral legs and back pain, with initial
treating physician Kevin Khoa, D.O., expressing doubts about a GBS diagnosis or a demyelinating
disease given Petitioner’s existing reflexes plus the lack of evidence of any recent infection. Id. at
1624, 1608–09.
Later that day, Petitioner had a neurology inpatient consultation with Saien Lai, M.D. Ex.
4 at 1654. Petitioner reported that “he had chronic lower back pain previously associated with
occasional right leg weakness, but neither the pain nor the weakness has been as bad as his current
symptoms.” Id. Then, “[one] week ago he had his flu shot, which this year given his age, he was
given the double dose, then [three] days ago he started to have worsening of his lower back pain.”
Id. He also noted two episodes where he described his legs feeling “like jelly” and buckled, and
another two episodes where each knee buckled. Id. at 1655. And he noted that he often had felt
some post-vaccination malaise, and this time had also experienced such symptoms. Id.
3 “Troponin” is specifically defined as “a complex of globular muscle proteins of the I band that inhibits contraction
by blocking the interaction of actin and myosin; when combined with Ca2+, it so modifies the position of the
tropomyosin molecules that contraction takes place.” Troponin, Dorland’s Medical Dictionary Online,
https://www.dorlandsonline.com/dorland/definition?id=51302&searchterm=troponin (last visited Oct. 9, 2024).
3

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 4 of 22
GBS Diagnosis
Upon examination, Petitioner exhibited hip flexor strength deficits, although no baseline
could be determined. Ex. 4 at 1659. Petitioner also was now unable to elicit a right patellar reflex,
a right ankle trace reflex, and a left lower extremity trace reflex. Id. His brain MRI showed mild
chronic white matter ischemic changes and no evidence of acute infarction, while his lumbar spine
MRI showed multilevel degenerative changes. Id. at 1214–15. Based on all of the foregoing, Dr.
Lai opined that Petitioner’s “history of intermittent headache and acute lower back pain with right
[greater than] left leg weakness, together with exam finding[s] of isolated right quad weakness and
described [bilateral] lower extremity reflexes, [and] normal spinal imaging” might suggest
Guillain-Barré syndrome (“GBS”), although “the asymmetry [was] not typical of GBS, [nor was]
the [cerebral spinal fluid white blood cell] count.” Id. at 1218–19. Dr. Lai also considered
meningitis, femoral nerve infarct, and lumbosacral plexitis. Id. at 1219.
The next day (September 14, 2020), neurologist Matthew Christopher, M.D., diagnosed
Petitioner with GBS and “weakness of right leg”—further noting that Petitioner had an “acute
onset [of right greater than left] lower extremity weakness and mild numbness on gross
examination) following flu shot.” Ex. 4 at 1711. Petitioner’s gram stain resulted as abnormal with
few white blood cells. Id. at 1717. Following further evaluation, Dr. Lai started Petitioner on a
four-day course of IVIG, 4 while ordering an additional MRI of the lumbar spine to rule out
lumbosacral plexus inflammation. Id. at 1721–22. Petitioner’s MRI results indicated “diffuse
lumbar disc disease with several level lumbar canal stenosis” but “[n]o suspicious abnormal
enhancing mass.” Id. at 1722.
Petitioner continued IVIG treatment and received inpatient PT through September 18,
2020. Ex. 4 at 1731–1852. By that time, he began to exhibit improved balance, endurance, strength,
and stability. Id. at 1849–52. Before being discharged later that day, Petitioner underwent an EMG5
and NCS,6 which showed “[d]ecreased recruitment of motor unit on right L3-L5 myotomes”
4 “Intravenous Immunoglobulin” is defined as “[a] substance made from antibodies that have been taken from the
blood of many healthy donors. It is given to a patient through a needle or tube inserted into a vein. IVIGs are used to
treat certain types of immune disorders in which there are low amounts of antibodies in the blood. They are also used
to treat many different autoimmune disorders, infections, or other conditions. They may also be used to help prevent
infections in patients who have had a stem cell or organ transplant. IVIGs are a type of immunotherapy.” IVIG,
National Cancer Institute, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ivig (last visited Oct. 9,
2024).
5 “Electromyography” is defined as “an electrodiagnostic technique for recording the extracellular activity (action
potentials and evoked potentials) of skeletal muscles at rest, during voluntary contractions, and during electrical
stimulation; performed using any of a variety of surface elctrodes, needles electrodes, and devices for amplifying,
transmitting, and recording the signals.” Electromyography, Dorland’s Medical Dictionary Online,
https://www.dorlandsonline.com/dorland/definition?id=15854&searchterm=electromyography (last visited Oct. 9,
2024).
6 “Nerve Conduction Study” is defined as “an essential tool in the evaluation of the peripheral nervous system. The
sensory nerve action potential (SNAP) provides information on the sensory nerve axon and its pathway from the distal
receptors in the skin to the dorsal root ganglia, while the compound muscle action potential (CMAP) is an assessment
4

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 5 of 22
consistent with GBS, as well as “[s]uperimposed moderate to severe right median neuropathy at
[the] wrist.” Id. at 1209. His discharge summary repeated the diagnosis of GBS “leading to
weakness of right leg suspected post flu vaccine,” plus hyponatremia from mild syndrome of
inappropriate secretion of antidiuretic hormone7 (“SIADH”), for which he was to take salt tablets.
Id. at 1636. Petitioner was discharged for home physical therapy, and he declined admission to a
skilled nursing facility. Id.
Post-Hospitalization Treatment
On September 21, 2020, Petitioner had a telehealth appointment with Dr. Ramos reporting
that he could not walk and had been experiencing severe pain, leading Dr. Ramos to prescribe
medications. Ex. 4 at 1125, 1134. Over the course of the next six months, Petitioner attended
twenty-eight sessions of physical therapy and fourteen sessions of occupational therapy. See
generally Ex. 5. His difficulties walking/standing plus numbness continued that month. Ex. 6 at
86–87.
By late-October 2020, Mr. Allas was reporting to Dr. Lai some improvement in performing
daily tasks, but remained unable to walk independently. Ex. 4 at 1207. He also began experiencing
some toe swelling and pain through December, and for which he received treatment. Id. at 1242,
1244, 1299–1300. But in this same timeframe he experienced significant improvement (which he
attributed to physical therapy) in his ability to ambulate and move generally, and displayed far less
weakness as well. Id. at 1310.
Petitioner was discharged from PT on March 6, 2021. Ex. 5 at 385. By this time, he was
deemed to have “made increasing gains in regard[] to transfers, ambulation, and musculoskeletal
strength.” Id. And while Petitioner remained homebound, he was still “progressing in functional
independence”—including ambulating with a one-handed device and independently walking. Id.
at 368. His improvement continued into October 2021—by which time his strength and overall
condition had returned to baseline and he no longer needed assistance walking, although he took
care in that regard and employed a cane for safety purposes. Ex. 7 at 78.
The records also reflect that Petitioner attended an additional six healthcare appointments
from March 15 to May 20, 2022, although none reference Petitioner’s GBS. See generally Ex. 11
at 95–184.
of the motor nerve fibers from their origins in the anterior horn cell to their termination along muscle fibers.” See
Nerve Conduction Studies: Basic Concepts, NIH National Library of Medicine,
https://pubmed.ncbi.nlm.nih.gov/31277849/ (last visited Oct. 9, 2024).
7 “Syndrome of Inappropriate Antidiuretic Hormone” is defined as “hyponatremia with decreased extracellular fluid
osmolality, inability to produce dilute urine, normovolemia, and elevated urinary sodium excretion in the absence of
kidney disease or other cause of normovolemic hypo-osmolality. Causes include vasopressin-secreting tumor cells,
neoplasms (especially oat cell carcinoma of the lung or pancreatic carcinoma), pulmonary disorders, central nervous
system disease, and adverse drug reactions.” Syndrome of Inappropriate Antidiuretic Hormone, Dorland’s Medical
Dictionary Online, https://www.dorlandsonline.com/dorland/definition?id=110798 (last visited Oct. 9, 2024).
5

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 6 of 22
II. Fact Witnesses and Experts
A. Fact Witnesses
1. Robin Allas
Ms. Allas, Petitioner’s daughter, was the first fact witness to testify at hearing. See
generally Tr. at 7–15. She began her testimony with a brief description of Petitioner’s history of
chronic back pain—noting that it was something that she never really noticed, but when she did,
he simply appeared “a little bit more sedentary throughout the day.” Id. at 9. Otherwise, she
testified that Petitioner was relatively active—playing tennis weekly, gardening daily, or walking
the family dogs. Id.
Ms. Allas then recounted the day she, her brother Christopher, and Petitioner received their
yearly flu vaccines on September 6, 2020. Prior to the vaccinations, the family was playing tennis,
and at no point during that time did Petitioner complain of any back pain. Id. at 11. It was not until
several days later (approximately midweek) when she began noticing changes in Petitioner’s
health. Id. at 12. She explained that Petitioner started having difficulty walking which prompted
him to use a cane, and that over the course of the coming days he became progressively weaker.
Id.
On the evening of September 12, 2020, Ms. Allas recounted, she and her parents were
going upstairs to wash up and get ready for bed, but as they were going up the stairs, Petitioner
suddenly fell backwards and into his wife, Mrs. Allas. Tr. at 13. Ms. Allas noticed Petitioner was
already relatively weak at that time, as he was relying on the handrails before becoming too weak
and falling. Id. Because Petitioner was “almost [ ] immobile” and could not walk, Mrs. Allas and
Robin decided to take him to the emergency room (“ER”) at Henry Mayo. Id. Ms. Allas testified
that it took approximately two days for Petitioner’s symptoms to deteriorate before taking him to
the ER. Id. at 13.
Ms. Allas concluded her testimony with a brief description of Petitioner’s recovery process.
Id. at 15. She noted that it took him approximately six months to be able to walk again, and that
Petitioner underwent occupational therapy and physical therapy almost daily. Id. Although she felt
he was doing better, it seemed to her that he was not as strong as before. Tr. at 15.
2. Christopher Allas
Petitioner’s son was the second fact witness to testify at hearing. See generally Tr. at 20–
30. He described Petitioner’s history of chronic back pain as “very minimal”—noting further that
it did not prevent Petitioner from doing “his day-to-day tasks.” Id. at 22. When Petitioner did need
to treat his back pain, he would typically utilize a “Salonpas” patch or ice, but the overall treatment
was quite minimal. Id.
6

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 7 of 22
Several days post-vaccination, Mr. Allas recalled, he noticed a change in Petitioner’s
health. Id. at 23. He testified that Petitioner began exhibiting “a pattern of fatigue and weakness”
and that he was “a little bit more lethargic.” Id. at 24. And on the evening of September 12, 2020
(the date Petitioner was eventually taken to the ER), Petitioner had been laying on the couch all
day. Id. These new symptoms, Mr. Allas explained, were not the same as Petitioner’s history of
chronic back pain—noting that the long-standing pain was rarely noticeable, whereas the new
symptoms caused Petitioner to be obviously weaker and more lethargic. Tr. at 25.
Thereafter, Petitioner was “bedridden for a couple of months,” and Mr. Allas had to assist
him with daily activities such as getting out of bed, going to the bathroom, and showering. Id. at
26. In his recollection, it took Petitioner approximately four to six months before being able to
walk again, and despite a significant recovery, Petitioner still experiences some limitations with
weakness and fatigue. Id.
On redirect, Mr. Allas was asked to clarify statements contained in his declaration
regarding the difference between Petitioner’s previous back pain and the onset of these new
symptoms. Id. at 28. Mr. Allas reiterated his view that the pain was different—noting that “[w]hen
[Petitioner’s] back was bothering him, he would sit down and rest” but that “[h]e was always able
to walk and stand, even when he had back pain.” Id. (citing Declaration of Christopher Allas, filed
as Ex. 35 (ECF No. 45-5) at ¶ 16).
3. Teresa Allas
Petitioner’s wife began her testimony with a brief overview of Petitioner’s history of
chronic back pain. Tr. at 33. She noted that he had experienced chronic back pain ever since they
met (a little over thirty years ago), but that it generally did not impact his life or cause him
significant limitations. Id. Mrs. Allas further testified that other than the occasional visit to the
doctor for his back pain, Petitioner would typically treat the pain with over-the-counter
medications, like a Salonpas patch. Id. at 34. She then recounted the day Petitioner received his
flu vaccine. Id. at 35. Mrs. Allas recalled growing more concerned for Petitioner’s health sometime
mid-week (approximately Wednesday, September 9, 2020), when she noticed that Petitioner was
using a cane for assistance and eventually a walker. Id. at 36.
She then described the evening Petitioner was hospitalized—recounting how much trouble
he had walking up the stairs and how he eventually started falling. Mrs. Allas testified that once
she and her daughter were able to get Petitioner to the car to take him to Henry Mayo, a nurse
transported him by wheelchair, as Petitioner could no longer walk on his own. Tr. at 37. Petitioner
was later transferred to a different hospital, Kaiser Panorama, where he was admitted following a
diagnosis of GBS. Id. at 38.
Mrs. Allas recalled Petitioner being in the hospital for approximately five to seven days,
during which time he underwent a course of IVIG. Tr. at 39. Petitioner’s treating physicians
recommended an outpatient facility following discharge, but Mrs. Allas preferred that he return
7

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 8 of 22
home and as a result she became one of his primary caretakers for approximately four to five
months before returning to work. Id. During that time, Petitioner underwent OT and PT. Tr. at 40.
Mrs. Allas also noted that Petitioner’s symptoms have improved, but that he was still weaker than
before his receipt of the flu vaccine. Id.
4. Romeo Allas
Petitioner was the last fact witness to testify at hearing. See generally Tr. at 46–81. He
described his career as a member of the United States Air Force through his retirement. Id. at 46–
51. When asked about any injuries he might have received during his time in the military, Petitioner
testified he experienced “nagging back pains” after work as a result of moving heavy equipment
and various other supplies. Id. at 51–52. Nevertheless, he remained relatively active, through his
service and after, participating in activities such as tennis and martial arts. Id. at 52.
Mr. Allas next testified to his overall health prior to receipt of the flu vaccine on September
6, 2020. Tr. at 53. Other than his chronic back pain, Petitioner felt that he was an overall healthy
and active individual. When he did experience flare-ups of back pain, he would typically self-treat.
Tr. at 55. But he would occasionally seek medical attention for these flare-ups, at which time his
doctors would commonly recommend alternating a hot/cold pack as treatment. Id. at 56. Petitioner
then briefly spent some time distinguishing his complaints of chronic back pain in 2019 from the
pain he experienced after receiving the flu vaccine in September 2020. See generally Id. at 58–63.
Petitioner next recounted the day he received his flu vaccine. On that day, he was playing
tennis with his children, and was not then experiencing any back pain. Id. at 65. He further testified
that he did not recall experiencing any post-vaccination malaise, as he had received the flu
vaccination approximately every year. Id. at 66. When asked about his telehealth appointment with
Dr. Ramos on September 9, 2020, Petitioner recalled reporting “[c]onstant and persistent severe
back pain traveling to both legs[;] [d]ifficulty sleeping, SX times three days, [and] painful when
walking.” Id. at 69; Ex. 4 at 1096. However, he explained that these symptoms did not differ from
his previous complaints of chronic back pain. Tr. at 69. It was not until Petitioner began
experiencing feelings of weakness and fatigue later that night that he noted a difference in pain
which led him to seek additional treatment. Id. at 70 (recalling the need to use a cane and a walker
for additional support due to the progressive weakness in his legs).
Mr. Allas next recounted the events leading up to his wife and daughter taking him on
September 12, 2020, to Henry Mayo, noting his inability to walk up the stairs and eventually his
inability to walk on his own and without any support. Tr. at 73. Petitioner was subsequently
transferred to Kaiser Panorama, where he was eventually diagnosed with GBS and underwent a
course of IVIG. Id. at 74. Once discharged, Petitioner recalled, his wife took leave to become his
primary caretaker—with the help of the other Allas family members—until he recovered and was
able to walk on his own again. Id. at 75. During his approximate six-month recovery, Petitioner
participated in both PT and OT in a home health setting. Id.
8

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 9 of 22
Petitioner concluded by briefly commenting on the overall impact his GBS diagnosis has
had on him. Tr. at 77. He noted that prior to the diagnosis, he was an active individual—playing
tennis, gardening, walking, etc. But since then, his ability to partake in such activities is very
limited. Id. For example, Petitioner noted that he does not play tennis as frequently, he can only
walk a block or two before having to use his cane, and he needs assistance with putting on his
socks and shoes. Id. Mr. Allas also testified that if he has the ability to partake in an activity of
daily living or one of his many hobbies, he will, but if he needs assistance then he will rely on his
wife and children to help. Id.
B. Petitioner’s Expert – Dr. Steven N. Sykes
Dr. Sykes, a neurologist, offered two written reports and testified on behalf of Petitioner.
See generally Tr. at 83–144; Report, dated Feb. 22, 2023 (ECF No. 29-2) (“First Sykes Rep.”);
Report, dated Aug. 6, 2023 (ECF No. 32-1) (“Supp. Sykes Rep.”). Dr. Sykes opined that
Petitioner’s receipt of the influenza vaccine on September 6, 2020, “more likely than not caused
an abnormal activation of his immune system, leading to his development of [GBS].” Supp. Sykes
Rep. at 2.
Dr. Sykes attended the University of California, Los Angeles (“UCLA”), for his
undergraduate degree, and the University of Michigan School of Medicine for his medical degree.
Curriculum Vitae, filed as Ex. 34 (ECF No. 45-4) (“Sykes CV”) at 1; First Sykes Rep. at 1; Tr. at
83. He then completed an internship in Internal Medicine at St. Joseph Mercy Hospital in Ann
Arbor, Michigan, followed by his residency in Neurology at UCLA. Tr. at 84. Thereafter, Dr.
Sykes completed a fellowship in Clinical Neurophysiology at the University of Southern
California. Id. He is currently an Assistant Clinical Professor, as well as an Attending Physician at
Cedars-Sinai Medical Group/Center. Sykes CV at 1. He also serves as the Panel Lead for
Neurology for the Cedars-Sinai Medical Care Foundation. Id. Dr. Sykes’ practice is primarily
dedicated to his clinical practice which includes treating and evaluating patients with peripheral
nervous system disorders. First Sykes Rep. at 1. He is board certified by the American Board of
Psychiatry and Neurology in both Neurology and Clinical Neurophysiology. Id.
Dr. Sykes began his testimony with a brief overview of GBS. Tr. at 87. He explained that
GBS is a disorder of the peripheral nervous system of which weakness is often the predominate
manifestation. Id. at 87–88; Sykes First Rep. at 3. Dr. Sykes further noted that “[t]here [is] quite a
bit of variability in the way weakness may evolve, so while the traditional description is ascending,
it can [also] be descending.” Tr. at 88. Moreover, while back pain is a common symptom in an
individual with GBS, Dr. Sykes noted that back pain alone, without other neurological symptoms,
would not warrant an evaluation or concern for GBS. Id. Additional clinical symptoms that would
warrant further testing for GBS include weakness that “involves areas beyond what would be
immediately attributed to limitations from pain” (i.e., autonomic or sensory symptoms). Id. at 89.
9

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 10 of 22
Petitioner’s history of chronic back pain, Dr. Sykes contended, was distinguishable from
his GBS symptoms. That chronic pain “dated back to his service in the military with intermittent
flare-ups of low back pain,” and was frequently described as stemming from a combination of
several potential causes, such as lumbosacral radiculopathy, myofascial pain, or muscle strain. Id.
at 90. In discussing Petitioner’s doctor’s appointments as it related to his chronic back pain in
2019, Dr. Sykes noted that Petitioner never reported any associated weakness at these visits. Id. at
91; Ex. 4 at 299–301, 321, 324–25. According to Dr. Sykes, much of what Petitioner reported to
his various treating physicians was an exacerbation of his chronic history of back pain, including
his complaints reported during his September 9, 2020, telehealth appointment. Tr. at 97–100. Dr.
Sykes thus opined that Petitioner was not suffering from GBS up through the time of his telehealth
visit on September 9, 2020—three days post-vaccination. Id. at 101.
The admitting notes from Petitioner’s ER visit to Henry Mayo on September 12, 2020,
however, suggested a different type of pain than what Petitioner previously experienced, according
to Dr. Sykes. Tr. at 102. For example, Petitioner now was describing an “inability to walk and
associated generalized weakness without any focal weakness, loss of sensation, headache, vision
changes, neck pain, or any new or changing back pain.” Id.; Ex. 3 at 69–70. When forming a
clinical GBS diagnosis, “[w]eakness is a very common manifestation of GBS, arguably the most
common symptom of GBS.” Tr. at 102. Moreover, GBS becomes a greater concern when there is
“rapid evolution and evolution of weakness that is not confined to one particular part of the body.”
Id. at 103.
Dr. Sykes further emphasized the treater notes documenting Mr. Allas’ ability to ambulate
without difficulty and being at baseline three days prior to this ER visit, and ultimately opined that
Petitioner’s “GBS developed over th[ose] three days.” Tr. at 104; Ex. 4 at 1597 (documenting
Petitioner’s admitting notes from Kaiser Emergency Department on 9/13/2020). To the extent
there was still evidence of lower back pain consistent with Petitioner’s pre-vaccination history, Dr.
Sykes proposed that it had been worsened by the GBS—overlapping with “the evolution of
weakness could either have been from inflammation of the nerve roots from GBS or from further
exacerbation of the lumbosacral radiculopathy and myofascial pain.” Tr. at 105.
To further bulwark his opinion, Dr. Sykes briefly highlighted the significance of
Petitioner’s MRI results. Tr. at 107. As he explained, “[a]bnormal contrast enhancement of the
nerve roots in the lumbar spine is a very common finding in patients with GBS” but “[t]he absence
of abnormal contrast enhancement of the nerve roots in no way argues against a diagnosis of GBS.”
Id. While Dr. Sykes acknowledged that one typically would see the presence of abnormal nerve
root enhancement if pain is present in the lower back as a result from GBS, he further noted that
“[t]here are patients who will have no other reason for having back pain other than GBS who may
not [exhibit] nerve root enhancement.” Id. at 108; see also K. Gorson et al., Prospective Evaluation
of MRI Lumbosacral Nerve Root Enhancement in Acute Guillain-Barré syndrome, 47 Neurology
813 (1996), filed as Ex. A, Tab 4 (ECF No. 31-5) (“Gorson”). Gorson found that of the fourteen
studied patients who exhibited prominent nerve root enhancement, eight individuals reported pain,
10

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 11 of 22
whereas of the ten patients with mild to no nerve root enhancement, only one individual reported
pain. Gorson at 815. However, Dr. Sykes again maintained that the presence of nerve root
enhancement on MRI and the duration of an individual’s pain is not “an absolute” for a GBS
diagnosis or lack thereof. Tr. at 109.
Finally, Dr. Sykes emphasized the presence of “no identified source of infection or
alternate etiology identified” for Petitioner’s GBS by any treating physicians, as well as no
documented upper respiratory infections or gastrointestinal infections around the time of his
symptom onset. Tr. at 111. He stressed the opinion that Petitioner’s “back pain as described [on
September 8th and 9th] appeared to be an exacerbation of his chronic low back pain, [and] not
meaningfully different from previous episodes of back pain that he experienced [due to his history
of chronic back pain].” Id. at 112. Instead, Dr. Sykes noted an “abrupt evolution of his weakness”
on September 12, 2020, when he presented to the ER at Henry Mayo Hospital, as well as the
significance of Mr. Allas’s MRI findings, which helped distinguish pain that “might be caused
from the chronic processes” such as radiculopathy or radiculitis and lumbar strain, “versus pain
that might be attributed to active nerve root inflammation from an immune response such as GBS.”
Id.
On cross examination, Dr. Sykes briefly addressed the difference between Petitioner’s
complaints discussing his chronic back pain in 2019 versus the recorded complaints post-
vaccination—maintaining that the specific terminology used to describe his previous and/or new
onset of pain is irrelevant. Tr. at 119 (discussing whether Petitioner specifically cited muscular
and joint pain in portal message on September 8, 2020). He then addressed the notion that
weakness in GBS is oftentimes progressive. Id. at 129. Relying on several items of medical
literature, Dr. Sykes argued that “[m]ost patients with GBS will [report] that evolution is often
rapid.” See N. Yuki & H. Hartung, Guillain-Barré Syndrome, 366 N Engl J. Med. 2294, 2295
(2012), filed as Ex. 14 (ECF No. 29-3) (stating that “[t]he main feature is progressive bilateral and
relatively symmetric weakness of the limbs, and the weakness progresses over a period of 12 hours
to 28 days before a plateau is reached”); H. Wilson et al., Guillain-Barré Syndrome, 388 Lancet
717, 721 (2016), filed as Ex. 15 (ECF No. 29-4) (finding “[i]n typical Guillain-Barré syndrome,
rapidly progressive bilateral weakness is the key presenting symptom in most patients”). He
concluded his testimony reiterating his opinion that Petitioner’s onset of GBS occurred when he
began experiencing progressive weakness and a difficulty to walk. Tr. at 143.
C. Respondent’s Expert – Dr. Marcello Matiello
Dr. Matiello, a neurologist, offered one written report and testified on behalf of
Respondent. See generally Tr. at 147–207; Report, June 26, 2023 (ECF No. 31-1) (“Matiello
Rep.”). Dr. Matiello opined that the onset of Petitioner’s GBS symptoms likely preceded his
receipt of the flu vaccine by one day. Id. at 13.
11

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 12 of 22
Dr. Matiello received his medical degree from the Federal University of Rio de Janeiro in
2000. Curriculum Vitae, filed as Ex. B (ECF No. 31-18) (“Matiello CV”); Tr. at 147. He then
completed residencies in Internal Medicine and Neurology at the State Hospital of the Servers in
Rio de Janeiro and the Federal Hospital of Lagoa. Tr. at 148. Thereafter, he served as a research
fellow in Multiple Sclerosis and Neuromyelitis at the Mayo Graduate School of Medicine. Matiello
CV at 1; Tr. at 148. Dr. Matiello later received a Master of Science in Clinical and Translational
Research at the Mayo Graduate School of Medicine, and completed residencies in Internal
Medicine and Neurology at Yale New Haven Hospital and Massachusetts General Hospital and
Brigham and Women’s Hospital respectively. Matiello CV at 1–2. He is currently an Assistant
Professor of Neurology at Harvard Medical School and a board-certified neurologist at
Massachusetts General Hospital and Harvard Medical School. Id. at 3; Matiello Rep. at 2.
Dr. Matiello accepted Petitioner’s GBS diagnosis as supported by the record. Tr. at 155.
He briefly explained the typical presentation of GBS and its overall effects on the body—stating
that it “affects the peripheral nerve, sometimes initially, to the large roots coming out of the spinal
cord, and very frequently patients develop pain” and “[t]hey develop weakness and sometimes
sensory symptoms.” Id. Pain is common among GBS patients, with back pain often constituting
the first presenting symptom. Id. at 161; see also D. Moulin et al., Pain in Guillain-Barré
Syndrome, 48 Neurology 328, 329 (1997), filed as Ex. A, Tab 8 (ECF No. 31-9) (approximately
89% of the studied patients experienced pain attributable to GBS at some point during the course
of their illness); L. Ruts et al., Pain in Guillain-Barré Syndrome, 75 Neurology 1439 (2010), filed
as Ex. A, Tab 9 (ECF No. 31-10) (“Ruts”) (concluding that “[p]ain was reported in the [two] weeks
preceding weakness in 36% of patients” studied). This pain, Dr. Matiello added, often could not
be ameliorated by “common analgesics”—consistent with Petitioner’s testimony that initial pain
medication he took was ineffective. Ruts at 1443; Tr. at 164.
Dr. Matiello briefly addressed the differences he discerned in the record between
Petitioner’s pre-vaccination, chronic back pain versus the pain he experienced around the time of
vaccination. Tr. at 173. Petitioner typically would not reach out to his treating providers for help
with his preexisting back pain—yet he began attempting to contact his treating physicians
regarding that pain no sooner than two days post-vaccination, suggesting to Dr. Matiello that this
new bout of pain was more intense. Id. at 173, 174. Additionally, Petitioner’s typical self-treatment
methods were proving ineffective, further supporting the conclusion that this new pain was not the
same as what he had often experienced pre-vaccination. Id. And Petitioner’s portal message to Dr.
Ramos on September 8, 2020, discussing “muscular and joint pain” and its “nagging and
persistent” character were common ways that initial symptoms from GBS would be described. Id.
at 156; Ex. 4 at 1092.
Based on the overall record, Dr. Matiello opined that Petitioner’s first presenting symptom
of GBS was his severe back pain that traveled down to both legs, but was unresponsive to a typical
pain medication regimen. Tr. at 180. The September 8th portal message and Petitioner’s
description of his pain, Dr. Matiello opined, supported the conclusion that Petitioner’s GBS onset
12

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 13 of 22
fell some time around September 5th or 6th—before, or the day of, vaccination. Tr. at 157. Such a
timeframe would be too short for vaccine-induced GBS. Id. at 180–81. Petitioner had attempted to
offer independent support for a short onset,8 but Dr. Matiello criticized the contention that some
patients could have experienced an onset within zero to 3.5 days. Id. at 178. He explained that such
a short onset is a red flag “because the immune system needs to create a response, and it creates a
response by finding a normal antigen,” which takes time. Id.; L. Schonberger et al., Guillain-Barré
Syndrome following Vaccination in the National Influenza Immunization Program, United States,
1976–1977, 110 Am. J. Epidemiology 105, 110 (1979), filed as Ex. 18 (ECF No. 29-7) (finding
“[s]eventy-one per cent of the vaccinated cases with known intervals became ill within the first
four weeks after vaccination and [fifty-two] per cent in the second and third weeks after
vaccination.”).
III. Procedural History
The matter was originally assigned to a different special master before being reassigned to
me in February 2023. Respondent had already filed his Rule 4(c) Report contesting Petitioner’s
right to compensation on October 19, 2022. See Report, dated Oct. 19, 2022 (ECF No. 18).
Thereafter, the process of obtaining expert reports began, with the final report from Dr. Sykes filed
in August 2023. The parties submitted pre-hearing submissions and a one-day Entitlement Hearing
occurred on April 24, 2024.
IV. Relevant Law
A. Petitioner’s Overall Burden in Vaccine Program Cases
To receive compensation in the Vaccine Program, a petitioner must prove either: (1) that
he suffered a “Table Injury”—i.e., an injury falling within the Vaccine Injury Table—
corresponding to one of the vaccinations in question within a statutorily prescribed period of time
or, in the alternative, (2) that his illnesses were actually caused by a vaccine (a “Non-Table
Injury”). See Sections 13(a)(1)(A), 11(c)(1), and 14(a), as amended by 42 C.F.R. § 100.3; §
11(c)(1)(C)(ii)(I); see also Moberly v. Sec’y of Health & Hum. Servs., 592 F.3d 1315, 1321 (Fed.
Cir. 2010); Capizzano v. Sec’y of Health & Hum. Servs., 440 F.3d 1317, 1320 (Fed. Cir. 2006).9
8 A. Langmuir et al., An Epidemiologic and Clinical Evaluation of Guillain-Barré Syndrome Reported in Asociation
with the Administration of Swine Influenza Vaccines, 119 Am. J. Epidemiology 841, 859 (1984), filed as Ex. 19 (ECF
No. 29-8) (allowing for 6–8 week onset of GBS following the flu vaccine, but noting that “[t]he resulting theoretical
curves starts near 0 during the first 3.5 day period after vaccination”). Dr. Sykes maintains that “[w]hen [GBS]
develops after vaccination, neurological symptoms typically occur within [six] weeks of the vaccination, usually
between weeks [one] and [three]. Sykes First Rep. at 5 (citing Langmuir).
9 Decisions of special masters (some of which I reference in this ruling) constitute persuasive but not binding authority.
Hanlon v. Sec’y of Health & Hum. Servs., 40 Fed. Cl. 625, 630 (1998). By contrast, Federal Circuit rulings concerning
legal issues are binding on special masters. Guillory v. Sec’y of Health & Hum. Servs., 59 Fed. Cl. 121, 124 (2003),
aff’d 104 F. Appx. 712 (Fed. Cir. 2004); see also Spooner v. Sec’y of Health & Hum. Servs., No. 13-159V, 2014 WL
504728, at *7 n.12 (Fed. Cl. Spec. Mstr. Jan. 16, 2014).
13

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 14 of 22
In this case, Petitioner asserts a Table claim, along with a causation claim in the alternative.
Petitioner’s Brief, dated Jan. 11, 2024 (ECF No. 36) (“Br.”) at 12.
Vaccine Program petitioners bear a “preponderance of the evidence” burden of proof.
Section 13(1)(a). That is, a petitioner must offer evidence that leads the “trier of fact to believe
that the existence of a fact is more probable than its nonexistence before [he] may find in favor of
the party who has the burden to persuade the judge of the fact’s existence.” Moberly, 592 F.3d at
1322 n.2; see also Snowbank Enter. v. United States, 6 Cl. Ct. 476, 486 (1984) (mere conjecture
or speculation is insufficient under a preponderance standard). Proof of medical certainty is not
required. Bunting v. Sec’y of Health & Hum. Servs., 931 F.2d 867, 873 (Fed. Cir. 1991). In
particular, a petitioner must demonstrate that the vaccine was “not only [the] but-for cause of the
injury but also a substantial factor in bringing about the injury.” Moberly, 592 F.3d at 1321
(quoting Shyface v. Sec’y of Health & Hum. Servs., 165 F.3d 1344, 1352–53 (Fed. Cir. 1999));
Pafford v. Sec’y of Health & Hum. Servs., 451 F.3d 1352, 1355 (Fed. Cir. 2006). A petitioner may
not receive a Vaccine Program award based solely on his assertions; rather, the petition must be
supported by either medical records or by the opinion of a competent physician. Section 13(a)(1).
In attempting to establish entitlement to a Vaccine Program award of compensation for a
Non-Table claim, a petitioner must satisfy all three of the elements established by the Federal
Circuit in Althen, 418 F.3d 1274 , 1278: “(1) a medical theory causally connecting the vaccination
and the injury; (2) a logical sequence of cause and effect showing that the vaccination was the
reason for the injury; and (3) a showing of proximate temporal relationship between vaccination
and injury.”
Each of the Althen prongs requires a different showing. Under Althen prong one, petitioners
must provide a “reputable medical theory,” demonstrating that the vaccine received can cause the
type of injury alleged. Pafford, 451 F.3d at 1355–56 (citations omitted). To satisfy this prong, a
petitioner’s theory must be based on a “sound and reliable medical or scientific explanation.”
Knudsen v. Sec’y of Health & Hum. Servs., 35 F.3d 543, 548 (Fed. Cir. 1994). Such a theory must
only be “legally probable, not medically or scientifically certain.” Id. at 549.
Petitioners may satisfy the first Althen prong without resort to medical literature,
epidemiological studies, demonstration of a specific mechanism, or a generally accepted medical
theory. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1378–79 (Fed. Cir. 2009) (citing
Capizzano, 440 F.3d at 1325–26). Special masters, despite their expertise, are not empowered by
statute to conclusively resolve what are essentially thorny scientific and medical questions, and
thus scientific evidence offered to establish Althen prong one is viewed “not through the lens of
the laboratorian, but instead from the vantage point of the Vaccine Act’s preponderant evidence
standard.” Id. at 1380. Accordingly, special masters must take care not to increase the burden
14

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 15 of 22
placed on petitioners in offering a scientific theory linking vaccine to injury. Contreras, 121 Fed.
Cl. at 245.
In discussing the evidentiary standard applicable to the first Althen prong, the Federal
Circuit has consistently rejected the contention that it can be satisfied merely by establishing the
proposed causal theory’s scientific or medical plausibility. See Kalajdzic v. Sec’y of Health &
Hum. Servs., No. 17-792V, 2022 WL 2678877 (Fed. Cl. Spec. Mstr. June 17, 2022), mot. for
review den’d, Dkt. No. 79 (Fed. Cl. Oct. 27, 2022), aff’d No. 2023-1321, 2024 WL 3064398, at
*2 (Fed. Cir. June 20, 2024) (arguments “for a less than preponderance standard” deemed “plainly
inconsistent with our precedent” (citing Moberly, 592 F.3d at 1322)); Boatmon v. Sec’y of Health
& Hum. Servs., 941 F.3d 1351, 1359 (Fed. Cir. 2019); see also Howard v. Sec'y of Health & Hum.
Servs., 2023 WL 4117370, at *4 (Fed. Cl. May 18, 2023) (“[t]he standard has been preponderance
for nearly four decades”), aff’d, 2024 WL 2873301 (Fed. Cir. June 7, 2024) (unpublished). And
petitioners always have the ultimate burden of establishing their overall Vaccine Act claim with
preponderant evidence. W.C. v. Sec’y of Health & Hum. Servs., 704 F.3d 1352, 1356 (Fed. Cir.
2013) (citations omitted); Tarsell v. United States, 133 Fed. Cl. 782, 793 (2017) (noting that
Moberly “addresses the petitioner’s overall burden of proving causation-in-fact under the Vaccine
Act” by a preponderance standard).
The second Althen prong requires proof of a logical sequence of cause and effect, usually
supported by facts derived from a petitioner’s medical records. Althen, 418 F.3d at 1278; Andreu,
569 F.3d at 1375–77; Capizzano, 440 F.3d at 1326; Grant v. Sec’y of Health & Hum. Servs., 956
F.2d 1144, 1148 (Fed. Cir. 1992). In establishing that a vaccine “did cause” injury, the opinions
and views of the injured party’s treating physicians are entitled to some weight. Andreu, 569 F.3d
at 1367; Capizzano, 440 F.3d at 1326 (“medical records and medical opinion testimony are favored
in vaccine cases, as treating physicians are likely to be in the best position to determine whether a
‘logical sequence of cause and effect show[s] that the vaccination was the reason for the injury’”)
(quoting Althen, 418 F.3d at 1280). Medical records are generally viewed as particularly
trustworthy evidence, since they are created contemporaneously with the treatment of the patient.
Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
Medical records and statements of a treating physician, however, do not per se bind the
special master to adopt the conclusions of such an individual, even if they must be considered and
carefully evaluated. Section 13(b)(1) (providing that “[a]ny such diagnosis, conclusion, judgment,
test result, report, or summary shall not be binding on the special master or court”); Snyder v. Sec’y
of Health & Hum. Servs., 88 Fed. Cl. 706, 746 n.67 (2009) (“there is nothing . . . that mandates
that the testimony of a treating physician is sacrosanct—that it must be accepted in its entirety and
cannot be rebutted”). As with expert testimony offered to establish a theory of causation, the
opinions or diagnoses of treating physicians are only as trustworthy as the reasonableness of their
suppositions or bases. The views of treating physicians should be weighed against other, contrary
evidence also present in the record—including conflicting opinions among such individuals.
15

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 16 of 22
Hibbard v. Sec’y of Health & Hum. Servs., 100 Fed. Cl. 742, 749 (2011) (not arbitrary or capricious
for special master to weigh competing treating physicians’ conclusions against each other), aff’d,
698 F.3d 1355 (Fed. Cir. 2012); Veryzer v. Sec’y of Dept. of Health & Hum. Servs., No. 06-522V,
2011 WL 1935813, at *17 (Fed. Cl. Spec. Mstr. Apr. 29, 2011), mot. for review denied, 100 Fed.
Cl. 344, 356 (2011), aff’d without opinion, 475 F. Appx. 765 (Fed. Cir. 2012).
The third Althen prong requires establishing a “proximate temporal relationship” between
the vaccination and the injury alleged. Althen, 418 F.3d at 1281. That term has been equated to the
phrase “medically-acceptable temporal relationship.” Id. A petitioner must offer “preponderant
proof that the onset of symptoms occurred within a timeframe which, given the medical
understanding of the disorder’s etiology, it is medically acceptable to infer causation.” de Bazan
v. Sec’y of Health & Hum. Servs., 539 F.3d 1347, 1352 (Fed. Cir. 2008). The explanation for what
is a medically acceptable timeframe must align with the theory of how the relevant vaccine can
cause an injury (Althen prong one’s requirement). Id. at 1352; Shapiro v. Sec’y of Health & Hum.
Servs., 101 Fed. Cl. 532, 542 (2011), recons. denied after remand, 105 Fed. Cl. 353 (2012), aff’d
mem., 503 F. Appx. 952 (Fed. Cir. 2013); Koehn v. Sec’y of Health & Hum. Servs., No. 11-355V,
2013 WL 3214877 (Fed. Cl. Spec. Mstr. May 30, 2013), mot. for rev. denied (Fed. Cl. Dec. 3,
2013), aff’d, 773 F.3d 1239 (Fed. Cir. 2014).
B. Legal Standards Governing Factual Determinations
The process for making determinations in Vaccine Program cases regarding factual issues
begins with consideration of the medical records. Section 11(c)(2). The special master is required
to consider “all [ ] relevant medical and scientific evidence contained in the record,” including
“any diagnosis, conclusion, medical judgment, or autopsy or coroner's report which is contained
in the record regarding the nature, causation, and aggravation of the petitioner's illness, disability,
injury, condition, or death,” as well as the “results of any diagnostic or evaluative test which are
contained in the record and the summaries and conclusions.” Section 13(b)(1)(A). The special
master is then required to weigh the evidence presented, including contemporaneous medical
records and testimony. See Burns v. Sec'y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir.
1993) (determining that it is within the special master's discretion to determine whether to afford
greater weight to contemporaneous medical records than to other evidence, such as oral testimony
surrounding the events in question that was given at a later date, provided that such determination
is evidenced by a rational determination).
As noted by the Federal Circuit, “[m]edical records, in general, warrant consideration as
trustworthy evidence.” Cucuras, 993 F.2d at 1528; Doe/70 v. Sec'y of Health & Hum. Servs., 95
Fed. Cl. 598, 608 (2010) (“[g]iven the inconsistencies between petitioner's testimony and his
contemporaneous medical records, the special master's decision to rely on petitioner's medical
records was rational and consistent with applicable law”), aff'd, Rickett v. Sec'y of Health & Hum.
16

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 17 of 22
Servs., 468 F. App’x 952 (Fed. Cir. 2011) (non-precedential opinion). A series of linked
propositions explains why such records deserve some weight: (i) sick people visit medical
professionals; (ii) sick people attempt to honestly report their health problems to those
professionals; and (iii) medical professionals record what they are told or observe when examining
their patients in as accurate a manner as possible, so that they are aware of enough relevant facts
to make appropriate treatment decisions. Sanchez v. Sec'y of Health & Hum. Servs., No. 11–685V,
2013 WL 1880825, at *2 (Fed. Cl. Spec. Mstr. Apr. 10, 2013); Cucuras v. Sec'y of Health & Hum.
Servs., 26 Cl. Ct. 537, 543 (1992), aff'd, 993 F.2d at 1525 (Fed. Cir. 1993) (“[i]t strains reason to
conclude that petitioners would fail to accurately report the onset of their daughter's symptoms”).
Accordingly, if the medical records are clear, consistent, and complete, then they should
be afforded substantial weight. Lowrie v. Sec'y of Health & Hum. Servs., No. 03–1585V, 2005 WL
6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). Indeed, contemporaneous medical records
are often found to be deserving of greater evidentiary weight than oral testimony—especially
where such testimony conflicts with the record evidence. Cucuras, 993 F.2d at 1528; see also
Murphy v. Sec'y of Health & Hum. Servs., 23 Cl. Ct. 726, 733 (1991), aff'd per curiam, 968 F.2d
1226 (Fed. Cir. 1992), cert. den'd, Murphy v. Sullivan, 506 U.S. 974 (1992) (citing United States
v. United States Gypsum Co., 333 U.S. 364, 396 (1947) (“[i]t has generally been held that oral
testimony which is in conflict with contemporaneous documents is entitled to little evidentiary
weight.”)).
However, the Federal Circuit has also noted that there is no formal “presumption” that
records are accurate or superior on their face to other forms of evidence. Kirby v. Sec’y of Health
& Hum. Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021). There are certainly situations in which
compelling oral or written testimony (provided in the form of an affidavit or declaration) may be
more persuasive than written records, such as where records are deemed to be incomplete or
inaccurate. Campbell v. Sec'y of Health & Hum. Servs., 69 Fed. Cl. 775, 779 (2006) (“like any
norm based upon common sense and experience, this rule should not be treated as an absolute and
must yield where the factual predicates for its application are weak or lacking”); Lowrie, 2005 WL
6117475, at *19 (“[w]ritten records which are, themselves, inconsistent, should be accorded less
deference than those which are internally consistent”) (quoting Murphy, 23 Cl. Ct. at 733)).
Ultimately, a determination regarding a witness's credibility is needed when determining the
weight that such testimony should be afforded. Andreu, 569 F.3d at 1379; Bradley v. Sec'y of
Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
When witness testimony is offered to overcome the presumption of accuracy afforded to
contemporaneous medical records, such testimony must be “consistent, clear, cogent, and
compelling.” Sanchez, 2013 WL 1880825, at *3 (citing Blutstein v. Sec'y of Health & Hum. Servs.,
No. 90–2808V, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). In determining the
accuracy and completeness of medical records, the Court of Federal Claims has listed four possible
17

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 18 of 22
explanations for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person's failure to recount to the medical professional everything that happened
during the relevant time period; (2) the medical professional's failure to document everything
reported to her or him; (3) a person's faulty recollection of the events when presenting testimony;
or (4) a person's purposeful recounting of symptoms that did not exist. La Londe v. Sec'y of Health
& Hum. Servs., 110 Fed. Cl. 184, 203–04 (2013), aff'd, 746 F.3d 1334 (Fed. Cir. 2014). In making
a determination regarding whether to afford greater weight to contemporaneous medical records
or other evidence, such as testimony at hearing, there must be evidence that this decision was the
result of a rational determination. Burns, 3 F.3d at 417.
C. Analysis of Expert Testimony
Establishing a sound and reliable medical theory often requires a petitioner to present
expert testimony in support of his claim. Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357,
1361 (Fed. Cir. 2000). Vaccine Program expert testimony is usually evaluated according to the
factors for analyzing scientific reliability set forth in Daubert v. Merrell Dow Pharm., Inc., 509
U.S. 579, 594–96 (1993). See Cedillo v. Sec’y of Health & Hum. Servs., 617 F.3d 1328, 1339 (Fed.
Cir. 2010) (citing Terran v. Sec’y of Health & Hum. Servs., 195 F.3d 1302, 1316 (Fed. Cir. 1999).
Under Daubert, the factors for analyzing the reliability of testimony are:
(1) whether a theory or technique can be (and has been) tested; (2) whether the
theory or technique has been subjected to peer review and publication; (3) whether
there is a known or potential rate of error and whether there are standards for
controlling the error; and (4) whether the theory or technique enjoys general
acceptance within a relevant scientific community.
Terran, 195 F.3d at 1316 n.2 (citing Daubert, 509 U.S. at 592–95).
In the Vaccine Program the Daubert factors play a slightly different role than they do when
applied in other federal judicial settings, like the district courts. Typically, Daubert factors are
employed by judges (in the performance of their evidentiary gatekeeper roles) to exclude evidence
that is unreliable or could confuse a jury. By contrast, in Vaccine Program cases these factors are
used in the weighing of the reliability of scientific evidence proffered. Davis v. Sec'y of Health &
Hum. Servs., 94 Fed. Cl. 53, 66–67 (2010) (“uniquely in this Circuit, the Daubert factors have
been employed also as an acceptable evidentiary-gauging tool with respect to persuasiveness of
expert testimony already admitted”). The flexible use of the Daubert factors to evaluate the
persuasiveness and reliability of expert testimony has routinely been upheld. See, e.g., Snyder, 88
Fed. Cl. at 742–45. In this matter (as in numerous other Vaccine Program cases), Daubert has not
been employed at the threshold, to determine what evidence should be admitted, but instead to
determine whether expert testimony offered is reliable and/or persuasive.
18

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 19 of 22
Respondent frequently offers one or more experts in order to rebut a petitioner’s case.
Where both sides offer expert testimony, a special master's decision may be “based on the
credibility of the experts and the relative persuasiveness of their competing theories.”
Broekelschen v. Sec'y of Health & Hum. Servs., 618 F.3d 1339, 1347 (Fed. Cir. 2010) (citing
Lampe, 219 F.3d at 1362). However, nothing requires the acceptance of an expert's conclusion
“connected to existing data only by the ipse dixit of the expert,” especially if “there is simply too
great an analytical gap between the data and the opinion proffered.” Snyder, 88 Fed. Cl. at 743
(quoting Gen. Elec. Co. v. Joiner, 522 U.S. 146 (1997)); see also Isaac v. Sec'y of Health & Hum.
Servs., No. 08–601V, 2012 WL 3609993, at *17 (Fed. Cl. Spec. Mstr. July 30, 2012), mot. for
review den'd, 108 Fed. Cl. 743 (2013), aff'd, 540 F. App’x. 999 (Fed. Cir. 2013) (citing Cedillo,
617 F.3d at 1339). Weighing the relative persuasiveness of competing expert testimony, based on
a particular expert's credibility, is part of the overall reliability analysis to which special masters
must subject expert testimony in Vaccine Program cases. Moberly, 592 F.3d at 1325–26
(“[a]ssessments as to the reliability of expert testimony often turn on credibility determinations”);
see also Porter v. Sec'y of Health & Hum. Servs., 663 F.3d 1242, 1250 (Fed. Cir. 2011) (“this court
has unambiguously explained that special masters are expected to consider the credibility of expert
witnesses in evaluating petitions for compensation under the Vaccine Act”).
D. Consideration of Medical Literature
Both parties filed numerous items of medical and scientific literature in this case, but not
all such items factor into the outcome of this decision. While I have reviewed all the medical
literature submitted in this case, I discuss only those articles that are most relevant to my
determination and/or are central to Petitioner’s case—just as I have not exhaustively discussed
every individual medical record filed. Moriarty v. Sec’y of Health & Hum. Servs., No. 2015–5072,
2016 WL 1358616, at *5 (Fed. Cir. Apr. 6, 2016) (“[w]e generally presume that a special master
considered the relevant record evidence even though he does not explicitly reference such evidence
in his decision”) (citation omitted); see also Paterek v. Sec’y of Health & Hum. Servs., 527 F.
App’x 875, 884 (Fed. Cir. 2013) (“[f]inding certain information not relevant does not lead to—
and likely undermines—the conclusion that it was not considered”).
ANALYSIS
For cases alleging the Table claim of GBS after receipt of the flu vaccine, a petitioner must
establish onset of GBS symptoms within 3–42 days of vaccination. 42 C.F.R. § 100.3. In the
Vaccine Program, it does not matter whether a particular condition’s diagnosis would have been
possible at onset, nor is it relevant whether the claimant knew or understood an initial symptom to
reflect the subsequently-diagnosed illness. Caron ex rel. Carson v. Sec’y of Health & Hum. Servs.,
727 F.3d 1365, 1369 (Fed. Cir. 2013) (citing Markovich v. Sec’y of Health & Hum. Servs., 477
19

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 20 of 22
F.ed 1353 (Fed. Cir. 2007) (holding that “[a] symptom may be indicative of a variety of conditions
or ailments, and it may be difficult for lay persons to appreciate the medical significance of a
symptom with regard to a particular injury” whereas “[a] manifestation of onset is more self-
evident of an injury and may include significant symptoms that clearly evidence an injury”). Table
claims are properly dismissed for an inability to satisfy onset, even though onset may fall just
outside the period defined for the injury. Orton v. Sec’y of Health & Human Servs., No. 13-631V,
2015 WL 1275459 (Fed. Cl. Spec. Mstr. Feb. 23, 2015) (dismissing claim with a one-day onset of
GBS following flu vaccine).
Petitioner argues that the onset of his GBS occurred no sooner than three days post-
vaccination, when he first began to experience weakness on September 9, 2020. Br. at 5.
Complaints of back pain prior to this date, he argues, reflected his well-documented prior back
pain. Ex. 25 at 3 (evidencing Petitioner’s previous use of a back brace, over-the-counter pain
medications, PT, and acupuncture to aid his back pain). These medical issues were distinguishable
from what came after, such as his new experience of having difficulty walking. Ex. 25 at 4; see
also Ex. 3 at 46, 69 (complaining of bilateral lower extremity weakness and an inability to walk at
9/12/2020 ED visit); Ex. 4 at 1597, 1602 (reporting being at “baseline 3 days ago” and “able to
ambulate without difficulty” at 9/13/2020 visit to Kaiser ED); Ex. 4 at 1737 (summarizing
Petitioner’s hospital stay as having “a history of chronic low back pain, a right total knee
arthroplasty, and presented with ‘acute onset right > left weakness and numbness’”). And to the
extent mere back pain that pre-dated vaccination later worsened, that was part of the GBS process.
Ex. 13 at 4.
Respondent, by contrast, maintains that Petitioner’s medical records reflect an onset of
September 5, 2020—one day prior to Petitioner’s receipt of the subject vaccination. Petitioner’s
first post-vaccination record was from September 8th, but it notes a three-day history of back pain
issues. Ex. 4 at 1092. In addition, Dr. Ramos had documented two separate diagnoses during
Petitioner’s September 9, 2020 visit—“chronic low back pain >3 months” plus “back pain”—
suggesting Petitioner might be experiencing an additional form of pain distinguishable from what
he had experienced in the past, and different enough to lead him to seek professional help rather
than treat it with self-care. Ex. 4 at 321 (describing pain that radiated from Petitioner’s “right lower
back to the right lateral thing to the knee”); id. at 1092, 1096, 1597 (reporting pain that traveled or
“shot down” to both of Petitioner’s legs). Moreover, Petitioner’s reporting of worsening lower
back pain, within days, strongly correlates with rapidly progressive GBS symptoms.
In Respondent’s view, Dr. Sykes has not shown that Petitioner’s pre-existing issues could
be differentiated from his GBS-related complaints, whereas Dr. Matiello established the continuity
of these issues as all GBS-related. Respondent also notes one exam abnormality inconsistent with
Petitioner’s three-day onset: the fact that Petitioner’s protein levels (as measured by CSF testing)
were high by September 12–13th— a time when such findings are not commonly seen so early in
20

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 21 of 22
the course of an individual’s GBS. Respondent’s Opposition, dated Feb. 12, 2024 (ECF No. 37)
(“Opp.”) at 21–22; H. Hegen et al., Cerebrospinal Fluid Protein in Guillain-Barré syndrome: Need
for Age-Dependent Interpretation, 28 Eur. J. Neurol. 965 (2021), filed as Ex. A, Tab 15 (ECF No.
31-16) (finding age-adjusted elevated CSF total protein in 32%, 53%, 65%, and 64% at 0-3, 4-7,8-
14, and >14 days after disease onset, respectively); A. Wong et al., Cytoalbuminologic
Dissociation in Asian Patients with Guillain-Barré and Miller Fisher syndromes, 20 J. Peripheral
Nervous System 47 (2015), filed as Ex. A, Tab 16 (ECF No. 31-17) (studying 507 patients with
GBS and finding only 31–50% of patients who received a lumbar puncture within three days from
symptom onset exhibited elevated CFS protein).
Overall, the record preponderates (if barely) in favor of the finding that Petitioner’s onset
did fall within the Table timeframe—meaning his GBS likely began no sooner than September 9th
(and more likely the 10th). I base this determination on several factors. In particular, a combination
of the record and the credible and consistent testimony of the four fact witnesses all suggest that
whatever back pain Petitioner had been experiencing around the time of vaccination was consistent
with what he had previously experienced, and mild as well—enough to allow him to play tennis
the day of vaccination, even if he later took the somewhat unusual precaution (for him) to report
the pain to treaters. Thus, this pain could be distinguished from the other symptoms Petitioner later
experienced—weakness and sudden difficulties walking. The evidence therefore preponderates
against the conclusion that the pain Petitioner reported within two days of vaccination was a
presenting symptom of his later-diagnosed GBS.
Respondent made a number of persuasive points in opposition, but they were not sufficient
to rebut Petitioner’s showing. For example, it was reasonable to conclude, based on the records
alone, that Petitioner’s pain concerns spanning the date of vaccination were logically part of what
came later. But it is black-letter Program law that many post-vaccination injuries cannot
reasonably be said to have been vaccine-caused despite their literal “coincidence.” The same is
true of seemingly-related pre-vaccination symptoms, which could also be coincidental to the
subsequent onset of a vaccine-caused injury. Here, I find just that to be the case: the pre-
vaccination back pain issues complained of on September 8th can be deemed independent of
Petitioner’s GBS, even though they occurred close-in-time temporally.
Respondent also made a fair argument about CSF testing and its relationship to GBS’s
course. Dr. Matiello credibly argued that “abnormalities in Mr. Allas’ CSF findings are rarely
present early in his disease course, [ ] suggesting that the onset of Mr. Allas’ disease could have
been before the vaccine.” Opp. at 21–22; Matiello Rep. at 13. This is because even though “[t]he
spinal fluid albuminocytologic dissociation” is consistent with a diagnosis of GBS, it usually
would not be evident so early in the disease course (meaning that the period of September 9 to 12
or 13, 2020, was too short for such test results to manifest). Matiello Rep. at 10. However, on
cross-examination, Dr. Matiello hedged from this position somewhat, testifying that he would
21

Case 1:21-vv-02215-UNJ Document 49 Filed 11/05/24 Page 22 of 22
accept the legitimacy of a GBS diagnosis even if supported by evidence of elevated CSF protein
levels from within three days of symptom onset—further noting while “[i]t can rule in [a
diagnosis], [ ] a normal CSF would [also] not rule [one] out.” Tr. at 187.
At bottom, the onset dispute presents the quintessential “close case”—and under such
circumstances the Program consistently counsels special masters to decide the matter in the
claimant’s favor. Capizzano, 440 F.3d at 1326 (holding that close calls regarding causation are
resolved in favor of injured claimants, based on the system Congress created). I also reiterate that
this is not a claim where some other obvious factor, like an intercurrent infection, suggests an
alternative cause/“factor unrelated” that could have been causal. White v. Sec’y of Health & Hum.
Servs., No. 20-1319V, 2023 WL 4204568, at *15–16 (Fed. Cl. Spec. Mstr. June 2, 2023), mot. for
review den’d, 168 Fed. Cl. 660 (2023), appeal docketed, No. 2024-1372 (Fed. Cir. Jan. 23, 2024).
Otherwise, the remaining Table elements specific to a flu vaccine-GBS claim are met. The
GBS diagnosis is not contested, nor is Petitioner’s receipt of the covered version of the flu vaccine.
And Petitioner also established more than six months of disease severity, even though his GBS
overall was mild in nature.
CONCLUSION
Petitioner has established entitlement to a damages award. It is my initial sense that
damages should not be difficult to calculate—Petitioner’s insurance likely has covered most if not
all of his out-of-pocket expenses; his course was (thankfully) limited and mostly mild, with a short
in-patient experience, and no current treatment or obvious lingering symptoms; and his status as a
retiree suggests no lost wage claim would be tenable. Accordingly, the parties shall contact
chambers within one week of the issuance of this Ruling to set a status conference for resolving
damages as expeditiously as possible.
IT IS SO ORDERED.
/s/ Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
22

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_21-vv-02215-1
Date issued/filed: 2025-04-28
Pages: 9
Docket text: PUBLIC DECISION (Originally filed: 03/25/2025) regarding 56 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (mva) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 1 of 9
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-2215V
* * * * * * * * * * * * * * * * * * * * * * * * *
ROMEO ALLAS, * Chief Special Master Corcoran
*
Petitioner, * Filed: March 25, 2025
*
v. *
*
SECRETARY OF HEALTH AND *
HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Jeffrey S. Pop, Jeffrey S. Pop & Assoc., Beverly Hills, CA, for Petitioner.
Rachelle P. Bishop, U.S. Dep’t of Justice, Washington, DC, for Respondent.
DAMAGES DECISION1
On November 24, 2021, Romeo Allas filed a petition for compensation under the National
Vaccine Injury Compensation Program (the “Vaccine Program”). 2 Petitioner alleged his receipt
of an influenza (“flu”) vaccine on September 6, 2020, caused him to suffer Guillain-Barré
syndrome (“GBS”). Petition (ECF No. 1) at 1. An entitlement hearing in the matter was held in
Washington, D.C. on April 24, 2024, and I thereafter ruled in Petitioner’s favor. See Ruling on
Entitlement, filed Oct. 9, 2024 (ECF No. 48) (“Entitlement Ruling”).
The parties subsequently endeavored to resolve damages, but could not do so. They have
instead submitted their dispute to me for resolution. See Petitioner’s Brief, filed Jan. 8, 2025 (ECF
No. 53) (“Br.”); Respondent’s Opposition, filed Jan. 22, 2025 (ECF No. 54) (“Opp.”); Petitioner’s
Reply, filed Jan. 28, 2025 (ECF No. 55) (“Reply”).
1
Under Vaccine Rule 18(b), each party has fourteen (14) days within which to request redaction “of any information
furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or
confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly
unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the whole Decision will be available to the public
in its present form. Id.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660,
100 Stat. 3758, codified as amended at 42 U.S.C. §§ 300aa-10 through 34 (2012) [hereinafter “Vaccine Act” or “the
Act”]. Individual section references hereafter will be to § 300aa of the Act (but will omit that statutory prefix).

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 2 of 9
For the reasons set forth in greater detail below, I find that Petitioner is entitled to an
award of damages in the amount of $165,000.00 for actual pain and suffering.
I. Factual Background
A more complete summary of the relevant medical history and factual background is
contained in my entitlement determination. See generally Entitlement Ruling at 2–5. I incorporate
that history herein.
In short, on September 6, 2020, Petitioner (then 75-years-old) received the subject flu
vaccine. Ex. 2 at 2. Three days later (the late evening of September 12, 2020), he went to the Henry
Mayo Newall Hospital emergency department (“ED”), complaining of a sudden inability to walk.
Ex. 3 at 69, 70, 74. Physical and neurologic exams were normal, although treaters did not test
Petitioner’s reflexes at this time. Id. at 71. Petitioner was subsequently transferred to Kaiser
Permanente’s Panorama City Hospital for further evaluation and monitoring due to his inability to
walk, reported generalized weakness, and “indeterminate troponin with multiple cardiac risk
factors.” Id. at 74. Once there, Petitioner reported “3 days of lower extremity weakness and back
pain,” multiple instances where he ha[d] nearly fallen,” “worsening lower back pain,” and that he
“was unable to walk with his walker.” Ex. 4 at 1597.
Upon examination, Petitioner demonstrated diffuse lower lumber tenderness, mild midline
tenderness of the spine, a swollen right knee, 2/5 lower extremity strength at hip flexion, 4/5
strength at plantar and dorsiflexion, reflexes 1+ bilaterally at knee, and an inability to take more
than three steps with his walker. Ex. 4 at 1602. Petitioner underwent a lumbar puncture (revealing
a high cerebrospinal fluid protein level, normal white blood cell count, glucose of 169) and an
MRI of the lumbar spine (demonstrating no spinal cord compression). Id. at 1608, 1622, 1624,
1655.
Petitioner had an inpatient neurology consultation with Saien Lai, M.D. on September 13,
2020. Id. at 1654. On exam, Petitioner exhibited hip flexor strength deficits, although no baseline
could be determined. Id. at 1659. His brain MRI showed mild chronic white matter ischemic
changes and no evidence of acute infarction, while his lumbar spine MRI showed multilevel
degenerative changes. Id. at 1214–15. Dr. Lai opined that Petitioner’s “history of intermittent
headache and acute lower back pain with right [greater than] left leg weakness, together with exam
finding[s] of isolated right quad weakness and described [bilateral] lower extremity reflexes, [and]
normal spinal imaging” might suggest [GBS].” Ex. 4 at 1214–15. The next day (September 14,
2020), neurologist Matthew Christopher, M.D., diagnosed Petitioner with GBS and “weakness of
right leg”—noting further that Petitioner had an “acute onset [of right greater than left] lower
extremity weakness and mild numbness on gross examination following flu shot.” Id. at 1711.
Dr. Lai started Petitioner on a four-day course of IVIG, and he also received inpatient
2

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 3 of 9
physical therapy (“PT”) through September 18, 2020. Ex. 4 at 1731–1852. At this time Petitioner
began to demonstrate improved balance, endurance, strength, and stability. Id. at 1849–52. Prior
to his discharge later that day, Petitioner underwent an EMG and NCS, which showed “[d]ecreased
recruitment of motor unit on right L3-L5 myotomes” consistent with GBS, as well as
“[s]uperimposed moderate to severe right median neuropathy at [the] wrist.” Id. at 1209. Petitioner
was subsequently discharged for home PT, having declined admission to a skilled nursing facility.
Id.
Three days following his discharge, Petitioner had a telehealth appointment with his
primary care provided, reporting that he could not walk and had been experiencing severe pain.
Ex. 4 at 1125, 1134. He participated in twenty-seven additional sessions of PT and thirteen sessions
of occupational therapy over the course of the next five to six months, and by late-October 2020
was experiencing some improvement in performing daily tasks, but remained unable to walk
independently. Id. at 1207; see generally Ex. 5 (documenting PT and OT appointments). Petitioner
was discharged from PT on March 6, 2021, and noted to have “made increasing gains in regard[]
to transfers, ambulation, and musculoskeletal strength.” Ex. 5 at 395. By October 2021, Petitioner
reported that his strength and overall condition had returned to baseline and that he no longer
required assistance when walking, although he took care in that regard and employed a cane for
safety purposes. Ex. 7 at 78.
II. Parties’ Arguments
The sole damages component in dispute is actual pain and suffering (Petitioner requests no
reimbursement for any out-of-pocket medical expenses). Petitioner seeks $175,000.00, while
Respondent argues for the lesser sum of $100,000.00.
Petitioner
Petitioner notes that he experienced a moderate GBS injury that resulted in “being
bedridden for a couple of months and homebound throughout the duration of his home health
services.” Br. at 7. Over the course of his six-day hospitalization, Petitioner underwent four IVIG
treatments, extensive diagnostic testing (i.e., MRIs, an EMG/NCV study, and a lumbar puncture),
and approximately five months of extensive home health services consisting of PT and OT. Id. at
12; see also Ex. 5. Moreover, because Petitioner spent the first couple of months post-
hospitalization bedridden, he relied heavily of his family for help. Br. at 9, 10.
To support his proposed demand, Petitioner offers several cases he deems comparable,
where claimants received pain and suffering awards ranging from $165,000.00 to $180,000.00.
Gruba v. Sec’y of Health & Hum. Servs., No. 19-1157V, 2021 WL 1925630 (Fed. Cl. Spec. Mstr.
Apr. 13, 2021); McCray v. Sec’y of Health & Hum. Servs., No. 19-277V, 2021 WL 4618549 (Fed.
Cl. Spec. Mstr. Aug. 31, 2021); Enstrom v. Sec’y of Health & Hum. Servs., No. 20-2020V, 2023
WL 345657 (Fed. Cl. Spec. Mstr. Jan. 20, 2023). The Gruba petitioner, for example, suffered a
3

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 4 of 9
moderately severe case of GBS—requiring a ten-day hospitalization with a three-day course of
IVIG; a nine-day stay in an inpatient rehabilitation facility; seventeen PT sessions; and several
diagnostic tests such as an EMG and lumbar puncture. Gruba, 2021 WL 1925630 at *4. That
claimant received $165,000.00 in actual pain and suffering. Id. McCray resulted in an award of
$180,000.00 for actual/past pain and suffering, and involved a “moderate to serious” case of GBS.
McCray, 2021 WL 4618549, at *4. That petitioner’s treatment included an approximate two-week
hospitalization, IVIG therapy, an eighteen-day admission to a rehabilitation facility for PT and
OT, followed by PT and OT for one month via home health services. Id. at *2. Lastly, the Enstrom
decision awarded $170,000.00 for actual pain and suffering and involved “a moderate course” of
GBS that required a six-day hospitalization, a six-day admission to a rehabilitation hospital, a five-
day course of IVIG, and sixteen outpatient PT sessions. Enstrom, 2023 WL 345657, at *6.
Petitioner suggests that his injuries are consistent with those prior petitioners, noting that
they all made “relatively significant recoveries” from GBS despite some continued residual
symptoms. Br. at 18. However, Petitioner maintains that his case was also “more severe,” as
illustrated by his “inability to stand for six-weeks post-discharge” as well as his “inability to walk
at all for two months post-discharge.” Id. Moreover, Petitioner’s overall treatment included
significantly more home health services and therapy sessions than that of the other petitioners. Id.
Respondent
Respondent argues for a lesser award of $100,000.00. Opp. at 10. He maintains that
Petitioner suffered a “mostly mild injury in severity and duration”—spending only one night in
the ED and five days in the hospital, receiving four IVIG treatments, and undergoing six months
of PT and OT home services (completing twenty-seven PT sessions and thirteen OT sessions). Id.
at 12. He further emphasizes that Petitioner did not require neuropathic pain medications or
interventions such as feeding tubes, breathing tubes, or catheterization; suffered no respiratory
problems; and approximately eleven months after his GBS onset, Petitioner reported that he was
at his baseline and gaining strength. Id.; see also Ex. 7 at 78. Moreover, Respondent argues that
Petitioner’s non-vaccine-related comorbidities (i.e., periodic severe back pain which was
aggravated by ADLs, knee surgery, and gradual worsening bilateral knee pain) should not be
considered when determining the appropriate pain and suffering damages award. Opp. at 12, 13.
Respondent contends that the facts and circumstances herein are distinguishable from the
comparable cases cited in Petitioner’s brief. Opp. at 13. He offers four cases of mild-to-moderate
GBS injuries with pain and suffering awards ranging from $92,500.00 to $135,000.00. Id.;
Geschwindner v. Sec’y of Health & Hum. Servs., No. 17-1558V, 2022 WL 177372 (Fed. Cl. Spec.
Mstr. Jan. 28, 2022) (awarding $92,500.00); Castellanos v. Sec’y of Health & Hum. Servs., No.
19-1710V, 2022 WL 1482497, at *3 (Fed. Cl. Spec. Mstr. Mar. 30, 2022); Shankar v. Sec’y of
Health & Hum. Servs., No. 19-138V, 2022 WL 2196407 (Fed. Cl. Spec. Mstr. May 5, 2022);
Granville v. Sec’y of Health & Hum. Servs., No. 21-2098V, 2023 WL 6441388, at *1–2 (Fed. Cl.
Spec. Mstr. Aug. 30, 2023).
4

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 5 of 9
In Geschwindner, for example, the petitioner suffered a mild GBS injury featuring a three-
day hospitalization, oral prednisone, MRIs, EMG/NCV testing, and eight outpatient physical
therapy sessions. Geschwindner, 2022 WL 177372, at *1–3. The Geschwindner petitioner did not
undergo any IVIG treatment but continued seeking treatment from a neurologist for approximately
eight months post-vaccination. Id. The Castellanos decision awarded $125,000.00 for actual pain
and suffering to a petitioner who required a nine-day hospitalization, five IVIG treatments, thirty-
one days of inpatient rehabilitation, twenty-one outpatient PT sessions, and reported being able to
walk without an assistive device approximately five months after onset. Castellanos, 2022 WL
1482497, at *10. The petitioner in Shankar required approximately two weeks of hospitalization
inpatient rehabilitation, seven IVIG treatments, attended PT and OT over the course of several
months, experienced GBS symptoms for a minimum of one year, and was awarded $135,000.00
for her actual pain and suffering. Shankar, 2022 WL 2196407, at *5, 6. Finally, Granville awarded
$92,500.00 in actual pain and suffering and involved a mild GBS injury that required a five-day
hospitalization, five IVIG treatments, six PT sessions, one OT evaluation, as well as a lumbar
puncture. Granville, 2023 WL 6441388, at *4.
III. Relevant Law
A. General Principles in Calculating a Pain and Suffering Award
Compensation awarded pursuant to the Vaccine Act shall include “[f]or actual and
projected pain and suffering and emotional distress from the vaccine-related injury, and award not
to exceed $250,000.00.” Section 15(a)(4). There is no mathematic formular for assigning a
monetary value to a person’s pain and suffering and emotional distress. I.D. v. Sec’y of Health &
Hum. Servs., No. 04-1593V, 2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013)
(“[a]wards for emotional distress are inherently subjective and cannot be determined by using a
mathematical formula”); Stansfield v. Sec’y of Health & Hum. Servs., No. 93-0172V, 1996 WL
300594, at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the assessment of pain and suffering is
inherently a subjective evaluation”).
Factors to be considered when determining an award for pain and suffering include: 1)
awareness of the injury; 2) severity of the injury; and 3) duration of the suffering. I.D., 2013 WL
2448125, at *9 (citing McAllister v. Sec’y of Health & Hum. Servs., No. 91-1037V, 1993 WL
777030, at *3 (Fed. Cir. 1995)). I may also consider prior pain and suffering awards to aid my
resolution of the appropriate amount of compensation for pain and suffering in this case. See, e.g.,
Doe 34 v. Sec’y of Health & Hum. Servs., 87 Fed. Cl. 758, 768 (2009) (finding that “there is
nothing improper in the chief special master’s decision to refer to damages for pain and suffering
awarded in other cases as an aid in determining the proper amount of damages in this case.”). And
of course, I may rely on my own experience adjudicating similar claims. Hodges v. Sec’y of Health
& Hum. Servs., 9 F.3d 958, 961 (Fed. Cir. 1993) (noting that Congress contemplated that the
special masters would use their accumulated expertise in the field of vaccine injuries to judge the
merits of individual claims.
5

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 6 of 9
Although pain and suffering in the past was often determined based on a continuum, as
Respondent argues, that practice was cast into doubt by a decision from several years ago. Graves
v. Sec’y of Health & Hum. Servs., 109 Fed. Cl. 579 (Fed. Cl. 2013). Graves maintained that to do
so resulted in “the forcing of all suffering awards into a global comparative scale in which the
individual petitioner’s suffering is compared to the most extreme cases and reduced accordingly.”
Id. at 590. Instead, Graves assessed pain and suffering by looking to the record evidence, prior
pain and suffering awards within the Vaccine Program. Id. at 595. Under this alternative approach,
the statutory cap merely cuts off higher pain and suffering awards—it does not shrink the
magnitude of all possible awards as falling within a spectrum that ends at the cap. Although Graves
is not controlling of the outcome in this case, it provides reasoned guidance in calculating pain and
suffering awards.
B. Pain and Suffering Awards in GBS Cases
Table claims alleging GBS after receipt of the flu vaccine are common in the “special
processing unit” (“SPU”)—the process used by OSM for resolving matters it reasonably
anticipates are amenable to fast resolution or settlement. I therefore include herein some discussion
of the kinds of pain and suffering awards obtained in such cases.
As of July 1, 2024, on nearly every occasion that SPU has had to resolve the appropriate
award for GBS pain and suffering (49 cases), over $100,000.00 has been awarded in every case
but one (and there only the slightly lesser sum of $92,500.00 was awarded). The first-quartile value
is $155,000.00, the median is $165,000.00, the third-quartile value is $178,000.00, and the largest
award was $192,500.00. Holmberg v. Sec’y of Health & Hum. Servs., No. 21-1132V, 2024 WL
4607929, at *3–5 (Fed. Cl. Spec. Mstr. Oct. 7, 2024).
A consistent starting consideration in reaching these determinations is that “GBS pain and
suffering awards generally should be higher than those awarded to petitioners who have suffered
a less frightening and physically alarming injury, such as SIRVA.”3 Gross v. Sec’y of Health &
Hum. Servs., No. 19-0835V, 2021 WL 2666685, at *5 (Fed. Cl. Spec. Mstr. Mar. 11, 2021); see
also Castellanos, 2022 WL 1482497, at *10 (emphasizing recognition of “the seriousness of GBS
as a general matter,” in awarding a six-figure sum); Voeller v. Sec’y of Health & Hum. Servs., No.
20-1526V, 2023 WL 5019830, at *10 (Fed. Cl. Spec. Mstr. July 6, 2023) (noting GBS’s
“frightening” nature).
But not every GBS case is equally severe. Further details of the initial medical course are
considered—including any mistake or delay in diagnosing GBS; any in-patient hospitalization
and/or in-patient rehabilitation (and the duration of any such stays); diagnostic procedures (e.g.,
bloodwork, lumbar punctures, electrodiagnostic studies, imaging); the severity of symptoms at
their nadir (e.g., involving incontinence or respiratory failure); the extent and effectiveness of
3 Shoulder injury related to vaccine administration (“SIRVA”) is another Table injury. 42 C.F.R. §§ 100.3(a), (c)(10).
6

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 7 of 9
treatment (e.g., IVIg plasmapheresis, pain medications); other interventions (e.g., feeding tubes,
breathing tubes, catheterization); and any complications (e.g., sepsis during hospitalization).
Also relevant is a petitioner’s long-term course—as evidenced by out-patient therapies,
neurology evaluation, and other medical appointments concerning GBS; the results of repeat
electrodiagnostic studies and other relevant tests; medical providers’ assessments of the degree of
recovery achieved; ongoing reliance on assistive devices and medications; and relevant treatment
gaps. Previous opinions have recognized that “a substantial recovery does not mean that [an
individual] has fully recovered from his GBS and has no ongoing sequela. It is common for
petitioners to experience ongoing symptoms of GBS, such as numbness and fatigue, even with a
good recovery.” Elenteny v. Sec’y of Health & Hum. Servs., No. 19-1972V, 2023 WL 2447498, at
*5 (Fed. Cl. Spec. Mstr. Mar. 10, 2023). But symptoms of that nature are typically folded into a
“typical” past pain and suffering award, and will not justify a future component. See, e.g., id.;
Miller v. Sec’y of Health & Hum. Servs., No. 21-1559V, 2023 WL 2474322, at *8 (Fed. Cl. Spec.
Mstr. Feb. 10, 2023).
“The mere fact that a claimant had pre-vaccination comorbidities does not per se diminish
the impact of [the vaccine injury] on his life—especially one as alarming and potentially life-
altering as GBS—and therefore is not alone reason for a lower award.” Bircheat v. Sec’y of Health
& Hum. Servs., No. 19-1088V, 2021 WL 3026880, at *4 (Fed. Cl. Spec. Mstr. June 16, 2021).
However, a special master is statutorily required to consider to what extent a petitioner’s pain and
suffering is truly “from the vaccine-related injury,” Section 15(a)(4) (emphasis added), and nor
from any unrelated preexisting or subsequently-developed medical issues. See, e.g., Bircheat, 2021
WL 3026880, at *4; Gross, 2021 WL 2666685, at *5.
Finally, the injury’s impact on a petitioner’s personal circumstances, including his or her
family and other personal obligations, and professional life (whether or not lost wages are directly
claimed), is properly taken into account as well. All of these factors are primarily gleaned from
the medical records—although sworn statements and/or other evidence may also be considered,
especially if they supplement, and do not contradict, the facts reflected in the medical records.
ANALYSIS
In this case, awareness of the injury is not disputed. The record reflects that at all times,
Petitioner was a competent adult with no impairments that would impact his awareness of his
injury. Therefore, I analyze principally the severity and duration of Petitioner’s injury. In
performing this analysis, I have reviewed the record as a whole, including the medical records,
affidavits, and all assertions made by the parties in written documents and at hearing. I have also
considered prior awards for pain and suffering issued in comparable cases, although I ultimately
base my determination on the circumstances of this case.
7

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 8 of 9
The record shows that Petitioner, a retiree with a history of chronic back pain, presented
on September 12, 2020 (three days post-vaccination), to the emergency department with a three-
day history of lower extremity weakness and back pain. Ex. 4 at 1597. After being transferred to
a different facility later that evening, Petitioner was hospitalized for five-days and diagnosed with
GBS after undergoing extensive testing, including a lumbar puncture, and an EMG/NCV study.
Id. at 1208, 1655. In addition, Petitioner received four rounds of IVIG infusions. Id. at 1721–22.
Petitioner was discharged on September 18, 2020, with a discharge summary that repeated the
diagnosis of GBS “leading to weakness of [the] right leg suspected post flu vaccine,” as well as
hyponatremia from mild syndrome of inappropriate secretion of antidiuretic hormone, for which
he was to take salt tablets. Id. at 1209.
The record further indicates that Petitioner was discharged home due to his inability to
“tolerate the [three] hours of daily therapy required for the inpatient acute rehabilitation level of
care” and for “fear of contracting Covid at a long-term care facility.” Id. at 1636, 1640; Br. at 3.
Thus, from September 23, 2020 to March 6, 2021, Petitioner participated in twenty-seven PT
sessions and thirteen OT sessions through Pegasus Home Health to aid with his GBS recovery.
See generally Ex. 5. Three months post-hospitalization, Petitioner slept in a rented hospital bed in
his downstairs living room as he was unable to go upstairs during this time. Br. 11, 18. Petitioner
could stand at six-weeks following his discharge and started walking with an assistive device two
months post-hospitalization; however, he still requires the use of a cane when walking long
distances. Id. at 13, 18. During the course of his home health treatment, Petitioner remained
homebound and required a significant amount of support from his family. Br. at 9–10.
Based on the foregoing, and considering the parties’ written arguments, I find that
Petitioner suffered a moderately severe GBS injury—although as a class, GBS injuries are
distinguishable from many other kinds of more discrete or mechanical Program vaccine injuries.
Gross, 2021 WL 2666685, at *5. Under such circumstances, I find the severity of duration of
Petitioner’s GBS symptoms warrant a significant pain and suffering award, but one that is on the
lower end of the spectrum requested by Petitioner.
I equally find that Respondent’s recommendation of $100,000.00 is too modest and does
not give sufficient credence to the seriousness of GBS as a general matter, or to the facts of this
specific case. Moreover, it also is wholly unsupported by his cited comparable decisions, unlike
Petitioner’s proposed figure. Respondent merely argues that because Petitioner’s symptoms,
hospitalization, treatment course for his GBS was somewhat less severe than the petitioners in
prior relevant cases, and the fact that “he was unburdened by work, caretaking responsibilities, or
external stressors,” that a lower damages award is warranted. See Opp. at 16. While this may be
true in part—it is not an adequate defense to Respondent’s preferred figure.
8

Case 1:21-vv-02215-UNJ Document 60 Filed 04/28/25 Page 9 of 9
For these reasons, I find the comparable pain and suffering determinations offered by
Petitioner to be somewhat more helpful benchmarks for determining an appropriate award for pain
and suffering herein. Other decisions were even better in terms of providing a guideline, however.
Petitioner’s circumstances were especially similar to what was considered in Francesco v. Sec’y
of Health & Hum. Servs., No. 18-1622V, 2020 WL 6705564 (Fed. Cl. Spec. Mstr. Oct. 15, 2020)
(awarding $165,000.00 for actual pain and suffering)—a case not referenced by either side. The
Francesco petitioner saw his primary care provider four days post-vaccination with complaints of
tingling in his fingers and toes and weakness in his knees. 2020 WL 6705564, at *2. He was
referred to the emergency department and subsequently admitted to the hospital for eight days,
during which time he underwent a five-day course of IVIG. Id. Following his discharge, the
Francesco petitioner was transferred to an inpatient rehabilitation facility where he completed
twenty-two days of treatment. Id. The records further indicate that he began PT for approximately
two months and demonstrated “rather rapid progress.” Id. at *3.
Mr. Allas similarly presented to the emergency department six days post-vaccination (after
consulting his primary care physician several days earlier about severe back pain that traveled from
his back to his legs); required a six-day hospitalization; a four-day course of IVIG; diagnostic
testing such as MRIs, an EMG/NCV study, and a lumbar puncture; and twenty-seven PT sessions
and 13 OT sessions via home health services over a five-month period. Moreover, both the
Francesco petitioner and Mr. Allas relied on assistive devices to walk for a period of time
(although Mr. Allas continues to require the use of a cane for long distances). I find that Petitioner
is entitled to the same award of $165,000.00 for actual pain and suffering.
CONCLUSION
Based on the record as a whole and arguments of the parties, I award Petitioner a lump sum
payment of $165,000.00 for past pain and suffering, to be paid through an ACH deposit to
Petitioner’s counsel’s IOLTA account for prompt disbursement. This amount represents
compensation for all damages that would be available under 42 U.S.C. § 300aa-15(a).
In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of the
Court SHALL ENTER JUDGMENT in accordance with the terms of this Decision.4
IT IS SO ORDERED.
/s/ Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
4 Pursuant to Vaccine Rule 11(a), the parties may expedite entry of judgment if (jointly or separately) they file notices
renouncing their right to seek review.
9