VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00385
Package ID: USCOURTS-cofc-1_23-vv-00385
Petitioner: Al Raya
Filed: 2024-12-18
Decided: 2025-01-17
Vaccine: influenza
Vaccination date: 2021-10-25
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 24906

AI-assisted case summary:
Al Raya filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine he received on October 25, 2021. The respondent, the Secretary of Health and Human Services, denied that Mr. Raya sustained a SIRVA Table injury or that the vaccine caused his injury. Despite these denials, the parties filed a joint stipulation agreeing to settle the case and award compensation. The court adopted the stipulation as its decision. Mr. Raya was awarded a lump sum of $24,500.00 payable to him, and an additional $405.89 to reimburse a lien for services rendered by the Commonwealth of Virginia Department of Medical Assistance Services. These amounts represent compensation for all damages available under the Vaccine Act. The decision was issued on January 17, 2025, following the stipulation filed on December 18, 2024. The petition was originally filed on March 20, 2023.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_23-vv-00385-0
Date issued/filed: 2025-01-17
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 12/18/2024) regarding 29 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (ppa) Service on parties made.
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Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 23-0385V
AL RAYA, Chief Special Master Corcoran
Petitioner, Filed: December 18, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Glen Howard Sturtevant, Jr., Rawls Law Group (Richmond), Richmond, VA, for
Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On March 20, 2023, Al Raya filed a petition for compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine
Act”). Petitioner alleges that he suffered a shoulder injury related to vaccine administration
(“SIRVA”) as a result of an influenza (“flu”) vaccine administered to him on October 25,
2021. Petition at 1; Stipulation, filed on December 18, 2024, at ¶¶ 2, 4. Petitioner further
alleges that he received the vaccine in the United States, that he experienced the residual
effects of his injury for more than six months, and there has been no prior award or
settlement of a civil action for damages as a result of his alleged condition. Petition at ¶¶
1, 6; Stipulation at ¶¶ 3-5. “Respondent denies that [P]etitioner sustained a SIRVA Table
injury, denies that [P]etitioner’s alleged shoulder injury was caused-in-fact by the flu
vaccine, and denies that the flu vaccine caused [P]etitioner any other injury or his current
condition.” Stipulation at ¶ 6.
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the Decision will be available to anyone with access to the internet. In
accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other
information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I
agree that the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2018).

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 2 of 8
Nevertheless, on December 18, 2024, the parties filed the attached joint
stipulation, stating that a decision should be entered awarding compensation. I find the
stipulation reasonable and adopt it as my decision awarding damages, on the terms set
forth therein.
Pursuant to the terms stated in the attached Stipulation, I award the following
compensation:
A. A lump sum of $24,500.00 in the form of a check payable to Petitioner;
B. A lump sum payment of $405.89, which amount represents
reimbursement of a lien for services rendered on behalf of Petitioner by
the Commonwealth of Virginia Department of Medical Assistance
Services, in the form of a check payable jointly to Petitioner and
Department of Medical Assistance Services
Accounts Receivable Unit, TPLC, 8th Floor
600 E. Broad Street
Richmond, VA 23219
Petitioner agrees to endorse this check to the Commonwealth of Virginia
Department of Medical Assistance Services.
Stipulation at ¶ 8. These amounts represents compensation for all items of damages that
would be available under Section 15(a). Id.
I approve the requested amount for Petitioner’s compensation. In the absence of
a motion for review filed pursuant to RCFC Appendix B, the Clerk of Court is directed to
enter judgment in accordance with this decision.3
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
2

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 3 of 8
IN THE UNITED ST ATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
AL RAYA,
Petitioner, No. 23-385V
Chief Special Master Corcoran
ECF
V.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
1. Al Raya ("petitioner") filed a petition for vaccine compensation under the National
Vaccine Injury Compensation Program, 42 U .S.C. § 300aa-10 to -34 (the "Vaccine Program").
The petition seeks compensation for an injury allegedly related to petitioner's receipt of an
influenza ("flu") vaccine, which vaccine is contained in the Vaccine Injury Table (the "Table"),
42 C.F.R. § 100.3(a).
2. Petitioner received a flu vaccine on October 25, 2021.
3. The vaccine was administered within the United States.
4. Petitioner alleges that he sustained a shoulder injury related to vaccine administration
("SIRVA") within the time period set forth in the Table. Petitioner further alleges that he
suffered the residual effects of the alleged injury for more than six months.
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages on petitioner's behalf as a result of the alleged injury.

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 4 of 8
6. Respondent denies that petitioner sustained a SIRVA Table injury, denies that
petitioner's alleged shoulder injury was caused-in-fact by the flu vaccine, and denies that the flu
vaccine caused petitioner any other injury or his current condition.
7. Maintaining their above-stated positions, the parties nevertheless now agree that the
issues between them shall be settled and that a decision should be entered awarding the
compensation described in paragraph 8 oft his Stipulation.
8. As soon as practicable after an entry ofj udgment reflecting a decision consistent with
the terms of this Stipulation, and after petitioner has filed an election to receive compensation
pursuant to 42 U.S.C. § 300aa-2l(a)(1), the Secretary of Health and Human Services will issue
the following vaccine compensation payments:
a. A lump sum of $24,500.00 in the form of a check payable to petitioner;
b. A lump sum payment of $405.89, 1 which amount represents reimbursement of a lien
for services rendered on behalf of petitioner by the Commonwealth of Virginia
Department of Medical Assistance Services, in the form of a check payable jointly to
petitioner and:
Department of Medical Assistance Services
Accounts Receivable Unit, TPLC, 8th Floor
600 E. Broad Street
Richmond, VA 23219
Petitioner agrees to endorse this check to the Commonwealth of Virginia
Department of Medical Assistance Services.
1 This amount represents full satisfaction of any right of subrogation, assignment, claim, lien, or
cause of action the Commonwealth of Virginia may have against any individual as a result of any
Medicaid payments the Virginia Department of Medical Assistance Services has made to or on
behalf of Al Raya as a result of his alleged vaccine-related injury following the flu vaccine
administered on October 25, 2021, under Title XIX of the Social Security Act, see 42 U.S.C. §
300aa-1 S(g), (h).
2

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 5 of 8
These amounts represent compensation for all damages that would be available under 42
U.S.C. §300aa-l 5(a).
9. As soon as practicable after the entry of judgment on entitlement in this case, and after
petitioner has filed both a proper and timely election to receive compensation pursuant to 42
U.S.C. § 300aa-2 l (a)(l ), and an application, the parties will submit to further proceedings before
the special master to award reasonable attorneys' fees and costs incurred in proceeding upon this
petition.
I 0. Petitioner and petitioner's attorney represent that compensation to be provided
pursuant to this Stipulation is not for any items or services for which the Program is not
primarily liable under 42 U .S.C. § 300aa-l 5(g), to the extent that payment has been made or can
reasonably be expected to be made under any State compensation programs, insurance policies,
Federal or State health benefits programs (o ther than Title XIX of the Social Security Act ( 42
U.S.C. § 1396 et seq.)), or by entities that provide health services on a pre-paid basis.
I I . Payment made pursuant to paragraph 8 and any amounts awarded pursuant to
paragraph 9 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-l 5(i), subject
to the availability of sufficient statutory funds.
12. The parties and their attorneys further agree and stipulate that, except for any award
for attorneys' fees and litigation costs, and past unreimbursed expenses, the money provided
pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a
strict construction of 42 U.S.C. § 300aa-l 5(a) and (d), and subject to the conditions of 42 U.S.C.
§300aa-l 5(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in petitioner's
individual capacity, and on behalf of petitioner's heirs, executors, administrators, successors or
3

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 6 of 8
assigns, does forever irrevocably and unconditionally release, acquit and discharge the United
States and the Secretary of Health and Human Services from any and all actions or causes of
action (including agreements, judgments, claims, damages, loss of services, expenses and all
demands of whatever kind or nature) that have been brought, could have been brought, or could
be timely brought in the Court of Federal Claims, under the National Vaccine Injury
Compensation Program, 42 U.S.C. § 300aa-l O et seq., on account of, or in any way growing out
of, any and all known or unknown, suspected or unsuspected personal injuries to or death of
petitioner resulting from, or alleged to have resulted from, the flu vaccination administered on
October 25, 2021, as alleged by petitioner in a petition for vaccine compensation filed on or
about March 20, 2023, in the United States Court of Federal Claims as petition No. 23-385V.
14. If petitioner should die prior to entry ofj udgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete conformity with the terms of this Stipulation, then the parties'
settlement and this Stipulation shall be voidable at the sole discretion of either party.
16. This Stipulation expresses a full and complete negotiated settlement of liability and
damages claimed under the National Childhood Vaccine Injury Act of I 986, as amended, except
as otherwise noted in paragraph 9 above. There is absolutely no agreement on the part of the
parties hereto to make any payment or to do any act or thing other than is herein expressly stated
and clearly agreed to. The parties further agree and understand that the award described in this
Stipulation may reflect a compromise of the parties' respective positions as to liability and/or
4

Case 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 7 of 8
amount of damages, and further, that a change in the nature of the injury or condition or in the
items of compensation sought, is not grounds to modify or revise this agreement.
I 7. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the flu vaccine caused petitioner's alleged shoulder
injury or any other injury or petitioner's current disabilities, or that petitioner suffered an injury
contained in the Vaccine Injury Table.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, sucEcNesDso OrsF, a SndT/IoPr UasLsAigTnsI.O N
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C ase 1:23-vv-00385-UNJ Document 35 Filed 01/17/25 Page 8 of 8
Respectfully submined,
PETITIONER:
01
6'3
AL RAYA
ATTORNEY OF RECORD FOR AU THORJZED REPRESENTATIVE
PETITIONER: OF THE ATTORNEY GENERAL:
-&i-R y.£.;:,,,. --
GLEN H. STURTEVANT HEATHER L. PEARLMAN
Rawls Law Group, P.C. Deputy Director
211 Rocketts Way, Suite 100 Torts Branch
Richmond, VA 23231 Civil Division
Telephone: (804) 622·0675 U.S. Department of Justice
Email: gsturtevant@rawlslawgroup.com. P.O. Box 146
Washington, DC 2004 •
AUTHORIZED REPRESENTATIVE ATTORNEY.0
OF THE SECRETARY OF HEALTH RE
'
AND HUMAN SERVICES: •,..t.;
Jeffrey 5 • 1 t O Je l f g f i r t e a y lly S . s B ig f n fc e h d • i S ,, ,
Beach _5 -_.J 024.12.1009'.53:32 . ,.
''CAPT GEORGE REED GRlM
-irector, Division of-lnjury
· Jl)pensation Programs
• th SystenifB ureau
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h Resources and Se . : eiu of Justice
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Pl@ El 'lk.itli
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8.enjantinlf l'llrlltlin Station
Wasbillltollt oc 20044.0146
(202) l'SB-7722
alee1sq:-e@usdoj.gov