Melissa Trojanowiez v. HHS - DPT/DTP, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) (1998)

Melissa Trojanowiez, a child nearly five years old, received a diphtheria-pertussis-tetanus (DPT) vaccination on March 2, 1994. Shortly after the vaccination, Melissa's motor skills deteriorated.

Her pediatrician initially noted "no problems" on the day of vaccination but later referred her for evaluation, suspecting Guillain-Barre Syndrome (GBS). At the Alfred I. duPont Institute, chief neurologist Dr.

Harold Marks diagnosed Melissa with Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a condition not listed on the Vaccine Injury Table. Her parents, Laurie and John Trojanowiez, filed a petition for compensation under the National Childhood Vaccine Injury Compensation Program, alleging the DPT vaccine caused Melissa's CIDP.

Petitioners were represented pro se. Respondent was the Secretary of the Department of Health and Human Services.

To prove their case, petitioners employed Dr. Charles Bean, who focused on the tetanus toxoid component of the DPT vaccine.

Dr. Bean acknowledged no reported cases associating CIDP with tetanus toxoid but pointed to known associations between tetanus toxoid and acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

He analogized CIDP to AIDP, positing similar symptoms and pathogenesis, and concluded they could be analogized for causation. Dr.

Bean also cited the temporal proximity between vaccination and injury onset, and the lack of other known causes. Respondent's expert, Dr.

Barry G.W. Arnason, disagreed, stating that epidemiological studies of millions of people failed to find a connection between AIDP and tetanus toxoid or other vaccinations.

The medical literature also failed to support Dr. Bean's assertions, and the Special Master found it refuted his claims regarding similar causative agents between AIDP and CIDP.

The Special Master, in a decision issued July 1, 1998, concluded that Dr. Bean's testimony was "unsupported speculation" and that it was "logically and legally impermissible to extrapolate from similarities in pathogenesis to a conclusion of shared causative agents in light of the lack of support from the available medical literature, or some type of objective support from the relevant medical community, and in the face of medical literature indicating strong differences in antecedent events." Because the petitioners failed to prove by a preponderance of the evidence that the DPT vaccine caused Melissa's CIDP, the Special Master denied the petition.

Petitioners sought review in the United States Court of Federal Claims. The court noted that petitioners, proceeding pro se, failed to meet the formal requirements for a motion for review but examined the merits of their appeal.

The court applied a limited standard of review, affirming the Special Master's decision if it was not arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with the law. The court found no basis to overturn the Special Master's determination that there was no medical basis for a causal connection between DPT and CIDP.

The court affirmed the Special Master's decision, and judgment was entered accordingly. The public decision does not describe the specific onset of symptoms, diagnostic tests performed, or treatments received by Melissa Trojanowiez.

The Special Master noted that factual disputes regarding the onset of CIDP were unnecessary to resolve because the case failed on the issue of medical causation.