Britt v. Secretary of Health and Human Services
17-1352
Fed. Cl.Sep 21, 2021Background
- Petitioner Caprice Britt received an influenza vaccination at work on October 4, 2016 and alleges it caused acute left shoulder pain that progressed and ultimately required rotator cuff repair on October 16, 2017.
- Ms. Britt had a prior left shoulder history: subacromial decompression and bursectomy in December 2013 with documented improvement and discharge from PT by March 2014; medical records from 2014–mid‑2016 generally do not document ongoing left shoulder complaints.
- Disputed facts at hearing: whether Ms. Britt had preexisting chronic left shoulder pain before Oct. 4, 2016; whether the vaccine was given in the left or right arm; and whether shoulder pain began within 48 hours of vaccination.
- Documentary and testimonial evidence included medical records, employer/Quest vaccination records (which recorded the injection in the right arm), PT/clinic notes, chiropractor and orthopedist testimony, and Ms. Britt’s affidavits; a two‑day hearing resolved factual conflicts.
- The Special Master found by preponderance that Ms. Britt did not have significant left shoulder pain prior to June 2016 (and that her shoulder functioned normally through Oct. 4, 2016), that the flu shot was administered into her left shoulder, and that left shoulder pain began on Oct. 4, 2016; surgical repair and treating‑surgeon statements about possible vaccine causation were summarized but not definitively converted into a causation ruling.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Pre‑existing left shoulder condition before Oct. 4, 2016 | Britt contends shoulder was functioning normally after 2014 PT and any residual issues resolved; she did not have chronic left shoulder pain immediately before vaccine. | Sec'y points to isolated medical notes (e.g., Jan. 27, 2016) and ER/admitting notations suggesting prior left shoulder/arm pain. | Held: Preponderance shows no significant ongoing left shoulder pain through Oct. 4, 2016 (some trapezius/neck issues existed). |
| Laterality of vaccination (left vs. right arm) | Britt and contemporaneous PT note state pain "from flu shot" in left arm; Britt credibly testified vaccine was in left shoulder. | Quest’s vaccination form (filled by vaccinator) recorded the right arm; vaccinator could not be located to testify. | Held: Preponderance finds vaccination was administered into the left shoulder. |
| Onset timing (did pain begin within 48 hours / on Oct. 4, 2016) | Britt’s testimony and a PT record dated Oct. 10, 2016 attribute left arm pain to the flu shot; Britt says pain began day of vaccination and worsened over subsequent days. | Orthopedist’s Oct. 28, 2016 note recorded pain for "a month" and that she woke with pain, suggesting earlier onset. | Held: Special Master gives greater weight to contemporaneous PT note and testimony; finds pain began Oct. 4, 2016 (post‑vaccination). |
| Causation opinion of treating surgeon (Dr. Dantuluri) and next steps | Britt relies on treating surgeon’s later letter expressing that shoulder pain "could be causally related" to vaccination. | Sec'y notes treating surgeon did not provide an unequivocal opinion to reasonable degree of medical certainty in testimony; contemporaneous records did not document vaccination linkage. | Held: Court summarizes surgeon’s view that vaccine‑related inflammation can cause bursitis/rotator cuff tear but did not adopt a definitive causation finding; directed respondent to file status report on next steps. |
Key Cases Cited
- Moberly v. Sec'y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (explains preponderance‑of‑the‑evidence standard in Vaccine Program adjudication)
- James‑Cornelius v. Sec'y of Health & Human Servs., 984 F.3d 1374 (Fed. Cir. 2021) (petitioners competent to testify about onset of problems)
- Bradley v. Sec'y of Health & Human Servs., 991 F.2d 1570 (Fed. Cir. 1993) (absence of contemporaneous medical record entries can support inference that symptoms were not present)
- Kirby v. Sec'y of Health & Human Servs., 997 F.3d 1378 (Fed. Cir. 2021) (recognizes reasons petitioners may not report symptoms to particular treaters)
- Doe 11 v. Sec'y of Health & Human Servs., 601 F.3d 1349 (Fed. Cir. 2010) (special master may credit some evidence over contrary evidence without being arbitrary)