Bull v. Secretary of Health and Human Services
18-361
| Fed. Cl. | Jul 1, 2021Background
- Petitioner Michael Bull received an influenza vaccine in his left arm during an October 4–6, 2016 hospital admission and soon thereafter reported severe arm pain and later numbness/tingling.
- He sought treatment on December 6, 2016 (Dr. Simmons) with decreased left-arm light-touch sensation but intact grip strength; he filled gabapentin prescriptions through April 2017.
- Petitioner alleged vaccine-induced brachial neuritis (Parsonage–Turner) or significant aggravation of a preexisting neuropathy; he and a witness testified that symptoms began immediately after the shot.
- Petitioner’s expert (Dr. Nassab) opined brachial neuritis causation based on records and case reports; Respondent’s expert (Dr. Price) critiqued the diagnosis, emphasized lack of EMG/atrophy, and argued immediate onset is inconsistent with immune-mediated brachial neuritis.
- The special master held a fact hearing, found Petitioner credible but the medical record thin, accepted briefing in lieu of further hearing, and resolved the claim on the papers.
- Holding: petition dismissed for failure to prove (by preponderance) a compensable diagnosis and medically acceptable temporal relationship and causation under Althen.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Petitioner suffered brachial neuritis (diagnosis) | Bull: post‑vaccination neuropathy consistent with Parsonage–Turner | HHS: records lack cardinal findings (weakness/atrophy), no EMG confirmation | Not preponderantly established — diagnosis unsupported by records |
| Whether flu vaccine can cause brachial neuritis (Althen prong 1) | Bull: vaccines can cause brachial neuritis; case reports support plausibility | HHS: case reports weak; petitioner’s expert opinion is conclusory | Plausible but not preponderantly proven on this record |
| Whether onset was in a medically‑acceptable timeframe (Althen prong 3) | Bull: symptoms began immediately after shot; other reports cite 1–30 days | HHS: immune‑mediated brachial neuritis typically begins days–weeks (3–21 days); immediate onset inconsistent with immune mechanism | Immediate onset not medically acceptable; prong 3 not met |
| Whether there is a logical sequence of cause and effect (Althen prong 2) | Bull: local vaccine inflammation could trigger brachial neuritis in this case | HHS: record lacks evidence of immune/inflammatory process; expert opinion fails to link facts to mechanism | Prong 2 not satisfied; no reliable causal sequence shown |
Key Cases Cited
- Althen v. Sec'y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (establishes three‑prong test for non‑Table vaccine causation)
- Moberly v. Sec'y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (preponderance standard for causation; burden on petitioner)
- Andreu v. Sec'y of Health & Human Servs., 569 F.3d 1367 (Fed. Cir. 2009) (roles of medical theory and medical records in Althen analysis)
- de Bazan v. Sec'y of Health & Human Servs., 539 F.3d 1347 (Fed. Cir. 2008) (temporal relationship must be medically acceptable and align with causation theory)
- Cucuras v. Sec'y of Health & Human Servs., 993 F.2d 1525 (Fed. Cir. 1993) (contemporaneous medical records are presumptively accurate)