Garner v. Secretary of Health and Human Services, 133 Fed. Cl. 140

Background

Petitioner Finnettia Garner received a Twinrix (Hep A/B) vaccine on December 13, 2011 and reported first shoulder pain 45 days later while abroad; she did not seek immediate medical care for that episode.
Months later (June 2012) she sought treatment for left shoulder pain; treating orthopedist noted a partial humeral dislocation and diagnosed “possible” Parsonage-Turner Syndrome (PTS); subsequent records showed intermittent shoulder pain and later right-sided episodes in late 2013 and 2014.
Petitioner alleged the Hep A/B vaccination caused PTS (an off-Table claim) and submitted expert opinion from Dr. Yehuda Shoenfeld supporting an autoimmune/molecular mimicry theory and arguing a 45-day onset was plausible.
Respondent’s expert, Dr. Eric Lancaster, disputed the PTS diagnosis based on lack of objective neurologic findings and electrodiagnostic testing, and opined 45 days was an implausibly long interval for vaccine-triggered PTS; he also cited lack of evidence linking Hep vaccines to PTS.
The Special Master denied compensation, finding Petitioner failed to meet Althen prongs two and three (no persuasive ‘‘but-for’’ causation and unacceptable timing); he noted gaps in the medical record and alternative causes (dislocation, travel) were not ruled out.
The Court of Federal Claims affirmed: it applied deferential review to factual findings, declined to consider new literature filed on review, and found the Special Master reasonably weighed competing expert opinions and medical records.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether vaccination caused PTS (Althen prong 1 — medical theory)	Shoenfeld: autoimmune/molecular mimicry from Hep A/B can cause PTS; literature supports vaccine-induced autoimmunity	Lancaster: no reliable evidence Hep vaccines cause PTS; Petitioner’s cited literature weak and not PTS-specific	Court: Special Master reasonably found petitioner’s theory had limited reliability and did not fit the facts
Whether vaccination was the ‘‘but‑for’’ cause (Althen prong 2 — logical sequence)	Garner: treating diagnosis and affidavit support causal link to vaccine	HHS: alternative causes (shoulder dislocation, long flight) not ruled out; medical record lacks sustained objective findings	Held: Petitioner failed to prove ‘‘but‑for’’ causation; Special Master permissibly relied on alternative explanations and record gaps
Whether timing is medically proximate (Althen prong 3 — temporal relationship)	Shoenfeld: 45 days is a plausible latency based on analogous vaccine-autoimmune case reports	Lancaster: PTS typically occurs sooner; 45 days is too long; literature does not support that latency for PTS	Held: Special Master reasonably concluded 45 days (and intermittent symptom pattern) was not a medically acceptable timeframe to support causation
Whether Special Master abused discretion by ruling without an evidentiary hearing	Garner: absence of live testimony prevented credibility assessment and disadvantaged her	HHS: Special Master has discretion; petitioner requested ruling on the written record below	Held: No abuse of discretion; petitioner did not object below and Vaccine Rule allows decisions on the written record

Key Cases Cited

Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (establishes three‑prong test for causation in off‑Table vaccine claims)
Moberly v. Sec’y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (special masters weigh expert credibility; deferential review of factual findings)
Pafford v. Sec’y of Health & Human Servs., 451 F.3d 1352 (Fed. Cir. 2006) (‘‘but‑for’’ causation standard and discussion of timing relevance to causation)
Munn v. Sec’y of Health & Human Servs., 970 F.2d 863 (Fed. Cir. 1992) (standards of review for special master decisions)
Lampe v. Sec’y of Health & Human Servs., 219 F.3d 1357 (Fed. Cir. 2000) (noting difficulty of overturning special master’s factual determinations)