GOFORTH v. SECRETARY OF HEALTH AND HUMAN SERVICES
1:14-vv-01128-UNJ
| Fed. Cl. | Jan 10, 2022Background
- Petitioner received influenza vaccinations on September 29, 2011 and November 2, 2014; she filed a Vaccine Program petition in November 2014 and later amended to allege the 2014 shot significantly aggravated a pre‑existing condition.
- Medical history includes long‑standing sensory complaints and neuropathic symptoms reported as early as ~2006; workups over 2012–2016 produced varied impressions (rheumatologic, MS workup, sensory polyneuropathy).
- Treating neurologist Dr. Khoshnoodi (Johns Hopkins) later diagnosed a "sensory variant" Guillain‑Barré syndrome (GBS) and attributed worsening after the 2014 vaccine; petitioner’s retained expert Dr. Engstrand supported that diagnosis and causation.
- Respondent’s expert Dr. Chaudhry concluded petitioner did not have GBS, emphasized pre‑existing symptoms predating 2011, lack of diagnostic electrophysiologic/CSF evidence for GBS, and a chronic/fluctuating course inconsistent with GBS.
- The Special Master applied the six‑part Loving framework for off‑Table significant‑aggravation claims (which incorporates Althen), found petitioner failed to prove she ever had sensory‑variant GBS or that the 2014 vaccine significantly aggravated it, and dismissed the petition.
Issues
| Issue | Petitioner’s Argument | Respondent’s Argument | Held |
|---|---|---|---|
| Whether petitioner suffered sensory‑variant GBS prior to the 2014 vaccine | Onset after 2011 shot; treating neurologist and expert diagnose sensory‑variant GBS | Medical records show neuropathic symptoms since ~2006; testing and course inconsistent with GBS | No preponderant evidence of sensory‑variant GBS prior to 2014 |
| Whether the Nov. 2, 2014 influenza vaccine significantly aggravated a pre‑existing condition | 2014 shot produced worsening (increased paresthesia, weakness, falls) — significant aggravation of prior GBS | No objective new findings attributable to vaccine; declining/relapsing course predates 2014; subjective reports unreliable | No — petitioner failed to show significant aggravation |
| Causation‑in‑fact (Althen prongs: theory, logical sequence, timing) | Immune/molecular‑mimicry theory linking flu vaccine to GBS; temporal plausibility within weeks | Even accepting general vaccine–GBS link, petitioner has no reliable diagnosis or logical sequence tying vaccine to her specific course | Not met — Althen/Loving prongs two and three not satisfied |
| Procedural / Table issue (timeliness and Table presumption) | Initially alleged 2011 causation; amended to 2014 aggravation; sought but did not refile a Table claim after GBS added to Table | 2011 theory untimely; petition filed before GBS added to Table so no Table presumption applies to this petition | Operative claim is off‑Table 2014 aggravation; petitioner did not obtain benefit of Table presumption and failed on proof |
Key Cases Cited
- Althen v. Sec'y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (three‑part test for causation‑in‑fact in Vaccine Program cases)
- Hines v. Sec'y of Health & Human Servs., 940 F.2d 1518 (Fed. Cir. 1991) (petitioner bears burden to show causation‑in‑fact)
- Lombardi v. Sec'y of Health & Human Servs., 656 F.3d 1343 (Fed. Cir. 2011) (determine nature of injury before applying Althen)
- Broekelschen v. Sec'y of Health & Human Servs., 618 F.3d 1339 (Fed. Cir. 2010) (treating‑physician opinions are not binding and may be weighed)
- Loving v. Sec'y of Health & Human Servs., 86 Fed. Cl. 135 (Fed. Cl. 2009) (six‑part test for off‑Table significant aggravation claims)
- W.C. v. Sec'y of Health & Human Servs., 704 F.3d 1352 (Fed. Cir. 2013) (applying Loving framework on review)
- Sharpe v. Sec'y of Health & Human Servs., 964 F.3d 1072 (Fed. Cir. 2020) (clarifies comparison required for significant aggravation)
- Capizzano v. Sec'y of Health & Human Servs., 440 F.3d 1317 (Fed. Cir. 2006) (treating physicians often well‑placed but their opinions may be weighed)
- Knudsen v. Sec'y of Health & Human Servs., 35 F.3d 543 (Fed. Cir. 1994) (Althen prong one requires legally probable theory, not scientific certainty)
- Burns v. Sec'y of Health & Human Servs., 3 F.3d 415 (Fed. Cir. 1993) (expert opinions based on unsupported facts may be rejected)
- Moberly v. Sec'y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (factfinders may assess reliability and credibility of medical evidence)