Hibbard v. Secretary of Health & Human Services
100 Fed. Cl. 742
Fed. Cl.2011Background
- Ms. Hibbard sought Vaccine Act compensation for neurological symptoms after a November 1, 2003 flu vaccine.
- Special Master Moran denied compensation, finding no autonomic neuropathy to satisfy causation.
- Hibbard alleges dysautonomia with POTS; doctors disagree on diagnosis and etiology.
- Medical history includes extensive testing; some physicians suggested autonomic involvement while others did not confirm neuropathy.
- Hibbard’s expert linked vaccine to autonomic neuropathy via molecular mimicry; respondent’s expert rejected a causal link.
- Court reviews the special master’s decision de novo on law and for substantial evidence on fact, under the Vaccine Act.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the special master properly precluded full Althen analysis | Hibbard argues Broekelschen allows preliminary diagnosis to proceed | Respondent contends causation analysis requires established injury link first | No reversible error; analysis needs autonomic neuropathy as the injury link to proceed |
| Whether autonomic neuropathy was adequately proven as the injury | Evidence supports autonomic neuropathy; numerous references in records | Objective testing did not confirm autonomic neuropathy; record weight favors lack of injury | Court deferentially sustains factual finding; No clear error in concluding no autonomic neuropathy |
| Whether Althen prongs were properly applied if autonomic neuropathy is assumed | Vaccine caused dysautonomia via molecular mimicry; temporal relation adequate | Without autonomic neuropathy, causation cannot be established; prongs cannot be met | Court rejects because injury link not proven; Althen analysis not completed based on finding of no autonomic neuropathy |
| Whether the decision should be affirmed under deferential standard given record | Court should reweigh evidence in light of multiple autonomic references | Special master properly weighed objective testing and expert opinions | Affirmed; findings not arbitrary or capricious |
Key Cases Cited
- Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed.Cir.2005) (establishes the three-prong causation test for non-Table injuries)
- Walther v. Sec’y of Health & Human Servs., 485 F.3d 1146 (Fed.Cir.2007) (does not require eliminating all alternatives to prove causation)
- Broekelschen v. Sec’y of Health & Human Servs., 618 F.3d 1339 (Fed.Cir.2010) (preliminary diagnosis permissible where underlying injuries differ substantially)
- Pafford v. Sec’y of Health & Human Servs., 451 F.3d 1352 (Fed.Cir.2006) (defines the causation burden in Vaccine Act cases; presumption if on-Table injury)
- de Bazan v. Sec’y of Health & Human Servs., 539 F.3d 1347 (Fed.Cir.2008) (shifts burden to respondent to show vaccine not the cause)
- Devonshire v. Sec’y of Health & Human Servs., 76 Fed.Cl. 452 (Fed.Cl.2007) (precedes de novo review framework for causation questions)
- Cedillo v. Sec’y of Health & Human Servs., 617 F.3d 1328 (Fed.Cir.2010) (illustrates standard of review for Vaccine Act factual determinations)
- Masias v. Sec’y of Health & Human Servs., 634 F.3d 1283 (Fed.Cir.2011) (applies arbitrary and capricious review to special masters' factual findings)