PANKIW v. SECRETARY OF HEALTH AND HUMAN SERVICES
1:15-vv-01082-EMR
Fed. Cl.Apr 6, 2021Background
- Petitioner Alisha Pankiw received an influenza vaccine on September 28, 2012, and began reporting joint pain around October 1, 2012 (ankle, knee, finger, toe).
- Multiple treating clinicians evaluated her through 2013; providers documented inflammatory/undifferentiated or pauciarticular arthritis but none diagnosed rheumatoid arthritis (RA); some providers questioned inflammatory arthritis and noted postpartum factors and thyroiditis.
- Rheumatologist Dr. Thornberry later wrote the arthritis had resolved by September 5, 2013, and at times described later joint pain as noninflammatory.
- Petitioner’s expert (Dr. Utz) advanced a molecular mimicry theory that influenza antigen could trigger RA; respondent’s experts (including Dr. Matloubian) disputed both the theory and its applicability.
- Special Master found petitioner failed to prove (1) she had RA and (2) a persuasive medical theory (Althen prong 1) connecting the flu vaccine to RA, relying in part on the prior Tullio decision and the record; denied compensation and ruled on the papers.
Issues
| Issue | Petitioner (Pankiw) | Respondent (HHS) | Held |
|---|---|---|---|
| Whether petitioner had rheumatoid arthritis (diagnosis) | Pankiw’s experts treat her condition as inflammatory/RA-like and rely on that diagnosis for causation | Medical records and treating clinicians did not diagnose RA; some rejected inflammatory arthritis and cited alternative causes | No preponderant evidence of RA; diagnosis not established |
| Whether influenza vaccine can cause RA (Althen prong 1) | Molecular mimicry: influenza antigens can cross-react with self-antigens (e.g., collagen) to trigger RA | No reputable scientific evidence of molecular mimicry between influenza and RA antigens; literature does not support the theory | Theory rejected as unpersuasive (follows Tullio); Althen prong 1 not satisfied |
| Whether disposition on the papers was appropriate | Pankiw had opportunity to present evidence and respond to Tullio; requested ruling on the record | Respondent opposed causation theory; no hearing necessary given developed record | Ruling on the record appropriate given developed record and accumulated Program experience |
Key Cases Cited
- Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (sets three-part causation test for off‑Table vaccine claims)
- Broekelschen v. Sec’y of Health & Human Servs., 618 F.3d 1339 (Fed. Cir. 2010) (special master may determine diagnosis preliminarily before addressing causation)
- Tullio v. Sec’y of Health & Human Servs., 149 Fed. Cl. 448 (Ct. Fed. Cl. 2020) (court denied review of Special Master’s rejection of flu→RA molecular mimicry theory)
- Kreizenbeck v. Sec’y of Health & Human Servs., 945 F.3d 1362 (Fed. Cir. 2020) (special masters have discretion to decide cases on the papers where the record is fully developed)
- Whitecotton v. Sec’y of Health & Human Servs., 81 F.3d 1099 (Fed. Cir. 1996) (special masters may apply accumulated Program expertise when judging claims)
- Cucuras v. Sec’y of Health & Human Servs., 993 F.2d 1525 (Fed. Cir. 1993) (contemporaneous medical records are presumed accurate)