Rich v. Secretary of Health and Human Services
129 Fed. Cl. 642
| Fed. Cl. | 2016Background
- Petitioner Sydney Rich received an influenza vaccination on September 26, 2010 and later was hospitalized on December 27, 2010; she was diagnosed with acute disseminated encephalomyelitis (ADEM) on January 7, 2011.
- Rich alleges the September vaccine caused ADEM; she and lay witnesses testified she began to have neurological symptoms (fatigue, headaches, dizziness, leg heaviness) weeks after vaccination.
- Contemporaneous medical records from October–December 2010 document repeated treatment for asthma/bronchitis/pneumonia and do not record the neurological complaints Rich and witnesses later described; emergency-room records on December 27 show no focal neurological deficit and she denied weakness/fatigue then.
- Hospital workup in January 2011 showed multifocal brain and cervical cord lesions; testing detected H1N1 and treating physicians attributed ADEM to H1N1 infection; Rich remains paralyzed and wheelchair-dependent.
- Special master found onset of neurological injury on or after December 27, 2010, discredited lay testimony that symptoms began weeks after vaccination based on contemporaneous records, and concluded Rich failed Althen prongs 2 and 3 (causal sequence and temporal relationship); special master denied compensation.
- The Court of Federal Claims, applying the deferential arbitrary-and-capricious review of the special master’s factual findings, sustained the special master’s decision.
Issues
| Issue | Rich's Argument | Secretary's Argument | Held |
|---|---|---|---|
| When did neurological symptoms (onset) begin? | Symptoms began a few weeks after vaccine (mid-Oct–Nov 2010); lay witnesses corroborate. | Contemporaneous medical records show only pulmonary complaints until hospitalization; lay testimony not credible. | Special master’s finding that onset was on/after Dec. 27, 2010 is sustained. |
| Did vaccine cause ADEM (Althen prongs 2 and 3)? | Vaccine-induced ADEM medically plausible; sequence of symptoms supports causation if early onset is credited. | No close temporal relationship; treating and defense expert attributed ADEM to H1N1 infection; three-month latency is inconsistent with causation. | Rich failed to satisfy Althen prongs 2 and 3; causation not proven. |
| Proper weight to contemporaneous medical records vs later testimony? | Special master gave excessive weight to records over later witness statements. | Medical records are generally trustworthy and contemporaneous; failure to report symptoms undermines later claims. | Court upholds special master’s reliance on contemporaneous records and rejection of inconsistent witness testimony. |
Key Cases Cited
- Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir.) (establishing three-pronged test for causation in fact)
- Porter v. Sec’y of Health & Human Servs., 663 F.3d 1242 (Fed. Cir.) (deferential standard; court will not reweigh credibility or evidence when reviewing special master)
- Moberly v. Sec’y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir.) (causation in fact framework and burdens)
- Broekelschen v. Sec’y of Health & Human Servs., 618 F.3d 1339 (Fed. Cir.) (Table vs non-Table injuries and causation proof)
- Cedillo v. Sec’y of Health & Human Servs., 617 F.3d 1328 (Fed. Cir.) (weight of medical records and review principles)
- Cucuras v. Sec’y of Health & Human Servs., 993 F.2d 1525 (Fed. Cir.) (medical records generally trustworthy and contemporaneous)
- Figueroa v. Sec’y of Health & Human Servs., 715 F.3d 1314 (Fed. Cir.) (statutory purpose of Vaccine Act and remedial construction)
- Andreu v. Sec’y of Health & Human Servs., 569 F.3d 1367 (Fed. Cir.) (Table presumptions and burden-shifting)
- Doe v. Sec’y of Health & Human Servs., 601 F.3d 1349 (Fed. Cir.) (government’s burden to prove alternate cause after petitioner shows causation)