Schick-Cowell v. Secretary of Health and Human Services, 18-656

Petitioner Beverly Schick-Cowell received a left-arm influenza vaccine on September 16, 2016 and filed a Vaccine Act petition (No. 18-656V) alleging SIRVA/left shoulder injury.
Medical records show an 11‑month pre‑vaccination history (Oct 2015–Sept 2016) of chronic neck, bilateral shoulder, and back pain with repeated chiropractic visits documenting left‑side shoulder complaints.
After vaccination she reported increased left shoulder/arm/neck pain; first contemporaneous chart note tying pain to the shot appears Sept. 28, 2016 (12 days post‑vax); imaging (Nov. 21, 2016 MRI) showed teres minor edema and adjacent humeral signal abnormality.
Treating diagnoses included subacromial bursitis, brachial neuritis (one note), cervical radiculopathy, and chronic left shoulder pain; some neurological testing (EMG, brachial plexus MRI) later was normal.
Experts: Petitioner relied on Dr. Natanzi (theory: inadvertent needle over‑penetration producing local inflammatory reaction); Respondent relied on Drs. Brophy and Bromberg (challenging needle reach, timing, and pointing to preexisting conditions/alternative causes).
Special Master denied compensation: petitioner failed to meet on‑Table SIRVA elements (preexisting shoulder pain; pain not confined to vaccinated shoulder) and failed to establish a persuasive logical sequence of causation for an off‑Table claim. No hearing was held.

Issue	Schick-Cowell's Argument	Secretary's Argument	Held
On‑Table SIRVA — no prior shoulder pain	She denied prior left shoulder injury; argued pre‑vax pain was different/less severe and that shoulders were improved before shot.	Extensive chiropractic records show 11 months of bilateral/left shoulder pain before vaccination.	Not met — preexisting shoulder pain shown.
On‑Table SIRVA — onset within 48 hours	Affidavits and later medical entries assert immediate/severe pain after the shot.	Earliest clinic documentation tying pain to vaccine is Sept. 28 (12 days later); other records give inconsistent onset dates.	Timing unresolved but not dispositive given other failures.
On‑Table SIRVA — pain confined to vaccinated shoulder	Petitioner maintained injury was limited to left shoulder/arm.	Records show pain beyond left shoulder (neck, arm, back, right leg at times); symptoms not confined.	Not met — pain not limited to left shoulder.
Off‑Table causation (Althen) — logical causal sequence / mechanism	Dr. Natanzi: needle over‑penetration into teres minor/humerus + vaccine‑provoked inflammatory reaction explains MRI findings and symptoms.	Drs. Brophy/Bromberg: standard needle unlikely to reach bone/teres minor; MRI measurement and clinical findings don't support over‑penetration; alternative causes (lifting, chronic neck/shoulder conditions) more likely.	Prong 1 assumed for analysis, but prong 2 (logical sequence) not established; overall causation not shown.

Althen v. Sec'y of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (establishes three‑part test for off‑Table vaccine causation)
Moberly v. Sec'y of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (preponderance standard and requirement for a reputable explanation tied to the case)
Andreu v. Sec'y of Health & Human Servs., 569 F.3d 1367 (Fed. Cir. 2009) (warning against imposing a medical‑certainty standard)
Capizzano v. Sec'y of Health & Human Servs., 440 F.3d 1317 (Fed. Cir. 2006) (treating‑doctor views are relevant and should be carefully considered)
Boatmon v. Sec'y of Health & Human Servs., 941 F.3d 1351 (Fed. Cir. 2019) (prong‑1 requires a sound, reliable medical theory)
Hibbard v. Sec'y of Health & Human Servs., 698 F.3d 1355 (Fed. Cir. 2012) (special master may assume prong 1 if another prong is dispositive)
Kirby v. Sec'y of Health & Human Servs., 997 F.3d 1378 (Fed. Cir. 2021) (petitioner's statements in medical records may be considered as part of the record)