Smith v. Secretary of Health and Human Services, 16-1503

Petitioner Ginger Smith alleged her November 19, 2013 influenza vaccination caused or significantly aggravated left‑arm osteoarthritis and sought compensation under the Vaccine Program.
Medical records show longstanding osteoarthritis (knee since 2008) and pre‑existing left shoulder problems (rotator cuff tendinitis, limited ROM) with treatment beginning in spring 2013 before the vaccination.
Petitioner did not complain about the left arm immediately after vaccination; first post‑vax mention of left‑arm problems appears ~3 months later and she did not link symptoms to the vaccine until December 2014.
Treating clinicians documented degenerative shoulder disease (severe glenohumeral osteoarthritis, rotator cuff pathology) and none opined the vaccine caused or significantly aggravated her condition; a later physical incident (lifting her mother) was identified as a clear aggravator.
Petitioner filed no expert medical opinion supporting causation; she moved to dismiss after concluding she could not meet her burden.
Special Master Millman granted the motion and dismissed the petition for failure to prove causation/significant aggravation, directing entry of judgment absent review.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether petitioner proved vaccine caused new arthritis	Flu shot led to left‑arm arthritis after Nov 19, 2013	Medical records and treating clinicians show preexisting degenerative disease unrelated to vaccine	Dismissed — petitioner did not prove vaccine caused new arthritis
Whether vaccine significantly aggravated preexisting osteoarthritis	Vaccine significantly worsened preexisting left‑arm osteoarthritis	Records show preexisting shoulder disease, delayed onset of complaints, and alternative aggravators (e.g., lifting mother); no treating doctor or expert links vaccine to aggravation	Dismissed — petitioner failed to prove significant aggravation
Adequacy of evidence without expert testimony	Petitioner did not present an expert; argued facts/records suffice	Respondent emphasized lack of expert and treating‑doctor opinions supporting causation	Dismissed — court requires competent medical opinion; petitioner’s lay assertions insufficient
Timing/temporal relationship between vaccine and symptoms	Petitioner tied onset to November 2013 vaccination	Records show first post‑vax complaint months later and later inconsistent statements; immediate severe post‑vaccinal reaction absent	Dismissed — temporal relationship not established as proximate or persuasive

Althen v. Sec’y of HHS, 418 F.3d 1274 (Fed. Cir. 2005) (three‑part causation test: theory, logical sequence, and temporal relationship)
Grant v. Sec’y of HHS, 956 F.2d 1144 (Fed. Cir. 1992) (persuasive medical theory requires reputable medical/scientific explanation)
Shyface v. Sec’y of HHS, 165 F.3d 1344 (Fed. Cir. 1999) (but‑for and substantial‑factor principles in vaccine cases)
Capizzano v. Sec’y of HHS, 440 F.3d 1317 (Fed. Cir. 2006) (treating‑physician opinions warrant serious consideration)
Andreu v. Sec’y of HHS, 569 F.3d 1367 (Fed. Cir. 2009) (standards for admitting medical theory and proof in Program)
Broekelschen v. Sec’y of HHS, 618 F.3d 1339 (Fed. Cir. 2010) (deference to special master’s evaluation of record evidence)