Stiller v. Secretary of Health and Human Services
20-1841V
Fed. Cl.Dec 8, 2023Background
- Petitioner received a right‑deltoid TDaP vaccination on October 11, 2019 and reported onset of right upper‑arm/shoulder pain the same day.
- Initial primary‑care visit (10/25/2019) documented pain beginning the night of vaccination; orthopedic evaluation found painful, limited ROM and MRI (11/23/2019) showed supraspinatus/infraspinatus tendinosis with partial‑thickness tearing, subscapularis tendinosis, labral fraying, os acromiale with edema, AC joint degenerative change, and subacromial/subdeltoid bursitis with effusion.
- Treating clinicians diagnosed right shoulder impingement and bursitis; one orthopedist noted the vaccination may have exacerbated previously asymptomatic pathology; petitioner denied prior right‑shoulder symptoms and could not return to prior exercise regimen.
- Respondent argued petitioner had preexisting anatomic/degenerative shoulder variants (os acromiale, type II acromion) and a history of intense exercise that explained or caused her condition and that symptoms were not confined to the vaccinated shoulder.
- Petitioner moved for a ruling on the record; parties agreed the record was ripe. Special Master Horner found petitioner met the SIRVA QAI criteria and that respondent failed to prove a factor unrelated to vaccination caused the injury.
- Ruling: entitlement to compensation for a Table SIRVA was granted; damages to be determined in a separate order.
Issues
| Issue | Petitioner’s Argument | Respondent’s Argument | Held |
|---|---|---|---|
| Whether pain onset occurred within the 48‑hour Table timeframe | Onset the night of vaccination; medical records corroborate immediate onset | No specific dispute on timing | Held for petitioner — onset within 48 hours satisfied |
| Whether pain/limited ROM were limited to the vaccinated shoulder (QAI iii) | Right shoulder complaints and orthopedic diagnoses were localized; transient/isolated left‑side not continuous or causally linked | Records show bilateral and other musculoskeletal complaints suggesting a non‑localized pattern | Held for petitioner — evidence supports localization to right shoulder |
| Whether there was prior history of right shoulder pain/injury (QAI i) | Medical records show no pre‑existing right‑shoulder symptoms that would explain post‑vaccine findings | Preexisting asymptomatic anatomic variants (os acromiale, Type II acromion) and exercise history predisposed her to shoulder pathology | Held for petitioner — no prior symptomatic right‑shoulder history; variants are risk factors but do not preclude SIRVA |
| Whether another condition more likely caused the injury (QAI iv / factor unrelated) | MRI and treating clinicians documented inflammatory bursitis consistent with SIRVA and contemporaneous onset with vaccine | Anatomy and exercise more likely caused or wholly explain the condition; vaccination at most exacerbated preexisting disease | Held for petitioner — respondent failed to prove an unrelated factor more likely caused the injury |
Key Cases Cited
- Moberly ex rel. Moberly v. Secretary of Health & Human Servs., 592 F.3d 1315 (Fed. Cir. 2010) (explains Vaccine Program preponderance standard)
- Althen v. Secretary of Health & Human Servs., 418 F.3d 1274 (Fed. Cir. 2005) (discusses causation framework in vaccine cases)
- Deribeaux ex rel. Deribeaux v. Secretary of Health & Human Servs., 717 F.3d 1363 (Fed. Cir. 2013) (addresses burden on respondent to prove factors unrelated to vaccination)
- Kreizenbeck v. Secretary of Health & Human Servs., 945 F.3d 1362 (Fed. Cir. 2020) (special masters should ensure the record is fully developed before ruling on the record)