reversing special master's decision that petitioners were not entitled to compensation
How later courts described this case
- reversing special master's decision that petitioners were not entitled to compensation
- a “special master’s role is to apply the law”
Written by the judges who cited it.
The opinion
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
**********************
DUANE HOFFMAN, *
* No. 19-111V
Petitioner, * Special Master Christian J. Moran
*
v. *
* Filed: September 13, 2024
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
**********************
Isaiah Kalinowski, Bosson Legal Group, P.C., Fairfax, VA, for petitioner;
Felicia D. Langel, United States Dep’t of Justice, Washington, DC, for respondent.
RULING FINDING ENTITLEMENT TO COMPENSATION 1
Duane Hoffman alleges that an influenza (“flu”) vaccine caused him to
develop a neurologic problem, chronic inflammatory demyelinating
polyneuropathy (“CIDP”). Mr. Hoffman supported his claim with reports from a
neurologist retained for this litigation, Zurab Nadareishvili. The Secretary disputes
Mr. Hoffman’s claim that the flu vaccine injured him and has, likewise, supported
1
Because this Ruling contains a reasoned explanation for the action taken in this case, it
must be made publicly accessible and will be posted on the United States Court of Federal
Claims’ website, and/or at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in
accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal
Management and Promotion of Electronic Government Services). This means the Ruling will be
available to anyone with access to the internet. In accordance with Vaccine Rule 18(b), the
parties have 14 days to identify and move to redact medical or other information, the disclosure
of which would constitute an unwarranted invasion of privacy. Any changes will appear in the
document posted on the website.
1
his position with reports from a neurologist the Secretary retained for this
litigation, Michael Wilson.
An Initial Entitlement Decision rejected Mr. Hoffman’s argument that he
was required to present a plausible theory of how the flu vaccine can cause CIDP.
Initial Entitlement Decision, issued Jan. 10, 2024, 2024 WL 402731. Mr. Hoffman
contested this determination. Pet’r’s Mot. for Rev., filed Feb. 9, 2024. The Court
agreed that the Initial Entitlement Decision erroneously elevated Mr. Hoffman’s
burden of proof. Opinion and Order, issued July 8, 2024, 2024 WL 3688477. The
Court remanded for further adjudication.
Upon remand, the parties filed supplemental briefs. An oral argument with
the undersigned was held on August 16, 2024.2 A review of the evidence under
the Court’s standards shows that Mr. Hoffman is entitled to compensation.
I. Background3
Mr. Hoffman was born in 1960. For many years, he worked as a
corrections officer, although he was not employed when he received the allegedly
causal flu vaccination in 2017. Exhibit 23 (affidavit regarding damages).
More than two years before the flu vaccination, Mr. Hoffman was diagnosed
with chronic lymphocytic leukemia (“CLL”). Exhibit 10 at 7 (Mar. 31. 2015).
The Secretary’s expert, Dr. Wilson, has proposed that the leukemia is associated
with an increased risk for CIDP. Exhibit A at 5.
In January 2017, Mr. Hoffman was hospitalized due to an exacerbation of
chronic obstructive pulmonary disease. Exhibit 4 at 657. While hospitalized, Mr.
Hoffman received the flu vaccine. Exhibit 1. (Mr. Hoffman also received a
pneumococcal vaccine but his claim rests upon the flu vaccine.)
2
As part of the motion for review, the Court heard oral argument. The transcript from
June 20, 2024 contains pages 1-86. The transcript from the August 16, 2024 argument contains
pages 101-199.
3
Events in Mr. Hoffman’s life were summarized in the Initial Entitlement Decision and
largely adopted in the Court’s Opinion and Order. The parties were satisfied with the recitation
of events. Tr. 111.
2
Mr. Hoffman was diagnosed with low back pain on January 24, 2017.
Exhibit 4 at 819, 862. This pain continued and Mr. Hoffman developed other
problems for which he was admitted to Riverside Methodist Hospital. In Riverside
Methodist Hospital, Mr. Hoffman underwent tests, including an EMG/NCS. Based
upon the results, Mr. Hoffman’s doctors diagnosed him with a neurologic disorder,
Guillain-Barré syndrome. Exhibit 7 at 261, 876-81.
Guillain-Barré syndrome is:
(i) … an acute monophasic peripheral neuropathy that encompasses a
spectrum of four clinicopathological subtypes described below. For each
subtype of GBS, the interval between the first appearance of symptoms and
the nadir of weakness is between 12 hours and 28 days. This is followed in
all subtypes by a clinical plateau with stabilization at the nadir of symptoms,
or subsequent improvement without significant relapse. Death may occur
without a clinical plateau. Treatment related fluctuations in all subtypes of
GBS can occur within 9 weeks of GBS symptom onset and recurrence of
symptoms after this time-frame would not be consistent with GBS.
(ii) The most common subtype in North America and Europe, comprising
more than 90 percent of cases, is acute inflammatory demyelinating
polyneuropathy (AIDP), which has the pathologic and electrodiagnostic
features of focal demyelination of motor and sensory peripheral nerves and
nerve roots. . . . AIDP [is] typically characterized by symmetric motor
flaccid weakness, sensory abnormalities, and/or autonomic dysfunction
caused by autoimmune damage to peripheral nerves and nerve roots. The
diagnosis of AIDP. . . requires:
(A) Bilateral flaccid limb weakness and decreased or absent deep
tendon reflexes in weak limbs;
(B) A monophasic illness pattern;
(C) An interval between onset and nadir of weakness between 12
hours and 28 days;
(D) Subsequent clinical plateau (the clinical plateau leads to either
stabilization at the nadir of symptoms, or subsequent improvement
without significant relapse; however, death may occur without a
clinical plateau); and,
3
(E) The absence of an identified more likely alternative diagnosis.
***
(v) To qualify as any subtype of GBS, there must not be a more likely
alternative diagnosis for the weakness.
(vi) Exclusionary criteria for the diagnosis of all subtypes of GBS include
the ultimate diagnosis of any of the following conditions: chronic immune
demyelinating polyradiculopathy (CIDP) . . .
42 C.F.R. § 100.3(c)(15).
Mr. Hoffman’s doctors prescribed a standard treatment for GBS, the
infusion of intravenous immunoglobulin (“IVIG”). In early 2017, when Mr.
Hoffman’s doctors were treating him for GBS, at least one doctor stated that the flu
vaccine caused Mr. Hoffman’s GBS. Exhibit 7 at 266; see also Exhibit 4 at 1053
(note, from an unknown source, that Mr. Hoffman’s allergies include the flu
vaccine).
Mr. Hoffman attempted rehabilitation for several months and sought care
from various doctors. One neurologist, Geoffrey Eubank, ordered a test for anti-
ganglioside antibodies. The results were negative. Exhibit 9 at 32.
Approximately eight months after the diagnosis of GBS, Mr. Hoffman saw
Dr. Eubank again. Exhibit 19 at 66 (Oct. 9, 2017). Dr. Eubank changed the
diagnosis to CIDP. He explained his rationale. Dr. Eubank
previously thought that [Mr. Hoffman] had Guillain
Barre syndrome but . . . [h]e continued to have some
worsening this summer and subsequently improved with
a course of IVIG for 5 days. This would not be typical for
Guillain Barre which should be more of a monophasic
illness.
Id.
Another neurologist, Timothy Rust, confirmed the diagnosis of CIDP.
Exhibit 19 at 58 (Dec. 13, 2017). Dr. Rust wrote that “CLL can be associated with
peripheral nervous system pathology similar to non-Hodgkin lymphoma, including
a relatively high rate of CIDP.” Id.
4
The diagnosis of CIDP is accepted by the neurologists retained to provide
opinions. Exhibit 30 at 7; Exhibit A at 3-4. 4 “CIDP” stands for “chronic
inflammatory demyelinating polyneuropathy,” which explains the basic
information about the disease. See Exhibit A at 4. Although most cases of CIDP
develop insidiously, CIDP can develop abruptly as in Mr. Hoffman’s case. Exhibit
30 at 7, Exhibit A at 4.
As discussed below, the etiology of CIDP is “poorly understood.” Exhibit A
at 5. According to Dr. Nadareishvili, “An abundance of clinical and experimental
research has led to the conclusion that CIDP is mediated by humoral and cellular
immunity against Schwann cell/myelin target antigens in the nerves, thus its
classification as an autoimmune disease.” Exhibit 30 at 9. A primary question in
this litigation is whether the flu vaccine can provoke an autoimmune attack, which
leads to CIDP.
II. Procedural History5
Initially, Mr. Hoffman alleged that the flu vaccine caused him to suffer GBS.
Pet., filed Jan. 22, 2019, ¶ 15. He sought compensation via the Vaccine Injury
Table and adjudication through the special processing unit of the Office of Special
Masters. Id. ¶ 20-21. The case was assigned to the special processing unit. Mr.
Hoffman periodically filed medical records.
The Secretary reviewed the evidence and recommended that compensation
be denied. Resp’t’s Rep., filed June 12, 2020. The Secretary maintained that
based upon the records from Dr. Eubank and Dr. Rust, Mr. Hoffman suffered from
4
In the Vaccine Program, petitioners often allege that a vaccine caused them to suffer
CIDP. Thus, special masters are generally familiar with CIDP. For some examples of recent
opinions about CIDP, see Radford v. Sec’y of Health & Hum. Servs., No. 18-704V, 2023 WL
2159306, at *7-12 (Fed. Cl. Spec. Mstr. Feb. 22, 2023); Berg v. Sec’y of Health & Hum. Servs.,
No. 16-650V, 2021 WL 6883495 at *24-37 (Fed. Cl. Spec. Mstr. Dec. 14, 2021); Tomsky v.
Sec’y of Health & Hum. Servs., No. 17-1132V, 2020 WL 5587365, at *8-18 (Fed. Cl. Spec.
Mstr. Aug. 24, 2020).
5
The Initial Entitlement Decision set forth the procedural history through the date it was
issued. 2024 WL 402731. The procedural history is repeated here because each decision is
evaluated separately. Cottingham v. Sec’y of Health & Hum. Servs., 971 F.3d 1337, 1345 n.2
(Fed. Cir. 2020).
5
CIDP, not GBS. Id. at 8. Because resolution through the special processing unit
seemed infeasible, the case was reassigned. Notice, issued June 25, 2020.
Mr. Hoffman changed his claim. He alleged that the flu vaccine was the
cause-in-fact of his CIDP. Am. Pet., filed Sep. 17, 2020.
Mr. Hoffman supported his claim that the flu vaccine caused his CIDP with
a report from Dr. Nadareishvili. Exhibit 30. Dr. Nadareishvili stated that CIDP is
similar to GBS. He proposed that the flu vaccine can cause CIDP via molecular
mimicry. Id. at 7-16.
The Secretary countered by presenting a report from Dr. Wilson. Exhibit A.
Dr. Wilson disputed molecular mimicry as a theory to explain how a flu vaccine
might cause CIDP. Id. at 4-5. Dr. Wilson noted that to the extent that molecular
mimicry might predict an attack on gangliosides as causing CIDP, this theory
would not explain what happened to Mr. Hoffman because a test for anti-
ganglioside antibodies was negative. Id. at 5. Finally, Dr. Wilson suggested that
chronic lymphocytic leukemia is associated with CIDP. Id. at 5.
Dr. Nadareishvili responded to Dr. Wilson in a report filed on January 11,
2022. Exhibit 63. Dr. Nadareishvili contended that Dr. Wilson did not explain
how CLL can cause CIDP. Id. at 3.
Dr. Wilson replied that he did not say that CLL can cause CIDP because
“No one knows what triggers CIDP.” Exhibit C at 2 (filed Mar. 14, 2022). In an
ensuing status conference, the Secretary was asked how Mr. Hoffman’s chronic
lymphocytic leukemia affects the case given that Dr. Wilson has not presented any
mechanism by which CLL can cause CIDP. The Secretary stated that he might
obtain a report from a different expert and Mr. Hoffman objected to adding a new
expert on the ground that Mr. Hoffman’s CLL had been in the record. The
Secretary eventually reported that he was not interested in settlement and will
continue to defend the case. Resp’t’s Status Rep., filed Apr. 27, 2022.
The parties were directed to file briefs. Order, issued July 18, 2022. Mr.
Hoffman filed his primary brief on August 22, 2022 and his reply on October 5,
2022. In between, the Secretary filed his brief on September 21, 2022.
As noted previously, Mr. Hoffman was found not entitled to compensation.
Initial Entitlement Decision. 2024 WL 402731. The basis for denial was two-fold.
First, the appropriate burden of proof regarding Althen prong 1 is preponderant
6
evidence, not plausibility. Second, Mr. Hoffman failed to establish the
persuasiveness of the molecular mimicry theory in the context of a flu vaccine
causing CIDP. The Initial Entitlement Decision also commented, briefly, on
Althen prong 2 and Althen prong 3. The Initial Entitlement Decision found that
Mr. Hoffman had likely established Althen prong 3 because the interval between
the vaccination and the onset of his CIDP was appropriate for inferring causation.
However, the evidence regarding Althen prong 2 was less clear.
In granting Mr. Hoffman’s motion for review, the Court focused upon the
burden of proof for Althen prong 1. The Court instructed the undersigned to
determine whether Mr. Hoffman “has presented preponderant evidence linking the
flu vaccine to CIDP via a biologically plausible theory.” Opinion and Order, 2024
WL 3688477, at *14. Earlier, the Opinion and Order had defined “plausibility” as
“a qualitative inquiry into whether a fact is ‘[c]onceivably true.’” Id. at *2 n.1
(quoting Black’s Law Dictionary (11th ed. 2019)).
Following remand, the parties were directed to answer various questions and
they did. See Order, issued July 9, 2024; Pet’r’s Br. on Remand, filed July 24,
2024; Resp’t’s Br. on Remand, filed July 24, 2024. An oral argument was held on
August 16, 2024. With the oral argument, the case is again ready for adjudication.
III. Standards for Adjudication
A petitioner is required to establish his case by a preponderance of the
evidence. 42 U.S.C. § 300aa–13(1)(a). The preponderance of the evidence
standard requires a “trier of fact to believe that the existence of a fact is more
probable than its nonexistence before [he] may find in favor of the party who has
the burden to persuade the judge of the fact's existence.” Moberly v. Sec’y of
Health & Hum. Servs., 592 F.3d 1315, 1322 n.2 (Fed. Cir. 2010) (citations
omitted). Proof of medical certainty is not required. Bunting v. Sec’y of Health &
Hum. Servs., 931 F.2d 867, 873 (Fed. Cir. 1991).
Distinguishing between “preponderant evidence” and “medical certainty” is
important because a special master should not impose an evidentiary burden that is
too high. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379-80 (Fed.
Cir. 2009) (reversing special master's decision that petitioners were not entitled to
compensation); see also Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357
(Fed. Cir. 2000); Hodges v. Sec’y of Health & Hum. Servs., 9 F.3d 958, 961 (Fed.
Cir. 1993) (disagreeing with dissenting judge's contention that the special master
confused preponderance of the evidence with medical certainty).
7
When a petitioner, like Mr. Hoffman, claims that a vaccine caused an injury
not listed on the Vaccine Injury Table, such as CIDP, the elements of a petitioner’s
case are well defined. A petitioner bears a burden “to show by preponderant
evidence that the vaccination brought about [the vaccinee’s] injury by providing:
(1) a medical theory causally connecting the vaccination and the injury; (2) a
logical sequence of cause and effect showing that the vaccination was the reason
for the injury; and (3) a showing of a proximate temporal relationship between
vaccination and injury.” Althen v. Sec’y of Health & Hum. Servs., 418 F.3d 1274,
1278 (Fed. Cir. 2005).
The contents of the Opinion and Order are binding in this case. Boatmon v.
Sec’y of Health & Hum. Servs., 941 F.3d 1351, 1358 (Fed. Cir. 2019). In the
context of evaluating a district court's actions after a remand, the Federal Circuit
has stated that “the district court's actions on remand should not be inconsistent
with either the letter or the spirit of the mandate.” Laitram Corp. v. NEC Corp.,
115 F.3d 947, 951 (Fed. Cir. 1997).
IV. Analysis
The Secretary has not challenged prong three, which concerns timing. Tr.
112; Exhibit A at 5. Thus, the analysis concerns prongs one and two.
A. Althen Prong One
The Court’s Opinion and Order directed the undersigned to evaluate whether
Mr. Hoffman presented “preponderant evidence linking the flu vaccine to CIDP
via a biologically plausible theory.” The Court also defined “plausibility” in terms
of being “conceivably true.” The theory that Mr. Hoffman advances is molecular
mimicry. Thus, by substitution, the Court’s directive can be recast as requiring an
evaluation as to whether preponderant evidence supports a finding that it is
conceivably true that molecular mimicry can explain how the flu vaccine can cause
CIDP.6 The parties agreed that the Opinion and Order may reasonably be
6
Although the First Entitlement Decision cited a series of opinions from the Court of
Federal Claims about molecular mimicry as persuasive precedents, the Court’s Opinion and
Order did not cite to any of them. Similarly, although the First Entitlement Decision referenced
one case from the Federal Circuit about molecular mimicry, W.C. v. Sec’y of Health & Hum.
Servs., 704 F.3d 1352 (Fed. Cir. 2013), the Court’s Opinion and Order did not cite to W.C. See
8
interpreted as directing the undersigned to consider whether it is conceivable true
that molecular mimicry can explain how the flu vaccine can cause CIDP. Tr. 112-
15.
Through Dr. Nadareishvili, Mr. Hoffman advances molecular mimicry as a
biologically plausible way that a flu vaccine can cause CIDP. Pet’r’s Br. at 24-40;
see also Exhibit 30 at 11.7 Any vaccine is designed to engage people’s immune
systems. CIDP is considered an “immune-mediated neuropathy.” Exhibit 30 at 9.
This means that a person’s immune system attacks components of the nervous
system. A similar term is “autoimmune.” See Exhibit 32 (Lunn and Sheikh) at
768.8 Molecular mimicry is one of the most common theories offered by
petitioners to explain how a vaccine can cause a disease. See Tr. 123. A list of
more than 75 examples of cases with molecular mimicry is presented in the
appendices.
In simple terms, the theory of molecular mimicry is a vaccine -> (activates)
immune system -> (attacks) human tissue -> disease. Preponderant evidence
supports a finding that this proposition is conceivably true in the context of flu
vaccine and CIDP.
Evidence supporting the statement that it is conceivably true that molecular
mimicry explains how the flu vaccine can cause CIDP comes primarily from the
parties’ experts. Mr. Hoffman’s expert opined that “to a reasonable level of
scientific probability, this patient's seasonal influenza vaccination formed a
substantial factor in the development of inflammatory demyelinating
polyradiculopathy, which eventually became chronic (CIDP).” Exhibit 30 at 7.
Tr. 6 (identifying seven potentially relevant Federal Circuit precedential opinions). Under these
circumstances, review of those opinions would not be appropriate.
7
Although Mr. Hoffman alludes to “other pathologic mechanisms,” Pet.’r’s Br. at 24, he
has not developed any argument with regard to pathologic mechanisms except for molecular
mimicry. See Tr. 123.
8
Michael Lunn & Kazim Sheikh, Peripheral Neuropathies, 5 The Autoimmune Diseases
757 (2014). “Exhibit 31” is shown on the actual medical article; however, the comprehensive
exhibit list, submitted on April 1, 2023, indicates that this article is “Exhibit 32.” “Exhibit 31” is
shown on Dr. Nadareishvili’s curriculum vitae as well. The comprehensive exhibit list indicates
that Dr. Nadareishvili’s curriculum vitae is “Exhibit 31.” It appears that the Exhibit number on
the medical article is inaccurate. This decision will cite to this medical article as Exhibit 32.
9
The Secretary’s expert, Dr. Wilson, stated that “there is very weak evidence for
any association between CIDP and influenza vaccinations.” Exhibit A at 4. Dr.
Wilson did not opine that molecular mimicry is not conceivably true. Thus, to a
degree, Dr. Wilson’s opinion is not answering the question posed by the Court.
Beyond the opinion of Dr. Nadareishvili, relatively little evidence strongly
supports or strongly contradicts the proposition that it is conceivably true for
molecular mimicry to explain how flu vaccine can cause CIDP. For example, Dr.
Nadareishvili cited two articles in which the authors surveyed approximately 100
people who had CIDP to determine what were antecedent events. Exhibit 30 at 8
n.3. In one article, four people reported receiving vaccines but none reported the
flu vaccine. Exhibit 55 (McCombe) at 2622. 9 In the second article, none of the
people reported a vaccination within six weeks before the onset of their CIDP,
although 16 people reported an infection. Exhibit 56 (Bouchard) at 499. 10 At oral
argument, Mr. Hoffman’s counsel maintained that McCombe was relevant because
the authors “include vaccines in their data set.” Tr. 146. 11
It would be difficult to find that McCombe or Bouchard make it likely that
flu vaccination causes CIDP. See Howard v. Sec’y of Health & Hum. Servs., No.
16-1592V, 2022 WL 4869354, at *11, *24-25 (Fed. Cl. Spec. Mstr. Aug. 31, 2022)
(denying entitlement despite the presence of McCombe), mot. for rev. denied, 2023
WL 4117370, at *6 (Fed. Cl. 2023), aff’d without opinion, 2024 WL 2873301
(Fed. Cir. 2024). But, when the operative issue is whether it is conceivably true
that flu vaccination can cause CIDP via molecular mimicry, then McCombe and
Bouchard are supportive.
The same analysis also deepens the evidentiary value of a case report Dr.
Nadareishvili advanced. In this article, the authors described an instance in which
a 74-year-old man received a flu vaccination and, two days later, developed
9
P.A. McCombe et al., Chronic Inflammatory Demyelinating Polyradiculoneuropathy: A
Clinical And Electrophysiological Study of 92 Cases, 110 Brain 1617 (1987), filed as Exhibit 55.
10
C. Bouchard et al., Clinicopathologic findings and prognosis of chronic inflammatory
demyelinating polyneuropathy, 52 NEUROLOGY 498 (1999), filed as Exhibit 56.
11
At oral argument, Mr. Hoffman’s counsel was less familiar with the value of Bouchard.
See Tr. 1418-50.
10
weakness that led to a diagnosis of CIDP. Exhibit 44 (Brostoff) at 229. 12
Generally speaking, case reports provide little, if any, persuasive evidence that an
antecedent event (like a vaccination) caused the subsequence evident (like a
disease) because the case reports present sequences of events. 13 See Tr. 152-54.
But, the present inquiry is different: does a case report enhance the biologic
plausibility of the proposition? It does. See J. v. Sec’y of Health & Hum. Servs.,
155 Fed. Cl. 20, 47 (2021) (characterizing the Agmon-Levin case reports as
“probative”); Bryan v. Sec’y of Health & Hum. Servs., No. 14-898V, 2020 WL
7089841, at *21 (Fed. Cl. Spec. Mstr. Oct. 9, 2020). The authors’ creation of a
case report supports the idea that it is “conceivably true” that the preceding event
caused the subsequent event. See Tr. 154.
Under the “biological plausibility” / “conceivably true” standard, Mr.
Hoffman has passed this threshold with Dr. Nadareishvili’s invocation of
molecular mimicry as a method to explain how flu vaccine can cause CIDP. It also
seems that almost every offering of molecular mimicry would be seen as
conceivably true. The appendices demonstrate the variety of vaccine-injury
combinations in which petitioners have proposed molecular mimicry. In a non-
binding opinion, a different judge recognized the molecular mimicry could
encompass almost anything:
In fact, because Dr. Tornatore does not offer any specific
explanation as to the distinct connection between Tdap,
molecular mimicry, and GBS, one could take Dr.
Tornatore’s causation theory and substitute any table
vaccine (e.g., the measles vaccine) and any autoimmune
disorder (e.g., autoimmune encephalitis) and Dr.
Tornatore’s expert report’s discussion of molecular
mimicry would require absolutely no changes. That is
how general his molecular mimicry theory is—it does not
12
J.M. Brostoff et al., Post-influenza vaccine chronic inflammatory demyelinating
polyneuropathy, 37 AGE AND AGEING 229 (2008), filed as Exhibit 44.
13
A few case reports, such as those presenting examples of challenge-rechallenge, might
be different. However, Mr. Hoffman conceded that Brostoff was not one of those special case
reports. Tr. 156.
11
matter which vaccine and which autoimmune disorder
are plugged in.
Dennington v. Sec’y of Health & Hum. Servs., 167 Fed. Cl. 640, 654 (2023),
appeal dismissed, No. 2024-1214 (Fed. Cir. Mar. 25, 2024) When asked at oral
argument what evidence would negate the plausibility of molecular mimicry, Mr.
Hoffman’s counsel struggled to articulate any. See Tr. 174. Mr. Hoffman’s
attorney argued that “there will never be a point where the – where the Special
Masters are in a position to negate molecular mimicry.” Tr. 167. 14
The outcome of this ruling differs from the outcome in the First Entitlement
Decision because the burden of proof has changed. The First Entitlement Decision
found that Mr. Hoffman did not present a persuasive medical theory. However, for
the reasons explained above, Mr. Hoffman has presented a plausible medical
theory.
Accordingly, Mr. Hoffman has met the burden of proof as the Court has
defined it for Althen prong one.
B. Althen Prong Two
The second element of the causation-in-fact test is whether petitioner has
shown “a logical sequence of cause and effect showing that the vaccination was the
reason for the injury.” Althen, 418 F.3d at 1278. With respect to this prong, the
Federal Circuit has instructed special masters to consider carefully the views of a
treating doctor. Capizzano v. Sec’y of Health & Hum. Servs., 440 F.3d 1317, 1326
(Fed. Cir. 2006).
Here, Mr. Hoffman draws support from Dr. Nadareishvili, who opined that
the vaccination was “a substantial factor in the causation of Mr. Hoffman’s injured
condition.” Exhibit 30 at 1. Dr. Nadareishvili appears to reach this conclusion
because (1) in his view, the flu vaccine can cause CIDP, (2) the CIDP presented in
an appropriate time after the flu vaccination (12 days), and (3) an elimination of
14
The fact that under the biologic plausibility standard, petitioners will almost
universally satisfy Althen prong one by presenting molecular mimicry does not affect the
outcome. Appellate authorities define the elements of petitioners’ cases and special masters
(attempt to) implement those standards. Althen, 418 F.3d at 1280 (a “special master’s role is to
apply the law”).
12
other potential causes. See id. at 18. Mr. Hoffman reasons this way as well.
Pet’r’s Br. at 41-43; Tr. 184-87.
Whether other causes of CIDP have been eliminated is debatable. The
Secretary’s expert, Dr. Wilson, stated that CLL has been associated with CIDP.
Exhibit A at 4. But, Dr. Wilson confirmed with admirable honesty and clarity in
his second report: “I did not provide a mechanistic explanation for what causes
CIDP; however, I intentionally did not use the words ‘cause’ or ‘causal’ when
discussing the association between hematologic malignancies and CIDP. No one
knows what triggers CIDP.” Exhibit C at 2. The Secretary similarly conceded that
the Secretary has not explained how a cancer can cause CIDP. Tr. 193-94.15 Thus,
Mr. Hoffman’s experience of CLL four years earlier still allows for a finding that
the flu vaccine caused his CIDP. See Pet’r’s Supp’l Br., filed July 24, 2024, at 7-
10.
At the end of the day, relatively little evidence supports or detracts on this
point. See Exhibit 30 at 18 (Dr. Nadareishvili: “Regarding the opinions of treating
physicians on etiology, the record in this case is relatively quiet”). The scarcity of
evidence does not prevent a finding in Mr. Hoffman’s favor as the proverbial
evidentiary scales need to tip only slightly. There is sufficient evidence for Mr.
Hoffman to meet his burden.
V. Conclusion
Under the standards set in the Court’s Opinion and Order, Mr. Hoffman has
shown that he is entitled to compensation. A separate damages order will issue
shortly.
15
The Secretary’s primary argument regarding prong two is that this element is irrelevant
because Mr. Hoffman’s case fails on prong one. Tr. 110, 188. However, for reasons explained
in the text, molecular mimicry is conceivably true.
13
The Clerk’s Office is directed to provide this Ruling to the assigned judge.
See Vaccine Rule 28.1(a).
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
14
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2019 WL rheumatoid
Parker Sanders, SM. 14‐979V 6/24/2019 flu accepted
3425297 arthritis
2019 WL
McKown Corcoran, SM. 15‐1451V 7/15/2019 HPV POTS rejected
4072113
2019 WL transverse
Pearson Dorsey, SM. 16‐9V 7/31/2019 flu rejected
3852633 myelitis
SM was not
arbitrary or
146 Fed. Cl. capricious in
Yalacki Firestone, J. 14‐278V 8/5/2019 hepatitis B POTS, CFS rejected
80 rejecting
molecular
mimicry
2019 WL small fiber
Swaiss Gowen, SM. 15‐286V 11/4/2019 Tdap accepted
6520791 GBS
MFR
denied,
2019 WL rheumatoid
Tullio Moran, SM. 15‐51V 12/19/2019 flu rejected 149 Fed.
7580149 arthritis
Cl. 448
(2020)
2020 WL multiple
Hitt Moran, SM. 15‐1283V 1/24/2020 flu accepted
831822 sclerosis
GBS as diagnosis
2020 WL
Sweeney Sanders, SM. 13‐392V 2/28/2020 flu GBS not evaluated was not
1844672
established
1
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
Respondent's
expert offered
MM to explain
para‐ how lung cancer
2020 WL
Sweeney Sanders, SM. 13‐392V 2/28/2020 flu neoplastic accepted could have
1844672
syndrome neurologic
complications.
SM seemed to
endorse.
2020 WL
Allard Roth, SM. 14‐442V 3/9/2020 HPV ITP rejected
1649669
2020 WL Timing was
Rowan Corcoran, SM. 17‐760V 4/28/2020 flu GBS not evaluated
2954954 wrong
MFR
denied,
2020 WL MMR and Onset was too
Castaneda Oler, SM. 15‐1066V 5/18/2020 PANS rejected 152
3833076 others quick
Fed.Cl.
576 (2020)
MFR
flu and/or denied,
2020 WL cryoglobuline
Temes Corcoran, SM. 16‐1465V 5/21/2020 pneumoco rejected 151 Fed.
4198036 mia
ccal Cl. 448
(2020)
2020 WL
Walls Olers, SM. 16‐557V 6/23/2020 childhood ITP accepted
13801342
2020 WL pneumoco
Deshler Corcoran, SM. 16‐1070V 7/1/2020 GBS rejected
4593162 ccal
2
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
MFR
denied,
2020 WL
Duncan Moran, SM. 16‐1367V 10/19/2020 HPV PANDAS rejected 153 Fed.
6738118
Cl. 642
(2021)
Petition filed
Soltero 2020 WL
Horner, SM. 16‐808V 10/20/2020 flu GBS accepted before Table
Arias 6706071
change
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu narcolepsy rejected 154
9076620
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL small fiber
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu rejected 154
9076620 neuropathy
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu CFS rejected 154
9076620
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu POTS rejected 154
9076620
Fed.Cl.
149 (2021)
3
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2020 WL
Phillips Oler, SM. 16‐906V 11/23/2020 HPV ITP accepted
7767511
2020 WL
Phillips Oler, SM. 16‐906V 11/23/2020 live flu ITP rejected
7767511
Special master's
rejection of
flu and/or molecular
151 Fed. Cl. cryoglobuline
Temes Griggsby, J. 16‐1465V 12/7/2020 pneumoco rejected mimicry was
448 mia
ccal supported by
substantial
evidence.
2021 WL
Pickens Moran, SM. 17‐187V 1/22/2021 MMR SIDP rejected
615218
Special master
found that
2021 WL polyneuropat
Blender Dorsey, SM. 16‐1308V 2/26/2021 flu accepted pneumococcal
1096662 hy
vaccine played no
role
primary
2021 WL medistinal
Nifakos Oler, SM. 14‐236V 3/4/2021 HPV rejected
1345218 large B‐cell
lymphoma
Thrombotic
2021 WL
Parmer Roth, SM. 16‐880V 3/25/2021 flu Thrombo‐ accepted
1524512
cytopenia
2021 WL multiple
Robinson Oler, SM. 14‐952V 4/12/2021 flu accepted
2371721 sclerosis
4
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
SM was not
arbitrary or
153 Fed. Cl. capricious in
Duncan Davis, J. 16‐1367V 4/19/2021 HPV PANDAS rejected
642 rejecting
molecular
mimicry
vacated
On review, CFC and
found that remanded,
2021 WL brachial
Patton Horner, SM. 15‐1553V 5/17/2021 flu rejected molecular 157
2389835 neuritis
mimicry theory Fed.Cl.
satisfied Althen 1 159
(2021).
SM was not
MFR
arbitrary or
denied, affirmed,
2021 WL pneumoco capricious in
Loyd Corcoran, SM. 16‐811V 5/20/2021 ITP rejected not 2023 WL
2708941 ccal rejecting
available 1878572
molecular
on WL
mimicry
2021 WL small fiber
E.M. Sanders, SM. 14‐753V 7/9/2021 flu accepted
3477837 neuropathy
MFR
denied,
2021 WL
Caredio Corcoran, SM. 17‐79V 7/30/2021 flu epilepsy rejected 2021 WL
4100294
6058835
(2021)
5
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
Accepted theory
in ruling but later
dismissed for
insufficient
premature
2021 WL evidence that
Brayboy Sanders, SM. 15‐183V 8/30/2021 HPV ovarian accepted
4453146 Petitioner has
insufficiency
POI with
autoimmune
etiology, 2022
WL 1316235
2021 WL rheumatoid
Moran Oler, SM. 16‐538V 10/4/2021 flu rejected
4853544 arthritis
2021 WL pneumoco Miller‐Fisher
Koller Gowen, SM. 16‐439V 10/8/2021 accepted
5027947 ccal GBS
2021 WL
Andrews Oler, SM. 16‐196V 10/21/2021 flu SLE rejected
5755328
2021 WL peripheral
Haubner Sanders, SM. 16‐1426V 10/22/2021 flu rejected
5614942 neuropathy
Petitioner did not
2021 WL
Winkler Dorsey, SM. 18‐203V 12/10/2021 Tdap GBS not evaluated establish other
6276203
Althen prongs
2021 WL accepted in
Berg Oler, SM. 16‐650V 12/14/2021 flu CIDP
6883495 dicta
2022 WL transverse
I.J. Corcoran, SM. 16‐864V 1/4/2022 Tdap accepted Ruling on remand
277555 myelitis
juvenile
2022 WL
Putman Corcoran, SM. 19‐1921V 1/31/2022 MMR idiopathic rejected
600417
arthritis
2022 WL
Mason Corcoran, SM. 17‐1383V 2/4/2022 flu CIDP accepted
600415
6
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2022 WL
Clark Horner, SM. 18‐813V 2/7/2022 hepatitis B shoulder rejected
16635681
2022 WL
Sanchez Corcoran, SM. 18‐1012V 3/11/2022 Tdap CIDP rejected
1013264
2022 WL pneumoco
Maloney Dorsey, SM. 19‐1713V 3/17/2022 GBS accepted
1074087 ccal
2022 WL pneumoco transverse
Tracy Sanders, SM. 16‐213V 3/30/2022 accepted
1125281 ccal myelitis
MFR
denied, affirmed,
2022 WL
K.A. Corcoran, SM. 16‐989V 4/18/2022 Tdap GBS rejected 164 2024 WL
20213037
Fed.Cl. 98 2012526
(2022)
2022 WL pneumoco ulcerative
Gapen Moran, SM. 19‐422V 5/5/2022 rejected
1711616 ccal colitis
MMR,
2022 WL varicella,
Moses Moran, SM. 19‐739V 5/18/2022 sJIA rejected
2073346 pneumoco
ccal
MFR
Petitioner did not denied, affirmed,
2022 WL
Henkel Sanders, SM. 15‐1048V 8/31/2022 live flu narcolepsy accepted establish other 165 2024 WL
16557979
Althen prongs Fed.Cl. 3873569
153 (2023)
2022 WL small fiber
J.D. Sanders, SM. 14‐742V 8/31/2022 flu rejected
16543853 neuropathy
2022 WL pneumoco
Gross Dorsey, SM. 17‐1075V 9/22/2022 CIDP accepted
9669651 ccal
2023 WL
Mitchell Dorsey, SM. 19‐1534V 1/11/2023 flu ITP accepted
4483134
7
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2023 WL
C.F Horner, SM. 15‐731V 1/20/2023 HPV POTS rejected
2198809
2023 WL
E.A. Dorsey, SM. 18‐1587V 1/24/2023 flu Bell's palsy accepted
2640710
2023 WL
Bishara Moran, SM. 19‐115V 1/27/2023 Tdap scleroderma rejected
2799054
SM was not
arbitrary or
164 Fed. Cl. hepatitis B, capricious in affirmed
J.S. Meyers, J. 16‐1083V 2/13/2023 POTS rejected
314 HPV rejecting 9/5/24
molecular
mimicry
MFR
denied,
2023 WL pneumoco
Trollinger Corcoran, SM. 16‐473V 2/17/2023 GBS rejected 167
2521912 ccal
Fed.Cl.
127 (2023)
2023 WL
Radford Moran, SM. 18‐704V 2/22/2023 flu CIDP rejected
2159306
auto‐immune
2023 WL autonomic
Ambriz Sanders, SM. 15‐502V 2/27/2023 HPV rejected
2771037 ganglionopat
hy
MFR
premature Denied denied,
2023 WL
Bello Sanders, SM. 13‐349V 3/10/2023 HPV ovarian accepted entitlement on 167
2447497
failure other prongs Fed.Cl.
517 (2023)
8
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2023 WL transverse
Le Dorsey, SM. 16‐1078V 3/30/2023 Tdap accepted
3049203 myelitis
Giannanto 2023 WL
Moran, SM. 18‐497V 3/30/2023 varicella ADEM rejected
nio 2721387
2023 WL
J.G. Dorsey, SM. 20‐664V 4/3/2023 hepatitis A GBS accepted
2752634
2023 WL
Specks Sanders, SM. 15‐491V 4/14/2023 flu POTS rejected
2947619
2023 WL
DrummondSanders, SM. 16‐702V 4/21/2023 HPV POTS rejected
3035072
2023 WL myasthenia
Kelly Horner, SM. 16‐1548V 5/5/2023 flu rejected
3274159 gravis
2023 WL myasthenia
Smilo Dorsey, SM. 18‐1585V 5/15/2023 flu rejected
3918397 gravis
2023 WL multiple
Bravo Moran, SM. 17‐501V 5/31/2023 hepatitis B rejected
4147146 sclerosis
2023 WL
Hofer Gowen, SM. 18‐1752V 6/12/2023 flu MAID accepted
4397810
2023 WL rheumatoid
Clark Oler, SM. 17‐1553V 6/16/2023 flu rejected
4897284 arthritis
2023 WL dermato‐
McDaniel Dorsey, SM. 17‐1322V 6/26/2023 flu rejected
4678688 myositis
2023 WL small fiber
Schlusser Sanders, SM. 16‐901V 6/30/2023 flu rejected
4926908 neuropathy
2023 WL
Osso Dorsey, SM. 18‐575V 7/13/2023 hepatitis B GBS accepted
5016473
2023 WL hepatitis A multiple
Williams Roth, SM. 13‐471V 7/25/2023 accepted
4741993 &B sclerosis
2023 WL multiple
Mathis Moran, SM. 20‐431V 8/1/2023 flu rejected
5436135 sclerosis
2023 WL
Cobb Oler, SM. 17‐1123V 8/21/2023 HPV narcolepsy accepted
6457568
9
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
MFR
denied,
2023 WL multiple appeal
Townsend Dorsey, SM. 14‐266V 8/29/2023 flu rejected 170
6212496 sclerosis filed
Fed.Cl.
130 (2024)
2023 WL transverse
Bowling Moran, SM. 18‐109V 9/20/2023 flu rejected
6846491 myelitis
2023 WL alopecia
Farag Sanders, SM. 17‐714V 9/29/2023 HPV rejected
7203034 areata
167 Fed. Cl.
DenningtonSomers, J. 18‐1303V 10/6/2023 tetanus GBS rejected
640
chronic
2023 WL
Stoev Moran, SM. 19‐1434V 10/12/2023 HPV regional pain rejected
7297981
syndrome
Arredond 2023 WL
Dorsey, SM. 18‐1782V 10/31/2023 flu Bell's palsy accepted
o 8181138
2023 WL small fiber
Fiske Oler, SM. 17‐1378V 11/13/2023 flu accepted
8352761 neuropathy
2023 WL pneumoco
Sprenger Dorsey, SM. 18‐279V 11/14/2023 GBS accepted
8543435 ccal
2023 WL rheumatoid
Wilson Oler, SM. 17‐1264V 12/7/2023 flu rejected
9053671 arthritis
2024 WL small fiber
Greenhaw Moran, SM. 21‐2032V 1/2/2024 flu rejected
263123 neuropathy
mot. for
systemic rev.
2024 WL lupus denied,
Stricker Moran, SM. 18‐56V 1/2/2024 HPV rejected
263189 erthematosu 170
s (SLE) Fed.Cl.
701 (2024)
10
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2024 WL pneumoco
Anderson Dorsey, SM. 18‐484V 1/17/2024 GBS accepted
557052 ccal
2024 WL
Alsaadeh Dorsey, SM. 19‐1097V 1/23/2024 flu hearing loss rejected
694072
2024 WL
Rocha Moran, SM. 16‐241V 2/1/2024 hepatitis B vasculitis rejected
752787
MFR
denied,
Gamboa‐ 2023 WL pneumoco appeal
Tapp, J. 18‐925V 2/26/2024 GBS rejected 170
Avila 6536207 ccal filed
Fed.Cl.
441 (2024)
MFR
sensori‐
2024 WL denied,
Herms Dorsey, SM. 19‐70V 3/4/2024 DTaP neural rejected
1340669 2024 WL
hearing loss
3837327
2024 WL
Sparrow Moran, SM. 18‐295V 3/19/2024 MMR ADEM rejected MFR filed
1599165
Petitioner did not
2024 WL transverse
Brancheau Dorsey, SM. 21‐1209V 3/21/2024 flu not evaluated establish other
1619606 myelitis
Althen prongs
2024 WL GBS ‐ non‐
Lau Dorsey, SM. 19‐1956V 3/22/2024 flu accepted
1638367 Table
2024 WL Anti‐NMDAR
L.R. / BaxteOler, SM. 16‐922V 3/28/2024 various rejected
1912575 encephalitis
2024 WL small fiber
Coons Dorsey, SM. 20‐1067V 3/29/2024 Td accepted
1741619 neuropathy
2024 WL
Broussard Moran, SM. 18‐302V 4/4/2024 hepatitis B NMO rejected
1829210
11
Appendix 1:
Some Cases with Molecular Mimicry Sorted by Date
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
Petitioner did not
2024 WL neuroinflama have
M.M. Dorsey, SM. 18‐583V 7/18/2024 flu not evaluated
4164557 mation neuroinflammati
on
2024 WL pneumoco
Morrison Oler, SM. 18‐386V 7/18/2024 GBS rejected
3738934 ccal
12
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2020 WL
Walls Olers, SM. 16‐557V 6/23/2020 childhood ITP accepted
13801342
MFR
sensori‐
2024 WL denied,
Herms Dorsey, SM. 19‐70V 3/4/2024 DTaP neural rejected
1340669 2024 WL
hearing loss
3837327
2021 WL peripheral
Haubner Sanders, SM. 16‐1426V 10/22/2021 flu rejected
5614942 neuropathy
2023 WL
E.A. Dorsey, SM. 18‐1587V 1/24/2023 flu Bell's palsy accepted
2640710
Arredond 2023 WL
Dorsey, SM. 18‐1782V 10/31/2023 flu Bell's palsy accepted
o 8181138
vacated
On review, CFC and
found that remanded,
2021 WL brachial
Patton Horner, SM. 15‐1553V 5/17/2021 flu rejected molecular 157
2389835 neuritis
mimicry theory Fed.Cl.
satisfied Althen 1 159
(2021).
2021 WL accepted in
Berg Oler, SM. 16‐650V 12/14/2021 flu CIDP
6883495 dicta
2022 WL
Mason Corcoran, SM. 17‐1383V 2/4/2022 flu CIDP accepted
600415
2023 WL
Radford Moran, SM. 18‐704V 2/22/2023 flu CIDP rejected
2159306
2023 WL dermato‐
McDaniel Dorsey, SM. 17‐1322V 6/26/2023 flu rejected
4678688 myositis
MFR
denied,
2021 WL
Caredio Corcoran, SM. 17‐79V 7/30/2021 flu epilepsy rejected 2021 WL
4100294
6058835
(2021)
1
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
GBS as diagnosis
2020 WL
Sweeney Sanders, SM. 13‐392V 2/28/2020 flu GBS not evaluated was not
1844672
established
2020 WL Timing was
Rowan Corcoran, SM. 17‐760V 4/28/2020 flu GBS not evaluated
2954954 wrong
Petition filed
Soltero 2020 WL
Horner, SM. 16‐808V 10/20/2020 flu GBS accepted before Table
Arias 6706071
change
2024 WL GBS ‐ non‐
Lau Dorsey, SM. 19‐1956V 3/22/2024 flu accepted
1638367 Table
2024 WL
Alsaadeh Dorsey, SM. 19‐1097V 1/23/2024 flu hearing loss rejected
694072
2023 WL
Mitchell Dorsey, SM. 19‐1534V 1/11/2023 flu ITP accepted
4483134
2023 WL
Hofer Gowen, SM. 18‐1752V 6/12/2023 flu MAID accepted
4397810
2020 WL multiple
Hitt Moran, SM. 15‐1283V 1/24/2020 flu accepted
831822 sclerosis
2021 WL multiple
Robinson Oler, SM. 14‐952V 4/12/2021 flu accepted
2371721 sclerosis
2023 WL multiple
Mathis Moran, SM. 20‐431V 8/1/2023 flu rejected
5436135 sclerosis
MFR
denied,
2023 WL multiple appeal
Townsend Dorsey, SM. 14‐266V 8/29/2023 flu rejected 170
6212496 sclerosis filed
Fed.Cl.
130 (2024)
2023 WL myasthenia
Kelly Horner, SM. 16‐1548V 5/5/2023 flu rejected
3274159 gravis
2023 WL myasthenia
Smilo Dorsey, SM. 18‐1585V 5/15/2023 flu rejected
3918397 gravis
2
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
Petitioner did not
2024 WL neuroinflama have
M.M. Dorsey, SM. 18‐583V 7/18/2024 flu not evaluated
4164557 mation neuroinflammati
on
Respondent's
expert offered
MM to explain
para‐ how lung cancer
2020 WL
Sweeney Sanders, SM. 13‐392V 2/28/2020 flu neoplastic accepted could have
1844672
syndrome neurologic
complications.
SM seemed to
endorse.
Special master
found that
2021 WL polyneuropat
Blender Dorsey, SM. 16‐1308V 2/26/2021 flu accepted pneumococcal
1096662 hy
vaccine played no
role
2023 WL
Specks Sanders, SM. 15‐491V 4/14/2023 flu POTS rejected
2947619
2019 WL rheumatoid
Parker Sanders, SM. 14‐979V 6/24/2019 flu accepted
3425297 arthritis
MFR
denied,
2019 WL rheumatoid
Tullio Moran, SM. 15‐51V 12/19/2019 flu rejected 149 Fed.
7580149 arthritis
Cl. 448
(2020)
2021 WL rheumatoid
Moran Oler, SM. 16‐538V 10/4/2021 flu rejected
4853544 arthritis
2023 WL rheumatoid
Clark Oler, SM. 17‐1553V 6/16/2023 flu rejected
4897284 arthritis
3
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2023 WL rheumatoid
Wilson Oler, SM. 17‐1264V 12/7/2023 flu rejected
9053671 arthritis
2021 WL
Andrews Oler, SM. 16‐196V 10/21/2021 flu SLE rejected
5755328
2023 WL small fiber
Fiske Oler, SM. 17‐1378V 11/13/2023 flu accepted
8352761 neuropathy
2024 WL small fiber
Greenhaw Moran, SM. 21‐2032V 1/2/2024 flu rejected
263123 neuropathy
2021 WL small fiber
E.M. Sanders, SM. 14‐753V 7/9/2021 flu accepted
3477837 neuropathy
2022 WL small fiber
J.D. Sanders, SM. 14‐742V 8/31/2022 flu rejected
16543853 neuropathy
2023 WL small fiber
Schlusser Sanders, SM. 16‐901V 6/30/2023 flu rejected
4926908 neuropathy
Thrombotic
2021 WL
Parmer Roth, SM. 16‐880V 3/25/2021 flu Thrombo‐ accepted
1524512
cytopenia
2019 WL transverse
Pearson Dorsey, SM. 16‐9V 7/31/2019 flu rejected
3852633 myelitis
2023 WL transverse
Bowling Moran, SM. 18‐109V 9/20/2023 flu rejected
6846491 myelitis
Petitioner did not
2024 WL transverse
Brancheau Dorsey, SM. 21‐1209V 3/21/2024 flu not evaluated establish other
1619606 myelitis
Althen prongs
MFR
flu and/or denied,
2020 WL cryoglobuline
Temes Corcoran, SM. 16‐1465V 5/21/2020 pneumoco rejected 151 Fed.
4198036 mia
ccal Cl. 448
(2020)
4
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
Special master's
rejection of
flu and/or molecular
151 Fed. Cl. cryoglobuline
Temes Griggsby, J. 16‐1465V 12/7/2020 pneumoco rejected mimicry was
448 mia
ccal supported by
substantial
evidence.
2023 WL
J.G. Dorsey, SM. 20‐664V 4/3/2023 hepatitis A GBS accepted
2752634
2023 WL hepatitis A multiple
Williams Roth, SM. 13‐471V 7/25/2023 accepted
4741993 &B sclerosis
2023 WL
Osso Dorsey, SM. 18‐575V 7/13/2023 hepatitis B GBS accepted
5016473
2023 WL multiple
Bravo Moran, SM. 17‐501V 5/31/2023 hepatitis B rejected
4147146 sclerosis
2024 WL
Broussard Moran, SM. 18‐302V 4/4/2024 hepatitis B NMO rejected
1829210
SM was not
arbitrary or
146 Fed. Cl. capricious in
Yalacki Firestone, J. 14‐278V 8/5/2019 hepatitis B POTS, CFS rejected
80 rejecting
molecular
mimicry
2022 WL
Clark Horner, SM. 18‐813V 2/7/2022 hepatitis B shoulder rejected
16635681
2024 WL
Rocha Moran, SM. 16‐241V 2/1/2024 hepatitis B vasculitis rejected
752787
5
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
SM was not
arbitrary or
164 Fed. Cl. hepatitis B, capricious in affirmed
J.S. Meyers, J. 16‐1083V 2/13/2023 POTS rejected
314 HPV rejecting 9/5/24
molecular
mimicry
2023 WL alopecia
Farag Sanders, SM. 17‐714V 9/29/2023 HPV rejected
7203034 areata
auto‐immune
2023 WL autonomic
Ambriz Sanders, SM. 15‐502V 2/27/2023 HPV rejected
2771037 ganglionopat
hy
chronic
2023 WL
Stoev Moran, SM. 19‐1434V 10/12/2023 HPV regional pain rejected
7297981
syndrome
2020 WL
Allard Roth, SM. 14‐442V 3/9/2020 HPV ITP rejected
1649669
2020 WL
Phillips Oler, SM. 16‐906V 11/23/2020 HPV ITP accepted
7767511
2023 WL
Cobb Oler, SM. 17‐1123V 8/21/2023 HPV narcolepsy accepted
6457568
MFR
denied,
2020 WL
Duncan Moran, SM. 16‐1367V 10/19/2020 HPV PANDAS rejected 153 Fed.
6738118
Cl. 642
(2021)
6
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
SM was not
arbitrary or
153 Fed. Cl. capricious in
Duncan Davis, J. 16‐1367V 4/19/2021 HPV PANDAS rejected
642 rejecting
molecular
mimicry
2019 WL
McKown Corcoran, SM. 15‐1451V 7/15/2019 HPV POTS rejected
4072113
2023 WL
C.F Horner, SM. 15‐731V 1/20/2023 HPV POTS rejected
2198809
2023 WL
DrummondSanders, SM. 16‐702V 4/21/2023 HPV POTS rejected
3035072
MFR
premature Denied denied,
2023 WL
Bello Sanders, SM. 13‐349V 3/10/2023 HPV ovarian accepted entitlement on 167
2447497
failure other prongs Fed.Cl.
517 (2023)
Accepted theory
in ruling but later
dismissed for
insufficient
premature
2021 WL evidence that
Brayboy Sanders, SM. 15‐183V 8/30/2021 HPV ovarian accepted
4453146 Petitioner has
insufficiency
POI with
autoimmune
etiology, 2022
WL 1316235
primary
2021 WL medistinal
Nifakos Oler, SM. 14‐236V 3/4/2021 HPV rejected
1345218 large B‐cell
lymphoma
7
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
mot. for
systemic rev.
2024 WL lupus denied,
Stricker Moran, SM. 18‐56V 1/2/2024 HPV rejected
263189 erthematosu 170
s (SLE) Fed.Cl.
701 (2024)
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu CFS rejected 154
9076620
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu narcolepsy rejected 154
9076620
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu POTS rejected 154
9076620
Fed.Cl.
149 (2021)
MFR
denied,
2020 WL small fiber
E.S. Corcoran, SM. 17‐480V 11/13/2020 HPV, flu rejected 154
9076620 neuropathy
Fed.Cl.
149 (2021)
8
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2020 WL
Phillips Oler, SM. 16‐906V 11/23/2020 live flu ITP rejected
7767511
MFR
Petitioner did not denied, affirmed,
2022 WL
Henkel Sanders, SM. 15‐1048V 8/31/2022 live flu narcolepsy accepted establish other 165 2024 WL
16557979
Althen prongs Fed.Cl. 3873569
153 (2023)
2024 WL
Sparrow Moran, SM. 18‐295V 3/19/2024 MMR ADEM rejected MFR filed
1599165
juvenile
2022 WL
Putman Corcoran, SM. 19‐1921V 1/31/2022 MMR idiopathic rejected
600417
arthritis
2021 WL
Pickens Moran, SM. 17‐187V 1/22/2021 MMR SIDP rejected
615218
MFR
denied,
2020 WL MMR and Onset was too
Castaneda Oler, SM. 15‐1066V 5/18/2020 PANS rejected 152
3833076 others quick
Fed.Cl.
576 (2020)
MMR,
2022 WL varicella,
Moses Moran, SM. 19‐739V 5/18/2022 sJIA rejected
2073346 pneumoco
ccal
2022 WL pneumoco
Gross Dorsey, SM. 17‐1075V 9/22/2022 CIDP accepted
9669651 ccal
2020 WL pneumoco
Deshler Corcoran, SM. 16‐1070V 7/1/2020 GBS rejected
4593162 ccal
2022 WL pneumoco
Maloney Dorsey, SM. 19‐1713V 3/17/2022 GBS accepted
1074087 ccal
9
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
MFR
denied,
2023 WL pneumoco
Trollinger Corcoran, SM. 16‐473V 2/17/2023 GBS rejected 167
2521912 ccal
Fed.Cl.
127 (2023)
2023 WL pneumoco
Sprenger Dorsey, SM. 18‐279V 11/14/2023 GBS accepted
8543435 ccal
2024 WL pneumoco
Anderson Dorsey, SM. 18‐484V 1/17/2024 GBS accepted
557052 ccal
MFR
denied,
Gamboa‐ 2023 WL pneumoco appeal
Tapp, J. 18‐925V 2/26/2024 GBS rejected 170
Avila 6536207 ccal filed
Fed.Cl.
441 (2024)
2024 WL pneumoco
Morrison Oler, SM. 18‐386V 7/18/2024 GBS rejected
3738934 ccal
SM was not
MFR
arbitrary or
denied, affirmed,
2021 WL pneumoco capricious in
Loyd Corcoran, SM. 16‐811V 5/20/2021 ITP rejected not 2023 WL
2708941 ccal rejecting
available 1878572
molecular
on WL
mimicry
2021 WL pneumoco Miller‐Fisher
Koller Gowen, SM. 16‐439V 10/8/2021 accepted
5027947 ccal GBS
2022 WL pneumoco transverse
Tracy Sanders, SM. 16‐213V 3/30/2022 accepted
1125281 ccal myelitis
2022 WL pneumoco ulcerative
Gapen Moran, SM. 19‐422V 5/5/2022 rejected
1711616 ccal colitis
2024 WL small fiber
Coons Dorsey, SM. 20‐1067V 3/29/2024 Td accepted
1741619 neuropathy
10
Appendix 2:
Some Cases with Molecular Mimicry Sorted by Vaccine and then Injury
CoFC Fed. Cir.
Title Judicial Officer Docket Date cite Vaccine Injury outcome notes
review review
2022 WL
Sanchez Corcoran, SM. 18‐1012V 3/11/2022 Tdap CIDP rejected
1013264
Petitioner did not
2021 WL
Winkler Dorsey, SM. 18‐203V 12/10/2021 Tdap GBS not evaluated establish other
6276203
Althen prongs
MFR
denied, affirmed,
2022 WL
K.A. Corcoran, SM. 16‐989V 4/18/2022 Tdap GBS rejected 164 2024 WL
20213037
Fed.Cl. 98 2012526
(2022)
2023 WL
Bishara Moran, SM. 19‐115V 1/27/2023 Tdap scleroderma rejected
2799054
2019 WL small fiber
Swaiss Gowen, SM. 15‐286V 11/4/2019 Tdap accepted
6520791 GBS
2022 WL transverse
I.J. Corcoran, SM. 16‐864V 1/4/2022 Tdap accepted Ruling on remand
277555 myelitis
2023 WL transverse
Le Dorsey, SM. 16‐1078V 3/30/2023 Tdap accepted
3049203 myelitis
167 Fed. Cl.
DenningtonSomers, J. 18‐1303V 10/6/2023 tetanus GBS rejected
640
Giannanto 2023 WL
Moran, SM. 18‐497V 3/30/2023 varicella ADEM rejected
nio 2721387
2024 WL Anti‐NMDAR
L.R. / BaxteOler, SM. 16‐922V 3/28/2024 various rejected
1912575 encephalitis
11