Correira v. Secretary of Health and Human Services

In the United States Court of Federal Claims

No. 22-1269

(Filed Under Seal: November 12, 2025)

(Reissued: December 3, 2025) 1

**************************************

ALAN CORREIRA, *

*

Petitioner, *

*

v. *

*

SECRETARY OF HEALTH AND HUMAN *

SERVICES, *

*

Respondent. *

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Ronald C. Homer, with whom was Meredith Daniels, Conway, Homer, P.C., Boston, MA,

counsel for Petitioner.

James V. Lopez, U.S. Department of Justice, Civil Division, Washington, DC, counsel for

Respondent.

OPINION AND ORDER

DIETZ, Judge.

Petitioner Alan Correira seeks review of Chief Special Master (“CSM”) Brian Corcoran’s

decision denying him compensation under the National Childhood Vaccine Injury Act of 1986,

42 U.S.C. §§ 300aa-1 et seq. (“Act”). Mr. Correira alleges that he suffered from Guillain-Barré

Syndrome (“GBS”) because of an influenza (“flu”) vaccine. The CSM concluded that, because

the onset of Mr. Correira’s GBS symptoms fell outside a medically acceptable timeframe, his

illness was not caused in fact by the flu vaccine. Mr. Correira contends that the CSM’s decision

was arbitrary, capricious, or otherwise not in accordance with the law. The Court agrees.

Therefore, the Court GRANTS the petition, VACATES the decision, and REMANDS the case

for further action in accordance with this opinion.

1

Pursuant to Vaccine Rule 18(b) of the Rules of the United States Court of Federal Claims, the Court issued this

Opinion and Order under seal on November 12, 2025, and directed the parties to file a proposed public version of

this Opinion and Order on or before November 26, 2025. See [ECF 37]. The parties did not file a proposed public

version of the Opinion and Order, nor did they otherwise propose any redactions. Accordingly, the Court reissues

this Opinion and Order without redactions.

I. BACKGROUND 2

On September 20, 2019, Mr. Correira received a flu vaccine. Correira v. Sec’y of Health

& Hum. Servs., No. 22-1269, 2025 WL 1892886, at *1 (Fed. Cl. June 3, 2025). On October 1,

2019, he underwent prostate surgery, during which he received nitrous oxide. Id. On November

23, 2019, sixty-four days after receiving the vaccine, Mr. Correira went to the Emergency

Department (“ED”), complaining of “numbness and tingling in his bilateral upper extremities.”

Id. Mr. Correira claimed these symptoms began on November 18, 2019, five days earlier. Id. He

was examined and “diagnosed with bilateral upper extremity neuropathy.” Id. Thereafter, on

November 26, 2019, Mr. Correira had a follow-up appointment with his primary care physician,

Dr. Irwin. Id. During that visit, Mr. Correira complained of “numbness in his upper extremities,

feet, tongue, and lips, but denied [any] weakness.” Id. He “also stated that his symptoms had

improved over the past three days, but were still present.” Id. He was examined and “assessed

with paresthesia of unclear etiology,” but his gait was deemed normal, and he did not display any

“motor or sensory deficits.” Id. The next day, Mr. Correira visited a neurologist, Dr. Leber. Id.

At that visit, Mr. Correira complained of “numbness in his forearms, tongue, and left foot,” and

“stated that on November 18, 2019, he woke with his hands and forearms feeling cold and

somewhat number.” Id. He also told Dr. Leber that he had undergone “prostate surgery on

October 1, 2019, which Dr. Leber noted could cause myelopathy in patients with previous

anemia.” Id. Dr. Leber conducted a neurologic exam and noted “a slight Bell’s palsy of the left

eyelid and mild absent sensation in the right foot.” Id. Additionally, Dr. Leber noted that given

the sudden onset of numbness, “one has to think of cervical myelopathy or cervical issues.” Id.

“A subsequent MRI was unremarkable,” and Mr. Correira’s “B12 and folic acid were within

normal limits.” Id.

On December 6, 2019, Mr. Correira again saw Dr. Leber. Correira, 2025 WL 1892886,

at *2. This time, although Mr. Correira complained of a “recent onset of stumbling, slurring

speech and tingling in his face and scalp,” Dr. Leber did not note any “objective abnormality on

examination, other than residual from previous left Bell’s palsy.” Id. Additionally, Dr. Leber did

not have an explanation for Mr. Correira’s “subject sensory symptoms.” Id. Dr. Leber

“prescribed alprazolam for his anxiety.” Id. Later that day, Mr. Correira returned to the ED,

complaining of “increased left facial droop that started that morning.” Id. There, he was

diagnosed with Bell’s palsy. Id.

On December 9, 2019, Mr. Correira returned to his primary care physician, who

examined him, found nothing remarkable, and then referred him to a neurologist. Correira, 2025

WL 1892886, at *2. Three days later, Mr. Correira returned once more to the ED. Id. This time,

he presented with “numbness throughout his body, upper extremity pain, dizziness, and difficulty

walking that started just prior to his arrival.” Id. The left side of his face was drooping, and he

displayed “absent bilateral reflexes, and an abnormal gait.” Id. Mr. Correira was given a lumbar

puncture, which “showed elevated protein levels.” Id. The admitting ED physician noted that Mr.

Correira had received a flu vaccine in September and questioned whether he had “progressive

[GBS] versus Lambert-Eaton syndrome.” Id. (alteration in original). Additionally, notes taken

the following day indicated that while Mr. Correira reported subjective symptoms, “no objective

2

The factual background is derived from the CSM’s decision. See Correira v. Sec’y of Health & Hum. Servs., No.

22-1269, 2025 WL 1892886 (Fed. Cl. June 3, 2025).

2

abnormalities could be observed.” Id. A neurologist, Dr. Khademi, opined that he “could not rule

out the possibility [that Mr. Correira was suffering from] an autoimmune neuropathy” such as

GBS. Id. He “also noted that the nadir of the weakness [was] usually 3-4 weeks from onset.” Id.

On December 14, 2019, the ED discharged Mr. Correira “with possible diagnoses including GBS

and La[m]bert-Eaton syndrome, an autoimmune neurological condition.” Id.

On December 16, 2019, Mr. Correira followed up with Dr. Irvin, who suspected that he

had a “predominantly sensory form of GBS.” Correira, 2025 WL 1892886, at *2 (internal

quotation marks omitted). Four days later, Mr. Correira went to Dr. Khademi for a second

opinion. Id. Dr. Khademi examined Mr. Correira and noted that he presented with “absent

reflexes, left peripheral facial weakness, impaired gait, [and] reduced sensation, but [that he had]

normal motor strength.” Id. Dr. Khademi concluded that he had “inflammatory polyneuropathy

and possible GBS.” Id.

On December 21, 2019, Mr. Correira returned once more to the ED, complaining of

“worsening paresthesia, and trouble breathing and swallowing.” Correira, 2025 WL 1892886, at

*2. He presented with “decreased sensation in his trunk and chest, decreased grip strength, left

sided facial droop, and absent reflexes.” Id. He was alternatively diagnosed with “GBS versus

variant, a more chronic condition such as chronic demyelinating syndrome, and Eaton-Lambert

syndrome.” Id. While there, Mr. Correira saw another neurologist, Dr. Huntley, and told him that

he had experienced five weeks of “progressive weakness.” Id. Dr. Huntley noted that Mr.

Correira demonstrated “‘wildly’ uncontrolled ambulation and absent reflexes,” and assessed him

“with paresthesia, dysphagia, [and] a history of Bell’s palsy with gait disorder.” Id. Dr. Huntley

also indicated that he was unsure whether Mr. Correira required Intravenous Immunoglobulin

(“IVIG”), which Dr. Khademi had ordered but which had not yet been set up, and concluded that

“at the core [Mr. Correira] has [GBS].” Id. (second alteration in original). Mr. Correira received

“a five-day course of IVIG and was discharged on December 26, 2019.” Id. at *3. His symptoms

improved markedly after his discharge and on May 20, 2020, although “he reported some

residual numbness,” he also reported “significant improvement to Dr. Vasquez, a neurologist.”

Id.

On September 9, 2022, Mr. Correira sought compensation under the Act. Pet. for Vaccine

Compensation [ECF 1]. He amended his petition on March 6, 2023, alleging that he contracted

GBS from the flu vaccine. Am. Pet. for Vaccine Compensation [ECF 18] at 1. 3 On August 1,

2023, because Mr. Correira’s “alleged first symptoms appeared outside of the longest time

accepted for a non-Table flu/GBS claim,” the CSM ordered Mr. Correira to show cause why his

claim should not be dismissed and to file any additional evidence. [ECF 24] at 1 (emphasis in

original). Thereafter, Mr. Correira filed a medical expert report and additional medical literature,

[ECF 25], and responded to the show cause order, [ECF 27]. On June 3, 2025, the CSM denied

Mr. Correira’s request for compensation and dismissed his claim. Correira, 2025 WL 1892886,

at *7. Mr. Correira sought review of the CSM’s decision on June 30, 2025. Pet’r’s Mot. for

Review [ECF 29]. The government responded on July 29, 2025, Resp. [ECF 33], and the Court

held oral argument on October 30, 2025.

3

All references to page numbers within documents filed electronically with the Court refer to the page numbers

generated by the CM/ECF system.

3

II. STANDARD OF REVIEW

This Court has jurisdiction under the Act to review a special master’s decision. 42 U.S.C.

§ 300aa-12(e)(2). In reviewing a special master’s decision, this Court may:

(A) uphold the findings of fact and conclusions of law of the special

master and sustain the special master’s decision, (B) set aside any of

the findings of fact or conclusions of law of the special master found

to be arbitrary, capricious, and abuse of discretion, or otherwise not

in accordance with law and issue its own findings of fact and

conclusions of law, or (C) remand the petition to the special master

for further action in accordance with the court’s direction.

42 U.S.C. §§ 300aa-12(e)(2)(A)-(C).

This Court reviews a special master’s findings of fact under the “arbitrary and

capricious” standard, legal questions under the “not in accordance with law” standard, and

discretionary rulings under the “abuse of discretion” standard. Turner v. Sec’y of Health & Hum.

Servs., 268 F.3d 1334, 1337 (Fed. Cir. 2001). With respect to the arbitrary and capricious

standard, “no uniform definition . . . has emerged,” but it is “a highly deferential standard of

review” such that “[i]f the special master has considered the relevant evidence of record, drawn

plausible inferences and articulated a rational basis for the decision, reversible error will be

extremely difficult to demonstrate.” Hines v. Sec’y of Health & Hum. Servs., 940 F.2d 1518,

1527-28 (Fed. Cir. 1991); accord Motor Vehicle Mfrs. Ass’n of U.S., Inc. v. State Farm Mut.

Auto Ins. Co., 463 U.S. 29, 43 (1983) (a decision is arbitrary and capricious only if it is “so

implausible that it could not be ascribed to a difference in view”). The “not in accordance with

law” standard, on the other hand, is applied without deference to legal determinations such as

“[w]hether the special master applied the appropriate standard of causation . . . .” Deribeaux v.

Sec’y of Health & Hum. Servs., 717 F.3d 1363, 1366 (Fed. Cir. 2013). Lastly, the abuse of

discretion standard applies to the special master’s evidentiary rulings, such as determinations

regarding the qualification of experts and the admissibility of their testimony. Piscopo v. Sec’y of

Health & Hum. Servs., 66 Fed. Cl. 49, 53 (2005) (citing Kumho Tire Co. v. Carmichael, 526 U.S.

137, 152 (1999)). 4

The United States Court of Appeals for the Federal Circuit has made it clear that special

masters, as the finders of fact, have the responsibility to weigh the persuasiveness and reliability

of evidence presented to them, and if appropriate, the credibility of testimony. Moberly v. Sec’y

of Health & Hum. Servs., 592 F.3d 1315, 1325 (Fed. Cir. 2010); see Terran v. Sec’y of Health &

Hum. Servs., 195 F.3d 1302, 1316 (Fed. Cir. 1999) (“[T]he rules of evidence require that the trial

judge determine whether the testimony has a reliable basis in the knowledge and experience of

[the relevant] discipline.” (internal quotation marks omitted) (second alteration in original)).

Further, the special masters have broad discretion in determining the credibility of witnesses and

weighing the evidence, and these credibility determinations are “virtually unreviewable” by the

4

“The [abuse of discretion standard] will rarely come into play except where the special master excludes evidence.”

Munn v. Sec’y of Health & Hum. Servs., 970 F.2d 863, 870 n.10 (Fed. Cir. 1992); accord Caves v. Sec’y of Health &

Hum. Servs., 100 Fed. Cl. 119, 131 (2011), aff’d, 463 F. App’x 932 (Fed. Cir. 2012).

4

reviewing court. Bradley v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir.

1993). In other words, the reviewing court does not reweigh the evidence, assess whether the

special master correctly evaluated the evidence, or examine the probative value of the evidence

or the credibility of the witnesses because these matters are within the purview of the factfinder.

Broekelschen v. Sec’y of Health & Hum. Servs., 618 F.3d 1339, 1349 (Fed. Cir. 2010); accord

Loyd v. Sec’y of Health & Hum. Servs., No. 2022-1371, 2023 WL 1878572, at *2 (Fed. Cir. Feb.

10, 2023). As explained by the Federal Circuit, which applies the same standard of review, this

Court is highly deferential to the special masters’ factual determinations:

We review de novo decisions of the Claims Court arising under the

Vaccine Act, applying the same standard of review as the Claims

Court applied to its review of the special master’s decision. We owe

no deference to the Claims Court or the special master on questions

of law. We uphold the special master’s findings of fact unless they

are arbitrary or capricious. Thus, although we are reviewing as a

matter of law the decision of the Claims Court under a non-

deferential standard, we are in effect reviewing the decision of the

special master under the deferential and capricious standard on

factual issues. We do not reweigh the factual evidence, assess

whether the special master correctly evaluated the evidence, or

examine the probative value of the evidence or the credibility of the

witnesses—these are all matters within the purview of the fact

finder. Rather, as long as a special master’s finding of fact is based

on evidence in the record that [is] not wholly implausible, we are

compelled to uphold that finding as not being arbitrary or capricious.

It is not our role to second guess the Special Master[’]s fact-

intensive conclusions particularly in cases in which the medical

evidence of causation is in dispute.

Porter v. Sec’y of Health & Hum. Servs., 663 F.3d 1242, 1248-49 (Fed. Cir. 2011) (internal

citations and quotation marks omitted) (alterations in original); accord White v. Sec’y of Health

& Hum. Servs., 153 F.4th 1214, 1220 (Fed. Cir. 2025) (noting that while the Federal Circuit

reviews United States Court of Federal Claims’ decisions de novo, it applies the same legal

standards).

III. LEGAL STANDARDS

The Act was established to compensate individuals for a vaccine-related injury or death

after a showing that the vaccine caused that injury or death. 42 U.S.C. §§ 300aa-10(a)-13(a). The

Act provides two ways for a petitioner to establish causation. Munn, 970 F.2d at 865. First, a

petitioner may demonstrate causation through a statutorily prescribed presumption by showing

that the alleged injury meets the criteria listed on the vaccine injury table (“Table”). 42 U.S.C. §

300aa-14. Thus, in a Table case, “if a petitioner can establish that [he] received a listed vaccine

and experienced such symptoms or injuries within the specified timeframes, [he] has met [his]

prima facie burden to prove that the vaccine caused [his] injuries.” de Bazan v. Sec’y of Health &

Hum. Servs., 539 F.3d 1347, 1351 (Fed. Cir. 2008); accord Grant v. Sec’y of Health & Hum.

5

Servs., 956 F.2d 1144, 1147 (Fed. Cir. 1992) (“The Table replaces traditional tort standards of

causation in fact with a causation in law based on temporal association.”). Alternatively, if a

petitioner suffered an injury listed on the Table but not within the specified time period or if a

petitioner suffered an “off-Table injury,” he must prove “causation-in-fact” by a preponderance

of the evidence. 5 See 42 U.S.C. §§ 300aa-11(c)(1)(C)(ii); see also Broekelschen, 618 F.3d at

1341-42. “[C]ausation-in-fact in the Vaccine Act context is the same as ‘legal cause’ in the

general torts context.” de Bazan, 539 F.3d at 1351 (quoting Shyface v. Sec’y of Health & Hum.

Servs., 165 F.3d 1344, 1352 (Fed. Cir. 1999)). Thus, “the vaccine is a cause-in[-]fact when it is

‘a substantial factor in bringing about the harm.’” Id. (quoting Restatement (Second) of Torts

§ 431(a)).

In Althen v. Secretary of Health and Human Services, the Federal Circuit articulated the

following three-part test for demonstrating causation-in-fact:

[A petitioner must] show by preponderant evidence that the

vaccination brought about [the] 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.

418 F.3d 1274, 1278 (Fed. Cir. 2005). “The third Althen factor—a proximate temporal

relationship between the vaccination and the injury—serves as a check on the first two factors.”

Cerrone v. Sec’y of Health & Hum. Servs., 146 F.4th 1113, 1121-22 (Fed. Cir. 2025). Further,

“[w]hile this court’s cases make clear that temporal association is not enough by itself to prove

causation, the absence of temporal association can be enough to defeat a claim of causation.” Id.

(internal citations omitted). Before applying the Althen test, however, the Court must determine

whether a petitioner has shown by preponderant evidence a “medically recognized” injury that is

“more than just a symptom or manifestation of an unknown injury.” Lombardi v. Sec’y of Health

& Hum. Servs., 656 F.3d 1343, 1352-53 (Fed. Cir. 2011) (explaining that “if the existence and

nature of the injury itself is in dispute,” then “identification of a petitioner’s injury is a

prerequisite to an Althen analysis of causation”). Next, “[w]hen applying Althen, the special

master must consider the degree to which each factor is satisfied.” Cerrone, 146 F.4th at 1122.

“[A]fter weighing the degree to which the petitioner has proved each factor and considering any

remaining evidence bearing on causation, the special master must determine whether the

petitioner has proved that it is more likely than not that the vaccine caused his injury.” Id.

“Once the petitioner has established a prima facie case for entitlement to compensation

and thus met [his] burden to prove causation-in-fact, the burden shifts to the government to prove

‘[by] a preponderance of the evidence that the [petitioner’s injury] is due to factors unrelated to

the administration of the vaccine described in the petition.’” de Bazan, 539 F.3d at 1352 (quoting

42 U.S.C. § 300aa-13(a)(1)(B) (second and third alterations in original)). Under the Act, “factors

unrelated to the administration of the vaccine” may include “infection, toxins, trauma (including

5

“This court has interpreted the ‘preponderance of the evidence’ standard referred to in the Vaccine Act as one of

proof by a simple preponderance, of ‘more probable than not’ causation.” Althen v. Sec’y of Health & Hum. Servs.,

418 F.3d 1274, 1279 (Fed. Cir. 2005).

6

birth trauma and related anoxia), or metabolic disturbances which have no known relation to the

vaccine involved, but which in the particular case are shown to have been the agent or agents

principally responsible for causing the petitioner’s illness, disability, injury, condition, or death.”

42 U.S.C. § 300aa-13(a)(2)(B). Significantly, while a petitioner need only demonstrate that the

vaccine was a substantial factor in bringing about the alleged harm, the government must

demonstrate that an unrelated factor “was the sole substantial factor in bringing about the

injury.” de Bazan, 539 F.3d at 1354 (emphasis added). In addition, the government’s proof of

alternative actual causation-in-fact must satisfy the same standard as the petitioner’s proof of

actual causation-in-fact in off-Table cases. See Deribeaux, 717 F.3d at 1368 (“The Secretary was

‘required not only to prove the existence of [a factor unrelated], but also to prove by a

preponderance of the evidence that the [factor unrelated] actually caused’ the injury alleged.”)

(alterations in original) (quoting Knudsen v. Sec’y of Health & Hum. Servs., 35 F.3d 543, 549

(Fed. Cir. 1994)). However, if the Court finds that the government failed to prove alternative

actual causation-in-fact, the petitioner is entitled to compensation. de Bazan, 539 F.3d at 1352. If

the Court finds the parties’ evidence to be in equipoise, the petitioner is still entitled to

compensation. Heinzelman v. Sec’y of Health & Hum. Servs., No. 07-01, 2008 WL 5479123, at

*19 (Fed. Cl. Dec. 11, 2008) (citing Knudsen, 35 F.3d at 550).

IV. ANALYSIS

The CSM denied Mr. Correira’s petition, concluding that “[t]he evidentiary record [did]

not support [his] contention that his GBS began in a medically-acceptable timeframe after

vaccination.” Correira, 2025 WL 1892886, at *7. Mr. Correira argues that the CSM erroneously

found—under the third Althen prong—that there was no proximate temporal relationship

between the flu vaccine he received and his GBS symptoms. Pet’r’s Mem. [ECF 30] at 11.

Specifically, he asserts that the CSM arbitrarily conflated eight weeks with two months, id. at 12,

that the CSM’s interpretation of the pertinent medical study is flawed, id. at 15, and that the

CSM erred by establishing an inflexible eight-week onset deadline, id. at 19. 6 For the reasons

provided below, the Court concludes that the CSM’s analysis under the third Althen prong was

arbitrary, capricious, or otherwise not in accordance with the law. Thus, the Court remands the

case to the CSM under 42 U.S.C. § 300aa-12(e)(2)(C) for further action in accordance with this

opinion.

To begin, the Court is not persuaded that the CSM conflated eight weeks with two

months. Mr. Correira argues that the CSM arbitrarily equated eight weeks (or fifty-six days) with

two months (or approximately sixty days), [ECF 30] at 12, and that, because Mr. Correira’s onset

occurred fifty-nine days after he was vaccinated, the CSM’s “failure to distinguish between these

terms is not a mere technicality,” id. at 14. While the CSM references the term “two months” on

one occasion in his decision, see Correira, 2025 WL 1892886, at *6, and cites to other vaccine

cases that appear to use the terms “two months” and “eight weeks” interchangeably, id. at *5-6,

the CSM clearly applied an eight-week or fifty-six day timeframe in finding that Mr. Correira’s

GBS symptoms did not begin in a medically-acceptable timeframe, id. at *7. This is evident

throughout the decision. See id. at *5 (stating that “onset of symptoms is demonstrated to have

occurred no longer than six to eight weeks after vaccination” and that “[t]his means up to 56

6

Mr. Correira does not challenge the CSM’s finding that his GBS symptoms began “on or around November 18,

2019,” fifty-nine days after he was vaccinated. Id. at 7.

7

days” (first alteration in original)); id. at *6 (stating that “[t]hese facts accordingly are

inconsistent with even the longest timeframes (eight weeks) accepted for a similar non-Table

claims” (alteration in original)); id. *6 n.7 (referring to “the proposed up-to-eight weeks

timeframe”). Thus, there is no evidence that the CSM arbitrarily conflated eight weeks with two

months.

However, the Court nevertheless finds that the CSM’s decision is arbitrary. In the

decision, the CSM stated that “[m]easuring from the September 20, 2019 vaccination, . . . a

Table version of the claim in this case could only succeed if onset had occurred on or before

November 1, 2019 – which clearly did not occur” and that “even a causation-in-fact claim would

have needed to be based on symptoms beginning no more than two weeks after – or by

November 15, 2019, at the latest.” Correira, 2025 WL 1892886, at *6 (emphasis added). In

other words, the CSM stated that, for Mr. Correira’s non-Table claim to succeed, the onset of his

symptoms needed to occur, at latest, eight weeks or fifty-six days from vaccination. Yet, the

CSM failed to articulate a rational basis for imposing such an eight-week deadline to deny Mr.

Correira compensation. See Exum v. Sec’y of Health and Hum. Servs., 175 Fed. Cl. 681, 700

(“[A] special master must clearly articulate its reasons for its conclusions.”).

In his discussion of the applicable legal standard, the CSM made the following statement

regarding the temporal requirements a petitioner must meet to establish causation-in-fact under

Althen:

There are nevertheless limits to the kinds of fact patterns that

successfully establish that the flu vaccine “did cause” a particular

petitioner’s GBS under the second Althen prong. In most successful

non-Table cases, onset of symptoms is demonstrated to have

occurred no longer than six to eight weeks after vaccination. See,

e.g., Barone, 2014 WL 6834557, at *13 (eight weeks is the longest

reasonable timeframe for a flu/GBS injury). This means up to 56

days.

Correira, 2025 WL 1892886, at *5. It appears that the CSM is referring to the following

statement in Barone:

Other special masters have never gone beyond a two-month

(meaning eight week) interval in holding that a vaccination caused

a demyelinating illness. See, e.g., Aguayo v. Sec’y of Health &

Human Servs., No. 12-563V, 2013 WL 441013, at *3 (Fed. Cl. Spec.

Mstr. Jan. 15, 2013); Corder v. Sec’y of Health & Human Servs.,

No. 08-228V, 2011 WL 2469736, at *27-*29 (Fed. Cl. Spec. Mstr.

May 31, 2011) (proposed four month onset period from vaccination

to GBS too long; two months is longest reasonable timeframe).

Barone, 2014 WL 6834557, at *13. If the CSM was referring to the first sentence in the above

paragraph, wherein he (the author of Barone) states that “[o]ther special masters have never gone

beyond a two-month (meaning eight week) interval in holding that a vaccination caused a

8

demyelinating illness,” id., then the CSM failed to provide any support for his conclusion in

Corriera because the statement alone is conclusory. Alternatively, if the CSM was referring to

the cases he cited after the first sentence, the CSM similarly failed to provide support for his

conclusion in Corriera. In both Aguayo and Corder, the special master concluded that three and

one-half months and fourth months, respectively, was too long an interval between vaccination

and GBS symptom onset to support an inference of causation. 7 The difference between Mr.

Correira’s fifty-nine-day interval and fifty-six days (eight weeks) is hardly comparable to the

difference between the ninety-eight day interval (approximately three and one half months or

fourteen weeks) in Aguayo or the 112 day interval (approximately four months or sixteen weeks)

in Corder and fifty-six days. While these cases serve as examples of onset timeframes that fall

far outside of the medically-acceptable window for inferring causation, they do not support the

CSM’s conclusion that, “[i]n most successful non-Table cases, onset of symptoms is

demonstrated to have occurred no longer than six to eight weeks after vaccination.” Correira,

2025 WL 1892886, at *5 (alteration in original). Nor do these cases support the CSM’s

conclusion that Mr. Correira’s fifty-nine-day onset—three days outside of the eight-week

mark—is not medically acceptable.

Next, in his analysis of a medical study offered by Mr. Correira’s unrebutted expert, 8 the

CSM stated:

The medical literature offered in this case establishes that a

reasonable timeframe for onset of GBS after vaccine administration

would be no more than six to eight weeks, however. Schonberger at

105. Specifically, Schonberger indicates that most GBS cases after

the flu vaccine that it evaluated occurred around 13-17 days, with

their latest happening 41 days. Id. at 112. This is echoed by the

timeframe set for the Table version of the claim (see 42 C.F.R. §

100.3 (2017)). (It is in fact arguably the case that any onsets that

exceed the 3-42 day timeframe are suspect from a medical/scientific

standpoint, since the onset timeframe is specifically engineered to

be over-inclusive, rather than to reflect a precise framework in

which a vaccine can, or cannot, cause injury).

Correira, 2025 WL 1892886, at *6 (emphasis in original) (citing Lawrence B. Schonberger et

al., Guillain Barre Syndrome Following Vaccination in the National Influenza Immunization

Program, United States, 1976-1977, 110 Am. J. Epidemiology 105-23 (1979) (“the Study”)). 9

According to the CSM, the Study’s authors concluded on page 105 that “a reasonable timeframe

7

In Aguayo, the special master noted that the petitioner did not provide an expert report to support his contention

that his GBS was caused by the flu vaccine he received three and one-half months earlier. 2013 WL 441013, at *3.

In Corder, the special master discussed all three Althen prongs. 2011 WL 2469736, at *27-29. Regarding the third

prong, he stated that a four-month interval between vaccination and the onset of GBS symptoms was too long to be

deemed caused by the flu vaccine. Id. at *29.

8

The government neither offered its own expert nor submitted any evidence.

9

The Study compared the incidence of GBS in adults in the United States who received the 1976-1977 swine

influenza vaccine with the incidence of GBS in unvaccinated adults. Schonberger, 110 Am. J. Epidemiology at 105.

9

for onset of GBS after vaccine administration would be no more than six to eight weeks.” Id.

However, there is no explicit reference to such a timeframe on that page. Schonberger, 110 Am.

J. Epidemiology at 105. Rather, in what appears to be a summary of the Study, the authors only

make the following statement regarding the timing of GBS onset following vaccination: “The

period of increased risk [of contracting GBS] was concentrated primarily within the 5-week

period after vaccination, although it lasted for approximately 9 or 10 weeks.” Id.

Additionally, the CSM stated that on page 112 of the Study, the authors “indicate[] that

most GBS cases after the flu vaccine that [they] evaluated occurred around 13-17 days, with their

latest happening 41 days.” Correira, 2025 WL 1892886, at *6. Figure 5 on page 112 graphically

depicts the number of reported GBS cases by two-day incremental periods as follows:

Schonberger, Study, 110 Am. J. Epidemiology at 112. However, the CSM’s statement that the

latest GBS case the authors evaluated occurred forty-one days after vaccination is incorrect. As

noted above, in the introduction to the Study, the authors state that “[t]he period of increased risk

[of contracting GBS following vaccination] . . . lasted for approximately 9 or 10 weeks.” Id. at

105. Additionally, Figure 6, which graphically depicts the “[GBS] attack rates for population

over 17 years of age, by week of onset after [flu] vaccination,” shows .42 cases in week nine, and

.40 cases in week ten. Id. at 113. Thus, while Figure 5 supports the CSM’s conclusion that the

highest concentration of GBS cases “occurred around 13-17 days” after vaccination, Correira,

2025 WL 1892886, at *6, it does not establish that the latest GBS case occurred on day forty-one

or that the forty-one-day mark represents the outer limit of the risk period under the Study.

Schonberger, 110 Am. J. Epidemiology at 112. Consequently, the CSM failed to explain how the

Study “establishes that a reasonable timeframe for onset of GBS after vaccine administration

would be no more than six to eight weeks.” Correira, 2025 WL 1892886, at *6 (emphasis

added).

After finding that “contemporaneous medical records preponderantly establish that the

initial symptoms of Petitioner’s GBS did not occur before November 18, 2019, 59 days after his

vaccination,” Correira, 2025 WL 1892886, at *6, the CSM concluded:

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These facts accordingly are inconsistent with even the longest

timeframes (eight weeks) accepted for a similar non-Table claims

recognized in reasoned Program decisions. See, e.g., Barone, 2014

WL 6834557, at *13. Petitioner’s onset thus occurred far too long

after vaccination to be considered “medically acceptable to infer

causation-in-fact.” See de Bazan, 539 F.3d at 1352; De La Cruz v.

Sec’y of Health & Hum. Servs., No. 17-783V, 2018 WL 945834, at

*1 (Fed. Cl. Jan. 23, 2018) (finding onset of GBS more than two

months after flu vaccination to be not compensable under either a

theory of causation in fact or significant aggravation).

Id. (emphasis in original) (footnote omitted). Once more, the CSM cited Barone for the

proposition that, in similar non-Table claims, special masters have concluded that eight weeks is

the outer limit when determining whether a flu vaccination was the cause in fact of an

individual’s GBS. Id. As discussed above, neither Barone nor the cases cited therein provide

adequate legal support for this proposition. Further, while the special master in De La Cruz

found that the onset of petitioner’s GBS symptoms occurred “more than eight weeks after her flu

vaccination,” 2018 WL 945834, at *1, and that she did “not consider onset more than two

months after flu vaccination to be compensable under either a theory of causation in fact or

significant aggravation,” id., the only case she cited in support of his conclusion was Corder, id.

Again, as noted above, the timeframe at issue in Corder was four months—roughly twice as long

as the timeframe at issue in the instant case. See Corder, 2011 WL 2469736, at *29. Also, the

Court notes that De La Cruz is barely a two-page decision with no substantive analysis, that the

decision hinges, at least in part, on the petitioner’s lack of a medical expert report, and that the

petitioner concedes that she is unable to demonstrate entitlement to compensation. De La Cruz,

2018 WL 945834, at *1-*2. In contrast, Mr. Correira provided a medical expert report and

claims entitlement to compensation.

Lastly, in a footnote at the end of the decision, the CSM stated:

Admittedly, other special masters have accepted a comparably-

lengthy timeframe. See, e.g., Cooper v. Sec’y of Health & Hum.

Servs., No. 18-1885V, 2024 WL 1522331, at *20 (Fed. Cl. Mar. 12,

2024) (finding 60-day onset of GBS following a vaccination allows

inference of causation); Spayde v. Sec’y of Health & Hum. Servs.,

No. 16-1499V, 2021 WL 686682, at *19 (Fed. Cl. Jan. 27, 2021).

But such decisions do not control this outcome. Moreover, they

either involve a different vaccine (for Cooper, the pneumococcal

vaccine), or were based on reasoning that justified stretching the

eight-week timeframe a few days, in the interests of the Program’s

emphasis on generosity and a desire not to apply a hard, bright-line

“rule.” Spayde, 2021 WL 686682, at *19. Of course, the proposed

up-to-eight weeks timeframe itself already exceeds the “rule” of the

Table claim for the flu vaccine, and does not itself constitute

something that can be deemed accepted as a general matter.

Moreover, this thinking reflects a logic whereby any onset not

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shown to be facially impossible (say, more than 90 days) should be

deemed medically acceptable. I do not consider that kind of

reasoning consistent with the science applicable to how vaccines are

thought to cause GBS, and it is not demanding scientific certainty to

reject it.

Correira, 2025 WL 1892886, at *6 n.7 (emphasis in original). While it is of course true that a

petitioner seeking to establish that the flu vaccine caused GBS in a Table claim need only

demonstrate that the symptoms occurred within three and forty-two days of vaccination, 42

C.F.R. § 100.3(a), the CSM failed to explain why the instant case is distinguishable from Spayde,

which he described as being “based on reasoning that justified stretching the eight-week

timeframe a few days, in the interests of the Program’s emphasis on generosity and a desire not

to apply a hard, bright-line ‘rule,’” Correira, 2025 WL 1892886, at *6 n.7. In other words, it is

unclear why the CSM found that “the interests of the Program’s emphasis on generosity and a

desire not to apply a hard, bright-line ‘rule’” did not apply in the instant case. Id.; see Althen, 418

F.3d at 1279-80 (stating that under the “Vaccine Act’s preponderant evidence standard . . . close

calls regarding causation are resolved in favor of injured claimants”). Although the cited

decisions are not binding on the CSM, the fact that other special masters have found similar

onset timeframes that extend beyond eight weeks or fifty-six days from vaccination to be suitable

for inferring causation conflicts with the CSM’s decision to impose an inflexible “up-to-eight

weeks timeframe” in this case. Furthermore, the facts of this case do not require the CSM to

consider whether an onset timeframe that has not been “shown to be facially impossible” should

be “deemed medically-acceptable.” Correira, 2025 WL 1892886, at *6 n.7. Instead, Mr.

Correira’s GBS symptoms began fifty-nine days after vaccination—just outside of the suggested

eight-week timeframe. See [ECF 30] at 7. Because the CSM failed to articulate a rational basis

for imposing an eight-week or fifty-six day symptom onset deadline in this case, the Court finds

the decision to be arbitrary. See Paluck v. Sec’y of Health and Hum. Servs., 786 F.3d 1373, 1384

(Fed. Cir. 2015) (finding that “the special master had no reasonable basis for setting a hard and

fast deadline” where the relevant medical evidence “do[es] not purport to establish any definitive

timeframe for the onset of clinical symptoms”).

V. CONCLUSION

Accordingly, Mr. Correira’s motion for review of the CSM’s decision, [ECF 29], is

GRANTED, and the CSM’s decision of June 3, 2025, is VACATED. This case is

REMANDED for further action in accordance with this Opinion and Order. Pursuant to 42

U.S.C. § 300aa-12(e)(2)(C), the CSM shall issue a remand decision within 90 days. The parties

SHALL CONFER and FILE a notice with a proposed public version of this Opinion and Order

on or before November 26, 2025.

IT IS SO ORDERED.

s/ Thompson M. Dietz

THOMPSON M. DIETZ, Judge

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