# Beckwith v. Secretary of Health and Human Services

> United States Court of Federal Claims · March 9, 2026

URL: https://www.frixlaw.com/law-library/cases/11273325

## Case

- **Court:** United States Court of Federal Claims
- **Decided:** March 9, 2026
- **Precedential status:** Published
- **Opinion:** Opinion
- **Judges:** Robin M. Meriweather
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/11273325

## How later opinions describe it (automated extraction)

- noting the standard of review for factual findings is “the most deferential possible”
- noting the Court should presume the special master has considered all the material in the record, regardless of whether she mentions it all
- discussing proof requirements governing claim where special master concluded onset of symptoms occurred too soon to support inference of causation-in-fact

## Opinion text

In the United States Court of Federal Claims

DEBORAH BECKWITH,
Petitioner,
v. No. 21-vv-1660
(Filed Under Seal: February 20, 2026
SECRETARY OF HEALTH AND HUMAN Reissued for Publication: March 9, 2026)1
SERVICES,
Respondent.

David John Carney, Green & Shafle LLC, Philadelphia, PA, for Petitioner. With him on the
briefs were Grant Douglas Godfrey, Mctlaw, Washington, DC, and Jennifer Anne Gore Maglio,
Maglio Christopher & Toale, P.A., Sarasota, FL.
Parisa Tabassian, Torts Branch, Civil Division, United States Department of Justice,
Washington, DC, for Respondent. With her on the briefs were Brett A. Shumate, Assistant
Attorney General, C. Salvatore D’Alessio, Director, Heather L. Pearlman, Deputy Director, and
Lara A. Englund, Assistant Director.

OPINION AND ORDER

Meriweather, Judge.

Petitioner, Ms. Deborah Beckwith (“Ms. Beckwith”), seeks review of Chief Special
Master Corcoran’s Entitlement Decision (“Decision”), denying her entitlement to compensation
pursuant to the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1–aa-34
(“Vaccine Act”). See Decision at 1, ECF No. 67. Ms. Beckwith filed a Petition under the
Vaccine Program of the Vaccine Act, alleging the influenza (“flu”) vaccine caused her to suffer
Guillain-Barré Syndrome (“GBS”)—a neurological disorder that can lead to numbness and
muscle paralysis. See Petition at 1, ECF No. 1. The applicable regulations establish a
presumption that the flu vaccine caused GBS if a petitioner proves that she developed GBS
between three and forty-two days after receiving the flu vaccine. 42 C.F.R. § 100.3(a)(XIV)(D).
Following a dispute about the number and timing of vaccines Ms. Beckwith received, the Chief
Special Master determined Ms. Beckwith received one dose of flu vaccine at approximately 2:20
AM on September 24, 2019 and that the onset of her GBS occurred less than three days after
vaccination. See Order Granting Second Motion for Reconsideration at 2–3, ECF No. 37.

1
Pursuant to Vaccine Rule 18(b)(1)–(2), (d), this Opinion was initially filed under seal on
February 20, 2026, and the parties were afforded fourteen days to propose redactions. The
parties did not propose any redactions and, accordingly, this Opinion is reissued in its original
form for publication.
Accordingly, the Chief Special Master concluded he could not presume causation and Ms.
Beckwith had to prove causation-in-fact. The Chief Special Master determined that Ms.
Beckwith failed to prove causation-in-fact because she could not establish, by a preponderance
of the evidence, “that her GBS developed within a medically-acceptable timeframe after receipt
of the flu vaccine.” Decision at 21. He therefore denied her Petition. Id. at 2.

Ms. Beckwith now seeks review of the Chief Special Master’s Decision in this Court,
alleging he committed errors of law and made arbitrary and capricious factual findings. See
Pet’r’s Mot. for Review (“Mot.”), ECF No. 70; Pet’r’s Mem. of Law in Support of Pet’r’s Mot.
for Review (“Mem.”), ECF No. 70-1; see also 42 U.S.C. § 300aa-12(e)(1). Ms. Beckwith claims
the Chief Special Master: (1) erroneously limited the evidence she could use to prove that the
vaccine caused her GBS by treating the timeframe of onset that would support a presumption of
causation as a hard and fast rule with an overly narrow exception; (2) failed to properly consider
Ms. Beckwith’s medical theory of causation when evaluating whether she demonstrated a
proximate temporal relationship; (3) applied a heightened standard of proof to Ms. Beckwith’s
evidence; and (4) arbitrarily and capriciously evaluated Ms. Beckwith’s evidence. Mem. at 1.
Respondent, the Secretary of Health and Human Services (“the Secretary”), counters that Ms.
Beckwith has not shown the Chief Special Master erred. Resp’t’s Resp. to Mot. for Review
(“Resp.”) at 1, ECF No. 73.

Having reviewed the record, the parties’ legal filings,2 and the relevant law, the Court
DENIES Ms. Beckwith’s Motion for Review and SUSTAINS the Chief Special Master’s
Decision. The Chief Special Master did not commit an error of law, and Ms. Beckwith’s other
assertions amount to mere disagreement with the Chief Special Master’s well-reasoned factual
findings, which is not a basis for overturning his Decision. See Hines ex rel. Sevier v. Sec’y of
Health & Hum. Servs., 940 F.2d 1518, 1527 (Fed. Cir. 1991).

BACKGROUND

I. Statutory Framework

The Vaccine Act, enacted in 1986, created the National Vaccine Injury Compensation
Program, through which claimants can petition to receive compensation for vaccine-related
injuries or death. See generally 42 U.S.C. § 300aa-10(a). The Act identifies two ways for a
petitioner to establish causation and thus qualify for compensation. First, a petitioner may
establish that she, after receiving a designated vaccine, suffered an injury listed on the Vaccine
Injury Table within the requisite time-period—commonly called a “Table Injury,” see 42 C.F.R.
§ 100.3(a)—in which case causation is presumed. See 42 U.S.C. § 300aa-11(c)(1).
Alternatively, if a petitioner claims entitlement for an injury not listed in the Vaccine Injury

2
The following filings are relevant to this Opinion: Petition, ECF No. 1; Mot., ECF No.
70; Mem., ECF No. 70-1; Resp., ECF No. 73. Throughout, page citations to documents in the
record refer to the document’s original pagination, unless the page is designated with an asterisk
(e.g., *1), in which case the reference is to the pagination assigned by PACER/ECF.

2
Table, i.e., an “Off-Table case,” the petitioner must instead prove that the vaccination was the
cause-in-fact (“actual causation” or “causation-in-fact”) of the vaccinee’s asserted injury. See id.
§ 300aa-11(c)(1)(C)(ii)(I), (II). To prove causation-in-fact for an Off-Table case, a petitioner
must by a preponderance of the evidence demonstrate: “(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). Those three elements are commonly referred to as the “Althen prongs.” A
“failure to establish any one prong is dispositive.” Exum v. Sec’y of Health & Hum. Servs., 175
Fed. Cl. 681, 702 (2025).

II. Factual Background

The Chief Special Master summarized and evaluated Ms. Beckwith’s medical history
over the relevant time period, both parties’ expert reports, the medical literature submitted, and
the relevant legal standards. See generally Decision. The Chief Special Master reviewed all the
medical records, the medical literature, and the expert reports submitted in this case, but only
specifically discussed the records, literature, and reports relevant to his conclusion on the third
Althen prong in his Decision. Id. at 4, 20. This Opinion will briefly summarize the relevant
undisputed facts, the expert reports, and the Chief Special Master’s determinations.

A. Ms. Beckwith’s Medical History

Ms. Beckwith was admitted to the Emergency Department at a Department of Veterans’
Affairs Medical Center on September 23, 2019. Id. at 2 (citing Ex. 3 at 319, ECF No. 6-3). She
reported “abdominal pain that had persisted for 11 days” and that she was recovering from an
upper respiratory infection (“URI”). Id. A doctor diagnosed Ms. Beckwith with “[s]epsis
secondary to infection of the common bile duct.” Id. (citing Ex. 3 at 314, 322). At
approximately 2:20 AM on September 24, 2019, Ms. Beckwith received a flu vaccine and
experienced no immediate reactions to the vaccine. Id. at 2, 12 (citing Ex. 15 at 6, ECF No. 35-
1).

Later that day, a doctor referred Ms. Beckwith to a gastroenterologist due to concerns she
may be experiencing cholangitis stemming from a prior gallbladder removal. Id. at 2–3. The
gastroenterologist ordered an endoscopic retrograde cholangiopancreatography (“ERCP”). Id. at
3. Ms. Beckwith underwent the ERCP in the afternoon on September 25, 2019, and first
reported neurological symptoms that reflected GBS a few hours after the procedure, including
“numbness in both hands as well as numbness in both feet,” less than two days following her flu
vaccine. Id. (quoting Ex. 3 at 256). A doctor diagnosed Ms. Beckwith with GBS, Miller-Fisher
variant (“MFS”)—a “variant of Guillain-Barré syndrome characterized by areflexia, ataxia, and
ophthalmoplegia”—on September 30, 2019. Id. at 3 & n.4 (citation omitted).

3
B. Procedural History

On August 4, 2021, Ms. Beckwith filed her Petition against the Secretary alleging the flu
vaccine caused her to suffer GBS. Petition at 1. Initially, Ms. Beckwith asserted that she
received three doses of the flu vaccine between September 23 and September 24, 2019, and
alleged she was entitled to compensation for a Table injury. Id. at 2. The Secretary contested
Ms. Beckwith’s factual record of vaccination and contended that even if Ms. Beckwith received
the earliest alleged flu vaccine, her GBS onset occurred too early for a Table injury claim, given
the Table’s GBS-onset requirement of three to forty-two days after vaccination. Resp’t’s Rep. at
7, ECF No. 18. The Chief Special Master ordered the parties to brief the factual issue of whether
Ms. Beckwith’s records substantiated any of her vaccinations. Order, ECF No. 27. The Chief
Special Master then dismissed Ms. Beckwith’s Petition for failing to prove she received the flu
vaccine on any of the dates alleged. See ECF No. 30.

Ms. Beckwith moved for reconsideration twice and only on her second motion was she
able to identify a previously unfiled document confirming one of her alleged vaccinations. See
ECF Nos. 31, 36. The Chief Special Master granted the second motion and determined “that in
the early house of [September 24, 2019] (2:20 a.m.), Ms. Beckwith did in fact receive a single
dose of the flu vaccine.” ECF No. 37 at 2. However, the Chief Special Master also determined
Ms. Beckwith could not pursue a Table injury claim because her GBS-onset occurred less than
three days after this vaccination and instead ordered Ms. Beckwith to file an expert report
substantiating her alternative off-Table claim. Id. at 2–3.

C. Expert Opinions and Medical Literature

1. Ms. Beckwith’s Experts

a. Dr. Joseph Jeret

Ms. Beckwith submitted expert reports from Dr. Joseph Jeret, a neurologist, and one of
those reports is relevant to the current dispute. See Decision at 4. Dr. Jeret opined that the onset
of Ms. Beckwith’s GBS occurred “approximately 36 hours” after her flu vaccination and “that an
onset of neurologic symptoms the following day . . . [is] medically acceptable for flu vaccine-
caused GBS.” Id. at 5 (citing Jeret Rep. at 10, ECF No. 42-1). The Chief Special Master found
Dr. Jeret’s medical opinion unpersuasive. Id. at 24–26.

The Chief Special Master reviewed Dr. Jeret’s citations to medical and scientific
literature but found them unconvincing or irrelevant to establishing a medically acceptable
temporal connection between the flu vaccine and GBS in Ms. Beckwith’s case. Id. at 4–6, 24–
26. One study “relied on data derived from South Korea’s vaccine adverse event compensation
program, identifying 48 cases (over a 12-year period) in which individuals were compensated for
GBS post-vaccination injuries.” Id. at 5 (citing Y. Park et al., Clinical Features of Post-
Vaccination Guillain-Barré Syndrome (GBS) in Korea, J. Korean Med. Sci. 2017 Jul.
32(7):1154–59, filed as Ex. 45, ECF No. 44-8) (“Park”). The study found GBS “occur[ed]
within two days in a bit more than half” of cases.” Id. (citing Park at 1156). The Special Master

4
concluded the study “does not stand for the proposition that an onset of less than two days has
been found to be medically acceptable” because it relies on data from South Korea’s equivalent
of the Vaccine Program and “could reflect a policy decision.” Id. at 24.

Dr. Jeret also cited to “a retrospective study of passive surveillance data derived from the
Vaccine Safety Datalink” where “researchers observed evidence of [GBS] ‘[o]nset as early as 1
day after flu vaccination,’” but the Chief Special Master stated it “ma[de] no determination about
the relative risk temporally from vaccination.” Id. at 5 (citing Jeret Rep. at 10). A third paper
“relied on data from a pool of Medicare recipients,” some of whom “reported [GBS] onset within
a few days of [flu] vaccination.” Id. at 6 (citation omitted). But the Chief Special Master found
the paper “did not reach conclusions about more specific questions of temporal risk.” Id. A
fourth article focused specifically on instances of the MFS variant of GBS following several
vaccinations, including the flu vaccine. Id. But the Chief Special Master determined it did not
find an “increase in incidence of [MFS] after vaccination as compared to the general population”
and instead merely observed the variant within 2 weeks in 24% of instances. Id. (citation
omitted). Dr. Jeret contended “onset after 2 days is consistent with this review.” Id. (citing Jeret
Rep. at 10). However, the Chief Special Master found the study “does not stand for the
proposition that onset within a day or two of vaccination is as likely as within a week or more.”
Id. at 25.

The Chief Special Master concluded Dr. Jeret “repeatedly identifies literature relying on
passive surveillance reports of GBS beginning in a comparably-short timeframe” as Ms.
Beckwith’s GBS onset, but that the studies “do not opine as to the meaningfulness of these
occurrences, for purposes of causation” and reflect only “a temporal association between an
adverse event and vaccination.” Id. at 24 (citing Campbell v. Sec’y of Health & Hum. Servs., 97
Fed. Cl. 650, 668 (2011)). The Chief Special Master found the articles “do not provide any
reliable basis for concluding that the biologic process necessary” for the flu vaccine to cause
GBS “could occur in less than two days.” Id.

b. Dr. Omid Akbari

Dr. Omid Akbari, an academic immunologist, submitted two reports in support of Ms.
Beckwith’s theory of causation. Id. at 6. The Chief Special Master found neither report
persuasive. Id. at 6–9, 25–26. Regarding Dr. Akbari’s first report, the Chief Special Master
stated that while “prong one causation is not at issue in this case, a brief summary of Dr.
Akbari’s theory” was necessary, “since it bears on whether Petitioner’s GBS began in a
medically acceptable timeframe.” Id. at 7 (citing First Akbari Rep. at 7–17, ECF No. 43-1); see
also id. at 16–17 (citing de Bazan v. Sec’y of Health & Hum. Servs., 539 F.3d 1347, 1352 (Fed.
Cir. 2008)) (noting the “medically acceptable timeframe must align with the theory of how the
relevant vaccine can cause an injury (Althen prong one’s requirement)”).

The Chief Special Master characterized Dr. Akbari’s theory as “sweeping” and “all-
encompassing.” Id. at 7. He summarized the theory as follows:

[A] vaccine (a) causes a local reaction, stimulating an immune complex called the
“inflammasome,” (b) encourages the production of cytokines as well as T “helper

5
cells” that are integral to the process of production of antibodies by B cells, (c)
impacts the function of immune regulatory cells that suppress aberrant immune
responses, and (d) eventually prompts the creation of antibodies in response.

Id. (citing First Akbari Rep. at 7–8). Dr. Akbari also posited that vaccines activate a class of
immune cells known as “innate like lymphocytes (‘ILLs’) that act quickly, and are likely
involved []in the induction of demyelinating diseases such as GBS.” Id. (citing First Akbari Rep.
at 10). The Chief Special Master concluded that Dr. Akbari “applied an expansive definition” of
the “molecular mimicry . . . accepted as a likely mechanism for GBS,” because Dr. Akbari’s
definition included T helper cell reactions, one of which purportedly “encouraged” the
development of GBS. Id. (citing First Akbari Rep. at 5–9). The Chief Special Master further
stated that Dr. Akbari “claimed that molecular mimicry was accepted despite the difficulty in
ever showing an actual mimic.” Id.

The Chief Special Master was also unconvinced by Dr. Akbari’s citations to medical
literature to support his opinion that a vaccine-caused onset of GBS within two days of the flu
vaccine is medically acceptable. Some of these citations were to the same studies the Chief
Special Master found unpersuasive in Dr. Jeret’s medical opinion, including the Park study. Id.
at 7–8. Other citations included a study not specific to GBS that determined the flu vaccine was
“likely to encourage a faster immune response” and an article focused on the central nervous
system (“CNS”), which “established that T cells could quickly impact the nervous system” and
cause demyelination. Id. at 8. However, the Chief Special Master noted “GBS is not a CNS
disease, and so the speed with which [an immune cell] might be thought capable in some
instances of moving into, or out of, the CNS does not suggest GBS will occur as quickly as Dr.
Akbari posits.” Id.

In his second report, filed after the Secretary’s experts submitted reports, Dr. Akbari
maintained “ILLs were known to be fast-acting, could promote production of cytokines and T
helper cells, and likely played some role in encouraging ‘the development of demyelinating and
autoimmune disease,’ including acute forms of GBS.” Id. (citing Second Akbari Rep. at 28, ECF
No. 53-2). However, as the Chief Special Master noted, Dr. Akbari acknowledged the “need for
greater understanding of ILL function in the hyper-acute phase of inflammation such as
vaccination and adverse effects that may occur within hours or few days.” Id. (citing Second
Akbari Rep. at 28). That revealed that “the science on this subject is far less firm than [Dr.
Akbari] implied.” Id. Still, Dr. Akbari “deemed it likely the Petitioner ‘possessed a higher
number of ILLs,’ assuming ‘genetic or environmental factors’ relevant to her.” Id. at 9 (citing
Second Akbari Rep. at 29). But the Chief Special Master noted such unique genetic or
environmental factors were “not substantiated in this case.” Id. Dr. Akbari concluded it was
“plausible” for GBS onset to occur less than two days after vaccination. Id. (Second Akbari Rep.
at 30).

The Chief Special Master determined that Dr. Akbari’s theory “may be biologically
correct and/or supported by reliable independent evidence in many respects,” but does not
“implicat[e] vaccination as an ‘x factor’ leading to injury, and does not identify with enough
reliable specific evidence where and how this occurs.” Id. at 25. Further, while Dr. Akbari
“offered numerous literature citations, and provided an explanation about how different aspects

6
of the immune response work (or are speculated to work in some faster contexts—such as with
ILLs), his opinion amounted to the contention that it was plausible that GBS could be triggered
in a shorter time than commonly understood.” Id. The Chief Special Master noted plausibility
“is not equivalent to evidence that GBS likely occurs in a day or two of vaccination” and that Dr.
Akbari’s cited literature “does not constitute a preponderant showing on the timeframe
question.” Id. Rather, he concluded it “remains more likely than not that it takes more than two
days for flu vaccine-caused GBS to produce autoantibodies sufficient to result in manifestation
of outward, clinically-observable symptoms.” Id.

2. The Secretary’s Experts

i. Dr. Peter Kang

Dr. Peter Kang, a neurologist, submitted an expert report on behalf of the Secretary. Id.
at 9. Dr. Kang “maintained that ‘no compelling evidence in the literature’ supported the
conclusion that the GBS variant experienced by Petitioner could clinically manifest in such a
short time frame ‘following an immunogenic exposure.’” Id. at 10 (citing Kang Rep. at 16, ECF
No. 50-1). Dr. Kang asserted—and provided literature supporting the conclusion—that the
immune response following the flu vaccine takes several days. Id. He argued Ms. Beckwith
displayed GBS symptoms too early “for the vaccine to have been responsible for th[e]
antibodies” that drove the development of her GBS. Id. The Chief Special Master concluded
Dr. Kang “relied on what is known about GBS and its autoantibody propagation” to determine it
was unlikely the flu vaccine caused Ms. Beckwith’s GBS. Id. at 26. Thus, the Chief Special
Master found the medical opinion persuasive. Id.

ii. Dr. William Hawse

Dr. William Hawse, an academic immunologist, was the Secretary’s second expert. Id. at
10. Dr. Hawse found Ms. Beckwith’s GBS onset occurred “within a day of vaccination” and
thought “it unlikely GBS could manifest in so short a timeframe.” Id. at 10 (citing Hawse Rep.
at 11, ECF No. 49-1). Dr. Hawse maintained ILLs “could be quickly stimulated by vaccination.
But the existing scientific and medical literature on the topic was too sparse to conclude either
that vaccines likely do stimulate these immune cells, or (and more importantly) that they lead to
GBS.” Id. at 10–11 (citing Hawse Rep. at 11). Moreover, he contended that while “there is
some inflammasome stimulation attributable to receipt of the flu vaccine,” the medical literature
does not support the contention that “this stimulation would be sufficiently aberrant to cause a
disease process leading to GBS.” Id. at 11 (citing Hawse Rep. at 4–5). On the contrary, certain
scientific evidence pointed to the flu vaccine suppressing “some innate responses that would be
otherwise pro-inflammatory.” Id. (citing Hawse Rep. at 5–6). Dr. Hawse also opined that Ms.
Beckwith’s URI and infection-associated sepsis were more reasonable potential causes of her
GBS. Id. at 10.

Like Dr. Kang’s medical opinion, the Chief Special Master found Dr. Hawse’s medical
opinion convincing and supported by immunological science. Id. at 26. The Chief Special
Master also noted the Secretary’s experts’ opinions were both “consistent with the Table
timeframe” for GBS onset following the flu vaccine. Id.

7
D. The Chief Special Master’s Conclusions

After the parties filed expert reports, the Chief Special Master issued an Order to Show
Cause as to why the Petition should not be dismissed for failing to satisfy the third Althen prong,
which the parties briefed. See ECF Nos. 56, 60, 62. The Chief Special Master then issued his
Decision denying Ms. Beckwith’s Petition for failing to satisfy the third Althen prong on August
29, 2025. See generally Decision.

The Chief Special Master noted that Ms. Beckwith’s medical records “memorialize an
onset of neurologic symptoms following the September 25, 2019, ERCP procedure, which
included ‘ataxia, weakness, pain, areflexia, dysphagia, dysarthria, hypophonia, tremors and
sensory deficits in extremities.’” Id. at 4 (citing Ex. 5 at 14, ECF No. 6-5). He concluded both
parties accept Ms. Beckwith’s GBS onset occurred “less than three days” post-vaccination “and
the record preponderates in favor of an onset occurring sooner (35 to 40 hours post-
vaccination).” Id. at 21–22.

The Chief Special Master concluded that Ms. Beckwith “has not preponderantly
established that her GBS developed within a medically-acceptable timeframe after receipt of the
flu vaccine.” Id. at 21. He reasoned that “medical science suggests that it is unlikely, absent
factors specific to a given claimant, that vaccine-caused GBS will occur sooner than three days
post-vaccination.” Id. at 26. Rather, “in most cases GBS will more likely than not take a few
days to manifest clinically after an environmental trigger (whether infection or vaccination),
given the time it takes for the body to manufacture the pathogenic, cross-reactive antibodies.”
Id. The Chief Special Master acknowledged “Petitioner’s experts [] unquestionably vouched for
the medical acceptability of a one to two-day onset of GBS post-vaccination,” but stated he was
not bound by their insufficiently supported assertions and “found the counter-opinions of
[Respondent’s experts] far more persuasive.” Id. He determined Ms. Beckwith failed to prove
any “special factors,” such as “her personal health or other circumstances made a fast onset
likely” in her case. Id.; see also id. at 23 (“The[] facts do not suggest a faster aberrant immune
response leading to GBS was more likely in Petitioner’s case (no matter how plausible it might
be), or did occur.”).

Ms. Beckwith timely filed her Motion for Review on September 26, 2025. See Mot. The
Secretary filed his Response on October 24, 2025. See Resp.

STANDARD OF REVIEW

“Under the Vaccine Act, the Court of Federal Claims reviews the decision of the special
master to determine if it is arbitrary, capricious, an abuse of discretion, or otherwise not in
accordance with law.” de Bazan, 539 F.3d at 1350 (citing Althen, 418 F.3d at 1277); see also 42
U.S.C. § 300aa-12(e)(2). In Vaccine Act cases, this Court uses three distinct standards of
review—fact findings are reviewed under the “arbitrary and capricious” standard; legal
conclusions are reviewed under the “not in accordance with law” standard; and discretionary
rulings are reviewed under the “abuse of discretion” standard. Munn v. Sec’y of Health & Hum.
Servs., 970 F.2d 863, 870 n.10 (Fed. Cir. 1992) (cleaned up).

8
This Court reviews de novo whether a special master did not act in accordance with the
law. See Althen, 418 F.3d at 1279. “‘Not in accordance with the law’ refers to the application of
the wrong legal standard.” Rodriguez v. Sec’y of Health & Hum. Servs., 632 F.3d 1381, 1384
(Fed. Cir. 2011) (citing Markovich v. Sec’y of Health & Hum. Servs., 477 F.3d 1353, 1356 (Fed.
Cir. 2007)). The Court owes “no deference to the . . . special master on questions of law.”
Broekelschen v. Sec’y of Health & Hum. Servs., 618 F.3d 1339, 1345 (Fed. Cir. 2010).

The standard of review for factual findings is “the most deferential possible.” Munn, 970
F.2d at 870. The U.S. Court of Appeals for the Federal Circuit has warned against “second
guess[ing] the Special Master[’]s fact-intensive conclusions,” particularly in those cases “in
which the medical evidence of causation is in dispute.” Hodges v. Sec’y of Health & Hum.
Servs., 9 F.3d 958, 961 (Fed. Cir. 1993) (describing the standard of review as “uniquely
deferential for what is essentially a judicial process”). The law is settled that this Court cannot
“substitute its judgment for that of the Special Master merely because it might have reached a
different conclusion.” Snyder v. Sec’y of Health & Hum. Servs., 88 Fed. Cl. 706, 718 (2009)
(cleaned up). Further, a “special master’s decision often times is based on the credibility of the
experts and the relative persuasiveness of their competing theories.” Broekelschen, 618 F.3d at
1347 (citing Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357, 1362 (Fed. Cir. 2000)).
These credibility findings “are virtually unchallengeable on appeal.” Lampe, 219 F.3d at 1362.

A special master also does not need to “discuss every item of evidence in the record”
when making a factual finding “so long as the decision makes clear that the special master fully
considered a party’s position and arguments on point.” Snyder v. Sec’y of Health & Hum. Servs.,
36 Fed. Cl. 461, 466 (1996), aff’d, 117 F.3d 545 (Fed. Cir. 1997) (citation omitted); see also
Hazlehurst v. Sec’y of Health & Hum. Servs., 604 F.3d 1343, 1352 (Fed. Cir. 2010) (noting the
Court should presume the special master has considered all the material in the record, regardless
of whether she mentions it all). This Court “does 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.” Broekelschen, 618 F.3d at 1349
(citation omitted).

“If [a] 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, 940 F.2d at 1528. Accordingly, this Court should not deem a
special master’s fact conclusions arbitrary and capricious unless they are “so implausible that
[they] could not be ascribed to a difference in view.” Id. at 1527 (cleaned up). Indeed, if a
special master’s “conclusion is based on evidence in the record that is not wholly implausible,”
this Court must “uphold that finding as not being arbitrary or capricious.” Cedillo v. Sec’y of
Health & Hum. Servs., 617 F.3d 1328, 1338 (Fed. Cir. 2010).

DISCUSSION

Ms. Beckwith challenges the Chief Special Master’s conclusion that she failed to satisfy
the third Althen prong. Althen prong three requires a petitioner to establish a “proximate
temporal relationship between the vaccination and the injury.” Paluck v. Sec’y of Health &

9
Hum. Servs., 786 F.3d 1373, 1383–84 (Fed. Cir. 2015); see also Althen, 418 F.3d at 1278. That
requires “preponderant proof that the onset of symptoms occurred within a timeframe for which,
given the medical understanding of the disorder’s etiology, it is medically acceptable to infer
causation-in-fact.” de Bazan, 539 F.3d at 1352 (discussing proof requirements governing claim
where special master concluded onset of symptoms occurred too soon to support inference of
causation-in-fact). Special masters must conduct a case-by-case analysis of the merits of the
petitioner’s claim based on the evidence presented in that case. Althen, 418 F.3d at 1281; see
also Lampe, 219 F.3d at 1366; Davis v. Sec’y of Health & Hum. Servs., No. 14-978V, 2022 WL
1654743, *26 (Fed. Cl. Apr. 27, 2022).

As noted above, Ms. Beckwith contends the Chief Special Master erred in four ways.
She claims that he: (1) erroneously converted the required onset timeframe for a GBS Table
injury into a hard and fast rule regarding the timing of GBS onset for an Off-Table claim; (2)
failed to properly consider Ms. Beckwith’s medical theory of causation when evaluating whether
she demonstrated a proximate temporal relationship between the flu vaccine and her
development of GBS; (3) applied a heightened standard of proof to Ms. Beckwith’s evidence;
and (4) arbitrarily and capriciously evaluated Ms. Beckwith’s evidence. Mem. at 1. The Court
has considered each of Ms. Beckwith’s claims and sustains the Chief Special Master’s Decision.

I. The Chief Special Master Did Not Require Ms. Beckwith’s Off-Table Claim to
Satisfy the Timing Requirements Governing GBS Onset in Vaccine Injury Table
Claims.

Ms. Beckwith asserts that the Chief Special Master committed an error of law because he
purportedly applied a hard and fast three-day GBS onset rule from the Vaccine Injury Table to
her Off-Table GBS claim. See Mem. at 5, 9. In Paluck, the Federal Circuit faulted a special
master for applying a “hard and fast deadline” of three weeks for the onset of symptoms
allegedly attributable to a vaccine. Paluck, 786 F.3d at 1383–84. The Court concluded that the
variety of disorders and the paucity of relevant scientific literature made it unreasonable for the
special master to require the petitioner to show that symptoms manifested within that strict three-
week deadline. Id. Ms. Beckwith contends that the Chief Special Master similarly erred by
unlawfully requiring her to “overcome the presumption” that GBS onset generally only occurs at
least three days after vaccination, as articulated in the Vaccine Injury Table. Mem. at 11–12.
The Chief Special Master allegedly limited “the type of evidence and argument” she could
submit to showing how “specific facts of [her] medical history or personal circumstances
support[ed] a faster onset.” Id. (cleaned up). Ms. Beckwith contends that she should have been
allowed to submit “a new, general medical theory explaining how the immune system may react
earlier in outlier cases.” Id. at 12.

First, the Chief Special Master did not require Ms. Beckwith to prove that her GBS onset
occurred at least three days after her flu vaccine, as required for a Table claim, to meet her
burden of proof in this Off-Table case. In his Decision, the Chief Special Master stated “the
medical science behind a Table claim—the raison d’etre for its existence—should not be
ignored” and “should still be taken into account to some degree when deciding claims that ‘fall
out’ of the Table.” Decision at 22. He explained that the Table “timeframe best captures the
most likely period in which flu vaccine-caused GBS would begin, based on the most persuasive

10
and reliable science available when the terms of the Table claim were struck.” Id. at 23.
However, he was clear that “[p]etitioners alleging a non-Table, causation-in-fact flu vaccine-
GBS claim are of course not formally limited, in any ‘bright line’ sense, by the Table’s
timeframe element.” Id. at 22. He also acknowledged that a claimant theoretically could
establish temporal proximity even if their case presents “a shorter (or longer) onset timeframe
than what the Table allows for GBS.” Id. at 23. He then assessed whether Ms. Beckwith had
met her burden to show by a preponderance of the evidence that the onset of GBS less than three
days after vaccination was a medically acceptable means of establishing causation in her case.
Id. at 21–26. Thus, the Chief Special Master did not apply an improper “hard and fast”
timeframe like the ruling that Paluck overturned. See Paluck, 786 F.3d at 1383–84 (finding a
special master erred when he stated petitioners “must” show manifestation within a particular
timeframe to meet their burden of proof); see also Correira v. Sec’y of Health & Hum. Servs.,
179 Fed. Cl. 286, 298 (2025) (finding a special master erred when he “impose[d] an inflexible
‘up-to-eight weeks timeframe’” for when it is medically acceptable to infer the flu vaccine
caused GBS) (emphasis added).

Second, the Chief Special Master properly articulated the legal standard. He held that
where evidence establishing “what about the specific facts of [a petitioner’s] medical history or
personal circumstances suggests a faster onset due to vaccination could occur,” is lacking, “it is
reasonable to find the third Althen prong has not been satisfied.” Decision at 23. He concluded
Ms. Beckwith failed to prove any “special factors,” such as “her personal health or other
circumstances made a fast onset likely” in her case. Id. at 26. In doing so, he appropriately
evaluated whether Ms. Beckwith had established a medically acceptable timeframe from which
to infer causation “based on the circumstances of the particular case.” Knudsen v. Sec’y of
Health & Hum. Servs., 35 F.3d 543, 548 (Fed. Cir. 1994).

Finally, it was not legal error for the Chief Special Master to consider the Table
timeframe for GBS onset when assessing whether the record evidence supported an inference of
causation. Neither Althen nor this Court’s precedent requires special masters to ignore the
scientific findings on which the Table’s onset time parameters are based. The Chief Special
Master referenced the Table and evaluated the entirety of the evidence and medical opinions Ms.
Beckwith offered. See Decision at 2–14, 21–26.

This Court has repeatedly found similar applications of the third Althen prong to be
legally proper. For example, in Flowers, the Court upheld the Chief Special Master’s conclusion
that a claimant had failed to establish that the flu vaccine caused GBS where the onset occurred
less than three days after her vaccine. See Flowers v. Sec’y of Health & Hum. Servs., 173 Fed.
Cl. 613, 629 (2024). The Court cited the Chief Special Master’s observation that Flowers “ha[d]
not explained how or provided any evidence demonstrating that in this case, in an exception to
the generally accepted timeframe for the onset of symptoms, the flu vaccine caused her to
experience GBS symptoms less than three days after vaccination.” Id. Similarly, in Kindle, the
Court upheld the Chief Special Master’s recognition that it was inappropriate to infer causation
when the petitioner’s GBS onset occurred later than the longest timeframe previously accepted
by special masters “where Petitioner had failed to proffer preponderant evidence that such an
unusually lengthy post-vaccination onset . . . could still be deemed medically acceptable.”
Kindle v. Sec’y of Health & Hum. Servs., 177 Fed. Cl. 689, 715 (2025) (cleaned up). In Mager,

11
the Court upheld a special master’s consideration of the Table as “additional support” for the
expert opinions regarding a medically acceptable timeframe for the onset of a seizure disorder.
Mager v. Sec’y of Health & Hum. Servs., 166 Fed. Cl. 414, 449 (2023), appeal dismissed, No.
2023-2382, 2023 WL 7318303 (Fed. Cir. Nov. 7, 2023). For the same reasons, the Chief Special
Master’s recognition that Ms. Beckwith’s proposed onset timeframe conflicted with the Table’s
timeframe was not an error of law.

The Chief Special Master ultimately determined Ms. Beckwith’s position was
“unsupported by sufficient reliable independent proof” and her expert medical opinions have
“reliability issues that [her] evidence did not fully address or refute.” Cerrone v. Sec’y of Health
& Hum. Servs., 146 F.4th 1113, 1124 (Fed. Cir. 2025) (quotation omitted). Specifically, the
medical literature Dr. Jeret and Dr. Akbari relied upon showed only “a temporal association”
between vaccination and early GBS onset in some cases and did not constitute evidence of
causation. Decision at 24. Further, the Chief Special Master concluded that the medical science
Dr. Akbari cited concerning vaccine-activated fast-acting ILLs and their impact on the
development of GBS was insufficiently developed or reliable to satisfy the preponderance of the
evidence standard under the third Althen prong. Id. at 25 (noting the difference between
plausibility and “a preponderant showing”). The Chief Special Master found the Secretary’s
experts and the evidence they relied upon more persuasive. Id. at 26. He noted their conclusions
were “consistent with the Table timeframe,” but his final conclusion did not rely solely on the
Table timeframe. Id. Thus, the Chief Special Master evaluated all the evidence against the
proper legal standard when he determined Ms. Beckwith “has not preponderantly established that
her GBS developed within a medically-acceptable timeframe after receipt of the flu vaccine.” Id.
at 21.

II. The Chief Special Master Properly Considered Ms. Beckwith’s Medical Theory
of Causation in Denying Her Claim Under the Third Althen Prong.

Ms. Beckwith further contends that the Chief Special Master erroneously failed to fully
evaluate her “modified theory of flu-vaccine caused GBS” under the first Althen prong and
therefore improperly “disregarded the etiology [she] proposed” to satisfy the timing requirement
under the third Althen prong. Mem. at 14–15. However, the Chief Special Master properly
recognized that the proposed “medically acceptable timeframe must align with the theory of how
the relevant vaccine can cause an injury (Althen prong one’s requirement).” Decision at 17
(citing de Bazan, 539 F.3d at 1352); see also Veryzer v. Sec’y of Health & Hum. Servs., 100 Fed.
Cl. 344, 356 (2011) (noting that “the temporal association must relate to the pathology of the
specific medical theory alleged to have caused the injury”), aff’d per curiam, 475 F. App’x 765
(Fed. Cir. 2012). Accordingly, the Chief Special Master evaluated Dr. Akbari’s theory of
causation, recognizing “it bears on whether Petitioner’s GBS began in a medically acceptable
timeframe.” Decision at 7. The Chief Special Master simply found Dr. Akbari’s theory
unpersuasive and insufficient to meet Ms. Beckwith’s burden under the third Althen prong. Id. at
24–26.

In evaluating the theory of causation, the Chief Special Master did not, as Ms. Beckwith
contends, “cl[ing] to the standard molecular mimicry theory without examining how the innate
immune system can trigger symptoms earlier through the inflammasome, ILCs, or ILLs.” Mem.

12
at 14. Rather, the Chief Special Master thoroughly reviewed Dr. Akbari’s theory and
explanations to assess their reliability and credibility. See Decision at 7–8. The Chief Special
Master concluded that although Dr. Akbari “provided an explanation about how different aspects
of the immune response work (or are speculated to work in some faster contexts—such as with
ILLs), his opinion amounted to the contention that it was plausible that GBS could be triggered
in a shorter time than commonly understood.” Id. at 25. “[P]roof of a ‘plausible’ or ‘possible’
causal link between the vaccine and the injury . . . is not the statutory standard.” Moberly v.
Sec’y of Health & Hum. Servs., 592 F.3d 1315, 1322 (Fed. Cir. 2010); see also Boatmon v. Sec’y
of Health & Hum. Servs., 941 F.3d 1351, 1360 (Fed. Cir. 2019). Thus, the Chief Special Master
properly evaluated how the temporal association Ms. Beckwith proposed under the third Althen
prong “relate[d] to the pathology of the specific medical theory alleged to have caused the
injury.” Veryzer, 100 Fed. Cl. at 356. He did not commit an error of law. As further discussed
below, Ms. Beckwith’s other issues with the Chief Special Master’s evaluation of Dr. Akbari’s
medical theory amount to mere disagreement with the Chief Special Master’s credibility
determinations and factual conclusions, which this Court cannot second guess. See Hines, 940
F.2d at 1527.

III. The Chief Special Master Did Not Raise Ms. Beckwith’s Burden of Proof.

Ms. Beckwith next argues that the Chief Special Master erroneously “required [her]
prong 3 evidence to show that early onset was not legally probable, but scientifically or
medically certain, and required demonstration of a specific mechanism and a generally accepted
medical theory to establish a proximate temporal relationship.” Mem. at 16. Ms. Beckwith
contends this amounted to “requiring Ms. Beckwith to prove a Table revision is needed, rather
than that the vaccine was likely a substantial factor in her illness.” Id. at 17. Further, she asserts
that the Chief Special Master’s requirement she “explain the where and how of causation
constitutes a requirement of proof of mechanism, which is erroneous.” Id. (citing Althen, 418
F.3d at 1280). But the Chief Special Master did not err. Throughout his Decision, the Chief
Special Master “clearly articulated and applied the ‘more likely than not’ standard” to the third
Althen prong. White v. Sec’y of Health & Hum. Servs., No. 2024-1372, 2025 WL 3703259, at *5
(Fed. Cir. Aug. 27, 2025); see Decision at 21–26. Based on the record, he concluded “Petitioner
cannot show by preponderant evidence that her GBS began in a medically-acceptable
timeframe.” Decision at 26; see also id. at 23 (finding the “facts do not suggest a faster aberrant
immune response leading to GBS was more likely in Petitioner’s case (no matter how plausible
it might be), or did occur for the reasons alleged”).

The Chief Special Master did not require scientific or medical certainty anywhere in his
Decision. Nor did he require Ms. Beckwith to prove causation through “definitive statements of
causation and epidemiological certainty” so clear as to require that the Vaccine Table be revised.
Campbell, 97 Fed. Cl. at 673. When evaluating Ms. Beckwith’s medical opinions and the
underlying scientific literature, the Chief Special Master consistently differentiated evidence
indicating “GBS could occur in less than two days” after vaccination—a mere temporal
connection—from Ms. Beckwith’s burden to show it was “more likely than not” her GBS onset
occurred in a medically acceptable timeframe to infer the flu vaccine caused the injury. See
Decision at 24–26; see also Moberly, 592 F.3d at 1322 (differentiating between a “more likely
that not” standard and “proof of a ‘plausible’ or ‘possible’ causal link between the vaccine and

13
the injury, which is not the statutory standard”). He properly weighed the evidence, in line with
his authority as the factfinder, to determine its relevance and sufficiency for meeting Ms.
Beckwith’s burden of proof. See Bradley v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575
(Fed. Cir. 1993). As discussed above, he properly considered the Table timeframe along with
Ms. Beckwith’s evidence but ultimately found Ms. Beckwith failed to show that “her personal
health or other circumstances made a fast onset likely” in her particular case. Decision at 26; see
also Mager, 166 Fed. Cl. at 449 (finding it is proper for a special master to consider the Table
timeframe as “additional support”). Thus, he evaluated her claim of causation in fact “based on
the circumstances of the particular case.” Knudsen, 35 F.3d at 548.

Nor is the Chief Special Master’s conclusion that Dr. Akbari’s theory “does not identify
with enough reliable specific evidence where and how” Ms. Beckwith’s vaccination led her to
her GBS onset equivalent to an improper requirement of proof of mechanism. See Decision at
25. The Chief Special Master did not inappropriately “require identification and proof of
specific biological mechanisms” to satisfy the third Althen prong. See Althen, 418 F.3d at 1280
(citing Knudsen, 35 F.3d at 549). Rather, the Chief Special Master properly evaluated Dr.
Akbari’s opinion and the underlying evidence about fast-acting ILLs to determine whether it was
sufficiently credible and reliable for Ms. Beckwith to establish medical acceptability. See
Decision at 25. The Chief Special Master did not fault Ms. Beckwith for failing to provide proof
of specific biological mechanisms relating to ILLs. Instead, the Chief Special Master concluded
the theory Dr. Akbari offered only showed it was “plausible that GBS could be triggered in a
shorter time than commonly understood,” while acknowledging “need for greater understanding”
of how ILLs may contribute to that process. Id. at 8, 25–26. The Chief Special Master correctly
differentiated such evidence from a showing it is “more likely than not” true that in Ms.
Beckwith’s case flu-vaccine-triggered ILLs caused her GBS in less than two days. Id. at 25–26;
see Moberly, 592 F.3d at 1322.

IV. The Chief Special Master’s Factual Findings Were Neither Arbitrary Nor
Capricious.

Finally, Ms. Beckwith asserts that the Chief Special Master’s assessment of the evidence
was arbitrary and capricious, and he failed to articulate a rational basis for his Decision. See
Mem. at 18. She contends the Chief Special Master irrationally and implausibly evaluated the
scientific literature, improperly considered other potential causes of her GBS, ignored evidence
that overlapped with her causation theory under the first Althen prong, and improperly weighed
her evidence “against the Table” instead of “against the Althen requirements.” Id. at 18–20. But
Ms. Beckwith does not provide any basis for this Court to doubt the Chief Special Master’s
factual conclusions, which this Court must consider with special deference. Hodges, 9 F.3d at
961; see also Munn, 970 F.2d at 870 (noting the standard of review for factual findings is “the
most deferential possible”).

The record does not indicate that the Chief Special Master considered the scientific
literature irrationally or drew implausible conclusions. The Chief Special Master, within his
purview as the factfinder, considered all the scientific and medical literature Ms. Beckwith
submitted but found it unpersuasive. See Decision at 4–9, 23–26; Hines, 940 F.2d at 1528. He
rationally determined that the studies upon which her experts relied did not make sufficient

14
findings about causation and merely showed a temporal connection between the flu vaccine and
GBS. See, e.g., id. at 5 (finding one study “ma[de] no determination about the relative risk
temporally from vaccination”), 6 (determining another study “did not reach conclusions about
more specific questions of temporal risk”), 25 (referencing a study that “does not stand for the
proposition that onset within a day or two of vaccination is as likely as within a week or more”);
see also Campbell, 97 Fed. Cl. at 668 (“Case reports do not purport to establish causation
definitively, and this deficiency does indeed reduce their evidentiary value compared particularly
to formal epidemiological studies.”). He also reasonably determined that the Park study, which
only documented payouts under the South Korean equivalent of the Vaccine Program, “could
reflect a policy decision” and was not sufficiently probative of whether it is medically acceptable
to infer the flu vaccine can cause GBS in less than two days. Decision at 24.3 Further, he
rationally discounted a study about the CNS, because “GBS is not a CNS disease.” Id. at 8. Ms.
Beckwith would prefer that this Court reevaluate the scientific and medical literature to reach a
different conclusion. But this Court cannot do so, particularly since this is a case “in which the
medical evidence of causation is in dispute.” Hodges, 9 F.3d at 961; see also Snyder, 88 Fed. Cl.
at 718.

The Chief Special Master also did not err when he speculated, without deciding, about
other potential causes of Ms. Beckwith’s GBS. While the Chief Special Master noted that her
ERCP or her URI may have been other reasonable causes of her GBS, see Decision at 23 n.16,
he only did so to illustrate Ms. Beckwith’s failure to meet her burden to establish it was
medically acceptable to infer the flu vaccine caused her GBS. Id. at 23. And to the extent Ms.
Beckwith now takes issue, for the first time, with the Chief Special Master’s failure to assess
whether her URI acted synergistically with the flu vaccine to cause her GBS, see Mem. at 12, she
waived this argument by failing to raise it below. See Austin v. Sec’y of Health & Hum. Servs.,
818 F. App’x 1005, 1008 (Fed. Cir. 2020) (A petitioner “cannot fault the Special Master for not
considering a piece of evidence she never presented to him”); McCollum v. Sec’y of Health &
Hum. Servs., 135 Fed. Cl. 735, 741 (2017) (“The Special Master cannot be expected to, sua
sponte, apply a legal theory that petitioner did not himself raise,” as this would “shift the burden
of proof from the petitioner to the Special Master himself.”), aff’d, 760 F. App’x 1003 (Fed. Cir.
2019).

Further, the Chief Special Master did not ignore the evidence Ms. Beckwith submitted
under the first Althen prong. He did not discuss every piece of evidence in his Decision but
stated that he reviewed all the evidence submitted in this case. See Decision at 20. A special
master need not “discuss every item of evidence in the record” when making a factual finding
“so long as the decision makes clear that the special master fully considered a party’s position
and arguments on point.” Snyder, 36 Fed. Cl. at 466.

3
Contrary to Ms. Beckwith’s suggestion, the Chief Special Master did not unreasonably
change his mind about the Park study; he similarly found in a previous case that “Park is not
entitled to great weight for the reliability of its medical findings” when rejecting a petitioner’s
claim under the third Althen prong. Block v. Sec’y of Health & Hum. Servs., No. 19-969V, 2021
WL 5709764, at *4 (Fed. Cl. Spec. Mstr. Oct. 29, 2021).
15
Nor did the Chief Special Master irrationally evaluate Ms. Beckwith’s causation theory
when denying her claim under the third Althen prong. As noted above, the Chief Special Master
thoroughly considered Dr. Akbari’s theory of causation and his view that flu vaccine-induced
ILLs can cause GBS onset within two days of vaccination, but simply found it lacked a reliable
scientific basis. Decision at 25 (finding Dr. Akbari’s theory “founders [sic] in implicating
vaccination as an ‘x factor’ leading to injury” and is “inadequately bulwarked with sufficient
reliable evidence”); see also Moberly, 592 F.3d at 1324 (“Although a Vaccine Act claimant is
not required to present proof of causation to the level of scientific certainty, the special master is
entitled to require some indicia of reliability to support the assertion of the expert witness.”).
The Chief Special Master noted that even Dr. Akbari acknowledged the shortcomings in
available literature, which meant “the science on this subject is far less firm than [Dr. Akbari]
implied.” Decision at 8. The Chief Special Master drew rational and plausible conclusions from
the evidence. Thus, this Court cannot “reweigh the factual evidence, [] assess whether the
Special Master correctly evaluated the evidence[,] . . . [or] examine the probative value of the
evidence.” Broekelschen, 618 F.3d at 1349 (citation omitted).

The Chief Special Master also properly weighed Dr. Akbari’s opinion against the
opinions of the Secretary’s experts, who disagreed that it was medically acceptable to infer Ms.
Beckwith’s flu vaccine caused her GBS onset, given how quickly it occurred in her case.
Decision at 26. He found the Secretary’s experts relied on robust evidence and were more
persuasive. Id. The Chief Special Master’s conclusion was “based on the credibility of the
experts and the relative persuasiveness of their competing theories.” Broekelschen, 618 F.3d at
1347 (citing Lampe, 219 F.3d at 1362). It is not appropriate for this Court to second-guess his
determinations about the persuasiveness of competing expert theories, id., which “are virtually
unchallengeable on appeal.” Lampe, 219 F.3d at 1362.

The Chief Special Master also noted that the Secretary’s experts’ theories were aligned
with the Table, see Decision at 26, but he did not, as Ms. Beckwith claims, weigh her evidence
against the Table. See Mem. at 20. Along with the competing expert theories and medical
literature, the Chief Special Master appropriately considered the science behind the onset
requirement for the GBS Table injury, see Flowers, 173 Fed. Cl. at 628–29, and his own
extensive experience with GBS cases. See Ultimo v. Sec’y of Health & Hum. Servs., 28 Fed. Cl.
148, 152–53 (1993); Doe v. Sec’y of Health & Hum. Servs., 76 Fed. Cl. 328, 338–39 (2007). He
rationally weighed the competing evidence and concluded Ms. Beckwith failed to meet her
burden, under Althen, to show by a preponderance of evidence that it was medically acceptable
to infer the flu vaccine caused her GBS onset in less than two days. Decision at 26. Since the
Chief Special Master’s Decision “is based on evidence in the record that is not wholly
implausible,” this Court is “compelled to uphold that finding as not being arbitrary or
capricious.” Cedillo, 617 F.3d at 1338.

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CONCLUSION

For the reasons articulated above, Ms. Beckwith’s Motion for Review, ECF No. 70, is
DENIED and the Chief Special Master’s Decision, ECF No. 67, is SUSTAINED. The Clerk of
the Court shall enter Judgment for Respondent accordingly.

Date: February 20, 2026

ROBIN M. MERIWEATHER
Judge

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/11273325. Public record. Not legal advice.