Radke v. Secretary of Health and Human Services

In the United States Court of Federal Claims

No. 22-1384

(Filed Under Seal: April 2, 2026) *

(Reissued: April 23, 2026)

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

*

MARK RADKE, *

*

Petitioner, *

*

v. *

*

SECRETARY OF HEALTH *

AND HUMAN SERVICES, *

*

Respondent. *

*

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

Amber Diane Wilson, Attorney, Wilson Science Law, of Washington, D.C., for

Petitioner.

Tyler C. King, Trial Attorney, Torts Branch, Civil Division, U.S. Department of Justice,

of Washington, D.C., for Respondent.

OPINION AND ORDER

SOMERS, Judge.

The “Because I Said So Fallacy” (also referred to as the “Just Because Fallacy” or the

“Ipse Dixit Fallacy”) assumes a conclusion’s accuracy based solely on the authority of the

decisionmaker. The issue with conclusions premised on the “Because I Said So Fallacy” is that

they do not provide a reasoned explanation for a decision. Worn-down parents often employ this

tactic when their children repeatedly question their decisions. As most know, however, “because

I said so” is not usually a satisfactory answer to the disappointed party. Likewise, “because I

said so” is not a satisfactory answer when a decision comes before a reviewing court under the

standard of review prescribed by the Administrative Procedure Act. Under this standard of

review, a court need not accept the assertion, without more, that a decision is correct because the

*

On April 2, 2026, the Court issued this opinion and order under seal in accordance with

Rule 18(b) of the Vaccine Rules (Appendix B) of the Rules of the U.S. Court of Federal Claims.

The Court provided the parties 14 days to propose redactions. The parties did not propose any

redactions; accordingly, the Court reissues this opinion in its original form with a few minor

stylistic and typographical corrections.

decisionmaker says so. But that is exactly the position the chief special master’s entitlement

decision puts the Court in here: to uphold the decision, the Court would essentially have to

accept that the chief special master is correct because he said so.

Petitioner Mark Radke has asked the Court to review the chief special master’s decision

to deny him compensation under the National Vaccine Injury Compensation Program (“Vaccine

Act”). See ECF No. 45. Pursuant to the Vaccine Act, upon the filing of a motion for review, a

decision of a special master is reviewed by this Court to ensure that it is not “arbitrary,

capricious, an abuse of discretion, or otherwise not in accordance with law . . . .” See 42 U.S.C.

§ 300aa-12(e)(2)(B). As explained below, the Court finds that the chief special master’s

entitlement decision did not adequately explain his reasoning for denying Petitioner’s claim, and

it remands the case to the chief special master for further proceedings.

BACKGROUND

The facts of this case are largely set forth in the chief special master’s decision. See

Radke v. Sec’y of Health & Hum. Servs., No. 22-1384V, 2025 WL 3091516, at *1–11 (Fed. Cl.

Spec. Mstr. Oct. 6, 2025) (docketed in this case as ECF No. 43 at 1–22). Rather than repeating

the extensive factual record, the Court will recount only the salient facts and procedural

background here. On September 30, 2019, Petitioner Mark Radke received a pneumococcal

vaccine, which allegedly caused him to develop polymyalgia rheumatica (“PMR”). ECF No. 45

at 2. Petitioner based his claim on the expert testimony of Dr. Efthimiou, a board-certified

rheumatologist. Id. Dr. Efthimiou theorized that the pneumococcal vaccine could adversely

deregulate T-cells, which then could trigger inflammatory symptoms consistent with PMR. Id. at

11. Dr. Efthimiou further testified that Petitioner experienced this physical response, which

induced his PMR illness, three days after receipt of the vaccination. Id. at 18–19.

On October 6, 2025, the chief special master issued a decision finding for the Secretary

of Health and Human Services (“Secretary”). Radke, 2025 WL 3091516 at *1. The chief special

master found that Dr. Efthimiou’s testimony failed to satisfy the legal standard for general

causation under prong one of the test set forth in Althen v. Sec’y of Health & Hum. Servs., 418

F.3d 1274 (Fed. Cir. 2005). See id. at *17 (“I find [that Althen prong one] has not been

preponderantly established . . . . For even if Petitioner had experienced PMR, as alleged, he has

not preponderantly established that the pneumococcal vaccine could be causal of it.” (footnote

omitted)). Specifically, because “[t]he Vaccine Program has routinely dismissed claims alleging

PMR as a vaccine injury—regardless of the vaccine involved[,]” and Petitioner did not provide

any new proof of a vaccine-PMR association, the chief special master denied entitlement. Id. at

*1, *17.

On November 5, 2025, Petitioner filed a motion for review of the chief special master’s

decision pursuant to Vaccine Rule 23. ECF No. 45. Therein, Petitioner claims that the chief

special master placed “an erroneous legal burden” on Petitioner because he relied on

unfavorable, non-binding cases to draw his conclusion. Id. at 1, 5. In support, Petitioner argues

that: (1) Petitioner’s case is factually distinct from the cases relied upon by the chief special

master; (2) the chief special master’s reliance on non-binding authority to discount case report

evidence conflicts with the Federal Circuit’s decision in Doles v. Sec.’y of Health and Hum.

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Servs., No. 2023-2404, 2025 WL 1177875 (Fed. Cir. Apr. 23, 2025); (3) the medical studies that

Dr. Efthimiou relied on are more recent than the medical studies in the cases that the chief

special master considered; and (4) Dr. Efthimiou presented a unique medical theory, even though

he cited the same medical literature used in a previous case before the chief special master. Id. at

6, 8, 13, 15. On December 5, 2025, the Secretary filed a response to Petitioner’s motion for

review. ECF No. 47. Therein, the Secretary contends that the chief special master did not abuse

his discretion by using prior decisions to inform his conclusion here because he had already

found that PMR was not a vaccine-caused injury and thus should not have been required to

relitigate an issue he has already decided. Id. at 6. Furthermore, the Secretary claims that the

chief special master properly considered and weighed the record evidence to determine that

Petitioner’s medical theory was unsupported by a preponderance of the evidence. Id. at 10.

Therefore, the Secretary asserts that the Court cannot reweigh the evidence on review solely

because Petitioner believes that the chief special master should have accorded greater weight to

case report evidence. Id. at 11. The Court held oral argument on the issues raised by the parties’

on February 4, 2026, and Petitioner’s motion for review is ripe for adjudication. See ECF No.

48.

DISCUSSION

A. Legal Standard

Under the Vaccine Act, judges of this Court review decisions issued by special masters

upon the filing of a motion for review. 42 U.S.C. § 300aa-12(e)(1). As prescribed by the Act, in

reviewing the decision of a special master, the 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 findings of fact or conclusion of law of the special master found to be

arbitrary, capricious, an 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.

Id. § 300aa-12(e)(2). In other words, “[u]nder the Vaccine Act, the Court of Federal Claims

reviews [a special master’s] decision to determine if it is ‘arbitrary, capricious, an abuse of

discretion, or otherwise not in accordance with the law.’” Markovich v. Sec’y of Health & Hum.

Servs., 477 F.3d 1353, 1355–56 (Fed. Cir. 2007) (quoting id. § 300aa-12(e)(2)(B)). The Federal

Circuit has indicated that:

These standards vary in application as well as degree of deference. Each standard

applies to a different aspect of the judgment. Fact findings are reviewed by us, as

by the Claims Court judge, under the arbitrary and capricious standard; legal

questions under the “not in accordance with law” standard; and discretionary

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rulings under the abuse of discretion standard. The latter 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).

Thus, the Court’s standard of review in these cases is “uniquely deferential.” Milik v.

Sec’y of Health & Hum. Servs., 822 F.3d 1367, 1376 (Fed. Cir. 2016) (quoting Hodges v. Sec’y

of Health & Hum. Servs., 9 F.3d 958, 961 (Fed. Cir. 1993)). The 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—these are all matters

within the purview of the fact finder.” Porter v. Sec’y of Health & Hum. Servs., 663 F.3d 1242,

1249 (Fed. Cir. 2011). Instead, so long as a special master’s conclusions are “based on evidence

in the record that was not wholly implausible,” the Court is “compelled to uphold that finding as

not being arbitrary or capricious.” Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357,

1363 (Fed. Cir. 2000). Therefore, “[t]he court’s inquiry . . . must . . . focus on whether the

Special Master examined the ‘relevant data’ and articulated a ‘satisfactory explanation for its

action including a rational connection between the facts found and the choice made.’” Dixon v.

Sec’y of Health & Hum. Servs., 61 Fed. Cl. 1, 8 (2004) (quoting Motor Vehicle Mfrs. Ass’n v.

State Farm Mut. Auto. Ins. Co., 463 U.S. 29, 43 (1983)). “[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.’” Hibbard v. Sec’y of

Health & Hum. Servs., 698 F.3d 1355, 1363 (Fed. Cir. 2012) (quoting Hines v. Sec’y of Health &

Hum. Servs., 940 F.2d 1518, 1528 (Fed. Cir. 1991)).

Here, Petitioner’s asserted injury—PMR allegedly caused by the pneumococcal

vaccine—is a “non-table” injury. See 42 U.S.C. § 300aa-14(a). Accordingly, to prove actual

causation by a preponderance of the evidence, Petitioner was required to 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, 418 F.3d at 1278. In

this petition for review, only the first Althen prong is at issue, which requires a petitioner to

prove by preponderant evidence that “a medical theory causally connect[s] the vaccination and

the injury.” Id. (citations omitted).

Under Althen prong one, while the proffered medical theory need not “rise to the level of

scientific certainty” and a petitioner need not provide “detailed medical and scientific exposition

on the biological mechanisms,” a petitioner’s medical theory must give a “reputable medical

explanation for the relationship.” Cerrone v. Sec’y of Health & Hum. Servs., 146 F.4th 1113,

1120–21 (Fed. Cir. 2025); Knudsen ex rel. Knudsen v. Sec’y of Health & Hum. Servs., 35 F.3d

543, 549 (Fed. Cir. 1994). Put differently, the theory must be more than merely “plausible”; it

must be “supported by a sound and reliable medical or scientific explanation.” Knudsen, 35 F.3d

at 548; see also LaLonde v. Sec’y of Health & Hum. Servs., 746 F.3d 1334, 1339 (Fed. Cir. 2014)

(“[W]e have made clear that simply identifying a ‘plausible’ theory of causation is insufficient

for a petitioner to meet her burden of proof. Instead, the statutory standard of preponderance of

the evidence requires a petitioner to demonstrate that the vaccine more likely than not caused the

condition alleged.” (citation omitted)). Accordingly, “the evidence a claimant offers must, in

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totality, always accomplish one thing in the end: preponderantly establish that the vaccine(s) at

issue more likely than not can cause the relevant disease.” Cerrone, 146 F.4th at 1122 (emphasis

omitted) (citation omitted).

B. Analysis

As mentioned above, in reviewing a special master’s decision, Congress has instructed

the Court to “set aside any findings of fact or conclusion of law of the special master found to be

arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.” 42 U.S.C.

§ 300aa-12(e)(2)(B). This familiar standard of review is borrowed from the Administrative

Procedure Act (“APA”). Compare id., with 5 U.S.C. § 706(2)(A). Accordingly, the Court

employs general administrative law principles in applying this standard to its review of special

masters’ decisions under the Vaccine Act, see, e.g., Hines, 940 F.2d at 1527–28 (applying

several Supreme Court and federal appellate court administrative law decisions to define the

arbitrary and capricious standard under the Vaccine Act), because “[w]here Congress employs a

term of art obviously transplanted from another legal source, it brings the old soil with it,”

George v. McDonough, 596 U.S. 740, 746 (2022) (citation and internal quotation marks

omitted); see also United States v. Davis, 588 U.S. 445, 458 (2019) (“[W]e normally presume

that the same language in related statutes carries a consistent meaning.”); Azar v. Allina Health

Servs., 587 U.S. 566, 574 (2019) (“This Court does not lightly assume that Congress silently

attaches different meanings to the same term in the same or related statutes.”); Lorillard v. Pons,

434 U.S. 575, 580 (1978) (“Congress is presumed to be aware of an administrative or judicial

interpretation of a statute and to adopt that interpretation when it re-enacts a statute without

change.”).

At first blush, the chief special master’s entitlement decision would appear to pass muster

under the APA standard of review, as it is twenty-five pages, see generally ECF No. 43, and

contains a lengthy recitation of the facts, procedural history, and arguments of the parties, see

Radke, 2025 WL 3091516, at *1–11. However, even a cursory read of the analysis section

reveals that the chief special master’s explanation for his decision is insufficient for a decision

subject to APA review. See id. at *15–18. Critically, the chief special master fails to

demonstrate that his conclusions were based on “reasoned decisionmaking,” such that the Court

can assess whether his decision was “based on a consideration of the relevant factors and

whether there has been a clear error of judgment.” Dep’t of Homeland Sec. v. Regents of the

Univ. of Cal., 591 U.S. 1, 16 (2020) (first quoting Michigan v. EPA, 576 U.S. 743, 750 (2015);

then quoting Citizens to Preserve Overton Park, Inc. v. Volpe, 401 U.S. 402, 416 (1971)). Stated

differently, the chief special master did not “articulate a satisfactory explanation for [his] action

including a ‘rational connection between the facts found and the choice made.’” State Farm, 463

U.S. at 43 (quoting Burlington Truck Lines v. United States, 371 U.S. 156, 168 (1962)); accord

Allentown Mack Sales & Serv., Inc. v. NLRB, 522 U.S. 359, 374 (1998) (“Not only must [the]

decreed result be within the scope of [] lawful authority, but the process by which it reaches that

result must be logical and rational.”). As the Federal Circuit has explained, “[f]or judicial review

to be meaningfully achieved within the[] strictures [of APA review], the [special master] must

present a full and reasoned explanation of its decision. The [special master] must set forth [his

or her] findings and the grounds thereof, as supported by the [] record, and explain [his or her]

application of the law to the found facts.” In re Sang Su Lee, 277 F.3d 1338, 1342 (Fed. Cir.

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2002) (emphasis added). In short, “[t]his standard requires that the [special master] not only

have reached a sound decision, but have articulated the reasons for that decision.” Id.

In light of this standard, it is apparent that the chief special master’s analysis, which is

three pages long and replete with conclusory statements, does not supply a “reasoned

explanation” for his decision because “summariz[ing] and reject[ing] arguments without

explaining why” and conclusory statements “alone are insufficient.” In re NuVasive, Inc., 842

F.3d 1376, 1383 (Fed. Cir. 2016) (citation and internal quotations omitted) (rejecting a decision

of the Patent Trial and Appeal Board for insufficient reasoning). Indeed, after sifting through the

“analysis” section, it appears that a single six-sentence paragraph is the only portion that

arguably qualifies as analysis:

Dr. Efthimiou’s causation opinion largely repeats the kinds of arguments that other

special masters—including me—have routinely rejected as unpersuasive. See

generally Munoz, 2024 WL 4113486, at *13. Indeed, the report offered in this case

is exceedingly similar to what I reviewed in Munoz, even if the vaccines are not the

same. Further, and like experts in past cases, he fails to identify a specific antigen

associated with the development of PMR, or demonstrate that Petitioner himself

possessed any genetic susceptibility. Petitioner has not otherwise offered any more

recent scientific or medical studies or articles that would suggest a PMR-vaccine

association is now thought to be more likely. And he did not persuasively show

that the pneumococcal vaccine can be for present purposes deemed interchangeable

with the Tdap vaccine—the former does not include the tetanus toxoid component,

and pneumococcal conjugate is not wholly equivalent to the diphtheria component

of Tdap. By contrast, Respondent’s experts effectively and persuasively rebutted

Petitioner’s causation contentions—Dr. Jameson in particular, who succinctly

demonstrated the clear failings in Petitioner’s causation theory.

Radke, 2025 WL 3091516, at *17. However, to the extent that this paragraph qualifies as

analysis, missing entirely is a “reasoned explanation” of the chief special master’s decision to

deny Petitioner entitlement or an attempt to make a “rational connection” between the extensive

background section of the opinion and the conclusions drawn. To further illustrate this point, the

Court considers each sentence of the foregoing paragraph in turn.

To begin, the chief special master writes that “Dr. Efthimiou’s causation opinion largely

repeats the kinds of arguments that other special masters—including me—have routinely

rejected as unpersuasive.” Id. Here, the chief special master fails to identify what “kinds of

arguments” Dr. Efthimiou repeats or explain why they are unpersuasive. See id. Furthermore,

the only reference offered in support of this sentence is a general citation to Munoz v. Sec’y of

Health & Hum. Servs., No. 21-1369V, 2024 WL 4113486 (Fed. Cl. Aug. 12, 2024), rev. denied,

174 Fed. Cl. 276 (2024), which is the chief special master’s own decision currently on appeal to

the Federal Circuit. But Munoz offers no support: it contains neither a discussion of the

arguments that “other special masters have routinely rejected as unpersuasive” nor any “reasoned

explanation” of Dr. Efthimiou’s causation opinion. Radke, 2025 WL 3091516, at *17 (cleaned

up). Rather, in Munoz, the chief special master makes—almost verbatim—the exact same

conclusory statement that he makes here. Compare id. (“Dr. Efthimiou’s causation opinion

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largely repeats the kinds of arguments that other special masters—including me—have routinely

rejected as unpersuasive.”), with Munoz, 2024 WL 4113486, at *13 (“Dr. Efthimiou’s causation

opinion largely repeats the kinds of arguments that other special masters have routinely rejected

as unpersuasive.”). In other words, this is an ipse dixit stacked atop another ipse dixit.

Such a threadbare statement is essentially unreviewable. The Court would have to read

Dr. Efthimiou’s causation opinion, decide whether it finds the opinion “unpersuasive,” and then

determine whether the Court finds the opinion unpersuasive for the same reasons as the chief

special master. Besides being an impossible task, such an undertaking would require the Court

to reweigh the evidence, which is impermissible under the applicable standard of review. See,

e.g., Porter, 663 F.3d at 1249 (“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.”).

Prior to determining whether a special master’s decision is rational, the Court must be able to

understand the special master’s reasoning. Thus, the chief special master’s decision cannot be

sustained or overruled if it consists of conclusory reasoning.

Next, the chief special master asserts that “the report offered in this case is exceedingly

similar to what I reviewed in Munoz, even if the vaccines are not the same.” Radke, 2025 WL

3091516, at *17. But the chief special master offers no explanation as to why this is a problem.

Without any further reasoning offered in support of this sentence, the Court cannot discern what

is wrong with there being similarity between two medical opinions. Earlier in his opinion, the

chief special master opined that “Dr. Efthimiou also appears to have essentially copied and

pasted several sections of his of [sic] previously-filed experts [sic] reports to his reports

addressing the case at hand.” Id. Again, it is not clear, without explanation, why this is

problematic. The chief special master himself certainly copied and pasted most of his analysis in

this case from his opinion in Munoz. Compare Munoz, 2024 WL 4113486, at *12–14, with

Radke, 2025 WL 3091516, at *16–18. 1 More importantly, upon reviewing Munoz, the Court

1

For example, in Munoz the chief special master wrote:

Dr. Efthimiou’s causation opinion largely repeats the kinds of arguments that other

special masters have routinely rejected as unpersuasive. Like experts in past cases,

he fails to identify a specific antigen associated with the development of PMR, or

demonstrate that Petitioner himself possessed the proposed genetic susceptibility.

Further, Petitioner has not otherwise offered any more recent scientific or medical

studies or articles that would suggest a PMR-vaccine association is now thought to

be more likely . . . . By contrast, Respondent’s experts (especially Dr. Hawse)

effectively and persuasively rebutted Petitioner’s causation contentions.

Munoz, 2024 WL 4113486, at *13. Similarly, here, the chief special master wrote:

Dr. Efthimiou’s causation opinion largely repeats the kinds of arguments that other

special masters—including me—have routinely rejected as unpersuasive. . . .

Further, and like experts in past cases, he fails to identify a specific antigen

associated with the development of PMR, or demonstrate that Petitioner himself

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cannot discern what is “exceedingly similar” between Dr. Efthimiou’s opinion there and his

opinion here, especially given the equally limited analysis in Munoz.

Failing to explain this assertion, the chief special master continues, “[f]urther, and like

experts in past cases, he fails to identify a specific antigen associated with the development of

PMR, or demonstrate that Petitioner himself possessed any genetic susceptibility.” Radke, 2025

WL 3091516, at *17. This sentence is, once again, conclusory. Without any additional

reasoning or support, the chief special master does not demonstrate that his conclusions were

“the product of reasoned decision making”; there is no “reasoned explanation” of why Dr.

Efthimiou’s failure to identify a specific antigen or demonstrate that Petitioner possessed a

genetic susceptibility to PMR dooms his case.

Importantly, there are two glaring legal issues with this sentence. First, Petitioner is not

required to identify a specific antigen to satisfy Althen prong one. See, e.g., Knudsen, 35 F.3d at

549 (“[C]ausation can be found in vaccine cases based on epidemiological evidence and the

clinical picture regarding the particular [petitioner] without detailed medical and scientific

exposition on the biological mechanisms.”). Thus, if it was important that Petitioner identified a

specific antigen here, perhaps because of his causation theory, the chief special master needed to

explain why this was necessary. That Petitioner’s medical theory fails without identification of a

specific antigen may indeed be the correct conclusion, but without more clarification, the Court

cannot discern why that fact is dispositive here. Second, with regard to genetic disposition, the

Federal Circuit has held that “requiring either epidemiologic studies, rechallenge, the presence of

pathological markers or genetic disposition, or general acceptance in the scientific or medical

communities to establish a logical sequence of cause and effect is contrary to what we said in

Althen III.” Capizzano v. Sec’y of Health & Hum. Servs., 440 F.3d 1317, 1325 (Fed. Cir. 2006)

(emphasis added). Again, because the chief special master did not explain why proving genetic

susceptibility is important to Petitioner’s case, the Court cannot determine how that factor, which

Petitioner is not required to prove, advances the analysis.

The chief special master then adds, “Petitioner has not otherwise offered any more recent

scientific or medical studies or articles that would suggest a PMR-vaccine association is now

thought to be more likely.” Radke, 2025 WL 3091516, at *17. To begin, this sentence invites

speculation as to what the chief special master means by “more recent.” The Court assumes that

he is referring to studies more recent than those he reviewed in Munoz and his other previous

cases. As it stands, this statement would meaningfully show how Petitioner failed to meet his

burden under Althen prong one if Munoz had actually analyzed scientific and medical studies or

articles, or if the chief special master had discussed the factors that he found to have failed there.

possessed any genetic susceptibility. Petitioner has not otherwise offered any more

recent scientific or medical studies or articles that would suggest a PMR-vaccine

association is now thought to be more likely. . . . By contrast, Respondent’s experts

effectively and persuasively rebutted Petitioner’s causation contentions—Dr.

Jameson in particular, who succinctly demonstrated the clear failings in Petitioner’s

causation theory.

Radke, 2025 WL 3091516, at *17.

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But Munoz lacks any such analysis or discussion. The “analysis” in Munoz is marginally longer

than the limited analysis section in the instant decision but nevertheless contains the same

conclusory statements. Compare id. (“Petitioner has not otherwise offered any more recent

scientific or medical studies or articles that would suggest a PMR-vaccine association is now

thought to be more likely . . . .”), with Munoz, 2024 WL 4113486, at *13 (“Petitioner has not

otherwise offered any more recent scientific or medical studies or articles that would suggest a

PMR-vaccine association is now thought to be more likely . . . .”). Munoz cannot be the

foundation upon which the chief special master builds this decision because Munoz does not

contain sufficient reasoning to support the conclusions here. In other words, the chief special

master’s present analysis again amounts to a stacked ipse dixit, with his unsupported conclusions

here hinging on unsupported conclusions elsewhere.

This is not to say that special masters need to rehash the same analysis in case after case

or that every opinion needs to be a novel. See Radke, 2025 WL 3091516, at *18 (“I could

certainly write 50 or more pages spelling out in detail all the ways in which the proposed causal

theory is preponderantly deficient. But special masters should not be compelled to do so when

they are familiar with a theory that they understand has almost never succeeded—as is the case

here.” (emphasis omitted)). However, to be sustained under the APA standard that applies in

Vaccine Act cases, a special master must “reasonably explain” his or her reasoning at least once.

See, e.g., Bowman Transp., Inc. v. Arkansas-Best Freight Sys., Inc., 419 U.S. 281, 286 (1974)

(stating that the Court will “uphold a decision of less than ideal clarity if the agency’s path may

reasonably be discerned”). Here, the chief special master needed to, at the very least, refer to a

“patient zero” case that contains a more fulsome analysis showing that Petitioner’s theory cannot

cause PMR. Instead, the chief special master cites Munoz and a slew of other cases without

providing any discussion of them. See Radke, 2025 WL 3091516, at *16–17. The chief special

master’s reliance on these authorities to explain his conclusion—without any real analysis—is

problematic because the referenced cases involve either a different medical theory or a different

vaccine than is at issue here. See id. (citing Munoz, 2024 WL 4113486, at *1 (holding that the

Tdap vaccine did not cause claimant’s PMR); Van Dycke v. Sec’y of Health & Hum. Servs., No.

18-106V, 2023 WL 4310701, at *1 (Fed. Cl. Spec. Mstr. June 7, 2023) (same); Suliman v. Sec’y

of Health & Hum. Servs., No. 13-993V, 2018 WL 6803697, at *1 (Fed. Cl. Spec. Mstr. Nov. 27,

2018) (same); Thompson v. Sec’y of Health & Hum. Servs., No. 18-1217V, 2023 WL 9053982,

at *13 (Fed. Cl. Spec. Mstr. Dec. 5, 2023) (finding that cytokine upregulation caused by the

pneumococcal vaccine did not cause claimant’s PMR); Sciortino v. Sec’y of Health & Hum.

Servs., No. 22-99V, 2024 WL 4579389, at *1 (Fed. Cl. Spec. Mstr. July 24, 2024) (holding that

the flu vaccine did not cause claimant’s PMR); Giesbrecht v. Sec’y of Health & Hum. Servs., No.

16-1338V, 2023 WL 2721578, at *1 (Fed. Cl. Spec. Mstr. March 30, 2023) (same); Kelly v.

Sec’y of Health & Hum. Servs., No. 17-1475V, 2022 WL 17819157, at *1 (Fed. Cl. Spec. Mstr.

Oct. 12, 2022) (same)).

If Munoz or another of the foregoing authorities explained why PMR can never be caused

by a vaccine or held that Petitioner’s specific medical theory cannot cause PMR, then the chief

special master could have relied on those cases here without much further explanation. But the

cited cases do not do that. Moreover, even leaving aside the conclusory nature of the chief

special master’s above sentence, the sentence is also incorrect. See supra p. 8–9. Petitioner

alleges that he did introduce recent medical evidence demonstrating a PMR-vaccine association.

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See ECF No. 45 at 8 (“[T]he Chief failed to acknowledge that Dr. Efthimiou’s testimony was

based on novel published literature that could not have been discussed in the prior decisions

given the chronology. The recent peer-reviewed publications objectively confirmed that PMR

can be clinically triggered by environmental triggers . . . .” (citing cases whose hearings occurred

before studies which “confirmed that PMR can be clinically triggered by environmental triggers”

were published)).

Moving to the penultimate sentence of the analysis paragraph above, the chief special

master concludes that Petitioner “did not persuasively show that the pneumococcal vaccine can

be for present purposes deemed interchangeable with the Tdap vaccine—the former does not

include the tetanus toxoid component, and pneumococcal conjugate is not wholly equivalent to

the diphtheria component of Tdap.” Radke, 2025 WL 3091516, at *17. This statement is wholly

unhelpful to the reviewing Court, which is left to ask why the chief special master regarded as

dispositive Petitioner’s failure to show that the pneumococcal vaccine is interchangeable with the

Tdap vaccine. While the Vaccine Act’s use of the APA standard may not have required the chief

special master to issue a fifty-page decision, it does charge him to write a decision that provides

“a satisfactory explanation for [his] action including a ‘rational connection between the facts

found and the choice made.’” State Farm, 463 U.S. at 43 (quoting Burlington Truck Lines, 371

U.S. at 168). Here, the chief special master stated his conclusion—that Petitioner failed to meet

his burden under the Vaccine Act—but did provide any real explanation for that conclusion. As

in solving a mathematical problem, he did not adequately show his work.

This brings the Court to the final sentence of the paragraph: “By contrast, Respondent’s

experts effectively and persuasively rebutted Petitioner’s causation contentions—Dr. Jameson in

particular, who succinctly demonstrated the clear failings in Petitioner’s causation theory.”

Radke, 2025 WL 3091516, at *17. As with the previous sentences, this comparison of the

experts’ opinions is deficient. How did Respondent’s experts effectively and persuasively rebut

Dr. Efthimou’s opinion? What did Dr. Jameson demonstrate that shows the clear failings in

Petitioner’s causation theory? The sentence is either a topic sentence or a concluding sentence

bereft of any accompanying substance. The APA standard applicable here demands more.

Without knowing what the chief special master found so effective and persuasive, the Court

cannot review his decision. Even if the Court could divine flaws in Petitioner’s causation theory

itself, it cannot know which flaws influenced the chief special master’s decision-making. This

sentence calls on the Court to reweigh Petitioner’s causation theory against Respondent’s expert

reports, but in reviewing a special master’s judgment, the Court is not to “substitute its judgment

for that of the [special master].” FCC v. Fox Television Stations, Inc., 556 U.S. 502, 513 (2009).

Rather, the Court is only “to assess only whether the decision was ‘based on a consideration of

the relevant factors and whether there has been a clear error of judgment.’” Regents, 591 U.S. at

16 (quoting Citizens to Preserve Overton Park, 401 U.S. at 416). Put differently, the Court has

no way of ascertaining, without more, whether the chief special master’s conclusion is rational.

In short, the APA standard applicable here required the chief special master to explain both how

Respondent’s experts “effectively and persuasively rebutted Petitioner’s causation contentions”

and why the rebuttal was convincing. Radke, 2025 WL 3091516, at *17. Simply stating that “it

was” does not suffice.

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Based on the Court’s review, the paragraph discussed directly above is the only part of

the decision’s “Analysis” section that actually contains any analysis. Nowhere else in the

decision does the chief special master “reasonably explain” his conclusion or the “connection

between the facts found and the choice made.” Burlington Truck Lines, 371 U.S. at 168. The

other paragraphs under the “Analysis” header better qualify as recitation and conclusion. For

example, the first paragraph of the analysis is simply a laundry list of cases with brief

parentheticals devoid of any actual analysis. See Radke, 2025 WL 3091516, at *16. The second

paragraph touches on one of the listed cases, Thompson, 2023 WL 9053982, but the chief special

master does little to connect Thompson to the instant case other than to note that both cases

involve the pneumococcal vaccine and PMR. See Radke, 2025 WL 3091516, at *16. He also

notes that the special master who issued the opinion in Thompson cited five prior decisions that

rejected theories of vaccine causation of PMR; of course, four of those five citations were to

cases already cited by the chief special master, so this is essentially a re-citation to his previous

citation to those cases. Id. (citing Thompson, 2023 WL 9053982, at *16). In the third paragraph,

the chief special master states that he is familiar with Dr. Efthimou’s causation theory because

Dr. Efthimou previously proposed essentially the same theory in Munoz. See id. at *17.

Unfortunately, this leaves the Court with more questions than answers. Why does it matter that

Dr. Efthimou used the same causation theory in Munoz? Why did the chief special master reject

this theory both in Munoz and here? Why does the theory fail? Neither the chief special

master’s opinion here nor his opinion in Munoz answers these questions. The final paragraph of

this subsection merely states that “[t]hese cases do not control the outcome of this matter.” Id.

Once again, the chief special master declines to elaborate further on this point.

The paragraphs under the subheading regarding Petitioner’s failure to carry his burden of

proof are likewise replete with narration, excepting the second paragraph already dissected

above. To begin, the first paragraph restates the Althen standard, which the chief special master

does not connect to this or any other paragraph. Id. The third paragraph merely reiterates that

Petitioner did not “connect all the dots” to prove causation under Althen prong one. Id. Then, in

the fourth paragraph, the chief special master pivots from discussing the instant case to

commenting more generally about the Vaccine Program:

My analysis herein is admittedly truncated. I could certainly write 50 or more pages

spelling out in detail all the ways in which the proposed causal theory is

preponderantly deficient. But special masters should not be compelled to do so

when they are familiar with a theory that they understand has almost never

succeeded—as is the case here. The Vaccine Program has too many cases before

it to engage in lengthy analysis in each and every case, picking through each item

of literature filed and addressing every argument made by an expert, no matter how

many times that expert has said the same thing. Special masters must streamline

their review of matters so that Program resources can be devoted to reasonably

disputed issues and/or novel causation theories.

Id. at *18 (emphasis in original). While this paragraph does not advance the chief special

master’s conclusion, it sheds some light on the lack of analysis in the opinion. However, it goes

without saying that frustration with judicial backlog is not a justification for failing to provide

the reasoned analysis required for meaningful judicial review by this Court. Indeed, the chief

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special master admits this point in the foregoing paragraph by referring to his analysis as

“truncated.” Id. Although there is nothing inherently wrong with issuing a truncated opinion, a

more fulsome baseline opinion must already exist in order to be “cut short” or “curtailed.”

Truncated, MERRIAM-WEBSTER’s COLLEGIATE DICTIONARY (10th ed. 1994). But Munoz, the

opinion the chief special master is presumably truncating here, is itself short on analysis. See

supra p. 6–9. Finally, in the last paragraph of this section, the chief special master concludes

that Petitioner did not sufficiently show “what about the pneumococcal vaccine and PMR is now

known that is different from the past . . . .” Radke, 2025 WL 3091516, at *18 (emphasis in

original). This paragraph does little to advance the analysis because, as discussed above, the

chief special master does not analyze “the past” beyond mere citation. See supra p. 9.

Finally, the short “analysis” section is not saved by some form of analysis existing

elsewhere in the decision. For instance, there is no analysis or weighing of evidence in the

factual background section of the opinion from which conclusions are then drawn in the analysis

section. Contrary to what the Secretary contended at oral argument, the factual background does

not contain “findings of fact”; rather, it consists of a narration of the experts’ opinions. See

Radke, 2025 WL 3091516, at *3–9 (“Dr. Efthimiou maintained that PMR likely clinically

presents due to an environmental trigger . . . . Dr. Oddis summarized the pertinent medical facts

before discussing PMR in general . . . . Dr. Jameson primarily focused his brief report on

responding to Dr. Efthimiou’s proposition that Petitioner’s immune response to his receipt of the

pneumococcal vaccine subsequently led to his development of PMR . . . .”). Moreover, the

decision does not meaningfully draw upon the facts in the analysis section. See Burlington Truck

Lines, 371 U.S. at 168 (finding that the APA standard of review requires a “rational connection

between the facts found and the choice made”).

The Court does not fault the chief special master simply for writing a short analysis

section. Nor would the Court fault the chief special master for truncating his analysis here if he

had drawn on previous on-point cases and analyzed their applicability to the instant case. Simply

put, there is a happy medium between “writ[ing] 50 or more pages spelling out in detail all the

ways in which the proposed causal theory is preponderantly deficient” and issuing a decision

with an analysis that essentially consists of one six-sentence paragraph. Radke, 2025 WL

3091516, at *18. The chief special master did not need to write ten or even five pages of actual

analysis; the APA standard governs not the length of a decision but its adequacy. If a special

master’s decision concerns an issue repeatedly brought before the Vaccine Program, a few pages

of analysis may suffice, but those few pages must demonstrate that the decision is “the product

of reasoned decision making.” For example, this Court upheld the chief special master’s

succinct entitlement decision in Stiegler because he “adequately reviewed the record and

determined that it was fully developed before denying entitlement.” Stiegler v. Sec’y of Health

and Hum. Servs., 176 Fed Cl. 786, 802 (2025). There, the chief special master stated that he was

familiar with Petitioner’s medical theory and literature yet properly analyzed the evidence,

finding that Petitioner presented and articulated a “satisfactory explanation” for denying

entitlement. Id. at 799–800 (“As demonstrated above, the chief special master reviewed

Petitioner’s medical authorities and arguments in various prior cases and drew upon those

conclusions to inform his decision to deny entitlement to compensation . . . . Recognizing the

familiar allegations of Petitioner’s claims from his adjudication of identical arguments and

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authorities in previous cases, the chief special master ordered Petitioner to present something

new before progressing this case any further. Petitioner failed to do so.”).

The chief special master’s decision comes on the heels of this Court’s decision in

Goodwin and is fraught with the same deficiencies that caused the Court to remand there. See

Goodwin v. Sec’y of Health & Hum. Servs., No. 19-503, 2024 WL 4758470, at *3 (Fed. Cl. Oct.

10, 2024) (“[T]he special master’s decision does not demonstrate that his conclusions were the

product of reasoned decision making as his decision does not provide enough reasoning to show

the Court that he examine[d] the relevant data, and he did not articulate a satisfactory explanation

for [his] action including a rational connection between the facts found and the choice made.”

(alternations in original) (internal citations and quotations omitted)). Yet the analysis in

Goodwin was still more extensive than the chief special master’s reasoning here. See id. at *6

(discussing that the special master contrasted prior vaccine opinions with each other but that

doing so “cannot save a decision otherwise lacking a reasoned basis”).

The Court is thus compelled to remand this action to the chief special master, where he

faces the classic APA choice: he can bolster his original reason for denying entitlement or

essentially “rehear” the case should he decide to rest his decision on new reasons. See Biden v.

Texas, 597 U.S. 785, 807–08 (2022). In other words, if the chief special master believes that his

conclusions in this case regarding Althen prong one are correct, he can simply issue a new

decision that explains how he reached those conclusions. And while that opinion may be

“streamline[d],” Radke, 2025 WL 3091516, at *18, it must also provide “a satisfactory

explanation[,] . . . including a ‘rational connection between the facts found and the choice

made,’” State Farm, 463 U.S. at 43 (quoting Burlington Truck Lines, 371 U.S. at 168).

Although the result the chief special master reached in this case may ultimately be

correct, the Court simply cannot sustain that result based on the lack of explanation given. For

all the reasons discussed above, the Court must remand this matter to the chief special master so

that he can articulate a reasoned basis for his decision that the Court can consider under the

prescribed standard if either Petitioner or the Secretary is dissatisfied with the result on remand.

CONCLUSION

For the reasons stated above, the Court finds that the chief special master’s decision falls

short of meeting the APA standard that this Court is statutorily required to apply in reviewing the

decisions of Vaccine Act special masters. Accordingly, Petitioner’s motion for review

is GRANTED, and the chief special master’s decision, Radke, 2025 WL 3091516 (docketed as

ECF No. 43), is VACATED. The case is REMANDED to the chief special master for further

proceedings consistent with this opinion. The chief special master shall issue a new entitlement

decision within ninety days of the date of the issuance of this decision. See 42 U.S.C. § 300aa-

12(e)(2); RCFC App. B, Rule 28(b).

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IT IS SO ORDERED.

s/ Zachary N. Somers

ZACHARY N. SOMERS

Judge

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