finding that “there is nothing improper in the chief special master’s decision to refer to damages for pain and suffering awarded in other cases as an aid in determining the proper amount of damages in this case.”
How later courts described this case
- finding that “there is nothing improper in the chief special master’s decision to refer to damages for pain and suffering awarded in other cases as an aid in determining the proper amount of damages in this case.”
Written by the judges who cited it.
The opinion
corrected
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0956V
HANNAH BAKER WARNOCK,
Chief Special Master Corcoran
Petitioner,
v.
Filed: April 20, 2026
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
John D. Kassel, Kassel McVey Attorneys at Law, Columbia, SC, for Petitioner.
Katherine Carr Esposito, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On August 3, 2020, Hannah Baker Warnock filed a petition for compensation under
the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleged that she suffered vasovagal syncope within one hour of
receiving a meningococcal vaccine on June 27, 2019, which led to a “fall and fractured
skull, traumatic subarachnoid hematoma, hyponatremia, pituitary injury with syndrome of
inappropriate antidiuretic hormone (“SIADH”), cerebral contusion, a blood clot, and
personality changes from a traumatic brain injury.” Petition at 1. The case was assigned
to the Special Processing Unit of the Office of Special Masers.
Although Ms. Warnock has been found entitled to compensation, the parties could
not agree on the damages to be awarded for a number of items, including past and future
pain and suffering, the amount and form to be awarded for the life care plan, and an
1
Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Government
Services). This means the Decision will be available to anyone with access to the internet. In
accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other
information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I
agree that the identified material fits within this definition, I will redact such material from public access.
2
National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2018).
amount, if any, for Ms. Warnock’s lost earning capacity. Thus, an evidentiary damages
hearing was held on March 17, 2025. For the reasons set forth below, I find that Petitioner
is entitled to compensation in the amount of $170,000.00, for her past or “actual” pain and
suffering only (no amount awarded for future pain and suffering); $6,978.97, for her past
unreimburseable expenses; and future medical expenses comprised of 1) a lump sum of
$2,904.00 for first year expenses, and 2) an amount sufficient for respondent to purchase
an annuity contract that will provide payments for the life care items contained in
Respondent’s life care plan, as illustrated by the chart at Appendix, Tab A.
I. Procedural History
On September 3, 2021, I issued a ruling on entitlement in favor of Petitioner. ECF
No. 37. But the parties were unable to resolve damages informally, and Petitioner filed a
Motion for a Hearing on Damages on February 1, 2023. ECF No. 62. On May 12, 2023,
Petitioner filed her brief in support of damages (“Mot.”), and Respondent filed a Response
on June 12, 2023 (“Opp.”). Petitioner filed a reply (“Reply”) memorandum on July 12,
2023. ECF Nos. 68, 71-74, 77. I heard arguments from both parties during the March 17,
2025 damages hearing.
II. Factual History
On June 27, 2019, at 10:05 a.m., Ms. Warnock (a 20-year-old technical college
student at the time) went to her pediatrician’s office for her annual checkup. Petitioner’s
Exhibit (“Ex.”) Ex. 1 at 1; Ex. 3 at 18, 19. The first part of her visit was routine (Ex. 3 at
19), and Ms. Warnock was administered the Bexsero and Menactra meningococcal
vaccines (id. at 18).
At 10:56 a.m., emergency 9-1-1 dispatch received a call from the pediatrician’s
office. Ex. 1 at 2. Ms. Warnock’s pediatrician noted:
After immunizations were given, I was at my computer station and heard
what sounded like something being thrown against a wall. At that same
moment, I heard one of our nursing staff call for Brandy Tollison, LPN, who
is nursing with me today. When I entered the patient’s examination room,
the patient was on the floor in the corner with her neck flexed. Dr. Joseph
entered the room at that time. I instructed [sic] nursing staff to obtain BP
[blood pressure], Pulse and Blood Sugar and that EMS be contacted to
transport the patient. The patient was bradycardic w/HR of 51, BP 113/60
and BS 106. I called the mother to inform her that her child had passed out
and that we were transporting her via EMS to KHED [Kershaw Health
Medical Center]. I initially told the mother that the patient had fallen off the
2
table, however, the incident was not witnessed by any staff and patient was
unaccompanied during this visit… When EMS arrived, I requested a neck
collar due to the position of the patient when she was found on the floor.
EMS arrived and assumed care of the patient. She was transported by EMS
to KHED.
Ex. 3 at 19-20. The EMS staff found Ms. Warnock alert and oriented, but she did not
remember her age, and it was noted that she also did not remember falling or passing
out. Ex. 1 at 4. Petitioner reported pain to the occipital region of her head, and in her
cervical spine area. Id. EMS personnel noted no (external) bleeding, no obvious injury,
and no swelling or depressed area. Id. at 3. Ms. Warnock testified that she did not recall
anything about the incident, except having “tunnel vision” meaning that “the whole room
got black and then smaller and smaller and then --- and completely black… I don’t really
remember anything after the tunnel vision.” Tr. at 13. She next recalled waking up in the
emergency room with a neck brace on. Id.
Ms. Warnock was taken to Kershaw Health Medical Center (“KHMC”) Emergency
Department (“ED”), and the apparent fall history was recounted, along with the comment
that Petitioner “complains of a moderately severe, throbbing headache with photophobia
and nausea similar to previous migraines she has had in the past. She [had] two
concussions in the past playing sports. She complains of some mild posterior neck pain
with range of motion. She denies new weakness, numbness, slurred speech or vomiting.”
Ex. 3 at 41.
Petitioner underwent a computerized tomography (“CT”) scan of her head, which
showed:
Bilateral inferior frontal subarachnoid hemorrhage [SAH], left greater than
right. Hemorrhagic contusions noted along the left inferior frontal lobe. Small
amount of extra-axial hemorrhage noted along the left frontotemporal
convexity and anterior interhemispheric fissure. Nondisplaced occipital to
suboccipital skull fracture lines extending to posterior aspects of bilateral
jugular foramina. Nondisplaced fracture involving the sphenoid sinus at the
level of the cavernous sinus. Recommend CT angiogram of the head, given
skull base fractures to exclude vascular injury.
Ex. 3 at 33. A computed tomography venography of the brain showed “a small filling
defect, could be a small thrombus, no complete obstruction.” Ex. 15 at 39. Additional
imaging at KHMC was performed: a CT of the cervical spine, which showed “no acute C-
spine fracture of dislocation” (Ex. 3 at 34); pelvis imaging, which showed no acute fracture
(id. at 35); and a portal chest image, which showed no acute cardiopulmonary abnormality
3
(Ex. 6 at 59). The impressions were syncope, subarachnoid hemorrhage, cerebral
contusion, and basilar skull fracture. Ex. 3 at 36. Ms. Warnock was described to be in
critical condition, and arrangements were made for her transfer to an acute facility. Id.
Ms. Warnock was helicoptered to Prisma Health Richland Hospital (“Richland”),
where she stayed from June 27, 2019, until her discharge on July 8, 2019. Ex. 14 at 55-
59. During her stay, she was seen by neurosurgery, neurology, and endocrinology
services. Id. at 55. She was diagnosed with acute hyponatremia and syndrome of
inappropriate antidiuretic hormone secretion (“SIADH”). Ex. 2 at 12. Heparin was initiated
and Petitioner was later transitioned to Coumadin, a blood thinner. Ex. 14 at 55. Ms.
Warnock became hyponatremic (low sodium) on July 2, 2019, and she received a 3%
saline solution. Id. She was placed on a 750cc fluid restriction. Id. On the day of discharge,
Petitioner had normal sodium levels. Id.
Regarding her hospitalization, Ms. Warnock testified that she did not remember
much. Tr. at 15. She stated that she was “in and out of it a lot of the times,” but she did
recall that it was difficult for the medical staff to control her electrolytes, magnesium,
sodium, and potassium levels. Id. Ms. Warnock recalled that she started hallucinating at
one point, and she was rushed into a CT scan for assessment. Id. She stated that a lot of
her hospitalization was spent in observation, testing, and providing a heparin drip. Id. Ms.
Warnock stated that upon discharge, she had difficulty walking for about two to four
weeks. Id. at 19. Her mother bought her a walker to assist with ambulation. Id. Tr. at 19.
On July 18, 2019, Ms. Warnock saw her endocrinologist in follow-up for her SIADH.
Ex. 2 at 16. Petitioner reported she still had daily headaches (improved with Tylenol), that
she got dizzy sometimes when walking around a lot, and that her sense of taste and smell
were off. Id. She was noted to be doing well, and there was hope that her condition would
resolve in six to 12 months. Id. at 17. Her sodium blood level was within normal limits,
and there was discussion of loosening Petitioner’s fluid restriction. Id. Ms. Warnock’s
pediatrician submitted a report about Petitioner’s episode to the Vaccine Adverse Events
Reporting System. Ex. 3 at 56-57.
On July 25, 2019, while Ms. Warnock was in the laboratory at KHMC for a blood
draw, she had a shaking episode and loss of consciousness. Ex. 6 at 15. She was already
wearing her C-collar from her prior injury, and was then seen in the KHMC ED. Id. A CT
of her head showed no acute intracranial process; the previously seen bilateral frontal
extra-axial hemorrhage had resolved. Ex. 3 at 31. Mild bilateral inferior frontal
encephalomalacia was thought likely to be sequela of the prior June 2019 trauma. Id. A
CT of the spine showed no acute fracture or dislocation. Id. at 32. Petitioner was again
transported from KHMC to Richland, this time by ambulance, for concern about possible
4
seizures following her prior injury. She was admitted for observation. Exs. 5 at 3-4; 6 at
13-14.
The next day, on July 26, 2019, a treating neurologist considered Ms. Warnock’s
symptoms to be seizures but felt that with the precipitating vaccination and blood draw
events, this appeared most consistent with presyncope, followed by syncope with
syncopal myoclonus. Ex. 9 at 18. Ms. Warnock underwent a 24-hour EEG to monitor for
epilepsy, and the findings were normal. Ex. 10 at 25. She also underwent an MRI of her
brain which showed no new areas of abnormality and “internal improvement in bifrontal
sequela of hemorrhagic contusions with early encephalomalacia changes.” Ex. 9 at 42.
Lab work was benign, except for Petitioner’s ongoing hyponatremia along with her
diagnosis of SIADH following her head trauma. Id. The most likely etiology and diagnosis
of Petitioner’s condition was vasovagal syncope, due to her prodrome of nausea and
short recovery time. Id. at 21. She was instructed to lie down for future shots, blood draws,
and injections. Id. Ms. Warnock was discharged on July 28, 2019. Id.
On August 15, 2019, Ms. Warnock reported to Primary Care Camden (“Camden”)
as a new patient to establish care. Ex. 7 at 6. Her recent medical history was reviewed,
and it was noted she had plans to see an eye doctor about her vision changes during the
acute event and that she still needed to be cleared by neurology to drive. Id. Ms. Warnock
was also dealing with “the sense of loss that she has about not going to Florida for her
junior year [of college] this fall.” Id. She was noted to have anxiety and a cough. Id. at 5-
6. That same month, Petitioner was seen at Richland for a CT angiography of her brain.
Ex. 8 at 43. The impression was “[r]esolution of previously noted right transverse sinus
thrombosis with complete recannulization of the vessel. Id. at 44. Petitioner’s sodium level
was reported at 121 mmol/L, down from 135 mmol/L. Id. at 45.
On September 18, 2019, Ms. Warnock underwent another CT angiography of her
brain at Richland. Ex. 8 at 24. The summary showed “[n]o major dural venous sinus or
deep cerebral venous thrombosis. The right transverse sinus remains widely patent with
normal cerebral CT venogram.” Id.
On October 22, 2019, Ms. Warnock saw her endocrinologist for follow up of her
SIADH. Ex. 2 at 19. She was noted to be doing well, and had no complaints of dizziness,
headache, vision changes, fainting episodes, or altered mentation. Id. Ms. Warnock
remained asymptomatic, with a sodium level of 134 mmol/L, and was on a drink to thirst
mechanism. Id. at 22. Petitioner planned to return to school in January and the hope was
that her SIADH would resolve within the next six months. Id.
On December 3, 2019, Ms. Warnock saw her nurse practitioner at Camden for
complaints of her heart racing and being unable to catch her breath. Ex. 7 at 9. Petitioner
5
relayed two other episodes of tachycardia, one four days prior and the other about a
month before that. Id. at 9, 11. She reported that she was no longer taking Coumadin and
was ready and planned to go to college in Florida. Id. at 11. A referral was made to a
cardiologist, and Ms. Warnock was seen the same day. Exs. 4 at 30; 7 at 12. An EKG
performed in the office was abnormal with sinus arrhythmia and bradycardia. Ex. 4 at 30.
On December 18, 2019, Ms. Warnock returned to her cardiologist for a review of
her test results, and she was noted to have mild bradycardia. Ex. 4 at 24. Petitioner
reported that she was doing about the same, but the day before had an episode of heart
racing, becoming dizzy, and needing to sit. Id. She was prescribed Florinef, a
fludrocortisone. Id.
On January 6, 2020, Ms. Warnock returned to her cardiologist for surveillance after
starting Florinef. Ex. 4 at 22. Petitioner reported that the first four days were “really bad,”
but she had been “doing great since then,” and reported no more acute episodes. Id. Ms.
Warnock was leaving for college in Florida that day, and she was advised to remain on
her medication and keep herself hydrated. Id.
Ms. Warnock next saw her cardiologist on July 6, 2020. Ex. 4 at 19. She
complained of intermittent palpitations, which she described as worse with intermittent
fasting. Id. She had stopped using Florinef. Id. Her cardiologist encouraged her to restart
the Florinef, as her response to taking the medication was good. Id.
On January 6, 2021, Ms. Warnock returned to her cardiologist for a six-month
checkup. Ex. 36 at 2. Her physical exam that day was noted to be unremarkable. Id. She
reported intermittent episodes of fluttering and tachycardia with associated shortness of
breath, symptoms which became exacerbated with the use of caffeine. Id. She was only
using Florinef on an “as needed” basis. Id. She underwent heart monitoring for one week
and her results were “essentially normal.” Id. at 2, 5. Follow-up was advised in another
six months. Id. at 2.
On April 1, 2021, Ms. Warnock was seen by an endocrinologist for her
hyponatremia. Ex. 26 at 3. She denied frequent headaches, nausea, vomiting, gait issues,
dizziness, vision changes, fainting episodes, and altered mental status. Id. Petitioner
reported her menstrual periods had been irregular. Id. She also stated that she was
frequently fatigued. Id. Lab results showed that her sodium level was 124 mmol/L, within
normal limits. Petitioner was instructed to return in one year. Id. at 5, 8.
On April 24, 2021, while visiting Disney Springs with her friends, Ms. Warnock
stated that she was very dizzy and weak and could feel her blood pressure was very low.
Tr. at 20. She stated that she was on the floor of the bathroom for about 45 minutes and
could not get up. Id. Ms. Warnock was taken by ambulance to Advent Health Emergency
6
Department for complaints of weakness and fatigue. Ex. 27 at 26. Petitioner reported that
she had been feeling too weak to eat or drink that day, had diarrhea, and was on her
menses. Id. It was noted that she had taken three Midol with caffeine, which may have
triggered this particular episode. Id. at 20. She was diagnosed with acute weakness and
near syncope, given a prescription for fludrocortisone for electrolyte imbalance, and
advised to follow up with her primary care physician. Id.
On October 4, 2021, Ms. Warnock returned to her cardiologist for her five-month
general checkup. Ex. 36 at 13. She reported still having dizziness and feeling lightheaded,
but her recent symptoms had not been as severe. Id. Ms. Warnock reported having
COVID-19 in September of 2021, and her cardiologist advised her current symptoms
could possibly worsen in the coming few months, based on his experience with other
cardiac patients who had also had COVID-19. Id. Petitioner had not been taking Florinef
daily, but she was encouraged to restart it as she continued to experience symptoms. Id.
Follow-up was advised in one year. Id.
On October 7, 2021, Ms. Warnock underwent a routine gynecological visit which
was normal. Ex. 39 at 1-4. On December 7, 2021, she had bloodwork done which showed
that her sodium level was in the normal range. Ex. 40 at 7. On December 8, 2021,
Petitioner began care with a new endocrinologist, Brooke McAdams, M.D. Ex. 37 at 2.
On November 30, 2021, Ms. Warnock was taken to Kershaw Health Medical
Center. Petitioner testified that she was working on her farm when she suddenly felt dizzy
and lightheaded before she fell to the ground. Tr. at 22. She stated that her mother caught
her before she hit the ground. Id.; Ex. 31 at 14. At Kernshaw, her vitals were normal, and
she was given potassium and a heavy salt meal. Ex. 31 at 5. A CT of her head was
normal. Id. at 8-9. Ms. Warnock reported that she had not been taking her medication
regularly and only when she felt symptomatic. Id. Petitioner was instructed to take her
medication twice daily as scheduled until her doctors told her to stop. Id. at 6. She was
diagnosed with hyponatremia and discharged with instructions to follow up with her
physicians. Id. at 10.
On December 21, 2021, Ms. Warnock underwent MRI imaging of her brain and
pituitary gland. Ex. 38 at 3. The MRI indicated the likely presence of a tiny Rathke cleft
cyst. Id. There were no other abnormalities noted. Id. In comparison to Petitioner’s MRI
from July 26, 2019, the December 21, 2021 MRI again showed left greater than right
chronic bifrontal posttraumatic encephalomalacia. Id.
On May 11, 2022, Ms. Warnock saw Dr. McAdams in follow-up. Ex. 37 at 2. Dr.
McAdams noted that Petitioner “needs to take in salt tablets due to [the] desire to drink
more during the summer.” Id. at 3. However, Ms. Warnock was described as “stable.” Id.
7
Dr. McAdams noted that prior ACTH [adrenocorticotropic hormone] and cortisol tests
were normal and TFTs [thyroid function tests] were in a normal range. Id. Her doctor
recorded that “[t]here was hope that SIADH was transient and would slowly improve,” but
that “unfortunately [there are] no signs of recovery 3 years out from initial presentation.”
Id. at 7.
On October 18, 2022, Ms. Warnock saw her cardiologist for her yearly visit. Ex. 36
at 16. She reported more palpitation episodes in the preceding four-to-six-month period,
with episodes of near syncope once every one to two weeks. Id. A physical exam was
unremarkable, but an EKG done in the office was abnormal, with sinus rhythm and sinus
arrhythmia noted. Id. Further diagnostic testing was planned. Id.
Ms. Warnock returned to her cardiologist on November 9, 2022, to review her
cardiac results. Ex. 36 at 19. The results were noted to be “unremarkable.” Id. Overall,
Ms. Warnock was noted to be “doing well,” and she was advised to continue Florinef and
follow up in one year. Id.
On May 13, 2023, Ms. Warnock had her annual gynecologic exam with Dr. Jully
Aguirre. Ex. 57 at 3. It was noted that Petitioner’s seizures had resolved. Id. Other than
some minor issues with her menses, Ms. Warnock’s examination was normal. Id. at 8-10.
On May 16, 2024, Ms. Warnock saw her PCP to confirm her pregnancy. Ex. 57 at
24. She was counseled on prenatal practices, and she was scheduled for regular routine
appointments for the duration of her pregnancy. Id.
On September 4, 2024, Ms. Warnock was seen by Dr. Brooke McAdams for an
endocrinology follow-up. Ex. 58 at 3. Petitioner reported that she was last seen in 2022
and that since then, she had “been fairly stable.” Id. Ms. Warnock reported no recent
hospitalizations or seizure activity, although she had continued her fluid restrictions to up
to 2 and half liters a day. Id. Petitioner stated that she took sodium tablets once or twice
week when she feels dizzy, but that the dizziness usually resolves within 20 to 30 minutes.
Id. The notes state that Petitioner “feels well and is without complaint; sodium normal
January 2024 prior to pregnancy. Hopefully SIADH was transient…” Id. at 6. Dr.
McAdams stated that if the results of Petitioner’s labs taken that day were normal, then
the fluid restrictions would be further loosened. Id. Her exam was otherwise normal.
Ms. Warnock testified that she gave birth to a healthy baby girl on December 18,
2024. Tr. at 10. No additional medical records have been filed.
8
Affidavit and Hearing Testimony
a. Hannah Warnock
At the time Ms. Warnock prepared her affidavit in April 2023, she was working at
Duck Bottom Planation, a hunt club located near Camden, South Carolina. Ex. 43. Her
duties consisted of food preparation, working in the club’s pro shop, and leading and
coordinating women’s activities. Id. Ms. Warnock also worked at her family farm which
housed a bed and breakfast lodge. Id. On the farm, Petitioner was responsible for raising
the sheep and event planning at the lodge. Id. Ms. Warnock holds a bachelor’s degree in
hospitality from Flagler College located in St. Augustine, Florida. Ex. 43.
Ms. Warnock stated that she has always been very active – participating in school
softball and volleyball, and was later a consistent member at her gym. ECF No. 66-8 at
1. However, since her injury she cannot run for five minutes without getting dizzy. Id. She
stated that she has to participate in gentler exercises like yoga and Pilates, but if she
overextends herself, she will experience dizziness, fatigue, and shortness of breath. Id.
Ms. Warnock states that other activities may trigger her symptoms such as stress, eating
too fast, eating too much sugar, little sleep, or it can sometimes happen without warning.
Id. When her symptoms occur, she has to lie down, place a cool rag on her head, and
rest for at least 10 minutes so she can catch her breath. Id. Ms. Warnock states that these
symptoms happen at least once a week. Id. She is on fluid restrictions and must take
frequent breaks in an effort to prevent her symptoms from occurring. Id. at 2.
Ms. Warnock testified that she began working at Duck Bottom in November 2022.
Tr. at 27. She described working at Duck Bottom as “a hospitality dream.” Id. Ms. Warnock
stated that the facility was located on the Wateree River, with a tiki bar, and music, and
she was able to help host a number of different events. Id.
When she initially began working at Duck Bottom, Ms. Warnock was employed as
a sous chef cooking breakfast and lunch. Id. She stated that she worked by herself
prepping the food and helping to serve. Ms. Warnock explained that the clientele was
small at the time, about six to 12 people, so it was manageable for her. Id. In January
2023, Petitioner was promoted to hospitality manager where she was still handling
breakfast and lunch, but was also handling décor, table arrangements, and scheduling
the women’s activities. Id. at 28. Ms. Warnock stated that she also managed the entire
pro shop as well as any big events that were held. Id. Petitioner explained that from
November to December during the off-season, the work was manageable. Id. But as the
hunting season began, the environment became faster paced and the work became more
difficult. Id. at 29. Finally, in late March/early April 2024, she left Duck Bottom “because
of the toll it was having on my physical health. I was napping every single day after work
9
for an hour and half to two hours. And it just – it was not worth it for me.” Tr. at 30. Ms.
Warnock testified that she was paid a $36,000.00 annual salary as the hospitality
manager at Duck Bottom. Tr. at 32.
After leaving Duck Bottom, Ms. Warnock testified, she went to work at her
grandparents’ farm and bed and breakfast hospitality business, Old McCaskill’s Farm,
and remains employed there. Tr. at 33. Ms. Warnock testified that her grandmother takes
care of the gardening and the animals, and Petitioner is in charge of the bed and
breakfast. Id. Her duties consist of making phone calls, planning events, creating
itineraries, answering emails, as well as cleaning the bed and breakfast. Id. at 33-34. She
also cooked breakfast when guests were staying at the bed and breakfast. Id. at 34. Ms.
Warnock stated that at some point, she had a conversation with her grandmother stating
that her symptoms were not getting better and that she needed more breaks during the
workday. Id. at 35. Petitioner also requested lessening her responsibilities at the farm to
help cope with her symptoms. Id. After the conversation, Ms. Warnock stated that she
was only handling the bed and breakfast and organizing events for the farm. Id. at 36-37.
Petitioner stated that she was paid an annual salary of $30,700.00 at her grandparents’
farm. Id. at 38.
In her affidavit and in her testimony, Ms. Warnock explained how her injuries and
symptoms have affected her emotional state. Ex. 43. She stated that prior to her injury,
she felt “fearless, ready to take on the world when it came to accomplishing a task that
might seem hard to others.” Id. However now, she is guarded and anxious about how
certain activities at work and in her personal life might affect her. Id.
Ms. Warnock testified that she is still having many symptoms – at least once or
twice a week with her smaller symptoms, and once or twice a month with her “presyncopal
bigger symptoms.” Tr. at 39. She stated that she has had some improvement in that her
fatigue has decreased and her dizziness is not as present as it once was. Id.
Ms. Warnock gave birth to her daughter in December 2024. Tr. at 41. During her
pregnancy, she experienced preeclampsia, but her pregnancy was otherwise normal. Id.
Ms. Warnock testified that her current plan is to continue working at her grandparents’
farm, managing the bed and breakfast. Id. She stated that as a result of her injury, she
does not go out as much as she used to. Tr. at 42. She stated that she is more anxious
and fearful that she may become overwhelmed and pass out like she did at Disney
Springs. Id. Ms. Warnock testified that she is very cautious and monitors her heart rate
with her apple watch. Id. She also stated that she is more “forgetful” and needs to make
lists to ensure she does not forget something important. Tr at 43. Ms. Warnock stated
that she does feel that she has a permanent injury, and that it’s been a difficult period to
get through. Id.
10
b. Ashley Robinson
Ms. Ashley Robinson is Ms. Warnock’s mother. Ex. 44. She stated that she
operates a food truck business in Rembert, South Carolina and has three daughters, the
oldest being Ms. Warnock. Id. Ms. Robinson described Ms. Warnock as an “outstanding
athlete” in high school and before her accident. Id. She stated that Petitioner was very
competitive and strived to be the very best she could be, which included attending Flagler
College in Florida, to gain her degree and to work in international hospitality. Id.
Ms. Robinson detailed the events of June 27, 2019, when Petitioner received her
vaccines and her medical course since that date. Ex. 44 at 1-2. Although Ms. Warnock
was able to go to Flager in January 2020, Ms. Robinson felt very nervous because of
Petitioner’s symptoms and all the doctor appointments she needed to attend. Id. at 2. She
describes the impact of Petitioner’s vaccine injury as “life changing.” Id. She stated that
Petitioner “is an extremely hard worker and still wants to accomplish big things in life but
she is limited as to what her body will allow her to do.” Id. Ms. Robinson also stated that
she is concerned about the financial impact of her daughter’s vaccine injury and how it
will affect her life as she ages. At the time she prepared her affidavit, Ms. Robinson stated
that Petitioner was still under her father’s insurance plan, but she would not be once she
turned 26. Id. Thankfully, Ms. Robinson stated that Petitioner’s current employer is
understanding, but “she does not have the guarantee that all future employers will offer
the same sympathy.” Id.
c. Madison Baker
Ms. Madison Baker is Ms. Warnock’s younger sister. Ex. 45. In her affidavit, Ms.
Baker characterized Petitioner as a very active and outgoing person “who was strong and
secure in who she was.” Id. But after her vaccine injury, Ms. Warnock “changed an
immense amount emotionally, physically, and socially.” Id. She described her sister as
being more vulnerable and that her emotions were constantly fluctuating. Id. Ms. Baker
stated that “[t]his accident has given Hannah a perpetual feeling of fear in her physical
life with how her body is going to react to any activity which in return affects her
emotionally and socially because this is such a different life than what she previously was
used to before.” Id. at 1-2.
III. Pain and Suffering Component
a. Legal Standard
Compensation awarded pursuant to the Vaccine Act shall include “[f]or actual and
projected pain and suffering and emotional distress from the vaccine-related injury, an
11
award not to exceed $250,000.” Section 15(a)(4). Additionally, a petitioner may recover
“actual unreimbursable expenses incurred before the date of judgment award such
expenses which (i) resulted from the vaccine-related injury for which petitioner seeks
compensation, (ii) were incurred by or on behalf of the person who suffered such injury,
and (iii) were for diagnosis, medical or other remedial care, rehabilitation . . . determined
to be reasonably necessary.” Section 15(a)(1)(B). The petitioner bears the burden of proof
with respect to each element of compensation requested. Brewer v. Sec’y of Health &
Hum. Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18,
1996).
There is no mathematical formula for assigning a monetary value to a person’s
pain and suffering and emotional distress. I.D. v. Sec’y of Health & Hum. Servs., No. 04-
1593V, 2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013) (“[a]wards for
emotional distress are inherently subjective and cannot be determined by using a
mathematical formula”); Stansfield v. Sec’y of Health & Hum. Servs., No. 93-0172V, 1996
WL 300594, at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the assessment of pain and
suffering is inherently a subjective evaluation”). Factors to be considered when
determining an award for pain and suffering include: 1) awareness of the injury; 2) severity
of the injury; and 3) duration of the suffering. I.D., 2013 WL 2448125, at *9 (quoting
McAllister v. Sec’y of Health & Hum. Servs., No 91-1037V, 1993 WL 777030, at *3 (Fed.
Cl. Spec. Mstr. Mar. 26, 1993), vacated and remanded on other grounds, 70 F.3d 1240
(Fed. Cir. 1995)).
I may also consider prior pain and suffering awards to aid my resolution of the
appropriate amount of compensation for pain and suffering in this case. See, e.g., Doe
34 v. Sec’y of Health & Hum. Servs., 87 Fed. Cl. 758, 768 (2009) (finding that “there is
nothing improper in the chief special master’s decision to refer to damages for pain and
suffering awarded in other cases as an aid in determining the proper amount of damages
in this case.”). And, of course, I may rely on my own experience (along with my
predecessor Chief Special Masters) adjudicating similar claims. Hodges v. Sec’y of
Health & Hum. Servs., 9 F.3d 958, 961 (Fed. Cir. 1993) (noting that Congress
contemplated the special masters would use their accumulated expertise in the field of
vaccine injuries to judge the merits of individual claims).
Although pain and suffering in the past was often determined based on a
continuum, as Respondent argues, that practice was cast into doubt by a Court of Federal
Claims decision several years ago. Graves v. Sec’y of Health & Hum. Servs., 109 Fed.
Cl. 579 (Fed. Cl. 2013). Graves maintained that to do so resulted in “the forcing of all
suffering awards into a global comparative scale in which the individual petitioner’s
suffering is compared to the most extreme cases and reduced accordingly.” Id. at 590.
Instead, Graves assessed pain and suffering by looking to the record evidence, prior pain
12
and suffering awards within the Vaccine Program, and a survey of similar injury claims
outside of the Vaccine Program. Id. at 595. Under this approach, the statutory cap merely
cuts off higher pain and suffering awards – it does not shrink the magnitude of all possible
awards as falling within a spectrum that ends at the cap. Although Graves is not
controlling of the outcome in this case, it provides reasoned guidance in calculating pain
and suffering awards – and properly emphasizes the importance in each case of basing
damages on the specific injured party’s circumstances.
b. Pain and Suffering Analysis
In this case, awareness of the injury is not contested. The record reflects that at all
times, Petitioner was a competent adult with no impairments that would impact her
awareness of her injury. Therefore, I analyze principally the severity and duration of
Petitioner’s injury. Petitioner requested $150,000.00, for her actual/present pain and
suffering, plus an additional $25,674.97 (a yearly award of $7,500.00, for the duration of
Petitioner’s life expectancy (58 year) reduced to net present value) for a total award of
$175,674.97. Mot. at 17. In reaction, Respondent stated that the evidence supported the
lesser award of $105,000.00 for Petitioner’s past pain and suffering only, with no future
component appropriate. Opp. at 13-14.
In performing my analysis, I have reviewed the record as a whole, including all
medical records, affidavits, declarations, and all other filed evidence, plus the parties’
briefs, other pleadings, and the hearing testimony. My ultimate determination is based on
the specific circumstances of this case, although I give some consideration to comparable
cases. In addition, in any case in which the parties cannot agree to a damages
component, I take into account my experience adjudicating damages generally –
including the fact that even the most self-limiting and transient of vaccine injuries from an
immediate-impact stance can have “significant treatment consequences.” Hietpas v.
Sec’y of Health & Hum. Servs., No. 19-1702V, 2021 WL 688620, at *5 (Fed. Cl. Spec.
Mstr. Jan. 15, 2021).
Because most vaccine injuries involving syncope, presyncope, and vasovagal
responses are resolved informally, there are few reasoned decisions to guide the
outcome in this case. Thus, Petitioner cites mainly GBS cases, with just two syncope
cases by contrast - Campbell v. Sec’y of Health & Human Servs., No. 20-038V, 2022 WL
1074979, at *1 (Fed. Cl. Jan. 4, 2023) and Hietpas, 2021 WL 688620 - to support her
proposed award of $150,000.00, for pain and suffering.
Respondent cites to three cases to support the lesser sum he advocates for: (1)
H.S. v. Sec’y of Health & Human Servs., No. 14-1057V, 2015 WL 6155891 (Fed. Cl. Spec.
Mstr. Sept. 25, 2015); (2) Hietpas; and (3) Marcillo v. Sec’y of Health & Human Servs.,
13
2023 WL 3452274, at *7 (Fed. Cl. Spec. Mstr. May 15, 2023).
In H.S., a petitioner experienced a syncopal episode after receiving the Tdap
vaccine, resulting in head trauma, a concussion, and skull and a C1 vertebra fracture.
H.S., 2015 WL 6155891, at *1. That petitioner was required to wear an immobilizing cast
for six weeks and was unable to participate in sports. Id. at *3. Despite the clear imposition
the claimant suffered from treatment, the special master reasoned that $60,000.00 was
an appropriate amount to award in pain and suffering because the minor did not have a
permanent injury, with his suffering evidenced particularly by his inability to participate in
sports for nearly six months. Id. at *3.
The Hietpas petitioner was awarded a higher sum - $140,000.00 - for the pain and
suffering she experienced as a result of a post-vaccination syncopal injury. But the
severity of her injury, and invasive treatment it required, was more obviously significant
than the claimant in H.S. That individual sustained a chin laceration (causing permanent
scaring), a jaw fracture, and underwent ORIF surgery two days later. Although she was
noted to be healing well in the aftermath of her surgery, the Hietpas petitioner reported
jaw pain, ear pressure, and intermittent difficulty chewing in the following months.
Approximately seven months after surgery, her complaints included a clicking and
popping sensation when opening her mouth. And despite attending seven sessions of
physical therapy, she was eventually assessed with right and left TMJ displacement with
reduction. Approximately one year after her injury, she was fitted with an orthopedic cast
that had to be worn for 18 hours a day for a year. Based on this timeline, petitioner’s
course of treatment lasted approximately two years after her syncopal episode.
In Marcillo, 2021 WL 4704789, a petitioner suffered a syncopal episode after being
administered a Tdap vaccine. Id. at * 2. The petitioner had lost consciousness and hit his
head against a metal table before falling on to the ground. Id. Ultimately, the Marcillo
petitioner underwent four surgical procedures in a seven-month period – all of which were
complex. Id. In addition to surgery, the petitioner’s jaw was wired shut for approximately
one month. Id. During this time, the petitioner was required to abide by a liquid diet and
was forced to “vacuum” his mouth to suction out pooling blood and saliva. Id. Braces were
placed on petitioner’s approximately six months later. Id. Once the petitioner’s orthodontic
treatment was completed, he was required to undergo the extraction of his wisdom teeth
and removal of the hardware near his right condyle. Id. The petitioner would then undergo
a total joint replacement once a mold of his jaw was taken. It was found that based on
this timeline, the petitioner’s course of treatment was likely to extend over a total of at
least four years. Id. Considering the severity and duration of the petitioner’s syncopal
injury along with the personal hardships he experienced as a result, he was awarded the
maximum $250,000.00 in actual pain and suffering. Id.
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While the H.S., Hietpas, and Marcillo cases certainly provides some aid in
assessing the proper measure of damages in this case, there have been three additional
syncope cases that provide additional insight – Campbell v. Sec’y of Health & Human
Servs., No. 20-038V, 2022 WL 1074979, at *1 (Fed. Cl. Jan. 4, 2023); Neff v. Sec’y of
Health & Human Servs., 2010 WL 2710646 (Fed. Cl. Spec. Mstr. June 15, 2010), and
Hendricks v. Sec’y of Health & Human Services, No. 19-1061V, 2025 WL 2606536, at *1
(Fed. Cl. Aug. 6, 2025). All involve fairly large pain and suffering awards.
In Campbell, a petitioner was awarded $190,000.00 after becoming dizzy shortly
after receiving a flu vaccine and falling down a number of stairs, causing fractures and
other injuries to her left tibia and fibula. Campbell, 2022 WL 1074979, at *2. However,
due to the petitioner’s poor bone quality, the injuries required three surgeries to repair. Id.
at *3. Each surgery resulted in a brief hospitalization, prescription pain medication, and
limited range of motion and weightbearing. Id. at *5. The Campbell petitioner’s injuries
also caused a significant disruption to her life – including medically extended absences
totaling approximately one year (the petitioner was a histology specialist at
Massachusetts General Hospital). Although the petitioner’s initial injury was “transient and
seemingly minor,” the impact of the event was found to be uncommonly severe – justifying
a fairly high pain and suffering award. Id.
The Neff case is from 2010, and it involved a petitioner who suffered vasovagal
syncope caused by her receipt of an HPV vaccine. Neff v. Sec'y of Health & Hum. Servs.,
No. 08-0906V, 2010 WL 2710646, at *1 (Fed. Cl. June 15, 2010). That claimant fell and
struck her head, leading to brain bleeding, a concussion, and loss of sense of smell. Id.
She experienced these injuries for more than six months. The case was resolved by a
proffer, and the Neff petitioner was awarded a total of $110,000.00. Id.
In Hendricks (a case that I recently decided), the petitioner suffered a post-
vaccination syncopal episode while crossing the street, where she fainted, striking her
face on the sidewalk. Hendricks, 2025 WL 2606536, *1. That petitioner had to endure at
least three separate surgeries, some of which took multiple hours to perform. Id. at *6.
That petitioner also underwent four root canals, seven crowns, the placement of a metal
plate with six screws in her chin, two tooth extractions, which were eventually replaced
with dental implants. Id. Ms. Hendricks had her mouth fully wired shut for five weeks, and
partially wired shut for at least another two weeks. Id. During this time, she was required
to eat her food through a syringe. Id. After the wires were removed from her mouth, she
was still required to eat soft foods for at least six months. Id. Ms. Hendricks attended at
least 15 physical therapy appointments to assist in mobilizing her jaw to reduce pain while
she spoke, chewed, and moved her mouth. Id. Because of her jaw injury, she also
attended physical therapy to address the neck and shoulder pain she experienced as her
jaw caused tension into these areas. Id. I awarded Ms. Hendricks the maximum
15
$250,000.00 pain and suffering amount for her injury. Id.
Ms. Warnock’s Pain and Suffering Award
In making my determination on an appropriate award, I have also fully considered
Petitioner’s sworn affidavits and her testimony, in which she described, in detail, the
excruciating pain she experienced throughout her injury as well as the circumstances that
magnified the suffering and emotional distress she experienced as a result of her
syncopal injury.
Ms. Warnock argues in her brief that she was hospitalized twice for a total of 14
days for her injuries, and was taken to emergency rooms on four occasions. Mot. at 17.
She has been evaluated and treated by neurosurgery, neurology, endocrinology,
cardiology, ophthalmology, and oral surgery, as well as her family are provider. Id. She
experienced painful conditions including a skull fracture, subarachnoid hematoma and
blood clots. Id. She has suffered debilitating symptoms from dysautonomia,
hyponatremia, and SIADH. Id.
Respondent argues that although the circumstances Ms. Warnock endured were
“frightening and unpleasant,” her relatively good health does not appear to warrant a pain
and suffering award of the amount that Petitioner proposes. Opp. at 15-16. Respondent
noted that Petitioner complains of dizziness and various other symptoms of
dysautonomia, and that she is on a fluid restriction protocol to regulate her sodium levels.
Id. Respondent acknowledges that Ms. Warnock’s emotional state has been affected
since her injury, but that she is fortunately still able to perform activities of daily life,
including pursuit of full-time employment at a physically demanding job on a farm. Id. at
16. Respondent argues that Petitioner’s endocrinologist in May 2022 described Ms.
Warnock as stable, and that her cardiologist indicated as recently as November 2022 that
Petitioner has no physical disability and is able and self-reliant in the performance of her
usual daily activities. Id. Finally, Respondent notes that Petitioner participates in social
activities and is able to drive. Id.
The record in this case establishes that Ms. Warnock suffered a very serious and
traumatic injury on June 17, 2019, when she received the vaccines. Her fall from her
syncope episode was so serious that she fractured her skull and had to be airlifted to the
nearest medical center that was able to treat her injuries. At one point in her
hospitalization, Ms. Warnock was noted to be in critical condition as she was awaiting
transfer to an acute facility. Ex. 3 at 36. Her first hospitalization lasted for 11 days,
indicating a very severe injury. Ex. 14 at 55-59. As Ms. Warnock was only 20 years old at
the time, this had to have been a very traumatic experience for her and her family.
16
In addition, it is clear that Ms. Warnock suffered some ongoing sequela from her
initial traumatic injury. As Petitioner has noted in her brief, she was hospitalized twice for
a total of 14 days for her injuries and was taken to emergency rooms on four separate
occasions. She has been evaluated and treated by neurosurgery, neurology,
endocrinology, cardiology, ophthalmology, and oral surgery, as well as her family care
provider. Ms. Warnock has been diagnosed with dysautonomia, hyponatremia, and
SIADH.
Ms. Warnock credibly recounted her feelings of fear and anxiety as a result of all
her procedures and ongoing treatment. Tr. at 29. She explained in her affidavit that she
feels like a different person, grateful for her recovery, but mindful of the limitations she
now must endure. Tr. at 43. She has gone from being invincible to timid, worried how her
body will react to stresses and new experiences. Id. Ms. Warnock’s mother and sister
describe similar changes in Ms. Warnock’s personality and their worry for her future.
Thankfully, as both Ms. Warnock and Respondent have noted, Ms. Warnock has made a
good recovery, although she may have some lasting sequela as she approaches her
future.
Given all of the foregoing, this case reflects circumstances in which a minimum
award of $150,000.00 would be fair and reasonable – and in fact a slightly higher award
is probably appropriate. While the injury at issue was not life-threatening, and may not be
on all fours with the kind of devastating neurologic harm that some vaccine injuries can
be shown to produce, the degree of her injury and trauma to her head, and the intrusive
medical care required to ameliorate the Petitioner’s health was notably high – along with
the personal impacts of that treatment. The Program has unquestionably recognized that
the residual effects from an episode of vaccine-caused syncope can be severe and
significant – and that pain and suffering awards should recognize this.
However, given Ms. Warnock’s strong recovery (as her medical records indicate),
I do not believe that an award for future pain and suffering is adequately substantiated. I
would require more specific and compelling evidence of ongoing sequelae in order to
favor allowing that component.
But given the traumatic nature of Petitioner’s initial injury and subsequent
treatment, a reasonable and just result can be fashioned in which the claimant is provided
an actual pain and suffering somewhat higher than requested (if still a bit less than the
award would be if a future component was included). Accordingly, after considering the
severity and duration of Petitioner’s syncopal injury along with the personal hardships she
has experienced as a result, and considering the arguments presented by both parties at
the hearing, a review of the relevant caselaw and the written record, I find that
$170,000.00 in total compensation for actual pain and suffering is reasonable in this case.
17
IV. Life Care Plan
Legal Standard
Compensation awarded pursuant to the Vaccine Act shall also include “[a]ctual
unreimbursable expenses incurred from the date of the judgment awarding such
expenses and reasonable projected unreimbursable expenses” that:
(i) result from the vaccine-related injury for which the [P]etitioner seeks
compensation;
(ii) have been or will be incurred by or on behalf of the person who suffered
such injury; and
(iii) (I)have been or will be for diagnosis and medical or other remedial care
determined to be reasonably necessary, or (II) have been or will be for
rehabilitation, developmental evaluation, special education, vocational
training and placement, case management services, counseling, emotional
or behavioral therapy, residential and custodial care and service expenses,
special equipment, related travel expenses, and facilities determined to be
reasonably necessary.
§ 15(a)(1)(A).
“[R]easonable projected unreimbursable expenses” must be shown to be
“reasonably necessary.” Section 15(a)(1)(A)(iii). “Special masters have characterized this
phrase as a ‘vague instruction’ and a standard for which there is ‘no precise’ definition”
Lerwick ex rel. B.L. v. Sec'y of Health & Hum. Servs., No. 06-847V, 2014 WL 3720309,
at *5 (Fed. Cl. Spec. Mstr. June 30, 2014); see also I.D., 2013 WL 2448125, at *6 (defining
“reasonably necessary” to mean “that which is required to meet the basic needs of the
injured person ... but short of that which may be required to optimize the injured person's
quality of life” (quoting Scheinfield v. Sec'y of Health & Human Servs., No. 90-212V, 1991
WL 94360, at *2 (Cl. Ct. Spec. Mstr. May 20, 1991))); Bedell v. Sec'y of Health & Hum.
Servs., No. 90-765V, 1992 WL 2666285 (Cl. Ct. Spec. Mstr. Sept. 18, 1992) (defining
“reasonably necessary” to mean “more than merely barely adequate, but less than the
most optimal imaginable”); Alonzo v. Sec'y of Health & Hum. Servs., No. 18-1157V, 2023
WL 5846682, at *11 (Fed. Cl. Spec. Mstr. Aug. 14, 2023).
A. Life Care Plan Elements
The parties agree that the only differences between the two life care plans each
submitted are the costs of three of Petitioner’s medications/supplements: Florinef, salt
tabs, and Micronor. Compare Ex. A at 5, 6 with Ex. 46 at 15, 16.4; ECF 68 at 20 n. 39;
18
Opp. at 12, fn. 4. Petitioner’s life care planner stated that the cited medication prices
“include costs obtained specifically from local pharmacies in [Petitioner’s] area…” Ex. 46
at 13; see also Ex. 46 at 15, 18. Respondent’s life care planner indicated that her pricing
for the same items came from the online source www.goodrx.com. Ex. A at 3. Respondent
argues that the lower price for the exact medication prescribed to Petitioner is both
prudent and “reasonably necessary” pursuant to 42 U.S.C. §300aa-15(a)(1)(A)(iii)(I)
(emphasis added).
Respondent’s argument is persuasive on this point. The lower price for the
medication is in line with the Vaccine Act’s language of “reasonably necessary” and thus,
I will award the pricing of the three medications as set forth in Respondent’s life care plan.
B. Form of the Award of the Life Care Plan
Regarding the form of the award for future medical care, the Vaccine Act provides
that the special master may order that payment of compensation may include the
purchase of an annuity if determined to be in the best interests of petitioner. 42 U.S.C. §
300aa-15(f)(4)(A).
Petitioner has requested that the cost of the life care plan be awarded as a lump
sum for the entirety of the cost of the plan. Mot. at 20. Respondent has proposed that
Petitioner be awarded a specific amount for first-year life care plan expenses, and then
an amount sufficient for the Government to purchase an annuity contract to fund the
remaining life care plan items, as recommended by Respondent’s life care planner in Ex.
A, for Petitioner’s benefit over her lifetime. Respondent proposes an annuity purchase
instead of a lump sum payment, as a reasonably necessary and prudent measure, to
enable adequate medical coverage for Ms. Warnock.
As Respondent has stated, the longstanding practice in the Program has been to
award funds for future life care items via a life-contingent annuity, with an initial, lump sum
for first-year life care plan costs. Petitioner has not presented any compelling argument
as to why this practice should not be followed. Thus, the funding of the life care plan will
be as set forth in Respondent’s life care plan and shall consist of a lump sum for Ms.
Warnock’s first-year life care plan expenses, and an amount sufficient for the government
to purchase an annuity contract to fund the remaining life care plan items, as
recommended by Respondent’s life care planner in Exhibit A, for Ms. Warnock’s benefit
over her lifetime.
19
V. Lost Earnings Damages Component
Legal Standard
The Vaccine Act provides for recovery of “actual and anticipated loss of earnings
determined in accordance with generally recognized actuarial principles and projections,”
where the injured party's “earning capacity is or has been impaired by reason of such
person's vaccine-related injury.” Section 15(a)(3)(A). The calculation of lost earnings
damages must be performed in a “cautious manner ‘in accordance with generally
recognized principles and projections.’” Brown v. Sec’y of Health & Hum. Servs., No. 00-
182V, 2005 WL 2659073, at *6 (Fed. Cl. Spec. Mstr. Sept. 21, 2005) (citing Section
15(a)(3)(A)).
Compensation awarded for a petitioner’s anticipated loss of earnings may not be
based on speculation. J.T. v. Sec'y of Health & Hum. Servs., No. 12-618V, 2015
WL5954352, at *7 (Fed. Cl. Sept. 17, 2015) (indicating Section 15(a)(3)(A) “does not
envision that ‘anticipated loss of earnings’ includes speculation” and denying to calculate
lost wages on a planned business venture); Dillenbeck v. Sec'y of Health & Hum. Servs.,
147 Fed. Cl. 131, 139 (2020) (citing J.T., 2015 WL 5954352, at *7). It necessarily follows
that the Act also does not envision that any actual lost earnings awarded be speculative
in nature. The United States Court of Federal Claims has “recognize[d] that the
determination of compensation for lost earnings ‘in accordance with generally recognized
actuarial principles and projections’ would likely require expert opinion evidence.”
Dillenbeck,147 Fed. Cl. at 139.
Petitioner alleges that her vaccine injury restricted her earning ability as a
hospitality major and event planner. Mot. at 19-21. Petitioner thus requests lost earnings
totaling $114,289.70. Id. at 20. Respondent argues that the record shows that Ms.
Warnock’s earning capacity has not been impaired. Opp. at 18.
Petitioner’s Expert Reports
Ms. Caskey Report
To support her damages claim, Petitioner filed a report from Deborah L. Caskey,
a certified vocational evaluator, disability management specialist, rehabilitation counselor
and life care planner. Ex. 55 at 1; Ex. 60 at 1. She received her bachelor’s degree in
education and rehabilitation counseling and psychology from the University of Arizona.
Ex. 60 at 3. Ms. Caskey received her post graduate certificate in forensic vocational
rehabilitation from the University of Florida and completed her graduate program in
rehabilitation and vocational counseling at Liberty University. Id. She also obtained an
20
education in emergency medicine as a paramedic in the United States Army. Id. Ms.
Caskey has worked as a vocational expert since 1989 and has reviewed many lost
earnings evaluations from economists and other experts. Id. at 2.
Ms. Caskey was retained in the present case to provide a calculation for Ms.
Warnock’s loss of earning capacity due to her vaccine injury. Ex. 55 at 2. To do so, she
relied upon Petitioner's medical records, the affidavits of Ms. Warnock, her mother -
Ashley Robinson, and her sister – Madison Baker, the parties’ respective life care plans,
and Petitioner’s brief on damages. Id. at 3-4. Ms. Caskey briefly details Petitioner's
medical history and work experience, focusing on the difficulties Ms. Warnock states she
has experienced working in her current and past positions. Id. at 4. Ms. Caskey concludes
Petitioner's post-injury earnings capacity is $27,000.00 - $29,120.00 per year. Id. at 4-5,
8-12.
Dr. Oliver’s Expert Report
Dr. Oliver G. Wood, Jr., is a consulting economist retained by Ms. Warnock to
prepare an opinion regarding Petitioner’s economic damages and loss of earning
capacity. Dr. Wood received his Bachelor of Arts and master’s degree in economics from
the University of South Carolina. Ex. 61 at 1. He received his Ph.D. in Economics from
the University of Florida in 1965 and began working as a consulting economist in 1969.
Id. He has held several teaching positions at the University of South Carolina, including
a distinguished professor emeritus and economist in residence at the Charleston School
of Law. Id.
Dr. Wood prepared an opinion regarding Ms. Warnock’s earning capacity and
future medical care costs. Ex. 54 at 2 (revised report). He opines that Ms. Warnock’s
vaccine related losses range from $196,223.00, to $256,679.00, including loss of
earnings and offset earnings. Id. at 13. They rely on Ms. Caskey’s report regarding Ms.
Warnock’s post-injury earning capacity. Id. at 4. Dr. Wood calculates lost earnings
damages to Ms. Warnock age 67 based on her Social Security retirement age. Dr. Wood’s
analysis states that “all elements are discounted to present value at a rate of 5 percent”
which is the “rate that an ordinary person with average financial knowledge, with access
to commonly available investment outlets, and facing the full range of financial risks might
be expected to earn over a long period of time.” Id. at 3.
Respondent’s Expert Reports
Respondent maintains the legal requirements for an award of lost earnings remain
unmet. In support of this contention, Respondent has submitted two expert reports: one
21
from vocational expert Trey Moseley, MA, CRC, and a second report from economist
Patrick F. Kennedy, Ph.D. Exs. D, F.
Mr. Moseley’s Expert Report
Mr. Moseley is vocational expert with a Master of Arts degree from the University
of Alabama in 2006, and he has been a Certified Rehabilitation Counselor since 2007.
Ex. D at 1. Since 2011, he has provided vocational opinions in workers compensation,
long term disability, personal injury, Americans with Disability Act, and vaccine injury
cases. Id. Mr. Moseley is also a contracted Vocational Expert for the Office of Hearings
Operations for the Social Security Administration and has testified in more than one
thousand disability hearings. Id.
Dr. Moseley’s report notes the educational achievements Ms. Warnock has
attained since her vaccine injury. Ex. D at 4. He observed that:
at the time of the injury, Ms. [Warnock] had completed an associate’s
degree from Central Carolina Technical College and was preparing to
complete her Bachelor of Arts degree at Flagler college… Ms. [Warnock]
earned her degree from Flagler College on August 6, 2021. According to
her transcripts … she performed extremely well academically and
graduated Cum Laude with a Grade Point Average of 3.5428. Her attorney
also indicated that she had no accommodations made for her by Flagler
College during her coursework.
Id. As such, Mr. Mosely stated that because Ms. Warnock earned her bachelor’s degree,
it “only served to increase her earning capacity by means of her educational experience.”
Ex. D at 4.
Mr. Moseley next lists a representative list of jobs within a reasonable commuting
distance from Columbia, South Carolina, which he believed Ms. Warnock was qualified
for by means of her training, education, and experience. Ex. D at 5. These jobs ranged
in salary from $45,000.00 to $65,000.00 per year. Id.
Mr. Moseley concludes by stating that because Ms. Warnock did well in college
and did not require any type of accommodation and has been able to earn a living since
graduating college, “indicates that she would more likely than not be successful at other
positions earning higher wages. Ex. D at 5. Petitioner’s choice to select lower earning
positions does not appear to be reflective of her vocational abilities.” Id.
22
Based on the lack of medical evidence supporting Ms. Warnock’s alleged
limitations since the end of 2022, Mr. Moseley stated that “it is my opinion that Ms.
[Warnock] has not suffered a loss of earning capacity as a result of her vaccine related
injury. She has demonstrated the ability to earn $36,000.00 per year post-injury, and her
education and experience, in my opinion, have enabled her to potentially earn a figure of
at least $45,000.00 per year, which is significantly more than her current salary.
Accordingly, I do not see a basis for a lost wage component to her vaccine injury claim.”
Id. at 6.
Kennedy Expert Report
Dr. Kennedy is an economist with a doctorate in Economics earned from Stanford
University in 1992. Ex. F at 1. He has over 20 years of experience, serving as an expert
in the United States Court of Federal Claims, other federal and state courts, and in private
arbitrations nationwide. Ex. A, Tab 1. Dr. Kennedy analyses economic loss and damages
in a wide range of legal actions. Id.
In his report, Dr. Kennedy stated that “[b]ased on the opinions of Mr. Moseley, I
have not prepared any calculations of potential lost earnings for Ms. [Warnock]… ,” and
he thus limited his comments to Dr. Woods’s opinion. Ex. F at 3-4. Dr. Kennedy states
that the primary difference between his opinions and those of Dr. Woods is that the Woods
report relies on the opinion of Ms. Caskey, while Dr. Kennedy relies upon the report of
Mr. Mosely. Id. Without going into detail about the differences in the economic loss
calculations, Dr. Kennedy essentially states that the Woods analysis overstates Ms.
Warnock’s economic damages by failing to account for income taxes, her remaining work
life expectancy, and a miscalculation of damages by using a discounted net present value
at a rate of five percent. Id. at 5. However, Dr. Kennedy concludes his report by stating
that based upon the opinions of Dr. Moseley, there is no loss of earnings. Id. at 12.
Analysis of Lost Wage Issue
Respondent’s experts correctly observe that the medical record evidence in this
case is not generally supportive of the conclusion that Petitioner's vaccine related
symptoms were severe enough to prevent her from doing the kinds of hospitality work
that would have generated the lost earnings she seeks. Of note, while relying on her
economist’s calculation that her total lifetime earning capacity would be $1,142,897.00,
Petitioner argued that she should be awarded the equivalent of a ten percent loss of
earning capacity. Mot. at 19-20. Importantly, Petitioner acknowledged an “inability to
arrive at a number with mathematical precision,” (Mot. at 20) which proves the speculative
nature of these calculations.
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I also observe that while Petitioner's medical records document that she suffered
from bouts of lightheadedness, vertigo, and dizziness, they do not establish the existence
of any limitations or restrictions placed on Petitioner's ability to engage in work. On the
other hand, it demonstrates that Petitioner had mostly recovered from her injury. For
example, on May 12, 2023, Ms. Warnock had her annual gynecologic exam which noted
that she had “no complaints today.” Ex. 57 at 3. The notes from this visit state “[s]eizures
have resolved.” Id. Her vitals and overall exam were normal. Id. On May 16, 2024, when
Ms. Warnock returned to Lexington Women’s Care for suspected pregnancy, it is noted
that she had a history of SIADH and seizures, but that “[n]o further seizures of seizure
like activity,” although some light-headedness and syncope was noted in the review of
systems. Ex. 57 at 23. The record does not allow me to conclude that Petitioner could not
accomplish her work-related tasks during the relevant time period, or only at a lower level.
The above could be addressed by any medical treater who expressed the view that Ms.
Warnock was unable to work or placed any health-related restriction on her work or
professional endeavors. No such evidence has been offered.
Second, I do not find that Petitioner's witness statements or wage loss narrative fill
in these evidentiary gaps. These statements helped establish the nature and contours of
her lost earnings claim – but they were not corroborated with sufficient independent
evidence to accept the contentions they contained. Affidavits from petitioners and their
friends and family are most helpful when they support, elaborate upon, or buttress
otherwise unclear medical records and/or other evidence. Petitioner, however, has failed
to provide evidence establishing that her “earning capacity is or has been impaired by
reason of ... [her] vaccine injury” as required by Section 15(a)(3)(A). Rather, her
calculations were rooted in speculation about her abilities– not in “generally recognized
actuarial evidence and projections,” as required by Section 15(a)(3)(A).
Accordingly, because the record lacks preponderant support for an award of lost
wages/earnings in this case, no such award will be permitted.
VI. Award for Past Unreimbursable Expenses
The parties have agreed that Petitioner has adequately substantiated her request
for $6,978.97 in past out-of-pocket medical expenses through 2022. Mot. at 20; Opp. at
11. After carefully reviewing the documentation submitted by Petitioner and verifying the
payments that were actually incurred, I award Ms. Warnock that sum in full.
However, the parties disagree on how the parties should handle additional past
unreimbursable expenses incurred in the 2023-25 period. See Joint Status Report filed
April 10, 2026, ECF No. 104. Petitioner requests $6,275.00, maintaining that amount was
anticipated in Respondent’s original life care plan chart. Id. at 2. Respondent argues,
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however, that Petitioner has not provided the documentation necessary to substantiate
that these medical expenses were actually incurred. Respondent disagrees that the
$6,375.00 amount was meant to cover a past expense, but instead argues that it reflects
a future annuity payout (and hence is not reflective of previously-incurred costs). Id.
Respondent’s interpretation is more persuasive. There was a temporal delay in
resolving damages in this case, and thus costs that would have been prospective now
appear retrospective – but have not been adequately substantiated to be paid back by a
lump sum. Instead, the additional past unreimbursable expenses from 2023-25 will be
paid out as originally set forth in Respondent’s life care plan and updated appendices.
Conclusion
Based on the record as a whole and arguments of the parties,
1. I award Petitioner the following:
A. a lump sum payment of $176,978.97, (representing $170,000.00
for Petitioner’s actual pain and suffering, plus $6,978.97, for
past unreimbursable expenses), and
B. Future medical expenses comprised of 1) a lump sum of
$2,904.00 for first-year expenses. Components A and B are to
be paid through an ACH deposit to Petitioner’s counsel’s IOLTA
account for prompt disbursement to Petitioner.
2. In addition, I award an amount sufficient for Respondent to purchase
and fund an annuity contract for Petitioner’s benefit that will provide
payments for the life care items contained in Respondent’s life care
plan, and as illustrated by the appendixes filed by Respondent,
including the updated chart at Appendix A, Updated Summary of Life
Care Plan Items (ECF No. 104), Appendix A.
These amounts represent compensation for all damages that would be available
under Section 15(a). The Clerk of the Court is directed to enter judgment in accordance
with this Decision.3
3
Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice
renouncing the right to seek review.
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IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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