In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS
********************* MARISSA AREVALO, guardian * and mother of R.M.R., a minor, * * No. 15-406V Petitioner, * Special Master Christian J. Moran * v. * * Filed: June 12, 2018 SECRETARY OF HEALTH * AND HUMAN SERVICES, * Damages; decision based on proffer; * diphtheria-tetanus-acellular pertussis * (“DTaP”) vaccine; encephalopathy. Respondent. * *********************
Peter C. Beard, Springfield, IL, for Petitioner; Adriana R. Teitel, United States Department of Justice, Washington, DC, for Respondent.
UNPUBLISHED DECISION AWARDING DAMAGES1
On April 22, 2015, Marissa Arevalo filed a petition on behalf of her daughter, R.M.R., for compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. §§ 300aa-1 to 34 (2012). Ms. Arevalo alleged that R.M.R. suffered an on-Table encephalopahty as a result of a diphtheria-tetanus-acellular pertussis (“DTaP”) vaccination administered on May 10, 2012.
Following a hearing, the undersigned ruled that petitioner had established entitlement to compensation for R.M.R.’s on-Table encephalopathy claim under the Vaccine Act. Ruling, issued Dec. 15, 2016, 2016 WL 7666535.
1 The E-Government Act, 44 § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services), requires that the Court post this decision on its website. Pursuant to Vaccine Rule 18(b), the parties have 14 days to file a motion proposing redaction of medical information or other information described in 42 U.S.C. § 300aa-12(d)(4). Any redactions ordered by the special master will appear in the document posted on the website.
1 On June 8, 2018, respondent filed a Proffer on Award of Compensation, to which petitioner agrees. Based upon the record as a whole, the special master finds the Proffer reasonable and that petitioner is entitled to an award as stated in the Proffer. Pursuant to the attached Proffer the court awards petitioner:
a. A lump sum of $1,437,806.43 in the form of a check payable to petitioner as court-appointed guardian of R.M.R.’s estate for lost earnings, pain and suffering, and life care expenses for year one;
b. A lump sum of $3,852.60 in the form of a check payable to petitioner for past unreimbursable expenses;
c. A lump sum of $563,848.98 for compensation for satisfaction of the State of Illinois Medicaid lien in the form of a check jointly payable to petitioner and
Illinois Department of Healthcare & Family Services Bureau of Collections Technical Recovery Section P.O. Box 19174 Springfield, IL 62794-9174 Attn: Mr. Kevin Thornton Medicaid #: 96-080-091613
Petitioner agrees to endorse this payment to the State of Illinois.
d. An amount sufficient to purchase the annuity contract described in section II. D of the attached Proffer.
These amounts represent compensation for all damages that would be available under 42 U.S.C. §300aa-15(a)
In the absence of a motion for review filed pursuant to RCFC, Appendix B, the clerk is directed to enter judgment in case 15-406V according to this decision and the attached proffer.2
2 Pursuant to Vaccine Rule 11(a), the parties can expedite entry of judgment by each party filing a notice renouncing the right to seek review by a United States Court of Federal Claims judge.
2 Any questions may be directed to my law clerk, Andrew Schick, at (202) 357-6360.
IT IS SO ORDERED.
s/Christian J. Moran Christian J. Moran Special Master
3 IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS
MARISSA AREVALO, guardian and mother of R.M.R., a minor,
Petitioner, No. 15-406V v. Special Master Moran ECF SECRETARY OF HEALTH AND HUMAN SERVICES,
Respondent.
PROFFER ON AWARD OF COMPENSATION
On December 15, 2016, Special Master Moran issued a Ruling on Entitlement, which
found that petitioner was entitled to Vaccine Act compensation for R.M.R’s alleged Table
Encephalopathy injury.
I. Items of Compensation
A. Life Care Items
The respondent engaged life care planner, M. Virginia Walton, RN, MSN, FNP, CNCLP,
and petitioner engaged Terry K. Arnold, RN, CDMS, CRRN, CLCP, CNLCP, to provide an
estimation of R.M.R.’s future vaccine-injury related needs. For the purposes of this proffer, the
term “vaccine related” is as described in the Special Master’s Ruling Finding Entitlement. All
items of compensation identified in the joint life care plan are supported by the evidence, and are
illustrated by the chart entitled Appendix A: Items of Compensation for R.M.R., attached hereto
1 of 6 as Tab A. 1 Respondent proffers that R.M.R. should be awarded all items of compensation set
forth in the joint life care plan and illustrated by the chart attached at Tab A. 2 Petitioner agrees.
B. Lost Future Earnings
The parties agree that based upon the evidence of record, R.M.R. will not be gainfully
employed in the future. Therefore, respondent proffers that R.M.R. should be awarded lost
future earnings as provided under the Vaccine Act, 42 U.S.C. § 300aa-15(a)(3)(B). Respondent
proffers that the appropriate award for R.M.R.'s lost earnings is $829,794.00. Petitioner agrees.
C. Pain and Suffering
Respondent proffers that R.M.R. should be awarded $250,000.00 in actual pain and
suffering. See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.
D. Past Unreimbursable Expenses
Evidence supplied by petitioner documents her expenditure of past unreimbursable
expenses related to R.M.R.'s vaccine-related injury. Respondent proffers that petitioner should
be awarded past unreimbursable expenses in the amount of $3,852.60. Petitioner agrees.
E. Medicaid Lien
Respondent proffers that R.M.R. should be awarded funds to satisfy a State of Illinois
lien in the amount of $563,848.98, which represents full satisfaction of any right of subrogation,
1 The chart at Tab A illustrates the annual benefits provided by the joint life care plan. The annual benefit years run from the date of judgment up to the first anniversary of the date of judgment, and every year thereafter up to the anniversary of the date of judgment. 2 The parties have no objection to the proffered award of damages. Assuming the Special Master issues a damages decision in conformity with this proffer, the parties intend to waive their right to seek review of such damages decision, recognizing that respondent reserves his right, pursuant to 42 U.S.C. § 300aa-12(f), to seek review of the Special Master’s December 15, 2016, decision finding petitioner entitled to an award under the Vaccine Act.
2 of 6 assignment, claim, lien, or cause of action the State of Illinois may have against any individual as
a result of any Medicaid payments the State of Illinois has made to or on behalf of R.M.R. from
the date of her eligibility for benefits through the date of judgment in this case as a result of her
vaccine-related injury suffered on or about May 10, 2012, under Title XIX of the Social Security
Act.
II. Form of the Award
The parties recommend that the compensation provided to R.M.R. should be made
through a combination of lump sum payments and future annuity payments as described below,
and request that the Special Master's decision and the Court's judgment award the following 3:
A. A lump sum payment of $1,437,806.43, representing compensation for lost earnings
($829,794.00), pain and suffering ($250,000.00), and life care expenses for Year One
($358,012.43), in the form of a check payable to petitioner as guardian of the estate of R.M.R.,
for the benefit of R.M.R. No payments shall be made until petitioner provides respondent with
documentation establishing that she has been appointed as the guardian of R.M.R.'s estate. If
petitioner is not authorized by a court of competent jurisdiction to serve as guardian of the estate
of R.M.R., any such payment shall be made to the party or parties appointed by a court of
competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of R.M.R. upon
submission of written documentation of such appointment to the Secretary.
B. A lump sum payment of $3,852.60, representing compensation for past
unreimbursable expenses, in the form of a check payable to petitioner.
3 Should R.M.R. die prior to entry of judgment, the parties reserve the right to move the Court for appropriate relief. In particular, respondent would oppose any award for future medical expenses, future lost earnings, and future pain and suffering. 3 of 6 C. A lump sum payment of $563,848.98, representing compensation for satisfaction of
the State of Illinois Medicaid lien, payable jointly to petitioner and
Illinois Department of Healthcare & Family Services Bureau of Collections Technical Recovery Section P.O. Box 19174 Springfield, IL 62794-9174 Attn: Mr. Kevin Thornton Medicaid #: 96-080-091613
Petitioner agrees to endorse this payment to the State of Illinois.
D. An amount sufficient to purchase the annuity contract, 4 subject to the conditions
described below, that will provide payments for the life care items contained in the life care plan,
as illustrated by the chart at Tab A attached hereto, paid to the life insurance company 5 from
which the annuity will be purchased. 6 Compensation for Year Two (beginning on the first
anniversary of the date of judgment) and all subsequent years shall be provided through
4 In respondent’s discretion, respondent may purchase one or more annuity contracts from one or more life insurance companies. 5 The Life Insurance Company must have a minimum of $250,000,000 capital and surplus, exclusive of any mandatory security valuation reserve. The Life Insurance Company must have one of the following ratings from two of the following rating organizations:
a. R.M.R. Best Company: A++, A+, A+g, A+p, A+r, or A+s;
b. Moody's Investor Service Claims Paying Rating: Aa3, Aa2, Aa1, or Aaa;
c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-, AA, AA+, or AAA;
d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability Rating: AA-, AA, AA+, or AAA. 6 Petitioner authorizes the disclosure of certain documents filed by the petitioner in this case consistent with the Privacy Act and the routine uses described in the National Vaccine Injury Compensation Program System of Records, No. 09-15-0056. 4 of 6 respondent's purchase of an annuity, which annuity shall make payments directly to petitioner as
guardian of the estate of R.M.R., only so long as R.M.R. is alive at the time a particular payment
is due. At the Secretary's sole discretion, the periodic payments may be provided to petitioner in
monthly, quarterly, annual or other installments. The "annual amounts" set forth in the chart at
Tab A describe only the total yearly sum to be paid to petitioner and do not require that the
payment be made in one annual installment.
1. Growth Rate
Respondent proffers that a four percent (4%) growth rate should be applied to all non-
medical life care items, and a five percent (5%) growth rate should be applied to all medical life
care items. Thus, the benefits illustrated in the chart at Tab A that are to be paid through annuity
payments should grow as follows: four percent (4%) compounded annually from the date of
judgment for non-medical items, and five percent (5%) compounded annually from the date of
judgment for medical items. Petitioner agrees.
2. Life-Contingent Annuity
Petitioner will continue to receive the annuity payments from the Life Insurance
Company only so long as R.M.R. is alive at the time that a particular payment is due. Written
notice shall be provided to the Secretary of Health and Human Services and the Life Insurance
Company within twenty (20) days of R.M.R.’s death.
3. Guardianship
No payments shall be made until petitioner provides respondent with documentation
establishing that she has been appointed as the guardian of R.M.R.’s estate. If petitioner is not
authorized by a court of competent jurisdiction to serve as guardian of the estate of R.M.R., any
such payment shall be made to the party or parties appointed by a court of competent jurisdiction
5 of 6 to serve as guardian(s)/conservator(s) of the estate of R.M.R. upon submission of written
documentation of such appointment to the Secretary.
III. Summary of Recommended Payments Following Judgment
A. Lump sum paid to petitioner as court-appointed guardian of R.M.R.’s estate: $ 1,437,806.43
B. Paid to petitioner: $ 3,852.60
C. Medicaid Lien: $ 563,848.98
D. An amount sufficient to purchase the annuity contract described above in section II. D.
Respectfully submitted,
CHAD A. READLER Acting Assistant Attorney General
C. SALVATORE D’ALESSIO Acting Director Torts Branch, Civil Division
CATHARINE E. REEVES Deputy Director Torts Branch, Civil Division
ALEXIS BABCOCK Assistant Director Torts Branch, Civil Division
/s/Adriana Teitel ADRIANA TEITEL Trial Attorney Torts Branch, Civil Division U.S. Department of Justice P.O. Box 146 Benjamin Franklin Station Washington, D.C. 20044-0146 Telephone: (202) 616-3677
Dated: June 8, 2018
6 of 6 Appendix A: Items of Compensation for R.M.R. Page 1 of 15
Lump Sum Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9 2018 2019 2020 2021-2022 2023 2024 2025 2026 Insurance Premium 5% M 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 3,138.96 Insurance MOP Participating 5% 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 Insurance MOP Non-Participating 5% 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 Medicare Part B Premium 5% M Medicare Part B Deductible 5% Medicare Part D 5% M Medigap 5% M Dev Pediatrian 5% * Physiatrist 5% * Pediatrician/ Internist 5% * Orthopedist 5% * X-rays of Pelvis & Hips 5% * X-rays of Spine 5% * Urologist 5% * Labs: UA & Culture Sensitivity 5% * Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41 22.41 Neurologist 5% * Labs: CBC, CMP etc 5% * MRI of Brain 5% * Movement Disorder Clinic 5% * Botox Clinic 5% * Botox Inj 5% * Dentist 5% Optometrist 4% * Gastro-enterologist 5% * Nutritionist 4% * Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72 837.72 Scoliosis Screen 5% * Surgical Correction of Scoliosis 5% * Post Op X-rays 5% * TLSO 4% * Appendix A: Items of Compensation for R.M.R. Page 2 of 15
Lump Sum Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9 2018 2019 2020 2021-2022 2023 2024 2025 2026 G-Tube Revision 5% * Sleep Study 5% * Endometrial Ablation 5% * Hospitalization 5% * Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 Nitrofurantoin 5% * Felbamate 5% * Onfi 5% * Gabapentin 5% * Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00 286.00 Diazepam 2.5mg 5% * Diazepam 10mg 5% * Robinul 5% * Albuterol 5% * Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22 18.22 Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35 271.35 Adaptive Equip Eval 4% * Electric Bed 4% 9,551.58 Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80 83.80 Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99 52.99 Seizure Activity Monitor 4% 1,399.00 1,399.00 Reclining Shower Chair 4% 2,280.80 2,280.80 Hand Held Shower 4% 31.31 6.26 6.26 6.26 6.26 6.26 6.26 6.26 Rifton Chair 4% 3,545.00 3,905.00 Stander 4% * Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95 135.95 Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92 249.92 Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 YMCA 4% 916.00 816.00 816.00 816.00 816.00 816.00 816.00 816.00 Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00 250.00 Appendix A: Items of Compensation for R.M.R. Page 3 of 15
Lump Sum Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9 2018 2019 2020 2021-2022 2023 2024 2025 2026 WC Accessible Swing 4% 2,678.00 Special Needs Bike & Access 4% 1,420.00 1,420.00 Service Dog 4% 19,550.00 19,550.00 Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 Suction Machine 4% * Portable Suction Machine 4% * Suction Container Kit 4% * Yankauer Tip 4% * Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62 897.62 Nebulizer 4% * Nebulizer Mask 4% * Nebulizer Tubing 4% * Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69 2.69 Pulse Oximeter 4% * Stethescope 4% 43.07 8.61 8.61 8.61 8.61 8.61 8.61 8.61 Feeding Pump 4% * IV Pole 4% * Feeding Pump Set 4% * Enteral Oral Syringe 4% * Feeding Set 4% * Gauze 4% * Syringe 4% * Cotton Applicators 4% * Compleat 4% * Nutren 4% * Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40 152.40 Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 Diapers 4% M 1,191.49 1,191.49 1,191.49 Briefs 4% M 1,326.47 1,326.47 1,326.47 1,326.47 1,326.47 Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88 698.88 Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34 238.34 Appendix A: Items of Compensation for R.M.R. Page 4 of 15
Lump Sum Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9 2018 2019 2020 2021-2022 2023 2024 2025 2026 Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66 141.66 Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16 173.16 Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50 317.50 Supply Storage 4% 201.95 13.46 13.46 13.46 13.46 13.46 13.46 13.46 Bilateral AFOs 4% * Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00 130.00 WC Seating Eval & Clinic 4% * Quickie 4% * WC Maint 4% * 504.50 504.50 504.50 504.50 504.50 504.50 504.50 504.50 Backpack 4% 25.00 12.50 12.50 12.50 12.50 12.50 12.50 12.50 Portable Ramp 4% 339.00 Case Mngt 4% M 4,080.00 4,080.00 4,080.00 3,060.00 3,060.00 3,060.00 3,060.00 3,060.00 Home Mods 4% 77,307.00 Ceiling Lift 4% 11,000.00 Lift Motor Repl 4% Slings 4% 597.04 298.52 298.52 298.52 298.52 298.52 298.52 298.52 Lift Battery 4% 60.00 30.00 30.00 30.00 30.00 30.00 Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 Generator 4% 23,140.00 Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00 315.00 Car Seat 4% 2,640.00 WC Access Van 4% 53,061.00 45,101.85 AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00 114.00 Attendant Care 4% M 106,740.00 106,740.00 106,740.00 106,740.00 106,740.00 106,740.00 189,540.00 189,540.00 Lost Future Earnings 829,794.00 Pain and Suffering 250,000.00 Past Unreimbursable Expenses 3,852.60 Medicaid Lien 563,848.98 Annual Totals 2,005,508.01 159,193.61 159,253.61 158,338.59 167,343.39 158,338.59 305,790.44 250,690.17 Appendix A: Items of Compensation for R.M.R. Page 5 of 15
Lump Sum Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 1 Year 2 Year 3 Years 4-5 Year 6 Year 7 Year 8 Year 9 2018 2019 2020 2021-2022 2023 2024 2025 2026 Note: Compensation Year 1 consists of the 12 month period following the date of judgment. Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment. As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/ conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00), pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43. As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo, for past un-reimbursable expenses: $2,058.62. As soon as practicable after entry of judgment, respondent shall make the following payment jointly to petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98. Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment. Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment. Items denoted with an asterisk (*) covered by health insurance and/or Medicare. Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent. Appendix A: Items of Compensation for R.M.R. Page 6 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 2027 2028 2029 2030 2031 2032 2033 2034 Insurance Premium 5% M 3,417.96 3,524.64 3,631.32 3,746.16 3,861.12 Insurance MOP Participating 5% 7,350.00 7,350.00 7,350.00 7,350.00 7,350.00 Insurance MOP Non-Participating 5% 14,700.00 14,700.00 14,700.00 14,700.00 14,700.00 Medicare Part B Premium 5% M 1,608.00 1,608.00 1,608.00 Medicare Part B Deductible 5% 183.00 183.00 183.00 Medicare Part D 5% M 5,025.00 5,025.00 5,025.00 Medigap 5% M 3,888.00 3,888.00 3,888.00 Dev Pediatrian 5% * Physiatrist 5% * Pediatrician/ Internist 5% * Orthopedist 5% * X-rays of Pelvis & Hips 5% * X-rays of Spine 5% * Urologist 5% * Labs: UA & Culture Sensitivity 5% * Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41 22.41 Neurologist 5% * Labs: CBC, CMP etc 5% * MRI of Brain 5% * Movement Disorder Clinic 5% * Botox Clinic 5% * Botox Inj 5% * Dentist 5% 198.00 198.00 198.00 Optometrist 4% * Gastro-enterologist 5% * Nutritionist 4% * Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72 837.72 Scoliosis Screen 5% * Surgical Correction of Scoliosis 5% * Post Op X-rays 5% * TLSO 4% * Appendix A: Items of Compensation for R.M.R. Page 7 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 2027 2028 2029 2030 2031 2032 2033 2034 G-Tube Revision 5% * Sleep Study 5% * Endometrial Ablation 5% * Hospitalization 5% * Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 Nitrofurantoin 5% * Felbamate 5% * Onfi 5% * Gabapentin 5% * Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00 286.00 Diazepam 2.5mg 5% * Diazepam 10mg 5% * Robinul 5% * Albuterol 5% * Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22 18.22 Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35 271.35 Adaptive Equip Eval 4% * Electric Bed 4% Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80 83.80 Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99 52.99 Seizure Activity Monitor 4% 1,399.00 1,399.00 Reclining Shower Chair 4% 2,280.80 2,280.80 Hand Held Shower 4% 6.26 6.26 6.26 6.26 6.26 6.26 6.26 6.26 Rifton Chair 4% 3,905.00 Stander 4% * Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95 135.95 Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92 249.92 Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 YMCA 4% 816.00 816.00 816.00 816.00 816.00 816.00 816.00 816.00 Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00 250.00 Appendix A: Items of Compensation for R.M.R. Page 8 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 2027 2028 2029 2030 2031 2032 2033 2034 WC Accessible Swing 4% 2,678.00 Special Needs Bike & Access 4% 1,420.00 1,420.00 Service Dog 4% 19,550.00 Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 Suction Machine 4% * Portable Suction Machine 4% * Suction Container Kit 4% * Yankauer Tip 4% * Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62 897.62 Nebulizer 4% * Nebulizer Mask 4% * Nebulizer Tubing 4% * Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69 2.69 Pulse Oximeter 4% * Stethescope 4% 8.61 8.61 8.61 8.61 8.61 8.61 8.61 8.61 Feeding Pump 4% * IV Pole 4% * Feeding Pump Set 4% * Enteral Oral Syringe 4% * Feeding Set 4% * Gauze 4% * Syringe 4% * Cotton Applicators 4% * Compleat 4% * Nutren 4% * Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40 152.40 Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 Diapers 4% M Briefs 4% M 1,326.47 1,326.47 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88 698.88 Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34 238.34 Appendix A: Items of Compensation for R.M.R. Page 9 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 2027 2028 2029 2030 2031 2032 2033 2034 Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66 141.66 Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16 173.16 Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50 317.50 Supply Storage 4% 13.46 13.46 13.46 13.46 13.46 13.46 13.46 13.46 Bilateral AFOs 4% * Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00 130.00 WC Seating Eval & Clinic 4% * Quickie 4% * WC Maint 4% * 504.50 504.50 504.50 504.50 504.50 Backpack 4% 12.50 12.50 12.50 12.50 12.50 12.50 12.50 12.50 Portable Ramp 4% 339.00 Case Mngt 4% M 3,060.00 3,060.00 3,060.00 3,060.00 3,060.00 2,040.00 2,040.00 2,040.00 Home Mods 4% 77,307.00 Ceiling Lift 4% 11,000.00 Lift Motor Repl 4% 5,000.00 Slings 4% 298.52 298.52 298.52 298.52 298.52 298.52 298.52 298.52 Lift Battery 4% 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 200.00 Generator 4% Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00 315.00 Car Seat 4% WC Access Van 4% 45,101.85 AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00 114.00 Attendant Care 4% M 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 189,540.00 Lost Future Earnings Pain and Suffering Past Unreimbursable Expenses Medicaid Lien Annual Totals 241,417.59 254,641.07 245,661.27 241,871.11 241,986.07 290,104.30 318,859.25 225,452.45 Appendix A: Items of Compensation for R.M.R. Page 10 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 10 Year 11 Year 12 Year 13 Year 14 Year 15 Year 16 Year 17 2027 2028 2029 2030 2031 2032 2033 2034 Note: Compensation Year 1 consists of the 12 month period following the date of judgment. Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment. As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/ conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00), pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43. As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo, for past un-reimbursable expenses: $2,058.62. As soon as practicable after entry of judgment, respondent shall make the following payment jointly to petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98. Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment. Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment. Items denoted with an asterisk (*) covered by health insurance and/or Medicare. Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent. Appendix A: Items of Compensation for R.M.R. Page 11 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life 2035 2036 2037 2038 2039 2040-2076 2077-Life Insurance Premium 5% M Insurance MOP Participating 5% Insurance MOP Non-Participating 5% Medicare Part B Premium 5% M 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00 1,608.00 Medicare Part B Deductible 5% 183.00 183.00 183.00 183.00 183.00 183.00 183.00 Medicare Part D 5% M 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00 5,025.00 Medigap 5% M 3,888.00 3,888.00 3,888.00 3,888.00 3,888.00 3,888.00 3,252.00 Dev Pediatrian 5% * Physiatrist 5% * Pediatrician/ Internist 5% * Orthopedist 5% * X-rays of Pelvis & Hips 5% * X-rays of Spine 5% * Urologist 5% * Labs: UA & Culture Sensitivity 5% * Mileage: Doctors 4% 22.41 22.41 22.41 22.41 22.41 22.41 22.41 Neurologist 5% * Labs: CBC, CMP etc 5% * MRI of Brain 5% * Movement Disorder Clinic 5% * Botox Clinic 5% * Botox Inj 5% * Dentist 5% 198.00 198.00 198.00 198.00 198.00 198.00 198.00 Optometrist 4% * Gastro-enterologist 5% * Nutritionist 4% * Mileage: Doctors in MO 4% 837.72 837.72 837.72 837.72 837.72 837.72 837.72 Scoliosis Screen 5% * Surgical Correction of Scoliosis 5% * Post Op X-rays 5% * TLSO 4% * Appendix A: Items of Compensation for R.M.R. Page 12 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life 2035 2036 2037 2038 2039 2040-2076 2077-Life G-Tube Revision 5% * Sleep Study 5% * Endometrial Ablation 5% * Hospitalization 5% * Hippo Therapy 4% M 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 1,920.00 Aqua Therapy 4% M 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 7,306.50 Nitrofurantoin 5% * Felbamate 5% * Onfi 5% * Gabapentin 5% * Miralax 4% 286.00 286.00 286.00 286.00 286.00 286.00 286.00 Diazepam 2.5mg 5% * Diazepam 10mg 5% * Robinul 5% * Albuterol 5% * Vit D3 4% 18.22 18.22 18.22 18.22 18.22 18.22 18.22 Dulcolax 4% 271.35 271.35 271.35 271.35 271.35 271.35 271.35 Adaptive Equip Eval 4% * Electric Bed 4% 9,551.58 955.16 955.16 955.16 955.16 955.16 Mattress Underpad 4% 83.80 83.80 83.80 83.80 83.80 83.80 83.80 Mattress Cover 4% 52.99 52.99 52.99 52.99 52.99 52.99 52.99 Seizure Activity Monitor 4% 1,399.00 279.80 279.80 279.80 Reclining Shower Chair 4% 2,280.80 456.16 456.16 456.16 Hand Held Shower 4% 6.26 6.26 6.26 6.26 6.26 6.26 6.26 Rifton Chair 4% 3,905.00 650.83 650.83 650.83 650.83 650.83 650.83 Stander 4% * Benik Vest 4% 135.95 135.95 135.95 135.95 135.95 135.95 135.95 Collar 4% 249.92 249.92 249.92 249.92 249.92 249.92 249.92 Equip Maint Allowance 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 YMCA 4% 816.00 816.00 816.00 816.00 816.00 816.00 816.00 Dev, Therapeutic Toys & Equip 4% 250.00 250.00 250.00 250.00 250.00 250.00 250.00 Appendix A: Items of Compensation for R.M.R. Page 13 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life 2035 2036 2037 2038 2039 2040-2076 2077-Life WC Accessible Swing 4% 2,678.00 267.80 267.80 267.80 Special Needs Bike & Access 4% 1,420.00 284.00 284.00 284.00 Service Dog 4% 19,550.00 2,792.86 2,792.86 Dog Maint 4% M 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 1,404.40 Suction Machine 4% * Portable Suction Machine 4% * Suction Container Kit 4% * Yankauer Tip 4% * Oral Cleansing System 4% M 897.62 897.62 897.62 897.62 897.62 897.62 897.62 Nebulizer 4% * Nebulizer Mask 4% * Nebulizer Tubing 4% * Saline 4% 2.69 2.69 2.69 2.69 2.69 2.69 2.69 Pulse Oximeter 4% * Stethescope 4% 8.61 8.61 8.61 8.61 8.61 8.61 8.61 Feeding Pump 4% * IV Pole 4% * Feeding Pump Set 4% * Enteral Oral Syringe 4% * Feeding Set 4% * Gauze 4% * Syringe 4% * Cotton Applicators 4% * Compleat 4% * Nutren 4% * Bottle Adapter 4% M 152.40 152.40 152.40 152.40 152.40 152.40 152.40 Cath Kit 4% M 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 3,912.80 Diapers 4% M Briefs 4% M 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 1,451.79 Wipes 4% M 698.88 698.88 698.88 698.88 698.88 698.88 698.88 Disp Gloves 4% M 238.34 238.34 238.34 238.34 238.34 238.34 238.34 Appendix A: Items of Compensation for R.M.R. Page 14 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life 2035 2036 2037 2038 2039 2040-2076 2077-Life Hand Sanitizer 4% M 141.66 141.66 141.66 141.66 141.66 141.66 141.66 Barrier Cream 4% M 173.16 173.16 173.16 173.16 173.16 173.16 173.16 Underpads 4% M 317.50 317.50 317.50 317.50 317.50 317.50 317.50 Supply Storage 4% 13.46 13.46 13.46 13.46 13.46 13.46 13.46 Bilateral AFOs 4% * Toe Separator 4% 130.00 130.00 130.00 130.00 130.00 130.00 130.00 WC Seating Eval & Clinic 4% * Quickie 4% * WC Maint 4% * Backpack 4% 12.50 12.50 12.50 12.50 12.50 12.50 12.50 Portable Ramp 4% 339.00 33.90 33.90 33.90 Case Mngt 4% M 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00 2,040.00 Home Mods 4% Ceiling Lift 4% Lift Motor Repl 4% 5,000.00 500.00 500.00 500.00 Slings 4% 298.52 298.52 298.52 298.52 298.52 298.52 298.52 Lift Battery 4% 30.00 30.00 30.00 30.00 30.00 30.00 30.00 Lift Maint 4% 200.00 200.00 200.00 200.00 200.00 200.00 200.00 Generator 4% 23,140.00 1,157.00 1,157.00 1,157.00 Generator Maint 4% 315.00 315.00 315.00 315.00 315.00 315.00 315.00 Car Seat 4% WC Access Van 4% 45,101.85 6,443.12 6,443.12 AAA 4% 114.00 114.00 114.00 114.00 114.00 114.00 114.00 Attendant Care 4% M 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00 379,080.00 Lost Future Earnings Pain and Suffering Past Unreimbursable Expenses Medicaid Lien Annual Totals 418,897.45 425,194.86 416,598.44 452,855.24 484,228.95 428,813.08 428,177.08 Appendix A: Items of Compensation for R.M.R. Page 15 of 15
Compensation Compensation Compensation Compensation Compensation Compensation Compensation ITEMS OF COMPENSATION G.R. * M Year 18 Year 19 Year 20 Year 21 Year 22 Years 23-59 Years 60-Life 2035 2036 2037 2038 2039 2040-2076 2077-Life Note: Compensation Year 1 consists of the 12 month period following the date of judgment. Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment. As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/ conservators(s) of the estate of R.M.R. for the benefit of R.M.R., for lost future earnings ($829,794.00), pain and suffering ($250,000.00), and Yr 1 life care expenses ($358,012.43): $1,437,806.43. As soon as practicable after entry of judgment, respondent shall make the following payment to petitioner, Marissa Arevalo, for past un-reimbursable expenses: $2,058.62. As soon as practicable after entry of judgment, respondent shall make the following payment jointly to petitioner and the State of Illinois, as reimbursement of the state's Medicaid lien: $563,848.98. Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment. Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment. Items denoted with an asterisk (*) covered by health insurance and/or Medicare. Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent.