Hinojosa v. Secretary of Health and Human Services

CourtUnited States Court of Federal Claims
DecidedAugust 19, 2016
Docket14-827
StatusUnpublished

This text of Hinojosa v. Secretary of Health and Human Services (Hinojosa v. Secretary of Health and Human Services) is published on Counsel Stack Legal Research, covering United States Court of Federal Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Hinojosa v. Secretary of Health and Human Services, (uscfc 2016).

Opinion

In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS (Filed: July 20, 2016) ****************************** LUCAS HINOJOSA, * Unpublished * Petitioner, * No. 14-827 v. * * Attorneys’ Fees and Costs; Contested SECRETARY OF HEALTH * Reasonable Basis. AND HUMAN SERVICES, * * Respondent. * ************************* Ronald Homer, Conway, Homer & Chin-Caplan, P.C., Boston, MA, for petitioner. Adriana Teitel, U.S. Department of Justice, Washington, DC, for respondent.

DECISION ON FINAL ATTORNEYS’ FEES AND COSTS1

Roth, Special Master:

On September 8, 2014, petitioner 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 he suffered from “an injury, including, but not limited to, neuropathy and myositis” as a result of an influenza (“flu”) vaccination administered to him on September 20, 2011. Petition (“Pet.”) at 1. On August 31, 2015, Chief Special Master Nora Beth Dorsey issued a decision dismissing petitioner’s claim for insufficient proof. Decision, ECF No. 31. Petitioner now requests an award for attorneys’ fees and costs pursuant to §15(e). After careful consideration, the undersigned has determined to grant the request in full for the reasons set forth below.

1 Because this unpublished decision contains a reasoned explanation for the action in this case, the undersigned intends to post it on the United States Court of Federal Claims' website, in accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services). 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, the undersigned agrees that the identified material fits within this definition, the undersigned 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa (2012). I. FACTS

Petitioner received a flu vaccine on September 20, 2011. Petitioner’s Exhibit (“Pet. Ex.”) 1 at 1. Prior to vaccination, he was a healthy 31 year old man who “exercised regularly” and was active both at work and at home. Pet. Ex. 15 at 1; Pet. Ex. 2 at 1-6. According to petitioner’s affidavit, his legs ached during his evening run on September 20, 2011, the day he received the allegedly causal vaccination, and felt sore afterwards; that night, he also had “chills and felt feverish” but claimed he did not have a fever. Pet. Ex. 15 at 2. He stated that he was unable to exercise regularly and his fatigue worsened over the next few weeks. Id. Petitioner visited his primary care physician, Dr. Alvaro Zamora, on October 19, 2011, complaining of fatigue, feeling foggy, “flashers in vision,” occasional headaches, forgetting his train of thought, and muscle weakness. Pet. Ex. 2 at 7. Dr. Zamora noted that the “[e]pisodes were more pronounced and more often after flu shot a few weeks ago.” Id. Dr. Zamora’s assessment was fatigue and malaise and he ordered several laboratory tests. Pet. Ex. 2 at 7-9. At a follow-up appointment on November 1, 2011, petitioner stated that in addition to worsening fatigue, he also had mood swings, an inability to concentrate, and lack of libido. Pet. Ex. 2 at 10. Dr. Zamora discussed petitioner’s laboratory results with him and expanded petitioner’s diagnosis to include hypogonadism, vitamin B-2 deficiency, and vitamin D deficiency. Pet. Ex. 2 at 10-11.

On December 15, 2011, petitioner met with a neurologist, Dr. Mavis Fujii. Dr. Fujii noted that petitioner complained of “fatigue, leg pain, some difficulty moving his legs, and some blurred vision.” Pet. Ex. 4 at 44. Petitioner was also experiencing shaking and numbness in his upper extremities. Id. Dr. Fuji’s impression was “[p]roximal upper and lower extremity weakness after a flu shot.” Id. at 46. Petitioner had nerve conduction studies and electromyography (“EMG”) of his lower extremities on December 20, 2011; the results were “consistent with a distal demyelinating motor polyneuropathy.” Id. at 35-40. A brain MRI performed that same day showed sinusitis. Id. at 63. A magnetic resonance image (“MRI”) of petitioner’s cervical spine showed a small disc protrusion at C7-T1, while an MRI of petitioner’s thoracic spine showed a disc protrusion at T7-T8 causing a “mild impression upon the right ventral cord.” Id. at 64-65. Petitioner also had small disc protrusions at T5-6, T6-7, T10-11, and T12-L1, none of which had “definite nerve root impingement.” Id. at 65. Petitioner had nerve conduction studies and an EMG of his upper extremities on December 28, 2011; the results were again “consistent with a distal demyelinating [sic] motor polyneuropathy.” Id. at 21.

Petitioner had a follow-up appointment with Dr. Fujii on January 9, 2012; Dr. Fujii noted that petitioner was experiencing increased leg pain and weakness. Id. at 13-15. She recommended an MRI of petitioner’s lumbar spine, as well as intravenous immunoglobulin (“IVIG”) and a lumbar puncture. Id. at 15. Petitioner had a lumbar puncture on January 17, 2012. Pet. Ex. 3 at 296. On the same day as the procedure, petitioner developed a headache and neck pain; at an ER visit on January 18, 2012, petitioner was diagnosed with a post-lumbar puncture headache and was given an epidural blood patch. Pet. Ex. 3 at 163, 184-186. At a follow-up appointment with Dr. Fujii on February 3, 2012, Dr. Fujii noted that petitioner was still complaining of nerve pain and right leg pain after the lumbar puncture. Pet. Ex. 4 at 10-12. Petitioner had an MRI of his lumbar spine on February 13, 2012; it showed “L5-S1 broad-based disc protrusion” and “shallow disc bulges at L4-L5 and T12-L1” however, none had nerve root contact. Id. at 62.

2 On February 21, 2012, petitioner presented to the ER with difficulty walking and weakness. Pet. Ex. 8 at 4. He had a follow-up appointment with Dr. Fujii on February 24, 2012; she noted that petitioner “had 2 episodes when he couldn’t stand [and] had to sit down,” and another episode “where [he] couldn’t stand/support self,” which lasted about 15 minutes. Pet. Ex. 4 at 7-9. Dr. Fujii ordered a muscle biopsy and advised petitioner to go on short term disability. Id. at 8. Petitioner had a left thigh muscle biopsy on March 13, 2012. Pet. Ex. 3 at 12-13. The biopsy results were mild to moderate “type I fiber atrophy.” Pet. Ex. 7 at 1-2.

Petitioner saw a second neurologist, Dr. Robert Glenn Smith, on May 11, 2012. Dr. Smith noted that the progression of petitioner’s symptoms may suggest a “post vaccination polyneuritis”; alternatively, petitioner’s progression suggests “that a metabolic problem, unmasked by the post-vaccination myalgias, is currently worsening.” Pet. Ex. 10 at 43. Petitioner underwent a non-ischemic forearm exercise test on October 16, 2012; results indicated that petitioner’s ongoing metabolic problem was likely to be longstanding. Id. at 20. At a follow up appointment with Dr. Smith on March 8, 2013, petitioner was noted to have myalgia and muscle weakness. Id. at 6.

II. PROCEDURAL HISTORY

Petitioner filed his petition on September 8, 2014. Pet. He filed several medical records and other supporting documentation, labeled as exhibit numbers 1 through 16, along with a statement of completion the following day.

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