W.C. v. Secretary of Health & Human Services

704 F.3d 1352, 2013 WL 151714, 2013 U.S. App. LEXIS 1069
CourtCourt of Appeals for the Federal Circuit
DecidedJanuary 15, 2013
DocketNo. 2012-5058
StatusPublished
Cited by503 cases

This text of 704 F.3d 1352 (W.C. v. Secretary of Health & Human Services) is published on Counsel Stack Legal Research, covering Court of Appeals for the Federal Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
W.C. v. Secretary of Health & Human Services, 704 F.3d 1352, 2013 WL 151714, 2013 U.S. App. LEXIS 1069 (Fed. Cir. 2013).

Opinion

RADER, Chief Judge.

The United States Court of Federal Claims affirmed the special master’s decision denying W.C. (Petitioner) compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa~l to -34 (Vaccine Act). W.C. v. Sec’y of Health & Human Servs. (Trial Court Decision), 100 Fed.Cl. 440 (2011). Because the special master’s factual determinations were not arbitrary or capricious and the decision was in accordance with law, this court affirms.

I.

Petitioner alleges that an influenza vaccination he received at the age of thirty-four resulted in the onset of multiple sclerosis or significantly aggravated his preexisting, but asymptomatic, multiple sclerosis. Trial Court Decision, 100 Fed.Cl. at 443. Multiple sclerosis is a disorder of the central nervous system that causes clinical symptoms including weakness, loss of coordination, speech disturbances, and visual complaints. Id. at 443 n. 2. The cause of multiple sclerosis is unknown. W.C. v. Sec’y of Health & Human Servs. (Special Masters Decision), No. 07-456V, 2011 WL 4537877, at *3 (Fed.Cl. Feb. 22, 2011). For many years, researchers have considered multiple sclerosis to be an autoimmune disease. Id. The disease may begin with a breach in the blood-brain barrier that allows cells from the immune system to cross into the brain. Id. These immune cells may mistakenly attack the myelin sheath that coats nerve cells. Id. This attack would cause inflammation and subsequent scarring of the brain, called lesions. Id.

Petitioner suffers from the most common type of multiple sclerosis, known as relapsing remitting multiple sclerosis. Id. at *4. Patients with this type of multiple sclerosis usually have about one relapse of clinical symptoms per year. Id. “Much of the disease process is clinically silent,” meaning that a person can have active brain inflammation and develop new lesions without experiencing relapse (i.e., clinical symptoms). Bruce D. Trapp and Klaus-Armin Nave, Multiple Sclerosis: An Immune or Neurodegenerative Disorder?, 31 Annu. Rev. Neurosci. 247, 249 (2008). Brain imaging studies in patients with multiple sclerosis “indicate that inflammatory brain lesions can outnumber relapses by as much as 10 to 1.” Id. In this context, the term “clinical symptoms” refers to the outwardly-visible symptoms associated with a relapse (e.g., numbness and loss of motor function), as distinguished from elinically-silent brain lesions, which are also a symptom of multiple sclerosis.

Medical professionals use magnetic resonance imaging (MRI) to observe lesions in the brain of a patient diagnosed with or suspected to have multiple sclerosis. Id. at *6. By administering a contrast agent called gadolinium before an MRI, medical professionals can locate active inflammation at the site of a brain lesion. Id. In active brain inflammation, a breakdown in the blood-brain barrier permits gadolinium to enter the brain. Id. When gadolinium enters the brain, active lesions appear on an MRI as “enhanced.” Id. After inflammation subsides, the body repairs the blood-brain barrier and lesions no longer appear enhanced. Id. Most new lesions (approximately 90%) first appear as enhanced on MRI for a period of time, while older lesions do not enhance. Id. The trial court dedicated considerable time to considering the length of time that new lesions appear enhanced on MRI. See Part III. B. below.

Petitioner received the influenza vaccine on December 13, 2004. Special Masters Decision, 2011 WL 4537877, at *1. Before then, Petitioner had no clinical symptoms [1355]*1355of multiple sclerosis or other neurological problems. Id. On December 24, 2004, Petitioner experienced numbness in his left hand, arm, and the left side of his head and face. Id. An MRI performed on December 30, 2004 identified six scattered lesions in Petitioner’s brain, none of which were enhanced on the gadolinium MRI. Id. at *7. The interpreting physician noted the “MRI in conjunction with the patient’s clinical history suggest multiple sclerosis as a possible etiology.” Id. at *1.

Petitioner experienced another episode of numbness and loss of motor function in his left hand and arm in January 2005. Id. at *2. Petitioner then saw a neurologist, Dr. John Hannam, who suggested that Petitioner might have multiple sclerosis. Dr. Hannam noted that “if [Petitioner] had [multiple sclerosis], I can’t blame it on the flu shot.” Id. Dr. Hannam recommended a second opinion from Dr. Rifaat Bashir, who specializes in multiple sclerosis. Id. Dr. Bashir noted that Petitioner’s MRI “is certainly consistent with a demyelinating disease. He could have had a single isolated event possibly related to his vaccination which he did receive two weeks before the event.” Id. After two additional MRIs, the latter of which showed a new, enhanced lesion, Dr. Bashir diagnosed Petitioner with multiple sclerosis. Id. at *3.

Petitioner filed a claim for compensation under the Vaccine Act in June 2007, alleging the influenza vaccine caused his multiple sclerosis or significantly aggravated his pre-existing, subclinical multiple sclerosis. In support of his claim, Petitioner presented an expert report and testimony by Dr. Carlo Tornatore, the director of the Multiple Sclerosis Center at Georgetown University Hospital. Id. at *4. Dr. Tornatore opined that the influenza vaccine caused Petitioner’s multiple sclerosis through a process called “molecular mimicry.” Id. In this process, the immune system attacks normal proteins in the body because they are structurally similar to foreign substances, such as viral or bacterial peptides. Id. at *11. Specifically, Dr. Torna-tore opined that portions of the influenza vaccine mimic myelin basic protein, a component of the central nervous system that is implicated in multiple sclerosis. Id. According to Dr. Tornatore’s theory, the influenza vaccine could trigger production of immune cells (called T-cells) that are “cross-reactive” with myelin and therefore attack the person’s own nerve cells. Id.

On February 22, 2011, the special master denied Petitioner compensation under the Vaccine Act. Id. at *1. The special master found Petitioner had multiple sclerosis before receiving the influenza vaccine and therefore the vaccine could not have caused Petitioner’s disease. Id. Further, the special master found Petitioner did not establish a plausible medical theory that the influenza vaccine causes significant aggravation of multiple sclerosis. Id. The Court of Federal Claims affirmed. Trial Court Decision, 100 Fed.Cl. at 456. Petitioner appeals, and this court has jurisdiction under 42 U.S.C. § 300aa-12(f).

II.

When reviewing decisions under the Vaccine Act, this court “performs the same task as the Court of Federal Claims and determines anew whether the special master’s findings were arbitrary or capricious.” Lampe v. Sec’y of Health & Human Sens., 219 F.3d 1357, 1360 (Fed.Cir. 2000).

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704 F.3d 1352, 2013 WL 151714, 2013 U.S. App. LEXIS 1069, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wc-v-secretary-of-health-human-services-cafc-2013.