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Contreras v. Secretary of Health and Human Services

United States Court of Appeals, Federal Circuit

January 3, 2017

JESSIE CONTRERAS, Petitioner-Appellant
v.
SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent-Appellee

         Appeal from the United States Court of Federal Claims in No. 1:05-vv-00626-LJB, Senior Judge Lynn J. Bush.

          Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, argued for petitioner-appellant.

          Voris Edward Johnson, Jr., Vaccine/Torts Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent-appellee. Also represented by Benjamin C. Mizer, Vincent J. Matanoski, Rupa Bhattacharya, Linda Sara Renzi.

          Before Dyk, Mayer, and Hughes, Circuit Judges.

          Hughes, Circuit Judge.

         Jessie Contreras appeals from a U.S. Court of Federal Claims judgment upholding a Special Master's denial of compensation for his Guillain-Barre Syndrome and Transverse Myelitis allegedly caused by vaccinations. Because the Special Master improperly diagnosed Mr. Contreras and failed to consider relevant evidence related to his Guillain-Barre Syndrome, we vacate and remand for further proceedings consistent with this opinion.

         I

         On June 16, 2003, Jessie Contreras (Mr. Contreras), then thirteen years old, received the Tetanus-Diphtheria vaccine and his third inoculation of the Hepatitis B vaccine. Before he received these vaccinations, Dr. Fred Kyazze conducted a complete physical examination and determined that Mr. Contreras was healthy.

         Approximately twenty-four hours later, Mr. Contreras complained to his mother that he was experiencing back pain and numbness in his hands. She immediately took Mr. Contreras to the emergency room, where Dr. Mark Wagner, a board-certified emergency room physician, diagnosed him with atypical Guillain-Barre Syndrome (GBS), a peripheral nervous system disease that causes descending paralysis from the upper to lower extremities. J.A. 281; 586. Mr. Contreras's symptoms rapidly escalat-ed-within hours he had difficulty standing or walking, weakness in his arms, and required catheterization. Mr. Contreras was ultimately transferred to the pediatric intensive care unit at Miller Children's Hospital.

         Upon admittance at Miller Children's, Mr. Contreras was described as presenting "progressive neuromuscular deterioration and life-threatening respiratory failure." J.A. 288. Over the next three months, Mr. Contreras suffered from a variety of symptoms caused by his illness, including quadriplegia and acute respiratory failure. J.A. 289. Mr. Contreras was discharged from Miller Children's on September 11, 2003, with a discharge diagnosis of Transverse Myelitis (TM), an inflammatory disease of the spinal cord.[1] J.A 289; J.A. 608.

         On June 15, 2005, Mr. Contreras's father filed a petition for vaccine compensation under the Vaccine Act, alleging that Mr. Contreras suffered TM and GBS as the result of the vaccinations administered on June 16, 2003. Mr. Contreras's petition included affidavits from: (1) Dr. Kyazze; (2) Dr. Wagner; and (3) Dr. Jeremy S. Garrett, a general pediatrician and critical care physician, who treated Mr. Contreras during his admission to Miller Children's and ultimately diagnosed him with TM. Mr. Contreras also filed the expert report of pediatric neurologist Dr. Charles M. Poser, M.D., who concluded that he developed GBS and TM as a direct result of the administration of the vaccines.

         On October 7, 2005, the Secretary of Health and Human Services filed her Vaccine Rule 4 Report indicating that Mr. Contreras was not entitled to compensation because he had failed to establish, by a preponderance of the evidence, that either vaccine caused his condition. The Secretary also filed the expert report of pediatric neurologist John T. Sladky, M.D., who opined that Mr. Contreras only suffered from TM, not both TM and GBS, and that the time interval-less than twenty-four hours between the administration of Mr. Contreras's vaccines and the onset of his TM-was too soon for one or both of the vaccinations to have caused his condition.

         To address whether Mr. Contreras's illness had occurred within a medically-appropriate time-frame, Mr. Contreras submitted the medical expert report of pediatric neurologist Lawrence Steinman, M.D., who concluded that Mr. Contreras developed both GBS and TM caused by a rapid adverse immunological response to both vaccinations. In response to Dr. Steinman's report, the Secretary filed an expert report from immunologist J. Lindsay Whitton, M.D., Ph.D., who agreed that Mr. Contreras suffered from both GBS and TM, but disputed Dr. Steinman's theory of causation and the timing of Mr. Contreras's condition in relation to his vaccinations, reiterating that twenty-four hours was not enough time for either TM or GBS to develop after vaccination.

         On April 5, 2012, the Special Master issued his first decision (Contreras I) denying Mr. Contreras compensation under the Vaccine Act. See J.A. 30-64. The Special Master determined that Mr. Contreras only suffered from TM, not both TM and GBS. The Special Master then concluded that Mr. Contreras failed to establish that the TM arose within a "medically appropriate" timeframe following his vaccinations under the ...


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