Background
Jennifer and Charles Williford sought compensation under the National Childhood Vaccine Injury Act for injuries sustained by their daughter, R.W., after she received Tdap and meningococcal vaccines in September 2015. Sixteen days later, R.W. developed rapidly progressing leg weakness and paralysis, ultimately leaving her with paraplegia, bowel and bladder dysfunction, and scoliosis.
The parents alleged that the vaccinations caused transverse myelitis. The special master denied compensation, finding that the preponderance of the evidence instead supported acute flaccid myelitis, likely virally mediated. The parents moved for review, contending that the special master arbitrarily discounted treating physicians, medical records, and their experts’ evidence favoring transverse myelitis.
The Court’s Holding
Judge Carolyn N. Lerner affirmed the special master’s decision and denied the motion for review. The court held that the special master’s factual conclusion that R.W. more likely had acute flaccid myelitis rather than transverse myelitis was not arbitrary or capricious.
The special master reasonably relied on R.W.’s gray-matter-predominant MRI findings, rapid onset and progression, persistent absent reflexes and low muscle tone, lack of response to immunotherapies, positive Rhinovirus A29 test, and Duke physicians’ view that the condition was probably virally mediated. Because the petitioners did not prove the specific injury underlying their vaccine-causation theory, that finding alone defeated the claim. The court also upheld the alternative causation finding: the record supported a possible vaccine connection to transverse myelitis, but not to acute flaccid myelitis.
Key Takeaways
- In an off-Table Vaccine Act claim, petitioners must prove the specific injury on which their causation theory rests.
- On review, the Court of Federal Claims cannot reweigh competing medical evidence or substitute its judgment for the special master’s plausible factual findings.
- A special master may credit later, more complete treating-physician assessments over an earlier diagnosis when the record and expert evidence support doing so.
Why It Matters
The decision underscores the demanding deference afforded to special masters’ medical factfinding in Vaccine Act cases. Even where a claimant presents substantial evidence supporting an initial diagnosis, the court will uphold a contrary diagnosis if the special master considered the competing evidence, made plausible inferences, and explained the decision rationally.
It also confirms that timing alone cannot establish causation. Petitioners alleging an off-Table injury must connect the particular injury they prove to the vaccine through a legally sufficient causation theory.