Motion for Review Denial – Not Capricious to Reject Diagnoses


D’Angiolini v. HHS, Case No. 99-578V (Fed. Cl. Jul. 27, 2015) (Block, J)

Appeal from a denial of entitlement in a case alleging SLE, CFS and ASIA attributable to Hepatitis B vaccination.  The Special Master had ruled that Petitioner failed to establish that he suffered from CFS and SLE, and had failed to establish that the ASIA is a legitimate and generally accepted medical condition.

On appeal, Petitioner argued that the Special Master had imposed a heightened evidentiary burden by requiring “identification and proof of specific biological mechanisms” of how the hepatitis B vaccination can cause CFS.  But because the Court affirmed the Special Master’s factual finding that the Petitioner did not even have CFS, it was unnecessary to address the Special Master’s application of the Althen prongs.  The Court held that it was not arbitrary or capricious to reject the CFS diagnosis where the court applied a comprehensive analysis of the diagnostic criteria over twelve pages of its decision.

The Court also rejected the claim that the Special Master abused his discretion by failing to consider or discuss relevant evidence.  With respect to the claimed diagnosis of lupus, the Court noted that the Special Master likewise devoted over eleven pages of the opinion to a thorough analysis of whether the record evidence satisfied the diagnostic criteria for that disease as well.  In particular, the diagnosis of lupus had “never really crossed [the] mind” of the board-certified treating rheumatologist that had treated Petitioner for twelve years.  The Court observed that the Special Master thought Dr. Shoenfeld had stretched the application of the diagnostic criteria and was therefore not credible on that point.  In sum, the Court declined to second-guess the Special Master’s fact-intensive conclusions.

Petitioner also advanced a theory on appeal that the Special Master had abused his discretion by rejecting Dr. Shoenfeld’s testimony that the Hepatitis B vaccine can cause CFS, SLE, and ASIA.  Because the Special Master’s factual findings that Petitioner did not suffer from CFS or SLE were affirmed, the Court only reviewed this argument with respect to the ASIA claim.

The reviewing court held that the Special Master did not err by examining the conflicting expert testimony and determining that ASIA does not provide a biologically plausible theory for recovery.  The Special Master based his decision on testimony that ASIA’s criteria were changing and imprecise and that, as currently formulated, ASIA’s criteria cannot distinguish between afflicted and un-afflicted patients. Thus the Special Master’s determination that ASIA did not meet the minimum threshold for reliability was not arbitrary or capricious.

Finally, the Court held that the Special Master was not arbitrary and capricious in weighing the expert and treating physicians’ relative credibility.

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