case in this particular situation the petition received a flu vaccine which subsequently led to the diagnosis and yes in the middle of the hearing the respondent brought up the issue that the plaintiffs a petition at that point had a preexisting case of and that's based on interpretation of an m r i and a special master issued a decision based on his ability to make a diagnosis but th i which isn't the special master have some basis to say that it's not likely those lesions then were caused by the vaccine they were more likely preexisting be performed every week there was a spirit of trying when it could be either one day or thirteen days of the lesions in his that was a general musing on the part of the authors the specific facts in this me and as i was indicating the specific facts in this particular case would render deck decisions suspect cotton itself the fact in this case the vaccine was administered and sorry the eleventh the symptoms occurred on christmas eve which is perhaps an eleven days later all parties agreed that that's an appropriate period of time the m r i took place on december thirtieth which is six days later now the cotton anchal specifically said that if we were able to do these m r i every week was frequently we would probably find that this in these people disappear at five days just like they do in the animal models so we have specifics in a moment of support in this particular case the lesions disappeared provided the special master had applied the proper legal standard this court had never indicated what the proper legal standard was is in an arc table significant  special master in a previous case issued what he called the loving decision and under the loving decision he decided that in a white cotton which is significant aggravation table case he would apply the standard is the reason again pretty good before you can give the aggravation you have to prove causation so he could because they standards of all of them along with the aggravation standard that is who is seeking asked table causation is treated in the same manner as somebody who is claiming significant amputation the statute specifically says a person for stuff an injury or a significant a additional three criteria are attached to a significant aggravation claim it seems that you have to prove causation before you can get to whether or not it was an aggravated right in this particular case that the genealogy is submitted then they're not required to evaluate the epidemiology with the eyes of the laboratory and a laboratory looks for statistical significance and it indicates that the requires statistical significance and we will a petition increase there are no studies out there that provides disco sickness primarily because this is a relatively where disorder and to demonstrate how relatively come to have all article actually needed to is there you will for us patients to develop a lot of study population large enough to even conduct an analysis and when you look at the data that submitted they indicated that they had roughly six hundred fifty patients and but they were looking at a period of time of less than one year and after that six hundred fifty eight patients only fifteen percent of those patients had received an immunization within one year of trying which might have delays in was in a very bad at this is rough it's under a hundred of which two point three percent had received that image vision within eight weeks or two months which was the study period in question two point three percent i calculate we could be two to three patients so even though there is a study out there when one looks at the data the data simply isn't large enough to join any statistical conclusions what can be stated and i believe these articles have pointed that out is that the risk benefit analysis is that it is still better to administer fl goes on to say which was caused by the vaccine that is show the aggravation has to be caused by the vaccine causation has to come for that is true and in this particular which is really problem why and the outgoing analysis indicated that he was not persuaded however this quote the the stench indicates that you must base a decision on the entire record the entire record in whose testimony and evidence yet a significant aggravation clane would require the evidence for a six punters and that seemingly elevates the burden of proof for a significant aggravation  statute seems to invision that they would be treated equally and the the court with the trap quite found that a legal error had been committed and that that doesn't end the case because of respond it has the ability to challenge the causation analysis he has the ability to challenge the theory and if the theory is deficient then the other two concepts out then and this statute can be used to support the claim to make preponderance evidence so in this case in this particular situation where he finds he could help the analysis at the  at the theory does not look at problem two which is a logical sequence of cause and effect and does not mention that in promptly both parties have already the greed that the eleven days post immunization is a proper immunological master he indicated that the case should have been and there you waited under both out then and a significant aggravation clane however he found that it harmless error because there was an implicit analysis of the problems two and three of l and the special master himself indicated that since he did not find what he calls pro contradicts the findings of the trial court and in this particular instance patricia here believes that there has been no proper legal analysis conducted in this please the court my name is deborah felt so badly that i represent the department of health and human services in today's case the scientific community and as a whole has looked for an association between the flu vaccine and multiple sclerosis and no association has been signed this is true both with regard to whether the flu vaccine causes multiple sclerosis or significantly aggravates it in fact based on these studies the american neurologic cademy has recommended that all patients with m receive the seasonal flu vaccination with regard to the special masters of the first portion of his decision he appropriately found that the petitioner's multiple sclerosis preexisted had flu vaccination his decision i'm changed in large part on the fact that petitioner didn't fact have s and that decision came out in july the citation the six eighty five s third thirteen seventy five and in that case it was a very similar condition similar situation where the petitioner allege i'm a chronic progressive illness like multiple sclerosis but in that case it was crohn's disease and the petitioner alleged in that case that because the special master determined as initial question whether the disease began before or after the vaccination to focus his analysis on whether he should do a causation in fact analysis of whether the vaccine caused the illness or significantly aggravated it was appropriate for the special master to focus only on the sniffing aggravation portion now and when i say that he still has to perform a complete health analysis but the petitioner would have the burden of both proving that the illness was significantly aggravated and two that the vaccination posit sniffing like evasion so well judge let so may have found that it was an error for the special master to first focus his decision on on the questions and some significant aggravation and he didn't have the benefit of this court's decision in all pain and looking in this court held that it was entirely appropriate relied on the cotton study which was submitted by petitioner to determine whether or not six not in times and lesions would would help him understand whether or not the disease preexist of the vaccination now it's important to note that in m s the disease process is initially clinically silence so we know that patients when they start the disease process will develop lesions in their brain and have no physical symptoms it's been proven that patients have ten that the conclusions of that the authors in the cotton seti are that on average lesions enhanced for an average of three weekly scans or a period of fifteen to twenty seven days but the article also following that half twenty eight percent people had these and that only in has for a shorter period of time but if you look at the cause article on the first page the authors indicated that when i'm in a tete a patient develops more than one lesions those lesions develop independently of one another and they resolve a different race in fact there's one study discussed later in the cotton article that had a number of lesions some lesions only enhance for two weeks while there are legions of hands for four weeks so there is no evidence that  took that average and compared with against petitions case so potentially an expert acknowledge that it would have taken at least three days if it's not true up to two weeks for british not even begin forming lesions in brain so the special master found that it would be highly unlikely that all six of those little lesions would have forms and would have fully resolved in within seventeen days given that if under petitioner's theory some of those  late as fifteen days post tax the nation it would have had to resolve within two days the special master found just that the preponderance of evidence here supported the fact that the cation are likely developed and just before hand on the second issue the special master properly evaluate a significant aggravation the statute does require petitioner both show that there was a significant aggravation and the court and white cotton laid up with the sniffing aggravation test is it least for table  we know for example that patients with m s will get worse so if a patient has a vaccination and then suffers a relapse sometime thereafter is that something unusual or is that something that's the the  that some patients after receiving the flu vaccine did experience a clinical relapse at some point after the vaccination and that's a study when she says she indicated that there were eleven patients or more patients that had relapses after the back scene than those who didn't receive the vaccine but the other specifically looked at that and it's on page eighty two sixty three of the others found that of the patients that did receive the vaccine and did have a relapse the the time period between the back scene and the relapse was over ninety days so the authors actually took that as further evidence that supports the vaccine did not cause the relapses in those cases and it didn't change their recommendation it's finally just to address a couple additional issues that were discussed in petitioners grace there are no treating doctors in this case that have found that none of the teachers treating doctors suggested that as multiple sclerosis was caused by  support that position and it was an article that discussed a test that was done and tested and what was done at the number of antigens were taken in cross reacted against human mylan basic protein which is thought to be the protein attacked in others dead and he said that he just simply hadn't done so when he was asked on cross examination if the article he presented the what you're finding article had been used by any other scientist to draw an association that the flu vaccine can cause multiple sclerosis his response was that study was never and that that study was never meant to show something like that would respondents admitted in response to that actually showed that any human model of this medical immunity just simply wasn't occurring so based on the record as a whole the special master fully considered all the evidence in front of him he probably  the blood was drawn by two from two m f patients and those she cells were drawn out and they were stimulated to determine whether they would react against my own basic proteins that's controlled they did react against my  protect up with the respondents indicating that simply because influenza a which is part of the tribe in vaccines with not the vaccine that this article has no significance but in fact