next day and the answer that question is also the same so we have two subjects do we know that she developed the da syndrome the next day yes because her seizures started the next day your honor and now everybody agrees  had a genetic abnormality it doesn't mean she had drove a she's the only one in the world who has this particular mutation dr ayman admitted i don't know of any other case that has this particular variation in the sodium channel  on the basis that he predicted he could say for certain that she was going to have this course that's absolutely not true as a matter of fact he had met it in the literature shows us that a third to one half of the cases observe a syndrome that's where you think the finding of special master lord was arbitrary compressors and certainly abuse of discretion let's talk about dr raymond the only expert that this decision is relied upon dr a minute a five thirty one has seen forty his very own testimony he said that his main interest adrenal leukodystrophy have about five hundred gene types of been identified so far but he admitted that environmental factors can impact the expression of the disease even said head trauma can prompt initial onset of the disease but with disease at the door they say look i just revealed his main interest research ok but then when we start talking about there of a something that he's had four or five cases of experience with as opposed to his main area of interest we also know th least five hundred genome types that have been identified as well it's not a single gene that we're talking about here we're talking about multiple variations in the sodium channel he admits he's not an epilepsy expert a five thirty secs he admits that complex complex federal seizures can hurt children's brains of a five thirty seven you often read way yes absolutely because it was contrary to the fact that this decision is absolutely contrary to the evidence even looking at a tory which is a six eleven to a six thirty nine and if you will compare that with the court's questioning of dr raymond a six six nine to a six seven five and a five six eight the five seven seven you will find a special master who did everything her power to help dr raymond give her the language necessary to rule against this young girl and everything in her power to try to get dr torne atory to she was practically another department of justice attorney apologies i too that all i have i am sorry but she interrupted dr thorne a tory look at the transcript wouldn't let him finish answers to questions if you look at those two those portions that i'm asking you'll find out what i'm talking let's let's go back to leos in the brain that quickly it doesn't happen that way he testified it takes months for that to occur and i can give you a reference if you like but let me go on because dr the other thing that happened the sparrow is within two weeks she was diagnosed with  susceptible she gets a vaccination and we know that a third to a half of the cases of dervaes occur after this vaccine so she gets the vaccine the next day she has seizures she has multiple c she goes on to develop a chronic it doesn't become drove a's until after you start having seizures we don't know how many people there are who have her particular mutation and don't enter absolutely normal we do know that the parents of children who have sodium channel mutations where they do have seizures with kids have seizures we know their parents who have the same genes are actually normal so we know there's no wonder one relationship between if you have this gene you're going to have seizures the court was kind of like saying if i'm an auto in genetics was important this case but the vaccine precipitated the first seizure which part which was the onset of the nerve is the back pain also called callous because kawasaki is which gives spiking fevers which causes more seizure because the children are very susceptible to fever that point so the whole chain and if you look at special master millman sixty pages station dr a's was even talked about back then before they did a test and knew that she actually had a specific mutation so dr normally wasn't aware of the fact that the child had been diagnosed with tourette know and it wasn't till later when the child was tested and there was a fire gene finding that the war was the stage of the proceedings  that but i mean the diagnosis of dr a sort before the damages you know actually wasn't a matter of fact it may have been lining the timing may have been there but what happens is when you go to say the timing may have been there i don't know what you're saying i'm just trying to find out right when that who's getting ongoing medical treatment there comes a point time you're going to go to a hearing so you are going to keep collecting records you have we think we have enough wreck it's to decide the case the case was decided there the damages phase these records new records were sent to the part of justice they had the records for over a year before somebody looked at those records apparently and said oh there's travails there's a test that was done here so i don't know if the test was done before or after but the point is it was done in december two thousand and five ok the point is mental and developmental delays and has the court is well aware given the procedural history it was initially posited that this child neurologic condition resulted from a series of routine childhood immunizations  that special master the claims court and whatever difference you know which is what i was coming to in my argument and that is although this is a tragic case there is clearly all that needs to be applied to the facts in this  situation the first special masters decision special master milligrams decision occurred at a time when the record was not complete as this court has indicated in the summer of two thousand and five madison their vote did undergo genetic testing which came back with mr schumaker says there always for the tests as well as the records well this record is set prior to judgment i mean at any time up until the date of judgment a special master has the statutory authority to request additional listen there was a fair judgment made with respect to the oncet with respect to the connection there was no judgment made as far as the concept findings findings of fact were made on an incomplete record that's correct at the case occurred before judge mehlman that's correct the hearing occurred on september twentieth two thousand the drive a stick testing occurred in december of two thousand special master milnes decision occurred in december two thousand and seventeen that's correct your honor the medical records were requested because of an adverse decision against the government case moves into damages and it's not uncommon therefore for the parties to say that time i mean looking back we can say that the record was incomplete or not everything was in but the planning that was made at that at that time was that she was entitled to compensation so legally there was a finding of first decision was not irrevocable until actually damage or said been awarded a special master has the discretion to reopen a hearing based upon new evidence it happens routinely times in vaccine cases when making a putting his eggs in in a factual basket here he's asked us to go back and review carefully as what you responded to his argument the special master special master lord applied to correct lord she considered all of the relevant evidence of the finder of fact and properly determined the government had established a factor unrelated to vaccination by a preponderance of the evidence and that that was the cause of madison sr disorder and he prevail it must demonstrate that at the factor unrelated to vaccine was a sole substantial factor in causing that condition and the government did that in this case the special master and george miller below in reviewing all of the record evidence has many different points on it and you can get a spectrum of neurologic disorders but in madison's case the exact location of this particular malformation reliably results in a very severe  to the fact finder after previous decision of viability yes your honor i was either you or stone or ham and i believe it may have been the hammett case in which the evidence of the laboratory eighteen months prior to that hearing the first hearing in this case that is it was in existence and presumably within the petitioners control to produce it was not produced and government is not alleging any any  malfeasance on the part of the two but it just wasn't disclosed and it was outcome determined and unlike those other two cases this is a unique case in that that evidence will still want embargo from consideration on the prime aphasia this evidence when considering the petitioners prime officially the government maintains that had the special masters done some dishes would not have been successful in demonstrating that the vaccination was a substantial factor in consing medicine there are those in your logic condition it's also important to note that this is a vase syndrome case which means that medicine was born with the genetic malformation there are other people walking around with that particular gene mutation that don't have the unaware of the fact that they have that i mean taste in the basin the evidence in this case response or the secretary would say no that given this type of mutation it would manifest itself based on what is no  raman testify that as far as he knows that specific point mutation has not been written on but it is in a region of that general in which it is well known to cause very severe neurological this isn't  is a distinct known condition there are there are characteristics clinical characteristics for the diagnosis on page eighty ninety two of the special masters decision at the scotts is the core features required for classification syndrome were defined as following first normal harm to two and a motor development previous to seizure onset madison darrow had that up to about seven months of age she had normal development no seizures no evidence of cognitive delay for an infant the next is onset of seizures before one year her onset occurred at seven months seizures mainly triggered by fever which was in this case found to be a federal seizure long lasting seizures greater than fifteen minutes she seized approximately one hour at that time and later occurrence of various seizure types from brunel a from growth to develop both in the year following the onset of her first seizure and then finally later cognitive regression and importantly in the driveway syndrome the cognitive regression usually happens about a year later medi at that time but a year later she meets all of the classical definitions of dr a syndrome and that is the most severe prognosis for a child with this s c n one a gene mutation because every one of her such medication and so the evidence totality indicated that the vaccination played no role in her condition neither did a cause nor did aggravate its outcome the petitioner's comment  about a number of these cases being caused by or manifesting ongoing immunization is observational but not those same medical literature is indicated that despite a fever caused by vaccination the trigger is the onset of the first unmasking if you will of the underlying condition has no impact known to the ultimate outcome of the child's neurologic condition a special master considered all of this and determined that the petition appellant have not offered proof of any error but rather asking this court to reweigh the evidence and second guess the special masters fact intent sense of decision and well reasoned determinations instead this court must determine whether the special master consider the role a substantial factor that's why this can't be a sole substantial factor it's impossible because it we first of all we also know these things we know from dr raymond that drove a is not  those are two things that distinguishes us from hammond stone we're not alleging in this case as they did him it's known that the very first seizure was sufficient to cause all the brain injury if you read dr trying to tory's testimony he's saying that either that first seizure caused the brain injury or her subsequent seizure is due to the cow itzhak is which was due to the vaccines cause that injury which was demonstrated by m r i and by spectra spectroscopy a year later and i urge you to read his testimony in that subject which was never answered by d raymond if you go to your question yes from a syndrome is a syndrome as a matter of fact if you look back at the browser article one of the articles in the appendix i guess the last one the syndrome was described before we even had genetic tests so you're absolutely right it's a syndrome and we have to know what dr raymond says about that he says we don't know the incidence of s c n one of the general population that's eight by thirty eight he says an eight by thirty nine madison is the only one that's ever been reported with this particular mutation so the answer you question is we don't know how many people are out there walking around the same mutation they're absolutely normal what we do know is that children who have se and want to mutations and are second have driven a have parents and siblings who have the same mutation and are not are perfectly normal now what they're trying to say is ok so the the seizure started so the dervaes onset occurred after the vaccination but you know if it hadn't happened then somewhere along the line something else entirely most whatever else would have prized that medicine thirty eight so there's no reason to think that the fact she has me taishan would protect her from something we know can happen from a vaccine as a matter of fact is dr trying to tory's that it made her more susceptible it wasn't because it wasn't the sole substantial cause it was a cause a lot of these cases are cases where things come together to cause if that weren't the case that every child got a vaccine without a reaction this is to make their lives have noted your red light is on and conviction and passion about the case will take