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Nature of Suit Code: 484
Nature of Suit: 
Cause of Action: 

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United States Court of Appeals

for the Federal Circuit ______________________ 

JESSIE CONTRERAS,

Petitioner-Appellant

v.

SECRETARY OF HEALTH AND HUMAN 

SERVICES,

Respondent-Appellee

______________________ 

2015-5097

______________________ 

Appeal from the United States Court of Federal 

Claims in No. 1:05-vv-00626-LJB, Senior Judge Lynn J. 

Bush.

______________________ 

Decided: January 3, 2017

______________________ 

 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.

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2 CONTRERAS v. HHS

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 escalated—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, 

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CONTRERAS v. HHS 3

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 

 

1 Although TM and GBS are both “diseases in 

which portions of the nervous system are demyelinated,” 

J.A. 41, TM affects the central nervous system, which is 

protected by the blood-brain barrier, see J.A. 459, and 

GBS affects the peripheral nervous system, which is not 

protected by the blood-brain barrier, see id. 

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4 CONTRERAS v. HHS

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 third prong of Althen

v. Secretary of Health & Human Services, 418 F.3d 1274

(Fed. Cir. 2005). J.A. 62–63.

Mr. Contreras sought review and on September 28, 

2012, the Court of Federal Claims vacated and remanded 

Contreras I after concluding that the Special Master’s 

finding of a specific diagnosis was not in accordance with 

law (Contreras II). The Special Master was instructed, on 

remand, to refrain from making a determination regarding Mr. Contreras’s specific diagnosis. The Special Master was also instructed to analyze the evidence under all 

three prongs of Althen, address the weight afforded to 

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CONTRERAS v. HHS 5

Mr. Contreras’s treating physicians, address whether 

Mr. Contreras had ruled out all alternative causes for his 

condition, consider case reports, and more thoroughly 

discuss the evidence proffered in Dr. Poser’s report. 

J.A. 110–13. 

During the pendency of the decision on remand, the 

Secretary filed a status report disclosing that Dr. Sladky’s 

medical license was suspended during the time that he 

had provided the Government with expert witness services in this case. J.A. 118. Moreover, Dr. Sladky’s CV 

indicated that he was licensed to practice medicine in 

Pennsylvania, but that license expired in 1996, nine years 

before his initial report was filed in this case. Id. The 

Secretary maintained that these “undisclosed licensure 

issues should not affect the evidentiary weight of his

opinions.” J.A. 119. Mr. Contreras disagreed and argued 

that Dr. Sladky’s testimony should “carry little, if any 

weight,” J.A. 118, because his “lack of transparency and 

untruthfulness . . . bear on his bias and character critically undermining his credibility as an expert,” J.A. 119

(omission in original). 

On November 19, 2013, the Special Master again denied Mr. Contreras compensation (Contreras III). 

J.A. 114–90. First, the decision found that Dr. Sladky’s 

opinion “retain[ed] some value” after determining that 

“the lack of disclosure and (implicit) misrepresentation 

about qualification do[] not entirely negate [his] opinion.” 

J.A. 120. Next, the Special Master determined that 

Mr. Contreras did not suffer from GBS—a direct violation 

of the court’s instruction to refrain from diagnosing 

Mr. Contreras—and therefore based his analysis solely on 

the TM diagnosis. J.A. 143–45. Finally, he determined 

that “the one-day interval is not a time-frame for which it 

is medically acceptable” to conclude that the vaccine 

caused the injury. J.A. 189. 

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6 CONTRERAS v. HHS

Mr. Contreras again sought review and on May 19, 

2014, the Court of Federal Claims vacated and remanded 

Contreras III (Contreras IV). J.A. 191–214. The Court of 

Federal Claims was highly critical of the Special Master’s 

finding that Dr. Sladky’s opinion retained “some value” in 

light of his failure to disclose his suspended medical 

license and his lack of candor during his testimony regarding his credentials and job description. J.A. 212. On 

remand, the Special Master was instructed to: (1) address 

Dr. Sladky’s credibility and reliability in light of his 

misrepresentations; (2) compare Dr. Sladky’s credibility to 

the credibility of the experts and witnesses testifying for 

Mr. Contreras; and (3) issue an alternative ruling that 

completely disregards all of Dr. Sladky’s opinions and 

testimony. J.A. 212–13. 

On October 24, 2014, the Special Master issued a second Decision on Remand denying Mr. Contreras compensation (Contreras V). J.A. 215–74. The Special Master 

again determined that although Dr. Sladky had misrepresented his credentials, J.A. 242, his opinions were based 

upon “reliable methodologies” and, therefore, retained 

some value, J.A. 244–45. The Special Master also issued 

an alternative opinion that disregarded the opinions and 

testimony of Dr. Sladky, and concluded that 

Mr. Contreras’s expert, Dr. Steinman, had failed to establish by a preponderance of the evidence a proximate 

temporal relationship between the vaccination and the 

injury as required under prong three of Althen. J.A. 265–

66; 273–74. 

Mr. Contreras sought review for a third time, which 

the Court of Federal Claims denied on April 17, 2015

(Contreras VI). The court determined that the Special 

Master abused his discretion by crediting Dr. Sladky’s 

opinion and therefore vacated the entitlement ruling in 

Contreras III, which was incorporated into Contreras V. 

J.A. 7–18. The court also found that the Special Master

erred by conducting a “threshold inquiry into the specific 

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CONTRERAS v. HHS 7

diagnosis of [Mr. Contreras’s] alleged vaccine injury,” and 

by imposing “a higher burden on petitioner [on Althen

prong one] than is appropriate under Federal Circuit 

precedent,” but that both errors were harmless. See

J.A. 22–23; 26. Finally, the court determined that the 

Special Master’s alternate ruling on Althen prong three—

that twenty-four hours was too short of time to develop 

TM or GBS after a vaccine—contained no error of law or 

abuse of discretion. J.A. 27. Therefore, the court denied 

the petition for review. 

Mr. Contreras appeals. We have jurisdiction under 42 

U.S.C. § 300aa-12(f). 

II

The Federal Circuit reviews an appeal from the Court 

of Federal Claims in a Vaccine Act case de novo, “applying 

the same standard of review as the Court of Federal 

Claims applied to its review of the special master’s decision.” Griglock v. Sec’y of Health & Human Servs., 687 

F.3d 1371, 1374 (Fed. Cir. 2012) (citation omitted); see 

also Paluck v. Sec’y of Health & Human Servs., 786 F.3d 

1373, 1378 (Fed. Cir. 2015). “We give no deference to the 

Claims Court’s or Special Master’s determinations of law, 

but uphold the Special Master’s findings of fact unless 

they are arbitrary or capricious.” Griglock, 687 F.3d at 

1374 (citation omitted). We review discretionary rulings—i.e., exclusion of evidence or limitation of the record 

upon which the special master relies—under the abuse of 

discretion standard. Munn v. Sec’y of Health & Human 

Servs., 970 F.2d 863, 870 n.10 (Fed. Cir. 1992). Ultimately, “if the special master ‘has considered the relevant 

evidence of record, drawn plausible inferences and articulated a rational basis for the decision, reversible error will 

be extremely difficult to demonstrate.’” Hibbard v. Sec’y 

of Health & Human Servs., 698 F.3d 1355, 1363 (Fed. Cir. 

2012) (quoting Hines ex. rel. Sevier v. Sec’y of the Dep’t of 

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8 CONTRERAS v. HHS

Health & Human Servs., 940 F.2d 1518, 1528 (Fed. Cir. 

1991)). 

To establish that the vaccine caused the injury, a petitioner must prove, by a preponderance of the evidence: 

(1) a medical theory causally connecting the vaccination 

to the injury; (2) a logical sequence of cause and effect 

demonstrating that the vaccination caused the injury; and 

(3) a proximate temporal relationship between the vaccine 

and the injury. Althen, 418 F.3d at 1278. 

Here, the Court of Federal Claims determined that 

the Special Master erred by conducting a “threshold 

inquiry into the specific diagnosis of Jessie’s alleged 

vaccine injury,” but that the error was harmless. We 

disagree. 

In Hibbard, this court determined that if there is a 

dispute as to the nature of a petitioner’s injury, the special master may opine on the nature of the petitioner’s 

injury. 698 F.3d at 1365. Here, however, there was no 

dispute as to the nature of Mr. Contreras’s injury—both 

parties’ experts agreed that he suffered from TM and 

GBS. See J.A. 379; 426. Therefore, the Special Master 

erred by concluding that Mr. Contreras only suffered from 

TM and not both TM and GBS. 

That error was harmful. Based on this improper diagnosis, the Special Master did not consider relevant 

evidence related to GBS in his Althen analysis. See

J.A. 256 (“Mr. Contreras did not suffer from GuillainBarre syndrome.”); J.A. 145 (“[T]he following Althen

analysis is limited to the issue of whether the hepatitis B 

vaccine can cause transverse myelitis.”); J.A. 63 (“The 

testimony of . . . Dr. Whitton was consistent with medical 

literature that shows that, at a minimum, the blood brain 

barrier [which is only implicated in TM] would prevent an 

immune-mediated reaction in the spinal cord in one 

day.”); id. (“[Dr. Whitton’s] opinion is that ‘there is no 

credible hypothesis that would explain a 24-hour 

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CONTRERAS v. HHS 9

timeframe, which would tie a vaccine causally to the 

induction of such a profound central nervous system 

disease [TM].’” (citation omitted)). Although the Special 

Master noted that Dr. Whitton’s conclusion “would not 

change depending upon the demyelinating disease,” J.A. 

257, this does not mean that the Special Master considered evidence related to demyelinating disease GBS. In 

fact, to the contrary, the record supports the conclusion 

that the Special Master failed to consider the medical 

theories advanced by Dr. Steinman and Dr. Whitton 

relating to Mr. Contreras’s GBS diagnosis. See id. 

Because TM and GBS are separate diagnoses that affect different parts of the nervous system, we find that the 

Special Master committed reversible error by failing to 

consider relevant evidence related to GBS. Therefore, 

this case must be remanded once again for a proper 

consideration of the evidence. 

III

Ordinarily, this case would be remanded to the originally assigned Special Master. See Richardson ex. rel. 

Richardson v. Sec’y of Health & Human Servs., 89 Fed. 

Cl. 657, 660 (2009). In this instance, however, we believe 

that fundamental fairness is best served by assigning the 

case to a different special master on remand. See id.; 

Vaccine Rule 3(d). 

This case has a lengthy history, including two separate remands before the present appeal. The Special 

Master has consistently maintained that Mr. Contreras 

only suffers from TM—despite specific instructions that 

he must consider both the TM and GBS diagnoses. See

J.A. 111 (“The special master may not diagnose Jessie’s 

illness, but shall examine whether petitioner has established a prima facie case that he suffered a vaccinerelated combination of TM and GBS.”). Given that the 

Special Master has maintained an erroneous viewpoint

throughout this case, despite instructions to the contrary, 

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10 CONTRERAS v. HHS

we advise that this case be assigned to a different special 

master on remand. See United States v. Robin, 553 F.2d 

8, 10 (2d Cir. 1977) (“[Reassignment is advisable] [w]here 

a judge has made detailed findings based on evidence 

erroneously admitted or factors erroneously considered, 

[because] the circumstances sometimes are such that 

upon remand he or she . . . cannot reasonably be expected 

to erase the earlier impressions from his or her 

mind . . . .”); id. at 11 (“[W]here a judge has repeatedly 

adhered to an erroneous view after the error is called to 

his attention, reassignment to another judge may be 

advisable in order to avoid an exercise in futility (in 

which) the Court is merely marching up the hill only to 

march right down again.” (internal quotation marks and 

citations omitted)). 

IV

Because the Special Master committed reversible error by failing to consider relevant evidence related to 

Mr. Contreras’s Guillain-Barre Syndrome, we vacate and 

remand for further proceedings consistent with this 

opinion. On remand, the newly assigned special master 

shall issue comprehensive findings and conclusions as to 

all issues. In light of our disposition, we need not address 

the appellant’s other asserted errors, which may well be 

obviated by the findings and conclusions of the new 

special master on remand.

VACATED AND REMANDED

Costs to Contreras.

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