Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca13-16-02096/USCOURTS-ca13-16-02096-0/pdf.json

Parties Involved:
D. A. C.
Appellant
Darius Canuto
Appellant
Teresita A. Canuto
Appellant
Secretary of Health and Human Services
Appellee

Document Text:

NOTE: This disposition is nonprecedential.

United States Court of Appeals 

for the Federal Circuit ______________________ 

DARIUS CANUTO AND TERESITA A. CANUTO, 

PARENT(S) OF, D. A. C., A MINOR,

Petitioners-Appellants

v.

SECRETARY OF HEALTH AND HUMAN 

SERVICES,

Respondent-Appellee

______________________ 

2016-2096

______________________ 

Appeal from the United States Court of Federal 

Claims in No. 1:04-vv-01128-RJY, Senior Judge Robert J. 

Yock.

______________________ 

Decided: October 4, 2016

______________________ 

DARIUS CANUTO, TERESITA A. CANUTO, D.A.C., 

Northridge, CA, pro se. 

VORIS EDWARD JOHNSON, JR., Vaccine/Torts Branch, 

Civil Division, United States Department of Justice, 

Washington, DC, for respondent-appellee. Also represented by BENJAMIN C. MIZER, RUPA BHATTACHARYYA, 

CATHERINE E. REEVES. 

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2 CANUTO v. HHS

______________________ 

Before O’MALLEY, BRYSON, and STOLL, Circuit Judges.

PER CURIAM. 

Petitioners Darius and Teresita Canuto (“the Canutos”), on behalf of their son, D.A.C., seek an award under 

the National Childhood Vaccine Injury Act, 42 U.S.C. 

§§ 300aa-1 to -34 (2012), as compensation for his autism, 

which they allege was caused by his receiving a series of 

diphtheria, tetanus, and pertussis (“DTP”) vaccinations. 

A Special Master of the United States Court of Federal 

Claims found that the Canutos had not established under 

any credible medical theory that D.A.C.’s autism had been 

caused by the DTP vaccinations and denied the Canutos’ 

claim. See Canuto v. Sec’y of Health & Human Servs., No. 

04-1128V, 2015 WL 9854939 (Fed. Cl. Sp. Mstr. Dec. 18, 

2015). After a thorough consideration of the record, the 

United States Court of Federal Claims affirmed the 

Special Master’s decision and denied the Canutos’ motion 

for review. See Canuto v. Sec’y of Health & Human 

Servs., No. 04-1128V, 2016 WL 2586510 (Fed. Cl. Apr. 18, 

2016). We affirm. 

BACKGROUND

The relevant facts are primarily those found by the 

Special Master in his detailed decision, issued December 

18, 2015. See Canuto, 2015 WL 9854939, at *6–16.

D.A.C. was born on July 17, 2000, in Bocaue, Philippines. 

His pediatrician noted on early visits that D.A.C. was a 

“well baby.” D.A.C. received several vaccines in the 

Philippines, in particular two doses of “Tritanrix” (combined DTP and hepatitis B). In 2001, after relocating to 

Los Angeles, California, D.A.C. received additional vaccines, including combined diphtheria, tetanus, and acellular pertussis (“DTaP”) and haemophilus influenza type B 

(“Hib”). 

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CANUTO v. HHS 3

At his one-year check-up on August 3, 2001, D.A.C.’s

pediatrician noted that he had poor weight gain and was 

“lagging behind” on speech and language milestones. The 

pediatrician found D.A.C. negative for adverse vaccine 

reactions. D.A.C.’s medical records give no indication of 

any serious injury or medical conditions over the next 

several years; however, it is clear that D.A.C. continued to 

struggle developmentally. In late 2003, he was diagnosed 

with severe to profound expressive and receptive language disorder.

On March 15, 2004, the Canutos took D.A.C. to a developmental behavioral pediatrician who diagnosed 

D.A.C. with autism. Despite a chronological age of 44 

months, his linguistic skills tested at a developmental age 

of 30.4. He displayed delayed language skills, difficulty 

interacting with peers, limited play skills, and repetitive 

behavior such as tightening his fists and echoing speech. 

In March 2006, a psychoeducational assessment of D.A.C. 

confirmed his prior diagnosis of autism.

The Canutos, on behalf of D.A.C., filed a Short-Form 

Autism Petition for Vaccine Compensation (“Petition”) on 

July 6, 2004, thus joining the Omnibus Autism Proceedings (“OAP”) and adopting the Master Autism Petition for 

Vaccine Compensation. After the OAP test cases became 

final, the Canutos pursued their case individually. On 

December 18, 2005, the Special Master issued his decision 

denying the Canutos’ claim as lacking any credible theory 

of causation between the covered vaccines administered 

and D.A.C.’s condition. After their motion for review was

denied by the Court of Federal Claims, the Canutos 

appeal to this court, alleging that the Special Master 

failed to consider certain relevant evidence.

We have jurisdiction under 42 U.S.C. § 300aa-12(f).

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4 CANUTO v. HHS

STANDARD OF REVIEW

In cases brought under the Vaccine Act, we review a 

ruling by the Court of Federal Claims de novo, applying 

the same standards it applies when reviewing decisions of 

the Special Master. LaLonde, v. Sec’y of Health & Human 

Servs., 746 F.3d 1334, 1338–39 (Fed. Cir. 2014) (citing 

Moberly ex rel. Moberly v. Sec’y of Health & Human 

Servs., 592 F.3d 1315, 1321 (Fed. Cir. 2010)). We review 

legal determinations to ensure they are in accordance 

with accepted law, and we do not disturb findings of fact 

unless they are arbitrary or capricious. See id. at 1339. 

As this court has said on more than one occasion in this 

context: 

[I]t is not . . . the role of this court to reweigh the 

factual evidence, or to assess whether the special 

master correctly evaluated the evidence. And of 

course we do not examine the probative value of 

the evidence or the credibility of the witnesses. 

These are all matters within the purview of the 

fact finder. 

Munn v. Sec’y of Health & Human Servs., 970 F.2d 863, 

871 (Fed. Cir. 1992). The reviewing court should look to 

see whether “the [S]pecial [M]aster has considered the 

relevant evidence of record, drawn plausible inferences 

and articulated a rational basis for the decision.” Hines v. 

Sec’y of Health & Human Servs., 940 F.2d 1518, 1528 

(Fed. Cir. 1991). If so, the ruling must stand.

DISCUSSION

To receive compensation under the Vaccine Act, a petitioner must demonstrate, by a preponderance of the 

evidence, that the vaccinated person received a covered 

vaccine and either: (1) suffered an injury, condition, or a 

significant aggravation of a preexisting injury or condition 

listed in the Vaccine Injury Table within the requisite 

time frame; or (2) suffered an injury, condition, or signifiCase: 16-2096 Document: 27-2 Page: 4 Filed: 10/04/2016
CANUTO v. HHS 5

cant aggravation of a preexisting injury or condition not

listed in the Table “but which was caused” by a covered 

vaccine. 42 U.S.C. §§ 300aa-11(c)(1)(C) (emphasis added), 

300aa-14; 42 C.F.R. § 100.3 (2011); LaLonde, 746 F.3d at

1338.

For a condition that is not listed in the table, the petitioner must prove their claim by a “preponderance of the 

evidence”—they “must do more than demonstrate a 

‘plausible’ or ‘possible’ causal link between the vaccination 

and the injury.” W.C. v. Sec’y of Health & Human Servs., 

704 F.3d 1352, 1356 (Fed. Cir. 2013) (citing Moberly, 592 

F.3d at 1322). To prove actual causation, it is the petitioner’s burden to demonstrate:

by preponderant evidence that the vaccination 

brought about [the] injury by providing: (1) a medical theory causally connecting the vaccination 

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

effect showing that the vaccination was the reason 

for the injury; and (3) a showing of a proximate 

temporal relationship between vaccination and injury.

Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274, 

1278 (Fed. Cir. 2005). A petitioner must prove their 

theory of causation by medical literature or by the medical opinion of an expert witness. Id. at 1279–80. If the 

petitioner meets this burden, they are entitled to recover 

under the Vaccine Act unless the government is able to 

prove—by preponderant evidence—that the injury was 

caused by factors unrelated to the vaccination. Id. at 

1278.

The Canutos’ Informal Brief on appeal alleges that

the Special Master failed to consider certain evidence 

which would have, if properly addressed, proved their 

theory of causation between vaccines and autism. The 

evidence submitted by the Canutos in this case consisted 

chiefly of medical records, medical literature, parental 

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6 CANUTO v. HHS

testimony, and the expert report of Dr. Levin. The Special Master, in his decision, addressed each category of 

evidence in turn, weighed all available evidence, and

applied the Althen test to determine whether the Canutos 

had met their burden under the law. The Special Master 

found that the Canutos failed to satisfy any of the Althen

test’s three prongs. 

Examining the Canutos’ testimonial evidence, the 

Special Master found significant conflict with the history 

contained in the medical records. The Canutos alleged by 

way of affidavits that D.A.C. was allergic to the vaccinations he received, causing him to develop seizures arising 

from adverse reactions to the vaccinations as early as 

eight months of age. The Special Master found no contemporaneous indication in the submitted medical records, however, of an adverse reaction to any of the 

administered vaccines. On the contrary, pediatricians 

repeatedly noted that D.A.C. had no adverse reactions. 

The Special Master also found no contemporaneous 

references in the medical records to D.A.C.’s alleged 

seizures, or any references to muscle spasms or other 

seizure-like behavior. The Special Master noted that, for 

D.A.C.’s pediatricians to “not recognize and not record a 

description of a seizure in one instance would be unusual 

enough,” but at least two of the alleged seizures occurred 

around the same time D.A.C. visited the pediatrician for

sick visits. Canuto, 2015 WL 9854939, at *12. The Special Master correctly attributed more weight to the evidence contained in the medical records than to later filed 

submissions and affidavits by the parents of the child. 

Because of their impartial nature, medical records strongly “warrant consideration as trustworthy evidence.” 

Cucuras v. Sec’y of Health & Human Servs., 993 F.2d 

1525, 1528 (Fed. Cir. 1993). 

Turning to the expert reports, the Special Master 

found the report submitted by Dr. Wiznitzer for the 

Secretary to be highly credible and Dr. Levin’s report 

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CANUTO v. HHS 7

submitted for the Canutos to be not credible, for several 

reasons. First, Dr. Wiznitzer’s training and specialization 

make him more qualified to offer an expert opinion in this 

matter. Dr. Wiznitzer is a specialist in pediatric neurology, with an extensive understanding of autism and other 

pediatric neurodevelopmental disorders. Dr. Levin, on 

the other hand, is a specialist in oncology and hematology, 

and has comparatively little experience with such disorders.

Second, Dr. Levin’s expert report presents a medical 

theory that the Special Master found to be “largely, if not 

entirely, unsupported speculation.” Canuto, 2015 WL 

9854939, at *21. Dr. Levin’s theory of causation was 

based on the general rise of autism rates in the United 

States, his unsubstantiated claim that the DTP vaccine 

“has been related to later development of autism,” and his

claim that the DTP vaccine “caused fever, seizures and 

encephalitis in this case”—a claim that, once again, 

contradicts the available medical records. Canuto, 2015 

WL 9854939, at *15. Dr. Levin failed to produce any 

scientific support for the notion that the DTP vaccine can 

cause autism generally, let alone evidence that it actually 

caused autism in D.A.C.’s specific case.

Finally, the Special Master noted that the Levin report “was mistaken on the critical point of identifying the 

type of vaccinations that DAC actually received,” misidentifying one of the vaccines received in 2001 as a DTP 

vaccine when it was in fact a DTaP vaccine—a vaccine 

which his own report describes as much safer than the 

DTP vaccine. Canuto, 2015 WL 9854939, at *21–22. 

Moreover, the Special Master observed that Dr. Levin’s 

summary of D.A.C.’s medical history seemed to “link the 

onset of” fever, which Dr. Levin purports as the root cause 

of D.A.C.’s autism, “to D.A.C.’s Hib vaccination of March 

30, 2001, and not to any of his DTP or DTaP vaccinations.” Canuto, 2015 WL 9854939, at *23 (emphasis 

added).

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8 CANUTO v. HHS

The Special Master also noted that, even if Dr. Levin’s 

underlying medical theories were taken at face value, he 

did not “offer any explanation for how such a reaction”—

like the one D.A.C. allegedly experienced following the 

Hib vaccination—“could ultimately lead to autism.” 

Canuto, 2015 WL 9854939, at *22. The Special Master 

thus ultimately concluded that Dr. Levin’s opinion was 

“wholly unpersuasive regarding every element necessary 

to proving causation-in-fact.” Canuto, 2015 WL 9854939, 

at *21.

The Canutos’ Informal Brief alleges that the Special 

Master and Court of Federal Claims failed to consider 

evidence regarding the “regulation of brain ions.” But Dr. 

Levin’s report contained no reference to brain ions. In 

addition, though the Special Master did not specifically 

mention brain ions in his decision, he did expressly refer 

to the multiple and voluminous submissions proffered by 

the Canutos, describe his search through those submissions, and note his subsequent finding that their theories 

of causation—including necessarily those relating to 

“brain ions”—“do not constitute a medical or expert opinion” and “therefore have very little evidentiary value.” 

Canuto, 2015 WL 9854939, at *17.

To succeed under the Althen test, the Canutos must 

provide by preponderant evidence a medical theory that 

causally connects the vaccination and the injury, a logical 

sequence of cause and effect that shows that the vaccination was the reason for the injury, and a proximate temporal relationship between the vaccination and the injury. 

Althen, 418 F.3d at 1278. The evidence that the Canutos 

presented is contradicted by the medical record, internally 

inconsistent, and fails to fully address causation. The 

Special Master, considering that evidence, drew plausible 

inferences and articulated a rational basis under Althen

to deny the Canutos’ claim.

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CANUTO v. HHS 9

CONCLUSION

Because the Special Master applied the appropriate 

legal framework and evidentiary standards to his analysis, and because his factual findings and weighing of 

evidence demonstrated plausible inferences and rationality, we discern no error in the United States Court of 

Federal Claims’ judgment that the Special Master did not 

rule arbitrarily or capriciously in denying the Canutos’ 

claim. See 42 U.S.C. § 300aa-13(a)(1)(A); Hines, 940 F.2d 

at 1528.

AFFIRMED

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