1

In the United States Court of Federal Claims 

OFFICE OF SPECIAL MASTERS

No. 17-1004V

Filed: November 7, 2018

PUBLISHED

ANNE KNUDSON,

 Petitioner,

v.

SECRETARY OF HEALTH AND 

HUMAN SERVICES,

 Respondent.

Special Processing Unit (SPU);

Decision Awarding Damages; 

Decision on the Written Record; 

Tetanus, Diphtheria, Acellular 

Pertussis (Tdap) Vaccine; Shoulder 

Injury Related to Vaccine 

Administration (SIRVA)

Shealene Priscilla Wasserman, Muller Brazil, LLP, Dresher, PA, for petitioner.

Christine Mary Becer, U.S. Department of Justice, Washington, DC, for respondent.

DECISION AWARDING DAMAGES1

Dorsey, Chief Special Master:

On July 26, 2017, petitioner filed a petition for compensation under the National 

Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.,

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(the “Vaccine 

Act”). Petitioner alleges that she suffered a left shoulder injury caused by her Tetanus, 

Diphtheria, Acellular Pertussis (“Tdap”) vaccination. Petition at 1. The case was 

assigned to the Special Processing Unit of the Office of Special Masters and the 

undersigned issued a Ruling on Entitlement finding petitioner entitled to compensation 

for a Shoulder Injury Related to Vaccine Administration or “SIRVA.” For the reasons 

discussed below, the undersigned now awards compensation in the amount of 

$110,305.07.

 

1 The undersigned intends to post this decision on the United States Court of Federal Claims' website. 

This means the decision will be available to anyone with access to the internet. In accordance with 

Vaccine Rule 18(b), petitioner has 14 days to identify and move to redact medical or other information, 

the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, the 

undersigned agrees that the identified material fits within this definition, the undersigned will redact such 

material from public access. Because this unpublished decision contains a reasoned explanation for the 

action in this case, undersigned is required to post it on the United States Court of Federal Claims' 

website in accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal 

Management and Promotion of Electronic Government Services).

2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for 

ease of citation, all “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 

300aa (2012).
2

I. Procedural History 

On July 26, 2017, along with her petition, petitioner filed medical records and an 

affidavit marked as exhibits 1-6. (ECF No. 1). However, petitioner did not file a 

statement of completion until August 3, 2017. (ECF No. 9). Subsequently, during the 

initial status conference held September 7, 2017, petitioner indicated that she would 

inquire as to whether there were more detailed vaccination records. (ECF No. 10). On 

September 12, 2017, petitioner filed a more detailed vaccination record marked as 

exhibit 6.

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(ECF No. 11). On October 18, 2017, petitioner filed additional medical 

records marked as exhibit 7. (ECF No. 15). 

On April 23, 2018, respondent filed his Rule 4(c) report in which he conceded 

that petitioner was entitled to compensation in this case. (ECF No. 26). On April 23, 

2018, the undersigned issued a ruling on entitlement finding petitioner entitled to 

compensation for her SIRVA. (ECF No. 28). The parties then began the process of 

negotiating the appropriate amount of damages.

On May 3, 2018, petitioner filed a status report indicating the parties had reached 

an impasse during settlement discussions. (ECF No. 30). Petitioner filed a status 

report on May 8, 2018 clarifying that the issue of disagreement concerned the 

appropriate amount to award petitioner for her past pain and suffering. (ECF No. 32). 

Petitioner indicated that she was not alleging ongoing sequela subsequent to January 

30, 2017. Id. Petitioner asserted that she preferred to resolve damages through briefs 

(and ruling on the record) while respondent would defer to the Court. Id. On May 9, 

2018, a scheduling order was issued noting that the undersigned was amenable to 

proceeding with a briefing schedule and setting a deadline for a joint status report. 

(ECF No. 33). In the scheduling order, the undersigned urged the parties to consider

mediation. Id. On May 18, 2018, the parties filed a joint status report indicating that 

they felt mediation would be inappropriate in this case. (ECF No. 34). The report noted 

that petitioner intended to file pain and suffering affidavits for consideration. Id. On July 

3, 2018 and July 11, 2018, petitioner filed affidavits marked as exhibits 8-15 (ECF Nos. 

36, 38). On August 27, 2018, the parties filed a joint status report indicating that the 

evidentiary record in the case was complete and that they wished to proceed to a 

decision on the written record. (ECF No. 41). 

The parties filed simultaneous briefs discussing the damages issues in this case

on October 9, 2018. (ECF Nos. 43, 44). This case is now ripe for a determination 

regarding petitioner’s pain and suffering award of damages. 

 

3 Because petitioner had previously designated her affidavit as Exhibit 6, this record will be referred to 

herein as Exhibit 6a.
3

II. Relevant Medical History

Petitioner received a Tdap vaccination in her left shoulder on March 14, 2016. 

Ex. 1 at 2; Ex. 6a at 1. The available medical evidence of record does not reflect a 

history of left shoulder impairment. 

Approximately two weeks following her vaccination, on March 31, 2016, 

petitioner presented to Nicholas Franssen, NP, at Aspirus Medford Hospital with 

complaints of “left arm soreness after a Tdap injection on [March 14, 2016].” Ex. 2 at 

214. Petitioner reported that her pain started in the “deltoid/mid bicep area” and 

radiated to the elbow. Id. She stated that she experienced pain with movement of her 

arm and rated her current pain as “8” out of “10.” Id. On examination, petitioner was 

observed to have muscle strength of 5/5 in both upper extremities and no evidence of 

joint swelling. Id. at 215. Mr. Franssen suggested over-the-counter NSAIDs or 

acetaminophen for pain control and recommended a course of physical therapy for 

treatment of petitioner’s symptoms. Id. 

On April 1, 2016, petitioner presented to Andrew Rawlsky, DPT, at Aspirus 

Pleasant View Outpatient Therapies for an initial evaluation. Ex. 4 at 1-4. Petitioner 

reported that she had not “been able to [move] her [left] arm” since receiving her Tdap 

vaccination and rated her current pain as “6” out of “10.” Id. at 1-2. An examination of 

petitioner’s left shoulder documented evidence of positive Neer impingement, 90

degrees of active flexion range of motion, 90 degrees of abduction, and 50 degrees of

external rotation. Id. at 2. Petitioner attended a total of four physical therapy sessions 

through May 6, 2016. Id. at 1-12. In a discharge summary completed on May 24, 2016, 

Mr. Rawlsky noted that petitioner continued to experience shoulder pain, but her overall 

symptoms had improved. Id. at 11. Petitioner was to continue with a home exercise 

program. Id. 

On April 15, 2016, petitioner presented for a follow-up visit with Mr. Franssen 

with complaints of recurrent left upper extremity pain that started after her Tdap 

vaccination. Ex. 2 at 225. Petitioner reported pain when putting her arm behind her 

back and radiation of pain from her neck through the elbow and wrist area. Id. 

Petitioner indicated that her physical therapy treatment had provided only limited 

improvement of her symptoms. Id. She rated her current pain as “4” out of “10.” Id. 

On examination, Mr. Franssen observed that petitioner presented with decreased range 

of motion of the left upper extremity, pain with movement of the arm behind the back, 

pain with lifting the arm above 20 degrees, and muscle strength of 4/5. Id. at 226. Mr. 

Franssen prescribed Mobic and referred petitioner for further orthopedic evaluation and 

treatment. Id. at 227, 229. 

On April 18, 2016, petitioner presented to Kelsey J. Krug, PA-C,4 at Bone & Joint 

at Medford for evaluation of left arm pain that began after her Tdap injection on March 

 

4 The available medical records contain references to both “Kelsey J. Krug, PA-C” and “Kelsey J. Brost, 

PA-C” as petitioner’s treating provider at Bone & Joint at Medford. See, e.g., Ex. 3 at 3, 7. A review of 
4

14, 2016. Ex. 3 at 26. Petitioner indicated that her pain had improved by 75% after 

taking Mobic and rated her current pain as “1-2” out of “10.” Id. However, petitioner 

reported that she continued to experience radiating pain from the bicep into the superior 

shoulder with rotation of the arm. Id. On examination, petitioner presented with 

tenderness to palpation along the left biceps and distal biceps tendon and exhibited 

pain with empty can and resisted deltoid and shoulder external rotation. Id. at 29-30. 

Given petitioner’s favorable response to medication, Ms. Krug advised her to continue 

taking Mobic and further recommended that she continue formal physical therapy. Id. at 

31. 

On May 9, 2016, petitioner returned for a follow-up visit with Ms. Krug. Id. at 35. 

Petitioner continued to report pain in the bicep area that radiated into the superior 

shoulder with rotation of the arm, pushing, and abduction. Id. In addition, petitioner 

noted that she experienced constant numbness of the left upper arm. Id. at 39. On 

examination, petitioner presented with tenderness to palpation over the left biceps and 

triceps and exhibited pain with flexion and abduction of the left shoulder. Id. at 38. Ms. 

Krug recommended that petitioner undergo EMG/NCV testing of her left upper extremity 

and continue physical therapy. Id. at 39. 

On June 8, 2016, petitioner presented to Kulpreet K. Sahota, M.D., at Bone & 

Joint Center to undergo EMG/NCV testing. Id. at 73. Petitioner reported that she had 

experienced left arm pain “since a tetanus shot in March/April 2016” with decreased grip 

strength. Id. at 73. However, petitioner denied numbness or tingling, dropping objects, 

or nocturnal paresthesia. Id. EMG/NCV testing of petitioner’s left upper extremity 

revealed evidence of “moderate left ulnar mononeuropathy via entrapment of the ulnar 

nerve by the deep flexor-pronator aponeurosis.” Id. at 75. The aforementioned 

EMG/NCV testing revealed no electrodiagnostic evidence of an axonal neuropathy, left 

peripheral polyneuropathy, left median mononeuropathy, left upper limb myopathy, left 

cubital tunnel syndrome of the left ulnar nerve, or left brachial plexopathy. Id. 

On June 22, 2016, petitioner returned for a follow-up visit with Ms. Krug. Id. at 

17. Petitioner reported that her “pain [had] remained the same since her last visit” with 

bicep pain radiating into the superior shoulder with rotation of the arm, pushing, and 

abduction. Id. On examination, petitioner was observed to have normal range of 

motion of the left upper extremity with no tenderness to palpation, normal sensation, 

and negative Neer’s and Hawkins testing. Id. at 19. Ms. Krug referenced petitioner’s 

subjective report of “mild discomfort at times” in the area of the bicipital groove 

extending into the biceps muscle; however, Ms. Krug noted that she was unable to 

reproduce this sensation on physical examination. Id. Ms. Krug prescribed Mobic and 

recommended that petitioner’s care be transferred to Dr. Glennon for surgical 

consultation. Id. at 20. 

 

the applicable records indicates that these two names refer to the same individual. Accordingly, for 

purposes of clarity, this decision will hereafter refer to this treating provider as “Kelsey J. Krug, PA-C.” 
5

On August 23, 2016, petitioner underwent an MRI of the left shoulder, which 

revealed mild longitudinally oriented partial-thickness tear of the infraspinatus tendon; 

mild supraspinatus and infraspinatus tendinopathy; small subcortical cysts and mild 

subcortical bone marrow edema over the posterior-superior-lateral aspect of the 

humeral head adjacent to the infraspinatus tendon insertion site; and minimal 

subacromial-subdeltoid bursitis. Ex. 2 at 109-10. The MRI revealed no evidence of 

biceps tenosynovitis. Id. 

On August 30, 2016, petitioner returned for a follow-up visit with Ms. Krug and 

reported that her symptoms remained unchanged. Ex. 3 at 3. On examination, 

petitioner was observed to have normal range of motion of the left upper extremity with 

no tenderness to palpation, normal sensation, and negative Neer’s and Hawkins testing. 

Id. at 5. Ms. Krug diagnosed petitioner with non-traumatic partial left rotator cuff tear, 

left humerus subcortical cysts, ulnar nerve entrapment, and numbness in the left arm. 

Id. at 6-7. Ms. Krug recommended that petitioner continue with her oral antiinflammatory medication, ice, and activity modifications until she made a decision 

regarding further treatment options. Id. at 6. 

On September 20, 2016, petitioner presented to Owen B. Keenan, M.D., at 

Marshfield Clinic – Marshfield Center for an initial evaluation of “left shoulder 

difficulties.” Ex. 5 at 17. Petitioner reported that she had experienced constant 

discomfort localized from the acromion down to the elbow that was “especially involved” 

with weight-bearing activities. Id. Nevertheless, petitioner indicated that her shoulder 

pain had improved “by about 95%” over time. Id. An examination of petitioner’s left 

shoulder documented 145 degrees of flexion, 150 degrees of abduction, and 65 

degrees of external rotation. Id. at 18. Additionally, petitioner was observed to have 

“some winging” on the left-hand side, “good” strength, “marked” discomfort to resisted 

external rotation and abduction, and “very positive” Hawkins testing. Id. An in-office xray of petitioner’s left shoulder revealed minimal subcortical sclerosis of the greater 

tuberosity at the rotator cuff footprint, likely reactive to the known rotator cuff 

tendinopathy; and early left acromioclavicular arthrosis. Id. at 20. In comparing the

aforementioned x-ray with petitioner’s MRI from August 2016, Dr. Keenan opined that at 

least some of the findings on imaging appeared to be the product of chronic changes 

rather than a discrete injury caused by petitioner’s vaccination. Id. at 18. Dr. Keenan 

ultimately concluded that petitioner likely had a full thickness rotator cuff tear and 

recommended surgical intervention. Id. at 18-19. 

On September 30, 2016, petitioner presented to Mirela E. Sandru, M.D., at 

Marshfield Clinic – Marshfield Center for a preoperative evaluation for left shoulder 

arthroscopy. Id. at 21-25. At that time, petitioner reported “some” pain in her shoulder 

but presented on examination with grossly normal muscle strength and tone. Id. at 24. 

On October 14, 2016, petitioner underwent a left shoulder arthroscopy and 

subacromial bursectomy procedure with Dr. Keenan at Marshfield Clinic - Marshfield 

Center. Id. at 32-33. The operative report notes that, in contradiction to the August 
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2016 MRI scan of petitioner’s left shoulder, her rotator cuff looked “excellent” with no 

abnormalities. Id. The operative report otherwise contains findings of “very mild” 

ascending tenosynovitis of the biceps tendon with no fraying and “excellent” 

appearance of the superior labrum and articular surface of the head/neck glenoid. Id. at 

33. The operative report indicates that the procedure was completed without 

complications, drains, or specimens. Id. 

On October 18, 2016, petitioner presented to Vivienne Neerdaels, OTR, CHT, 

CLT, at Flambeu Hospital for an initial evaluation following her arthroscopic surgery.

Ex. 7 at 1. Petitioner denied experiencing pain at rest but stated that “light activity” 

could produce pain of “3” out of “10.” Id. From October 18, 2016 through December 21, 

2016, petitioner presented for a total of nine5 physical therapy sessions. Id. at 1-23. At 

her final physical therapy visit on December 21, 2016, petitioner reported that her 

shoulder condition had improved compared to her pre-surgical condition, but she still 

experienced “achiness when reaching outwards and overhead.” Id. at 19. She was 

assessed as having shoulder strength ranging from “4” to “5” with 160 degrees of 

flexion, 60 degrees of extension, 150 degrees of abduction, 60 degrees of internal 

rotation, and 90 degrees of external rotation. Id. at 21. Petitioner was discharged from 

physical therapy with a home exercise program. Id. 

On November 28, 2016, petitioner returned for a follow-up visit with Dr. Keenan 

at Marshfield Clinic – Marshfield Center. Ex. 5 at 59. Petitioner reported that she was 

not currently taking any medications and was able to sleep on her left side. Id. 

However, petitioner noted that “[w]eather does bother her shoulder just a little bit.” Id. 

Overall, Dr. Keenan recorded that petitioner was doing “great” and advised her to 

continue with her physical therapy program. Id. At a subsequent treatment session 

with Dr. Keenan on January 30, 2017, petitioner reported that she had begun swimming 

again and was “having no trouble with [her] arm at all.” Id. at 60. Petitioner denied 

experiencing any pain. Id. On examination, Dr. Keenan observed that petitioner 

presented with “excellent” strength and 150 degrees of forward flexion, 165 degrees of 

abduction, and 75 degrees of external rotation. Id. Dr. Keenan concluded that 

petitioner was ready to be discharged from routine follow up and would thereafter be 

treated on an as-needed basis. Id. 

III. Affidavits Filed by Petitioner

On July 26, 2017, petitioner filed an affidavit pursuant to § 11(c)(1). Ex. 6. In her 

affidavit, petitioner asserted that she suffered a left shoulder injury caused by the Tdap 

 

5 Petitioner’s brief in support of damages asserts that petitioner presented for a total of 11 physical 

therapy sessions from October 18, 2016 through December 21, 2016. Petitioner’s Brief at 5. Although 

petitioner was scheduled for 11 physical therapy sessions during the period in question, the applicable 

records reflect a “no-show” appointment on November 29, 2016 and a cancelled appointment on 

December 14, 2016. Ex. 7 at 16, 18. Accordingly, petitioner actually attended only nine physical therapy 

sessions from October 18, 2016 through December 21, 2016.
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vaccination she received on March 14, 2016. Id. at ¶3. Petitioner averred that she 

suffered the residual effects of her injury for more than six months and had not received 

an award or settlement for the injury. Id. at ¶¶4-5.

On July 3, 2018 and July 11, 2018, petitioner filed additional affidavits from Rick 

Fahrenkrug (her father), Eric Knudson (her husband), Rebecca Macholl (her friend and 

former co-worker), Meredith Hueckman (her friend), Terese Ellis (her friend), and 

Kathleen Knox (her friend). Exs. 8-9, 12-15. Petitioner also submitted two additional 

affidavits in which she provided a more detailed description of her medical history and 

the impact of her shoulder injury on her activities of daily living. Exs. 10-11.

In his affidavit, Mr. Fahrenkrug described how petitioner lost her normal ability to 

care for her children due to her arm injury. Ex. 8 at ¶6. Mr. Fahrenkrug claimed that 

petitioner suffered from “continuously intense pain” and sleep disturbance due to 

“extreme discomfort,” but nevertheless was able to balance her family obligations and

job duties as the director of a community pool. Id. at ¶7. Mr. Fahrenkrug cited the 

period following petitioner’s October 2016 surgery as especially difficult due to the 

driving limitations ordered by her physicians. Id. at ¶¶8-9. During this post-surgical 

period, Mr. Fahrenkrug recounted that he was “very concerned about [petitioner’s] 

physical and emotional stability.” Id. at ¶8. 

Petitioner’s husband, Eric Knudson, echoed several of Mr. Fahrenkrug’s claims 

in his affidavit. Mr. Knudson emphasized that petitioner’s injury and subsequent 

treatment limited her ability to care for their children, complete chores, and maintain 

attendance at work. Ex. 14 at ¶¶4-6. Mr. Knudson recounted an episode following 

petitioner’s surgery in which she briefly lost consciousness after he removed a catheter 

from her arm. Id. at ¶5. Mr. Knudson alleged that two of his children witnessed this 

episode and were “very traumatized” because they thought their mother had died. Id. 

The affidavits from Ms. Macholl, Ms. Hueckman, Ms. Ellis, and Ms. Knox reiterate 

that petitioner’s injury caused physical and emotional distress and led to significant 

disruptions of her ability to work, care for her family, and perform recreational activities. 

Exs. 9, 12-13, 15. 

In her two detailed affidavits, petitioner provided a description of her medical 

history and the impact of her shoulder injury on her activities of daily living. In her first 

affidavit dated approximately one year following her shoulder injury, petitioner described 

how she experienced difficulties with sleeping, caring for her children, working, 

performing ballet, and swimming. Ex. 10 at ¶¶2-3. Petitioner noted that her pain had 

improved but “remain[ed] problematic.” Id. at ¶3. Although she described her surgery 

as providing some symptom relief, she averred that she still experienced weakness, 

residual “catching” of her arm, and episodes of itching. Id. at ¶¶5-6.

In petitioner’s second detailed affidavit dated approximately two years following 

her shoulder injury, petitioner indicated that she had completed a “nearly full recovery.” 

Ex. 11 at ¶5. Petitioner stated that her current symptoms were limited to occasional 
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pain in her left shoulder and itching due to surgical scars. Id. Nevertheless, petitioner

reported that she was capable of swimming, performing ballet, and hugging her 

children. Id. 

IV. Party Contentions 

Petitioner requests reimbursement of $305.07 for past mileage expenses. 

Petitioner’s Brief (“Pet. Brief”) at 1. Respondent states that he does not object to that 

amount. Respondent’s Brief (“Res. Brief”) at 1 n.1. Thus, the only disputed issue 

before the undersigned is the amount of damages to be awarded for pain and suffering.

Petitioner argues that she should be awarded $130,000.00 in compensation for 

pain and suffering. Pet. Brief at 1. Petitioner asserts that “[p]etitioners in the Vaccine 

Program with analogous SIRVA injuries are routinely awarded comparable damages to 

what Ms. Knudson is seeking for her personal pain and suffering.” Id. at 5. Petitioner 

compares the instant case to two prior cases in which damages were decided by the 

undersigned. Id. at 5-7. Specifically, petitioner cites: Collado v. HHS, No. 17-0225V, 

2018 WL 3433352 (Fed. Cl. Spec. Mstr. June 6, 2018) (awarding $120,000.00 for pain 

and suffering and $772.53 for unreimbursable expenses), and Dobbins v. HHS, No. 16-

0854V, 2018 WL 4611267 (Fed. Cl. Spec. Mstr. Aug. 15, 2018) (awarding $125,000.00 

for pain and suffering and $3,143.80 for unreimbursable expenses). 

Petitioner emphasizes that she underwent treatment for eight months, which 

included physical therapy, MRI and x-ray imaging, EMG/NCV testing, prescription antiinflammatories, and a left shoulder arthroscopy and subacromial bursectomy. Pet. Brief

at 5. Petitioner asserts that her geographical location, as well as work and familial 

obligations, prevented her from presenting for necessary medical treatment, including 

regular physical therapy. Id. at 7. As a result of her injury, petitioner avers that her 

family and work life suffered along with her emotional health. Id. Due to her pain, 

petitioner emphasizes she was unable to care for her children as she normally would 

and suffered sleep deprivation. Id. Petitioner also references an episode during her

treatment in which she lost consciousness after her husband removed a medical device

from her arm. Id. Petitioner avers that the aforementioned episode frightened her 

children. Id. 

Respondent argues that petitioner should be awarded $77,500.00 in 

compensation for pain and suffering. Res. Brief at 1. Respondent contends that his 

“position on an award of pain and suffering in this case is supported by pain and 

suffering awards in other Vaccine Act cases.” Id. at 5. Respondent cites multiple SPU 

cases involving SIRVA claims but only provides a specific comparison of the facts of the 

instant case to Collado and H.S. v. HHS., No 14-1057V, 2015 WL 6155891 (Fed. Cl. 

Spec. Mstr. Sept. 25, 2015) (awarding $60,000.00 for pain and suffering). Res. Brief at 

5-6. In general, respondent notes that petitioner’s medical records reflect that her 

complaints of left shoulder pain were largely controlled with medication. Res. Brief at 4. 
9

Respondent references petitioner’s arthroscopic surgery, but notes that it occurred 

within six months following her vaccination and revealed that her rotator cuff was 

healthy with no tears. Id. Respondent emphasizes that petitioner’s post-surgical 

treatment records reflect improvement of her pain and physical functioning. Id. at 4-5.

 

V. Legal Standard

Compensation awarded pursuant to the Vaccine Act shall include “[f]or actual 

and projected pain and suffering and emotional distress from the vaccine-related injury, 

an award not to exceed $250,000.” § 15(a)(4). Petitioner bears the burden of proof with 

respect to each element of compensation requested. Brewer v. HHS, No. 93-92V, 1996 

WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18, 1996). 

There is no formula for assigning a monetary value to a person’s pain and 

suffering and emotional distress. I.D. v. HHS, No. 04-1593V, 2013 WL 2448125, at *9 

(Fed. Cl. Spec. Mstr. May 14, 2013) (“Awards for emotional distress are inherently 

subjective and cannot be determined by using a mathematical formula”); Stansfield v. 

HHS, No. 93-172V, 1996 WL 300594, at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the 

assessment of pain and suffering is inherently a subjective evaluation”). Factors to be 

considered when determining an award for pain and suffering include: 1) awareness of 

the injury; 2) severity of the injury; and 3) duration of the suffering. 6I.D., 2013 WL 

2448125, at *9; McAllister v. HHS, No 91-103V, 1993 WL 777030, at *3 (Fed. Cl. Spec. 

Mstr. Mar. 26, 1993), vacated and remanded on other grounds, 70 F.3d 1240 (Fed. Cir. 

1995). 

The undersigned may also look to prior pain and suffering awards to aid in her 

resolution of the appropriate amount of compensation for pain and suffering in this case. 

Jane Doe 34 v. HHS, 87 Fed. Cl. 758, 768 (2009) (finding that “there is nothing 

improper in the chief special master’s decision to refer to damages for pain and 

suffering awarded in other cases as an aid in determining the proper amount of 

damages in this case.”). And, of course, the undersigned also may rely on her own 

experience adjudicating similar claims.7 Hodges v. HHS, 9 F.3d 958, 961 (Fed. Cir. 

1993) (noting that Congress contemplated the special masters would use their 

accumulated expertise in the field of vaccine injuries to judge the merits of individual

 

6

In this case, awareness of the injury is not in dispute. The record reflects that at all relevant times 

petitioner was a competent adult with no impairments that would impact her awareness of her injury. 

Therefore, the undersigned’s analysis will focus principally on the severity and duration of petitioner’s 

injury.

7 From July 2014 until September 2015 the SPU was overseen by former Chief Special Master Vowell. 

Since that time, all SPU cases, which include the majority of SIRVA claims, have remained on the 

undersigned’s docket. 
10

claims). Importantly, however, it must also be stressed that pain and suffering is not 

determined based on a continuum. Graves v. HHS, 109 Fed. Cl. 579 (2013).

In Graves, Judge Merow rejected the special master’s approach of awarding 

compensation for pain and suffering based on a spectrum from $0.00 to the statutory 

$250,000.00 cap. Judge Merow noted that this constituted “the forcing of all suffering 

awards into a global comparative scale in which the individual petitioner’s suffering is 

compared to the most extreme cases and reduced accordingly.” Graves, 109 Fed. Cl. 

at 590. Instead, Judge Merow assessed pain and suffering by looking to the record 

evidence, prior pain and suffering awards within the Vaccine Program, and a survey of 

similar injury claims outside of the Vaccine Program. Id. at 595. 

In that regard, the undersigned notes that over the past four years the Special 

Processing Unit has amassed a significant history regarding damages in SIRVA cases. 

In Kim v. HHS, the undersigned explained that after four years of SPU experience, 864 

SIRVA cases were resolved informally as of July 1, 2018. Kim v. HHS, No. 17-418V, 

2018 WL 3991022, at *6 (Fed. Cl. Spec. Mstr. July 20, 2018). The undersigned noted 

that the median award for cases resolved via government proffer is $100,000.00 and 

the median award for cases resolved via stipulation by the parties is $71,355.26.8 Id. 

The undersigned noted that “to the extent prior informal resolutions are to be 

considered, the undersigned finds that the overall history of informal resolution in SPU 

provides a more valuable context for assessing the damages in this case. Since it 

reflects a substantial history of resolutions among many different cases with many 

different counsel, the undersigned is persuaded that the full SPU history of settlement 

and proffer conveys a better sense of the overall arms-length evaluation of the 

monetary value of pain and suffering in a typical SIRVA case.” Id. at *9.

Additionally, since the inception of SPU in July 2014, there have been several 

reasoned decisions by the undersigned awarding damages in SPU SIRVA cases where 

the parties were unable to informally resolve damages.9 Typically, the primary point of 

dispute has been the appropriate amount of compensation for pain and suffering. 

 

8 The undersigned further stressed that the “typical” range of SIRVA awards – meaning the middle 

quartiles – is $77,500.00 to $125,000.00 for proffered cases and $50,000.00 to $95,228.00 for stipulated 

cases. The total range for all informally resolved SIRVA claims – by proffer or stipulation – spans from 

$5,000.00 to $1,500,000.00. 2018 WL 3991022, at *6. Importantly, these amounts represent total 

compensation and typically do not separately list amounts intended to compensate for lost wages or 

expenses. Id. The undersigned noted that “These figures represent four years’ worth of past informal 

resolution of SIRVA claims and represent the bulk of prior SIRVA experience in the Vaccine Program. 

However, these figures are subject to change as additional cases resolve and do not dictate the result in 

this or any future case. Nor do they dictate the amount of any future proffer or settlement.” Id.

9 See, e.g., Desrosiers v. HHS, No. 16-224V, 2017 WL 5507804 (Fed. Cl. Spec. Mstr. Sept. 19, 2017); 

Dhanoa v. HHS, No. 15-1011V, 2018 WL 1221922 (Fed. Cl. Spec. Mstr. Feb. 1, 2018); Marino v. HHS, 

No. 16-622V, 2018 WL 2224736 (Fed. Cl. Spec. Mstr. Mar. 26, 2018); Collado v. HHS, No. 17-225, 2018 

WL 3433352 (Fed. Cl. Spec. Mstr. Jun. 6, 2018); Knauss v. HHS, No. 16-1372V, 2018 WL 3432906 (Fed. 
11

VI. Discussion

Upon the undersigned’s review of the complete record in this case and in 

consideration of the undersigned’s experience evaluating SIRVA claims, petitioner

appears to have suffered a mild-to-moderate shoulder injury. Nonetheless, it was 

severe enough that arthroscopic surgery was recommended and performed. 

Petitioner reported left shoulder pain approximately two weeks following her 

Tdap vaccination on March 14, 2016. Ex. 2 at 214. Thereafter, she reported pain at 

multiple treatment sessions and underwent a course of physical therapy. Notably, 

petitioner reported significant improvement of her symptoms with medication and the 

passage of time. For example, at treatment sessions in the weeks immediately 

following her injury, petitioner described her pain as ranging from a “4” to “8” out of “10.” 

Ex. 2 at 214, 225; Ex. 4 at 2. However, at a treatment session on April 18, 2016, 

petitioner reported that her pain had improved by 75% after taking Mobic and rated her 

current pain as “1-2” out of “10.” Ex. 3 at 26. The available records reflect subsequent 

complaints of pain at treatment sessions with associated loss of functioning. 

Nevertheless, petitioner reported on September 20, 2016 – approximately one month 

prior to her left shoulder surgery – that her shoulder pain had improved “by about 95%” 

over the preceding months. Ex. 5 at 17. 

At treatment sessions immediately following her October 14, 2016 left shoulder 

arthroscopy and subacromial bursectomy procedure, petitioner reported mild pain with 

activity, but denied experiencing pain at rest. Ex. 7 at 1. The record indicates 

petitioner’s pain, strength, and range of motion improved after nine physical therapy 

sessions. Id. at 19-21. Significantly, at a treatment session on January 30, 2017, 

petitioner reported that she had begun swimming again and was “having no trouble with 

[her] arm at all.” Ex. 5 at 60. Petitioner denied experiencing any pain. Id. At that time, 

petitioner presented with “excellent” strength and 150 degrees of forward flexion, 165 

degrees of abduction, and 75 degrees of external rotation. Id. The aforementioned 

treatment records are inconsistent with petitioner’s subsequent affidavit in which she 

described ongoing weakness and pain symptoms six months following her surgery. Ex. 

10 at ¶6. 

Although petitioner indicated that her pain progressively improved in the months 

following her March 2016 vaccination, the record does reflect multiple examinations in 

which she presented with reduced left shoulder range of motion, tenderness to 

palpation, decreased strength, and positive Neer’s and Hawkins testing. See, e.g., Ex. 

3 at 29-30, 38; Ex. 4 at 2; Ex. 5 at 18. Furthermore, as indicated above, an August 

2016 MRI of petitioner’s left shoulder revealed mild longitudinally oriented partial-

 

Cl. Spec. Mstr. May 23, 2018); Kim v. HHS, No. 17-418V, 2018 WL 3991022 (Fed. Cl. Spec. Mstr. Jul. 20, 

2018); and Dobbins v. HHS, No. 16-854V, 2018 WL 4611267 (Fed. Cl. Spec. Mstr. Aug. 15, 2018).
12

thickness tear10 of the infraspinatus tendon; mild supraspinatus and infraspinatus 

tendinopathy; small subcortical cysts and mild subcortical bone marrow edema over the 

posterior-superior-lateral aspect of the humeral head adjacent to the infraspinatus 

tendon insertion site; and minimal subacromial-subdeltoid bursitis. Ex. 2 at 109-10. 

Petitioner underwent a left shoulder arthroscopic surgery in October 2016 and attended 

a total of 13 physical therapy sessions. These records are reflective of some left 

shoulder impairment during the period at issue in this case. 

The undersigned also acknowledges that additional non-medical mitigating 

factors are present in this case. For instance, petitioner has credibly described her 

physical difficulty in caring for her children and performing other activities of daily living. 

Exs. 9-10. Petitioner’s affidavits as a whole reiterate that petitioner’s injury caused 

physical and emotional distress and led to significant disruptions of her ability to work, 

care for her family, and perform recreational activities. Exs. 8-15. 

Overall, petitioner’s injury was of relatively brief duration for a SIRVA, based on 

the undersigned’s experience in SIRVA cases. She was vaccinated in March 2016 and 

appears to have recovered by January 2017. In January 2017, she described herself as 

being pain-free. Ex. 5 at 60. At that time, petitioner’s treating physician concluded that 

she was ready to be discharged from routine follow up and would thereafter be treated 

on an as-needed basis. Id. There are no further medical records available in this case. 

As described above, petitioner cites Collado and Dobbins as reflecting similar 

levels of pain and suffering. Pet. Brief at 5-7. Initially, she contends that the Collado 

petitioner’s treatment history was roughly analogous in terms of its duration, medication, 

radiographic imaging, and amount of physical therapy. Id. at 5-6. Although the instant 

case is somewhat similar to Collado, there are some significant differences. Notably, 

although the petitioner’s treatment in Collado was of a shorter duration, the documented 

severity of pain was greater than petitioner’s in the instant case. Indeed, the Collado

petitioner frequently rated her pain as at least “8” out of “10” despite medication and 

physical therapy. Collado, 2018 WL 3433352, at *2-3. As noted above, petitioner in the 

instant case reported significant improvement of her pain and other symptoms with 

medication and treatment. 

Moreover, although both petitioners eventually underwent surgery for their 

shoulder injuries, the nature of the Collado petitioner’s procedure suggests a greater 

degree of physical impairment. Specifically, the March 2016 surgery in Collado 

consisted of a rotator cuff repair, subacromial decompression, open biceps tenodesis, 

and extensive debridement. Id. at *3. Thus, the Collado petitioner underwent several 

procedures, including an open surgical procedure. The Collado decision describes the 

operative record as showing significant pathology. Id. at *7. By contrast, the 

petitioner’s shoulder surgery in the instant case was performed arthroscopically and 

 

10 As indicated above, the operative record of petitioner’s October 2016 left shoulder arthroscopy and 

subacromial bursectomy procedure noted that petitioner’s rotator cuff looked “excellent” with no 

abnormalities. Ex. 5 at 32-33. 
13

consisted only of a subacromial bursectomy. Ex. 5 at 32-33. As indicated above, the 

operative record notes that petitioner’s rotator cuff looked “excellent” with no 

abnormalities. Id. The operative record otherwise contains findings of “very mild” 

ascending tenosynovitis of the biceps tendon with no fraying and “excellent” 

appearance of the superior labrum and articular surface of the head/neck glenoid. Id. at 

33. The aforementioned information suggests a greater degree of shoulder impairment 

in Collado as compared to the instant case. 

Petitioner notes that, unlike the petitioner in Collado, she continued to experience 

left arm weakness, pain, and discomfort with activities more than six months following 

her surgery. Pet. Brief at 6. In support of this claim, petitioner provides a citation to her 

own affidavit. Id. However, as described above, at her last treatment session in 

January 2017, petitioner reported that she had begun swimming again and was “having 

no trouble with [her] arm at all.” Ex. 5 at 60. Petitioner denied experiencing any pain. 

Id. At that time, petitioner presented with “excellent” strength and 150 degrees of 

forward flexion, 165 degrees of abduction, and 75 degrees of external rotation. Id. The 

undersigned notes that medical records are the most reliable evidence regarding a 

petitioner’s medical condition and the effect it has on her daily life. Shapiro v. HHS, 101 

Fed. Cl. 532, 537-38 (2011) (“[t]here is little doubt that the decisional law in the vaccine 

area favors medical records created contemporaneously with the events they describe 

over subsequent recollections.”). The available medical records in this case show that 

petitioner was pain-free by January 2017 and able to engage in her usual activities. 

Turning to Dobbins, petitioner notes that, as in the instant case, the petitioner’s 

treatment was of a brief duration. Pet. Brief at 6. However, as petitioner correctly 

points out, the Dobbins petitioner underwent 50 physical therapy sessions compared to 

only 13 sessions in the instant case. Dobbins, 2018 WL 4611267, at *3-8. The 

undersigned notes that there are additional differences between the two cases. Indeed, 

as with Collado, the surgery in Dobbins was extensive and involved arthroscopic rotator 

cuff repair, distal clavicle resection, subacromial decompression, and biceps tenodesis. 

Id. at *3. Thus, several procedures were performed. During the surgery in Dobbins, the 

physician also observed a full-thickness tear involving the supraspinatus and 

subscapularis as well as significant labral pathology. Id. As described in greater detail 

above, petitioner’s October 2016 surgery consisted only of a subacromial bursectomy. 

Ex. 5 at 32-33. Furthermore, no significant pathology was observed on examination.

Id. at 33. In summary, the underlying facts of Dobbins also suggest a greater degree of 

shoulder impairment as compared to the instant case.

In his brief, respondent cites H.S. as being instructive in determining petitioner’s pain 

and suffering award in the instant case. Res. Brief at 5. The petitioner in H.S. 

sustained head trauma and skull and vertebra fractures after experiencing syncope 

following a Tdap vaccination. H.S., 2015 WL 6155891, at *1-2. The undersigned does 

not find the injury in H.S. to be sufficiently analogous to be of significant persuasive 

value in this case. 
14

VII. Conclusion

In determining an award in this case, the undersigned does not rely on a single 

decision or case. Rather, the undersigned has reviewed the particular facts and 

circumstances in this case, giving due consideration to the circumstances and damages 

in other cases cited by the parties and other relevant cases, as well as her knowledge 

and experience adjudicating similar cases. In light of all of the above, and in 

consideration of the record as a whole, the undersigned finds that petitioner should be 

awarded $110,000.00 in compensation for actual (or past) pain and suffering and 

$305.07 in compensation for travel expenses as stipulated by the parties. The 

undersigned makes no award for projected pain and suffering, future medical expenses, 

or past or future lost wages.

Accordingly, the undersigned awards petitioner a lump sum payment of 

$110,305.07, representing $110,000.00 in compensation for actual pain and 

suffering and $305.07 in compensation for travel expenses, in the form of a check 

payable to petitioner, Anne Knudson. This amount represents compensation for all 

damages that would be available under § 300aa-15(a). 

The clerk of the court is directed to enter judgment in accordance with this 

decision.11

IT IS SO ORDERED.

s/Nora Beth Dorsey

Nora Beth Dorsey

Chief Special Master

 

11 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice 

renouncing the right to seek review.