Opinion ID: 2427537
Heading Depth: 2
Heading Rank: 3

Heading: sle

Text: Lombardi argues that the special master imposed an improper burden by employing the criteria developed by the American College of Rheumatologists for a diagnosis of SLE and requiring her to prove that she met at least four of the eleven criteria before such a diagnosis can be made. Lombardi contends that that requirement reflects a diagnosis of SLE with 96 percent certainty, and her burden under the Vaccine Act cannot be that high. Even so, Lombardi argues, Dr. Shoenfeld extensively detailed the presence of more than four of the required criteria; yet the special master improperly discredited that opinion and arbitrarily denied Lombardi's claim. We agree with the government that the special master's decision here was reasonable. First, we find no error in the special master's decision to analyze Lombardi's claim under the ACR's criteria. Those criteria are generally accepted in the medical community for diagnosing SLE, and Lombardi's own expert referenced them in analyzing her condition. The special master properly decided that her burden of showing that she suffers from SLE would have been satisfied if Lombardi could have demonstrated that she met the ACR's criteria for a diagnosis of SLE. See Moberly, 592 F.3d at 1322 (A petitioner needs to provide a reputable medical or scientific explanation that pertains specifically to the petitioner's case.). The special master noted that the SLE claim was raised for the first time more than eight years after Lombardi's initial petition was filed. Special Master Op. at . Following her hepatitis B vaccinations, Lombardi's treating physicians actively investigated whether she suffered from SLE, but in the ten years that ensued, no doctor ever diagnosed her with that disease. On the contrary, two of her treating physicians affirmatively ruled out that diagnosis. Id. at . Yet, at a late stage of this litigation, Lombardi's expert Dr. Shoenfeld diagnosed her with SLE, contending that she met at least five of the ACR's criteria. The special master independently evaluated whether Lombardi met each of the eleven criteria. Id. at -29. The special master rejected Dr. Shoenfeld's characterization of Lombardi's upper lip rash as a malar rash, one of the eleven criteria. Id. at . Likewise, the special master rejected Dr. Shoenfeld's conclusion that Lombardi's joint pain, or arthralgia, demonstrated that she had arthritis, another ACR criterion. Id. at . He also rejected Dr. Shoenfeld's testimony that Lombardi suffered from a neurologic disorder even though she did not experience any seizures or psychosis. Id. at . In each of those determinations, the special master relied upon the definitions as provided by the ACR. We find that decision to be rational and conclude that the special master's decision was legally supported in ruling that, at best, Lombardi fulfilled only three of the eleven criteria for a diagnosis of SLE, thereby not satisfying the diagnostic requirement for SLE. Lombardi relies heavily on the opinion of her treating rheumatologist, Dr. Schlessel, who submitted a letter to the special master and who, Lombardi contends, is now treating her for SLE. Dr. Schlessel's short letter, however, appears to be written for the purpose of this litigation and his statement on Lombardi's condition is conclusory: Please be advised that [Lombardi] has a number of complaints. Her laboratory tests will be consistent with a diagnosis of systemic lupus erythematosus. No laboratory tests were ever provided to the special master and there is no evidence in the record that they even exist. Moreover, Dr. Schlessel's statement appears to predict what Lombardi's test will reveal, rather than state an actual diagnosis of SLE. We do not fault the special master for rejecting such unreliable evidence. Cf. Moberly, 592 F.3d at 1324 ([T]he special master is entitled to require some indicia of reliability to support the assertion of the expert witness.). We conclude that the special master's finding that Lombardi had not shown by a preponderance of the evidence that she suffered from SLE was not arbitrary or capricious. Lastly, we reject Lombardi's argument that, given his record, the special master in this case was biased against petitioners, and that we should not permit him to shield his actions from appellate review. In support of her argument, Lombardi cites scores of unrelated decisions rendered by the special master assigned to this case. We conclude that those decisions are irrelevant to the case before us and that Lombardi's allegations against the special master are misplaced. There is a difference between disagreement with a special master's fact findings and an accusation that he is biased against petitioners. We have stated before that special masters of the Claims Court have the unenviable job of sorting through these painful cases and ... judging the merits of the individual claims. Hodges v. Health & Human Servs., 9 F.3d 958, 961 (Fed.Cir.1993). The special master spent significant effort in deciding Lombardi's case, holding three separate hearings, analyzing Lombardi's extensive medical record, resolving conflicting expert opinions, and reviewing a gamut of evidentiary materials submitted by both parties to rule on multiple factual and legal issues in a significantly difficult case. The Claims Court affirmed his judgment, holding his factual findings to be reasonable and his conclusions in accordance with the law. We agree with the Claims Court. Contrary to Lombardi's assertion, the special master did not cloak the application of an erroneous legal standard in the guise of a credibility determination, and thereby shield it from appellate review. Andreu, 569 F.3d at 1374. To the extent that Lombardi urges us to independently evaluate the facts of this case to decide whether she suffers from any of the medical conditions that she alleges, we are not at liberty to do so. The special master's opinion in this case was well reasoned and put forth a thorough analysis of each of Lombardi's claims. We cannot second guess the special master's fact conclusions. Hodges, 9 F.3d at 961 (The statute makes clear that, on review, the Court of Federal Claims is not to second guess the Special Master's fact-intensive conclusions.). This is an unfortunate case. Lombardi obviously had a multitude of symptoms of illness. Whether any of them was caused by hepatitis B vaccine we do not know. But, having carefully reviewed Lombardi's arguments and the record in this case, we conclude that the special master's determination that Lombardi had failed to prove by a preponderance of evidence that she suffered from any of the three claimed medical conditions and that she is entitled to compensation under the Vaccine Act was not arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law. 42 U.S.C. § 300aa-12(e)(2)(B); Hines, 940 F.2d at 1524.