HORBELT v. SECRETARY OF HEALTH AND HUMAN SERVICES

In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-510V
UNPUBLISHED
PYUL HORBELT,
Petitioner,
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Chief Special Master Corcoran
Filed: November 24, 2025
Bridget C. McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On January 11, 2021, Pyul Horbelt filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), alleging that she suffered the Table injury of a left shoulder injury related
to vaccine administration (“SIRVA”) after receiving an influenza (“flu”) vaccine on August
22, 2020. Petition at 1 (ECF No. 1). The case was assigned to the Special Processing
Unit of the Office of Special Masters.
For the reasons set forth below, and after holding an expedited hearing on
entitlement, I find that Petitioner is entitled to compensation.
1 Although I have not formally designated this Decision for publication, I am required to post it on the United
States Court of Federal Claims' website in accordance with the E-Government Act of 2002, because it
contains a reasoned explanation for my determination. 44 U.S.C. § 3501 note (2012) (Federal Management
and Promotion of Electronic Government Services). 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, I agree that the identified material fits within this definition, I will redact
such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 1 of 10

2
I. 	Relevant Procedural History
This case was activated from “pre-assignment review” on June 2, 2022. (ECF No.
21). The parties’ attempts at informal resolution were hampered by a discrepancy
regarding Petitioner’s site of vaccination – therefore, while Respondent’s contesting Rule
4(c) motion was pending, I allowed Petitioner to file a Motion for a Fact Ruling regarding
the site of her vaccination at any time. On July 17, 2023, Petitioner filed a Motion for
Ruling on the Record. (ECF No. 30). On the following day, Respondent filed a status
report stating that he did not believe the case was appropriate for compensation, and he
followed up with his Report and a responsive brief on August 14, 2023. (ECF No. 32).
Petitioner filed a Reply brief on January 25, 2024. (ECF No. 36).
On October 8, 2025, I proposed this case for an expedited hearing on November
17, 2025, at which time I would decide the disputed issues based on all evidence filed to
date and any oral argument from counsel. (ECF No. 38). The parties agreed, and the
hearing took place as scheduled. During the hearing, I orally ruled on Petitioner’s
entitlement 	to 	compensation. 	This 	Decision 	memorializes 	those 	findings 	and
determinations.
I. 	Relevant Medical History
A. Medical Records
On August 22, 2020, Petitioner received a flu vaccine at a CVS pharmacy. Exhibit
(“Ex.”) 3 at 3. Documentation provided by the pharmacy indicates the vaccine was
administered in Petitioner’s right deltoid. Id. In a February 8, 2022 affidavit, Petitioner
states that “[t]he vaccine was given very high on [her] left shoulder and [she] felt pain as
it was being administered.” Ex. 2 at 1. Petitioner further states that “[a]bout a week or so”
after she received the flu vaccine, she returned to the same CVS pharmacy and “reported
the incident surrounding [her] vaccine to the pharmacist on duty.” Ex. 2 at 1.
Twelve days post-vaccination, Petitioner went to her primary care physician
(“PCP”) Dr. Frank Contacessa complaining of left shoulder pain “for the last 10 days.” Ex.
7 at 33. She reported that she received a flu vaccine at her local pharmacy and that the
injection was “very painful” and had “not stopped hurting since.” Id. Dr. Contacessa noted
no redness or swelling in Petitioner’s left shoulder, but did note that she had pain with
palpation above her deltoid and pain that limited her range of motion (“ROM”). Id. at 33-
34. Petitioner’s physical examination was otherwise unremarkable. See id. at 34. Dr.
Contacessa diagnosed Petitioner with acute pain of the left shoulder, noted that he
doubted there was any structural damage, and prescribed her a course of Meloxicam for
her pain. Id.
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 2 of 10

3
Nineteen days later, on September 22, 2020, Petitioner saw Dr. David Kovacevic,
an orthopedic surgeon. Ex. 11 at 15. Petitioner reiterated to Dr. Kovacevic that she had
been experiencing left shoulder pain since receiving a flu vaccine on August 22, 2020 at
her local CVS pharmacy. Id. She noted that she felt pain while reaching out in front of her
body and across her body. Id. She also noted that she had cut back on exercising
because of her left shoulder pain. Id. X-ray imaging taken that day was unremarkable.
See Ex. 11 at 19. On physical examination, Petitioner’s left shoulder active ROM was
noted to be identical to the ROM in her right shoulder. Ex. 11 at 19. Petitioner
demonstrated full strength and had no pain with external rotation, cross-body abduction,
scapularis, Jobe, O’Brien, Speed’s, and Yergason’s testing. Id. She did, however, wince
in pain with Hawkins impingement and Neer impingement testing. Id. Dr. Kovacevic’s
diagnosis was left shoulder impingement, and his plan was as follows: (1) apply Voltaren
gel three times per day; (2) attend physical therapy (“PT”) to work on rotator cuff
strengthening and ROM; (3) avoid heavy lifting and activities that cause sharp pain; and
(4) return for reassessment in four to six weeks. Ex. 11 at 19.
On September 24, 2020, Petitioner went for an initial PT evaluation. Ex. 8 at 7-8.
She reported that she had lost the ability to use her left arm for most activities of daily
living (“ADLs”) and that she was currently experiencing ten out ten pain. Id. at 7.
Petitioner’s therapist noted that she was able to tolerate their initial session but was
extremely apprehensive about active ROM testing. Id. at 8. The therapist educated
Petitioner on what he thought appeared to be “acute bursitis and acute onset of shoulder
impingement, as potential for acute inflammatory response to flu vaccine.” Id. The
therapist further noted that Petitioner’s prognosis was fair and recommended that she
attend PT twice per week for six weeks. Id.
On 	October 	2, 	2020, 	Petitioner 	saw 	orthopedist 	Brandon 	Erickson, 	M.D.,
complaining of left shoulder discomfort that had increased over the prior several weeks.
Ex. 9 at 14. On physical examination, Petitioner demonstrated full ROM of her left
shoulder with pain only at maximal abduction and forward flexion, tenderness on
palpation over the deltoid just off the lateral border of the acromion, and good strength
testing of the rotator cuff throughout. Id. Dr. Erickson’s assessment was: (1) other sprain
of left shoulder joint and (2) pain of left shoulder region. Id. at 15. His plan was to send
Petitioner for MR imaging and see her for a follow-up visit afterwards. Id.
On October 13, 2020, Petitioner attended her sixth and final PT session. Ex. 8 at
17-18. She told her therapist that she was feeling “a bit sore” from their last session but
had no increase in acute symptoms. Id. at 17. She further noted that the acute nature of
her symptoms was less than when she started therapy but that her pain was still limiting
her in her daily life. Id. The therapist noted that Petitioner had some pain and discomfort
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 3 of 10

4
throughout her shoulder during her therapy exercises that day but that they were able to
increase her active ROM with less immediate discomfort afterwards. See id. at 18.
On October 16, 2020, Petitioner underwent an MRI of her left shoulder, which
revealed mild insertional tendinosis and low-grade fissuring of the teres minor and
moderate regional interstitial edema and adjacent bursitis. Ex. 6 at 6. The interpreting
radiologist thought the findings “may suggest an inflammatory bursitis related to injection.”
Id.
Two months post-vaccination, on October 23, 2020, Petitioner returned to see Dr.
Erickson for her planned follow-up visit. Ex. 9 at 11-12. During the visit, she reported that
she had stopped doing physical therapy and was feeling better. Id. at 11. On examination,
she had full motion of her shoulder but still had some discomfort with certain movements,
including with resisted external rotation at 90 degrees of abduction. Id. Dr. Erickson noted
that Petitioner’s MRI showed subacromial bursitis with potentially a small tear of the teres
minor. Id. His assessment was “[o]ther sprain of left shoulder joint” and “[l]eft shoulder
subacromial bursitis in the setting of a recent flu shot.” Id. at 12. Dr. Erickson thought that
Petitioner would benefit from a one-time steroid injection followed by PT. Id. Petitioner
agreed with Dr. Erickson’s plan and was administered a steroid injection. Id.
Petitioner did not seek further medical attention for her left shoulder for the next
five months. Ex. 9 at 10. On January 11, 2021, Petitioner filed her Vaccine Program
Petition. On February 3, 2021, she was ordered to file additional records, including
“[r]ecords evidencing that the vaccine related injury persisted for at least six months . . .”
ECF No. 5 at 3. On March 29, 2021, Petitioner called her orthopedist’s office to report
recurrent left shoulder pain. Ex. 9 at 10. She spoke with Dr. Erickson and informed him
that the steroid injection he had given her had helped relieve her symptoms, but that her
pain had recently returned. See id. Dr. Erickson suggested she try acupuncture to help
with the pain. See id. Petitioner received left shoulder acupuncture treatment on March
30, 2021, April 2, 2021, April 6, 2021, April 13, 2021, and April 22, 2021. Ex. 4 at 4-8.
Since April 22, 2021, there are no records of Petitioner receiving further treatment on her
shoulder.
B. Witness Statement
Petitioner has submitted a sworn affidavit, executed on February 8, 2022, in
support of her claim. Ex. 2. In it, Petitioner describes how the vaccine was given very high
on her left shoulder, that as a result of her vaccination she sustained subacromial bursitis
and shoulder impingement syndrome, and that her injury began within 48-hours of
vaccination and lasted for more than six months. Id.
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 4 of 10

5
II. 	Parties’ Respective Arguments
Petitioner argues that preponderant evidence establishes that she received the flu
vaccine in her left arm, that she had onset of symptoms within 48 hours after vaccination,
and that she is accordingly entitled to compensation for her Table SIRVA claim. Motion
at 2. Respondent argues that Petitioner has not preponderantly established that she
received the subject flu vaccine in her left arm, given the vaccine administration record.
Response at 7-8. Respondent further argues that she has not established that she
suffered the residual effects or complications of her alleged SIRVA for more than six
months. Id. at 8-9.
III. 	Applicable Law
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy
evidence. 	The records contain information supplied to or by health professionals to
facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in
the 	balance, 	accuracy 	has 	an 	extra 	premium. 	These 	records 	are 	also 	generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. “Written records which are, themselves, inconsistent, should be
accorded less deference than those which are internally consistent.” Murphy v. Sec’y of
Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25,
1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd
per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as
incorrect the presumption that medical records are accurate and complete as to all the
patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021).
The United States Court of Federal Claims has outlined four possible explanations
for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 5 of 10

6
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y
of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health
& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998).
The credibility of the individual offering such fact testimony must also be determined.
Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley
v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v.
Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within
the special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
IV. 	Analysis
II. 	Fact Findings – Onset and Entitlement
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). In addition to requirements concerning the vaccination received, the
duration and severity of petitioner’s injury, and the lack of other award or settlement, 3 a
3 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception; suffered the residual effects of his injury for more than six months, died from his injury, or
underwent a surgical intervention during an inpatient hospitalization; and has not filed a civil suit or collected
an award or settlement for his injury. See § 11(c)(1)(A)(B)(D)(E).
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 6 of 10

7
petitioner must establish that he suffered an injury meeting the Table criteria, in which
case causation is presumed, or an injury shown to be caused-in-fact by the vaccination
he received. Section 11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of an influenza vaccine. 42 C.F.R. § 100.3(a)(XIV)(B). A
vaccine recipient shall be considered to have suffered SIRVA if such recipient manifests
all of the following:
(i) No history of pain, inflammation, or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
A special master must consider, but is not bound by, any diagnosis, conclusion,
judgment, 	test 	result, 	report, 	or 	summary 	concerning 	the 	nature, 	causation, 	and
aggravation of petitioner’s injury or illness that is contained in a medical record. Section
13(b)(1). “Medical records, in general, warrant consideration as trustworthy evidence.
The records contain information supplied to or by health professionals to facilitate
diagnosis and treatment of medical conditions. With proper treatment hanging in the
balance, 	accuracy 	has 	an 	extra 	premium. 	These 	records 	are 	also 	generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 7 of 10

8
A. Factual Findings Regarding Vaccination Situs
Respondent notes that the vaccine administration record documents an injection
in Petitioner’s right arm, not her left. Response at 7. Respondent then argues that
Petitioner has failed to offer preponderant evidence that she received the vaccination in
her left arm as alleged, because she has failed to produce any extrinsic evidence and
that any later statements that she received the flu vaccination in her left arm should not
outweigh the contemporaneous medical record that clearly documents administration in
her right arm. Id. at 7-8.
Upon consideration of the record, I find that it is more likely than not that the
notation for administration in the right arm for the August 22, 2020 vaccination is in error.
This kind of documented vaccine administration error has previously been noted as “an
issue that arises repeatedly in the specific context of SIRVA, both because SIRVA is a
localized injury occurring near the site of injection and that because experience . . . has
shown that pharmacy vaccine administration records are not necessarily reliable in
documenting injection site.” Mezzacapo v. Sec’y of Health & Hum. Servs., No., 2021 WL
1940435, at *6 (Fed. Cl. Spec. Mstr. Apr. 19, 2021). In Mezzacapo, testimony given by a
Rite Aid pharmacist established that this error typically stems from inputs to be completed
prior to the actual vaccination, because the request must be processed through the
vaccinee’s insurance, and that she always listed a left-arm injection site because most
people are right-hand dominant. Mezzacapo, 2021 WL 1940435, at *6. This testimony
was deemed consistent from similar testimony from other pharmacists in other cases. Id.
Although the record in the instant case does not contain any comparably-strong
extrinsic evidence, I note that in every medical visit associated with her SIRVA, Petitioner
consistently described the inciting event as a flu vaccine received in her left shoulder. In
this case, that is enough to meet the preponderant test.
B. Factual Findings Regarding a Table SIRVA
After a review of the entire record, I find that a preponderance of evidence supports
the conclusion that Petitioner has satisfied the Qualifications and Aids to Interpretation
(“QAI”) requirements for a Table SIRVA. Respondent has not argued, whether in his
briefing on entitlement or at the expedited entitlement hearing on November 17, 2025,
that Petitioner has failed to establish any of the QAI requirements for establishing a Table
SIRVA. For the sake of completeness however, this written decision shall briefly review
them as they apply to the record.
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 8 of 10

9
First, there is no evidence in the record that Petitioner had ever previously
experienced symptoms of pain or loss of ROM in her left shoulder prior to receiving the
subject flu vaccination in 2020
Second, Petitioner’s first symptom likely began within 48 hours following her
vaccination. Twelve days post-vaccination, Petitioner saw her PCP complaining of left
shoulder pain, stating that following receiving a flu vaccine at her local pharmacy which
was painful, her shoulder had not stopped hurting since. Ex. 7 at 33. In every report of
pain, Petitioner has consistently indicated it began right after her flu vaccination.
Therefore, Petitioner has proven this requirement.
Third, there is nothing in the record which documents pain and limited range of
motion in any part of Petitioner’s body other than her left shoulder, nor has Respondent
indicated he believes there is any documented evidence.
Finally, there is no evidence of another condition or abnormality which would
explain Petitioner’s symptoms. There is insufficient evidence in the record to suggest any
alternative cause of Petitioner’s left shoulder issues and Respondent does not argue
against this. Accordingly, Petitioner has established all the necessary QAI requirements
for entitlement for her SIRVA.
C. Other Requirements for Entitlement
In 	addition 	to 	establishing 	a 	Table 	injury, 	a 	petitioner 	must 	also 	provide
preponderant evidence of the additional requirements of Section 11(c). The overall record
contains preponderant evidence to fulfill these additional requirements.
The record shows that Petitioner received a flu vaccine intramuscularly on August
22, 2020. Ex. 1; see Section 11(c)(1)(A) (requiring receipt of a covered vaccine); Section
11(c)(1)(B)(i)(I) (requiring administration within the United States or its territories). There
is no evidence that Petitioner has collected a civil award for her injury. Petition at 4;
Section 11(c)(1)(E) (lack of prior civil award).
The last criteria which must be satisfied by Petitioner involves the duration of her
SIRVA. For compensation to be awarded, the Vaccine Act requires that a petitioner suffer
the residual effects of their left shoulder injury for more than six months or required
surgical intervention. See Section 11(c)(1)(D)(i) (statutory six-month requirement).
Respondent has argued that starting from August 24, 2020 (48 hours after
vaccination), the medical records do not reflect that Petitioner suffered the effects of her
injury for more than six months. Specifically, Respondent argues that the five-month gap
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 9 of 10

10
in treatment between Petitioner’s October 23, 2020, follow-up visit with Dr. Erickson, and
her March 29, 2021, telephone call with Dr. Erickson, strongly undermines her allegation
that her symptoms persisted throughout that time period. Response at 9. Respondent
further notes that during this five-month treatment gap, Petitioner had telehealth visits
with her PCP during which she never raised any shoulder related issues. Id. at 9-10.
Petitioner has established that her left shoulder symptoms likely persisted for at
least six months. As I noted at the expedited entitlement hearing, it is not uncommon for
a petitioner who receives a steroid injection to experience long periods of complete or
near-complete relief from their symptoms. Therefore, a gap of several months does not
necessarily undercut a finding of severity in favor of a petitioner. At most, it speaks to the
mildness of the injury and the potential amount of pain and suffering damages.
In this case, the record establishes Petitioner as having suffered a very mild injury
– Petitioner’s treatment course involved six PT sessions, five sessions of acupuncture,
one steroid injection, one MRI, and one x-ray. As I noted at the entitlement hearing, I
would not expect compensation in this case to exceed $20,000.00 for pain and suffering.
Ultimately, 	Petitioner 	has 	established 	that 	she 	suffered 	a 	Table 	SIRVA.
Additionally, she has satisfied all other requirements for compensation. I therefore find
that Petitioner is entitled to compensation in this case.
Conclusion
In view of the evidence of record, I find Petitioner is entitled to compensation. A
damages order will be entered following the issuance of this ruling to direct the
parties of the next steps in resolving damages.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
Case 1:21-vv-00510-UNJ Document 44 Filed 12/29/25 Page 10 of 10