Shalala v. Whitecotton

• Decision Date: 18 April 1995
• Docket Number: 94372
• Citation: 115 S.Ct. 1477,514 U.S. 268,131 L.Ed.2d 374
• Parties: Donna E. SHALALA, Secretary of Health and Human Services, Petitioner, v. Margaret WHITECOTTON et al
• Court: U.S. Supreme Court

514 U.S. 268

115 S.Ct. 1477

131 L.Ed.2d 374

Donna E. SHALALA, Secretary of Health and Human Services, Petitioner,

v Margaret WHITECOTTON et al.

No. 94-372.

Supreme Court of the United States

Argued Feb. 28, 1995.

Decided April 18, 1995.

Syllabus ^*

Respondents, Margaret Whitecotton and her parents, filed a claim for compensation under the National Childhood Vaccine Injury Act, alleging that Margaret had suffered encephalopathy as a result of her vaccination against diphtheria, pertussis, and tetanus (DPT). Under the Act, a claimant who, like Margaret, does not attempt to prove actual causation must make out a prima facie case by showing that "the first symptom or manifestation of the onset . . . of any . . . [listed] condition . . . occurred within the time period after vaccine administration set forth in the Vaccine Injury Table." 42 U.S.C. § 300aa-11(c)(1)(C)(i). That table specifies a 3-day period for encephalopathy following a DPT vaccination. § 300aa-14(a). The special master ruled that Margaret had failed to make out a prima facie case, finding, inter alia, that by the time she received her vaccination she was "clearly microcephalic," that this condition evidenced pre-existing encephalopathy, and that, accordingly, "the first symptom or manifestation" of her condition's onset had occurred before her vaccination and the 3-day table period. The Court of Federal Claims affirmed, but the Court of Appeals for the Federal Circuit reversed, holding, among other things, that a claimant satisfies the table requirements whenever she shows that any symptom or manifestation of a listed condition occurred within the table time period, even if there was evidence of the condition before the vaccination.

Held: A claimant who shows that she experienced symptoms of an injury after receiving a vaccination does not make out a prima facie case for compensation under the Act where the evidence fails to indicate that she had no symptoms of that injury before the vaccination. The Court of Appeals' assertion that the Act does not "expressly state" that a claimant relying on the table must show that the child sustained no injury prior to her vaccination i.e., that the first symptom of the injury occurred after vaccination—simply does not square with § 300aa-11(c)(1)(C)(i)'s plain language. If a symptom or manifestation of a table injury has occurred before the vaccination, a symptom or manifestation thereafter cannot be the first, or signal the injury's onset. There cannot be two first symptoms or onsets of the same injury. Thus, a demonstration that the claimant experienced symptoms of an injury during the table period, while necessary, is insufficient to make out a prima facie case. The claimant must also show that no evidence of the injury appeared before the vaccination. The Court of Appeals misread language in §§ 300aa-14(a), 300aa-14(b)(2), and 300aa-13(a)(2)(B) in coming to the contrary conclusion. Pp. __.

17 F.3d 374 (CA Fed.1994), reversed and remanded.

SOUTER, J., delivered the opinion for a unanimous Court. O'CONNOR, J., filed a concurring opinion, in which BREYER, J., joined.

Irving L. Gornstein, Washington, DC, for petitioner.

Robert Thomas Moxley, Cheyenne, WY, for respondents.

Justice SOUTER delivered the opinion of the Court.

The question in this case is whether a claimant who shows that she experienced symptoms of an injury after receiving a vaccination makes out a prima facie case for compensation under the National Childhood Vaccine Injury Act, 100 Stat. 3755, 42 U.S.C. § 300aa-1 et seq. (1988 ed. and Supp. V), where the evidence fails to indicate that she had no symptoms of that injury before the vaccination. We hold that the claimant does not make out a case for compensation.

I

For injuries and deaths traceable to vaccinations, the Act establishes a scheme of recovery designed to work faster and with greater ease than the civil tort system. H.R.Rep. No. 99-908, pp. 3-7 (1986). Special masters in the Court of Federal Claims hear vaccine-related complaints, 42 U.S.C. § 300aa-12(c) (1988 ed., Supp. V), which they adjudicate informally, § 300aa-12(d)(2), within strict time limits, § 300aa-12(d)(3)(A), subject to similarly expeditious review, § 300aa-12(e)(2). A claimant alleging that more than $1,000 in damages resulted from a vaccination after the Act's effective date in 1988 must exhaust the Act's procedures and refuse to accept the resulting judgment before filing any de novo civil action in state or federal court. 42 U.S.C. § 300aa-11(a) (1988 ed. and Supp. V).

The streamlining does not stop with the mechanics of litigation, but goes even to substantive standards of proof. While a claimant may establish prima facie entitlement to compensation by introducing proof of actual causation, § 300aa-11(c)(1)(C)(ii), she can reach the same result by meeting the requirements of what the Act calls the Vaccine Injury Table. The table lists the vaccines covered under the Act, together with particular injuries or conditions associated with each one. 42 U.S.C. § 300aa-14 (1988 ed., Supp. V). A claimant who meets certain other conditions not relevant here makes out a prima facie case by showing that she (or someone for whom she brings a claim) "sustained, or had significantly aggravated, any illness, disability, injury, or condition set forth in the Vaccine Injury Table in association with [a] vaccine . . . or died from the administration of such vaccine, and the first symptom or manifestation of the onset or of the significant aggravation of any such illness, disability, injury, or condition or the death occurred within the time period after vaccine administration set forth in the Vaccine Injury Table." 42 U.S.C. § 300aa-11(c)(1)(C)(i). Thus, the rule of prima facie proof turns the old maxim on its head by providing that if the post hoc event happens fast, ergo propter hoc. The Secretary may rebut a prima facie case by proving that the injury or death was in fact caused by "factors unrelated to the administration of the vaccine. . . ." § 300aa-13(a)(1)(B). If the Secretary fails to rebut, the claimant is entitled to compensation. 42 U.S.C. § 300aa-13(a)(1) (1988 ed. and Supp. V).

Respondents, Margaret Whitecotton and her parents, filed a claim under the Act for injuries Margaret allegedly sustained as a result of vaccination against diphtheria, pertussis, and tetanus (or DPT) on August 18, 1975, when she was nearly four months old. They alleged that Margaret (whom we will refer to as claimant) had suffered encephalopathy after the DPT vaccination, and they relied on the table scheme to make out a prima facie case. The Act defines encephalopathy as "any significant acquired abnormality of, or injury to, or impairment of function of the brain," 42 U.S.C. § 300aa-14(b)(3)(A), and lists the condition on the Vaccine Injury Table in association with the DPT vaccine. Under the Act, a claimant who does not prove actual causation must show that "the first symptom or manifestation of the onset or of the significant aggravation" of encephalopathy occurred within three days of a DPT vaccination in order to make out a prima facie right to compensation. § 300aa-11(c)(1)(C)(i); 42 U.S.C. § 300aa-14(a) (1988 ed., Supp. V).

The Special Master found that the claimant had suffered clonic seizures on the evening after her vaccination and again the following morning, App. to Pet. for Cert. 24a, 27a, and accepted those seizures as symptoms of encephalopathy. He also found, however, that by the time the claimant received the vaccination she was "clearly microcephalic" (meaning that she had a head size more than two standard deviations below the mean for a girl her age) and that her microcephaly was a symptom or evidence of encephalopathy that existed before the vaccination. Id., at 32a-33a. Accordingly, the Master concluded that the first symptom or manifestation of the onset of claimant's encephalopathy had occurred before the vaccination and the ensuing three-day period provided for in the table. Id., at 34a.

The Master then considered whether the series of seizures was "the first symptom or manifestation . . . of [a] significant aggravation" of the claimant's encephalopathy, 42 U.S.C. § 300aa-11(c)(1)(C)(i), and again decided that it was not. The Act defines "significant aggravation" as "any change for the worse in a preexisting condition which results in markedly greater disability, pain, or illness accompanied by substantial deterioration of health." § 300aa-33(4). The Master found that "[t]here is nothing to distinguish this case from what would reasonably have been expected considering [claimant's] microcephaly. . . . [T]here was nothing that occurred in temporal relationship to the DPT vaccination which indicates that it is more likely than not that the vaccine permanently aggravated her condition. . . . [T]he seizures did not continue and there was no dramatic turn for the worse in her condition. . . . Thus, there is no basis for implicating the vaccine as the cause of any aspect of [claimant's] present condition." App. to Pet. for Cert. 41a-43a. Because he found that the claimant had failed to satisfy the table requirements, and had not tried to prove actual causation, the Master denied her compensation for failure to make out a prima facie case.

The Court of Federal Claims found the Master's decision neither arbitrary nor otherwise unlawful, see 42 U.S.C. § 300aa-12(e)(2) (1988 ed., Supp. V), and affirmed. The Court of Appeals for the Federal Circuit then reversed, holding that a claimant satisfies the table requirements for the "first symptom or manifestation of the onset" of an injury whenever she shows that any symptom or manifestation of a listed condition occurred within the time period after vaccination specified in the table, even if there was evidence of the condition before the vaccination. Because claimant here showed symptoms of encephalopathy during the 3-day period after her DPT vaccination, the...