Capizzano was the first case granted compensation for the onset of a rheumatic disease, specifically, Rheumatoid Arthritis (“RA”) after the Hepatitis B vaccine.  In Capizzano, the petitioner developed an abdominal rash within hours after the receipt of her second hepatitis b vaccine.  Within days, her condition deteriorated and included the onset of stiff, swollen, painful joints.  She was diagnosed with RA and numerous treating physicians linked the onset of her symptoms to the administration of the hepatitis B vaccine and advised against the administration of the third shot in the series. 

Tried by Attorney Chin-Caplan, the Chief Special Master initially denied entitlement on the grounds that while petitioner had established that the hepatitis B vaccine can cause RA, she had failed to prove that the vaccine did cause her RA.  In his decision, the Chief Special Master concluded that in order to satisfy the second element of proof under Althen, a “logical sequence of cause and effect”, the petitioner was “required” to provide epidemiological evidence, evidence of rechallenge, presence of pathological markers or genetic predisposition, or evidence of general acceptance in the scientific and medical communities” that hepatitis B vaccine causes RA. 

On appeal, the Circuit reversed and held that the Chief Special Master’s reformulated “four prong test” was contrary to law and improperly raised petitioner’s burden of proof in a vaccine case by restricting the manner by which a petitioner could prove an off-Table case.  The Court further indicated that the Chief Special Master “erred in not considering the opinions of the treating physicians who concluded that the vaccine was the cause of Ms. Capizzano’s injury,” and found that medical records and medical opinion testimony “are favored in vaccine cases as treating physicians are likely to be in the best position to determine whether ‘a logical sequence of cause and effect show[s] that the vaccination was the cause of the injury.’ ”  The Circuit remanded the case back for a determination of whether the existing record supported a finding that the hepatitis B vaccine did, in fact, cause the petitioner’s RA.  On remand, entitlement was granted.