SIRVA Claims: A Former DOJ Vaccine Trial Attorney’s Guide

Symptoms, covered vaccines, VICP requirements, and four recent Vaccine Court rulings

Mild soreness after an upper-arm vaccination usually fades within a day or two. SIRVA is different. The pain persists, shoulder movement becomes limited, and ordinary tasks, such as reaching overhead, putting on a shirt, or sleeping on the vaccinated shoulder, can become difficult.

SIRVA (shoulder injury related to vaccine administration) is associated with how the injection was administered, not with a defect in the vaccine itself. For certain covered vaccines, it is listed on the federal Vaccine Injury Table↗ (opens in new tab, external site) and may qualify for compensation through the National Vaccine Injury Compensation Program (VICP).

Before founding Jani Law PLLC, I served as a federal judicial law clerk at the U.S. Court of Federal Claims, Office of Special Masters, the exclusive forum for deciding VICP claims. I later litigated VICP cases on behalf of the United States (U.S.) as a U.S. Department of Justice (DOJ) Trial Attorney in the Vaccine Litigation Branch (DOJ Vaccine Trial Attorney).

This guide explains the symptoms and diagnoses associated with SIRVA, which vaccines are covered, what the federal rules require, and what four contested rulings issued in June 2026 show about how special masters evaluate imperfect medical records.

1. What Is SIRVA?

Federal law defines SIRVA as shoulder pain and limited range of motion after an intramuscular vaccine is given in the upper arm. The regulation explains that the symptoms are thought to result when vaccine antigen or the needle reaches the bursa or nearby shoulder structures and causes inflammation. (The bursa is a small fluid-filled sac that cushions the shoulder.) SIRVA is an injury to the musculoskeletal structures of the shoulder, such as the tendons, ligaments, and bursae.

It is equally important to understand what SIRVA is not:

• It is not a claim that the vaccine was defective. The issue is the placement of the injection, not the contents of the vaccine itself.
• It is not a malpractice claim against the person who gave the shot. The VICP is a no-fault federal program created by the National Childhood Vaccine Injury Act of 1986 (the Vaccine Act). A VICP petition names the Secretary of Health and Human Services (HHS) as the defendant, and DOJ Vaccine Trial Attorneys represent the HHS (or government), and the claimant filing the VICP petition (petitioner) does not have to prove negligence.
• It is not a neurological injury. The federal definition says so expressly. When records mention numbness, radiculopathy (irritation of a nerve where it exits the spine in the neck), or an abnormal nerve study, the legal question is whether a neurological condition actually explains the shoulder symptoms. Section 6 discusses a recent decision addressing exactly that question.

2. SIRVA Symptoms and Common Diagnoses

Commonly reported symptoms include:

• Shoulder pain beginning during the injection, later that day, or within 48 hours of vaccination
• Stiffness and reduced range of motion in the vaccinated shoulder, especially reaching overhead or behind the back
• Difficulty dressing, washing hair, driving, fastening a seatbelt, or lifting with the affected arm
• Sleep disturbed by pain when lying on the vaccinated shoulder
• Pain centered in the vaccinated shoulder, sometimes extending into the nearby upper arm or shoulder blade

Common diagnoses

Medical records may include diagnoses such as:

• Bursitis (subacromial or subdeltoid): inflammation of the bursa beneath the shoulder muscles
• Adhesive capsulitis, often called frozen shoulder: progressive stiffness and loss of motion
• Rotator cuff tendinopathy or tears: conditions affecting the tendons that stabilize the shoulder
• Impingement syndrome: tendons or bursa pinched during shoulder movement
• Biceps tendon conditions: inflammation or fraying of the tendon at the front of the shoulder

What imaging shows (and does not have to show)

• An x-ray may be entirely normal.
• Magnetic resonance imaging (MRI) may show a tear, excess fluid in the bursa, or only age-related changes.
• The federal definition does not require any particular imaging result. As the case studies below illustrate, the claim is evaluated on the complete record.

How SIRVA Entered The Medical Literature

Atanasoff et al. (2010)↗ (opens in new tab, external site) described 13 cases involving rapid-onset shoulder pain and limited motion after vaccination, without prior dysfunction in the affected shoulder. The authors proposed that vaccine material unintentionally delivered into synovial tissue could produce an inflammatory response.

Hesse et al. (2020)↗ (opens in new tab, external site) later reviewed 476 SIRVA claims that HHS had recommended for concession between 2010 and 2016. Of those claims:

• 84 percent involved an influenza vaccine
• 80 percent involved physical or occupational therapy to alleviate SIRVA symptoms; and
• 36.1 percent reported an injection perceived as too high on the arm

These were selected VICP claims, not an estimate of how often SIRVA occurs after vaccination.

3. Which Vaccines Are Covered (and Which Are Not)

Not every vaccine given in the upper arm is covered by the VICP. The VICP covers SIRVA claims for the following vaccines:

• Seasonal influenza (flu)
• Tetanus-toxoid-containing vaccines (Tdap, Td, DTaP, DT, TT)
• Pertussis-containing vaccines (whooping cough)
• Hepatitis A and hepatitis B
• HPV (human papillomavirus)
• Meningococcal
• Pneumococcal conjugate
• Hib (Haemophilus influenzae type b)
• Measles, mumps, and rubella (MMR)
• Varicella (chickenpox)
• Inactivated polio vaccine (IPV)

The following vaccines are not currently covered by the VICP:

• COVID-19 vaccines. Under current federal guidance, these claims are handled through the Countermeasures Injury Compensation Program↗ (opens in new tab, external site), a separate program with different rules and a one-year filing deadline.
• Shingles vaccines (zoster vaccines such as Shingrix), even though varicella vaccines are covered under the VICP.
• Pneumococcal polysaccharide vaccines (such as PPSV23); only pneumococcal conjugate vaccines are covered under the VICP.

The exact product name, which appears on a vaccination card, pharmacy receipt, patient portal, or state immunization registry, determines which, if any, federal vaccine injury compensation program applies. HHS’s Health Resources and Services Administration (HRSA) maintains the authoritative list of covered vaccines↗ (opens in new tab, external site), and I discuss the covered vaccines and qualifying injuries further in my VICP guide.

4. What a Table SIRVA Claim Requires

A SIRVA petition is filed in the U.S. Court of Federal Claims, Office of Special Masters, often informally called the Vaccine Court, where a special master decides the vaccine injury claim.

The Vaccine Injury Table and the Qualifications and Aids to Interpretation, or QAI, appear in the same federal regulation: 42 C.F.R. § 100.3↗ (opens in new tab, external site). The Table identifies covered vaccines, recognized injuries, and the required onset periods. The QAI defines SIRVA and lists the four requirements below.

When those requirements are met, vaccine causation is presumed—a presumption that is then rebuttable by the government. The government may still try to prove that an unrelated factor caused the vaccine injury.

The six-month severity requirement

The Vaccine Act separately requires proof that the residual effects or complications of the injury lasted more than six months after vaccination, unless the injury resulted in inpatient hospitalization with surgery, or death. 42 U.S.C. § 300aa-11(c)(1)(D)(i)↗ (opens in new tab, external site). Some of the decisions discussed below address this requirement more fully.

Filing deadlines and claims outside the Table

• Three years. An injury petition generally must be filed within 36 months after the first symptom or manifestation of onset, or the significant aggravation, of the vaccine-related injury. For a typical Table SIRVA claim alleging a new shoulder injury, the relevant date is when the shoulder pain began, which must be within 48 hours of vaccination. The filing deadline therefore usually falls close to three years after the vaccination. It does not run from the date of diagnosis, an MRI, or when the person first learns about the VICP. See 42 U.S.C. § 300aa-16(a)(2)↗ (opens in new tab, external site).
• Off-Table SIRVA claims. An injury that does not satisfy every Table requirement may still be pursued as an off-Table claim. That claim does not receive the presumption of causation. Instead, causation generally must be established through medical evidence and expert opinion. Read more about off-Table vaccine injury claims.
• Other eligibility requirements. The Vaccine Act contains additional requirements concerning the vaccine received, where it was administered, and whether the petitioner has already recovered compensation through a civil action. See 42 U.S.C. § 300aa-11(c)(1). My VICP guide provides additional information about covered vaccines, filing deadlines, and how the VICP works.

5. What Recent SIRVA Decisions Show About Medical Records

Medical records are written for treatment, not litigation. They may contain shorthand, typographical errors, or no mention of a shoulder injury because the visit concerned something else. Special masters consider the complete record rather than treating one phrase as conclusive.

Three principles recur:

• The standard is more likely than not, not certainty. A petitioner must establish disputed facts by a preponderance of the evidence. See 42 U.S.C. § 300aa-13(a)(1)(A)↗ (opens in new tab, external site); see also Moberly ex rel. Moberly v. Sec’y of Health & Human Servs.↗ (opens in new tab, external site), 592 F.3d 1315, 1322 (Fed. Cir. 2010).
• Medical records matter, but they are not presumed to contain every symptom. A patient may not report every problem at every appointment, and a provider may not record everything that was discussed. See Kirby v. Sec’y of Health & Human Servs.↗ (opens in new tab, external site), 997 F.3d 1378, 1383 (Fed. Cir. 2021).
• A delayed visit, a mistaken date, or a gap in treatment may be important without automatically defeating a claim.

The four decisions below show how those principles work in actual SIRVA cases.

6. Four June 2026 SIRVA Rulings That Rejected Key Government Objections

Among the SIRVA decisions issued by the Chief Special Master of the U.S. Court of Federal Claims, Office of Special Masters↗ (opens in new tab, external site), in June 2026, four contested rulings offer particularly useful insight into how these claims are evaluated.

Three rulings found the petitioner entitled to compensation. The fourth resolved the disputed factual issues in the petitioner’s favor and encouraged the parties to pursue resolution.

Across the four cases, the government relied on isolated chart entries, delays or gaps in treatment, and possible competing diagnoses to argue that the petitioners had not satisfied the SIRVA requirements. The Chief Special Master rejected the government’s principal objections after reviewing each medical record as a whole and in context. Each ruling turned on its own facts and does not guarantee the outcome of another claim.

Starkey: An Eleven-Month Treatment Gap Did Not Defeat The Claim

Starkey v. Secretary of Health and Human Services↗ (opens in new tab, external site), No. 23-1541V (Fed. Cl. Spec. Mstr. June 5, 2026) (findings of fact and ruling on entitlement).

What happened:

• The petitioner received a flu vaccine in her left arm in October 2021, and her first treatment record noted that the shot itself was painful.
• The petitioner first sought care 64 days later, when she could not raise the arm much above shoulder height.
• An x-ray was normal. An MRI showed more fluid than expected in the bursa, and her doctor noted in the record that she wondered whether the vaccine had been injected into the bursa at the very spot the petitioner identified.
• An orthopedist diagnosed significant frozen shoulder, administered a cortisone injection, prescribed daily home exercises, predicted recovery could take six to eighteen months, and told her to return only if her symptoms worsened.
• The petitioner followed that plan and did not return for nearly a year. When she did, her pain was nearly gone, but the shoulder still lacked full motion.

The government’s arguments against compensation:

• The government argued that older records mentioning joint swelling, stiffness, and muscle pain suggested a possible preexisting shoulder condition.
• It argued that the petitioner’s three online prescription-refill requests did not mention shoulder pain, which undermined her claim that the pain began immediately after vaccination.
• It argued that petitioner’s statements about onset should receive less weight because she made them after researching SIRVA.
• It argued that references to pain near the elbow and occasional hand numbness showed that petitioner’s symptoms were not limited to the vaccinated shoulder.
• It argued that the petitioner had documented treatment for only about four months, followed by an eleven-month gap, and therefore had not established that the injury lasted more than six months.

Why the Chief Special Master rejected those arguments:

The Chief Special Master rejected each argument after reviewing the full medical record:

• The older records cited by the government concerned the petitioner’s knees and ankle, not the vaccinated shoulder. The government’s discussion of the MRI also omitted the petitioner’s physician’s assessment of the excess bursal fluid near the reported injection site. 
• The online prescription-refill requests were not visits or communications intended to report new symptoms. Their silence about the shoulder therefore did not undermine the petitioner’s evidence of immediate onset. 
• The petitioner’s first shoulder-treatment record stated that the injection itself was painful, and she consistently linked the shoulder pain to the vaccination afterward. Her later research into SIRVA did not make those earlier reports less credible. 
• Although some records mentioned pain extending toward the elbow and occasional hand numbness, the petitioner’s pain, reduced range of motion, imaging, and treatment remained centered on the vaccinated shoulder. 
• The eleven-month treatment gap was consistent with the orthopedist’s instructions to perform exercises at home, return only as needed, and expect recovery to take six to eighteen months. When the petitioner returned, she still lacked full range of motion, supporting the finding that the injury had continued beyond six months.

Spayd: Chart Errors, Radiating Pain, and Exercise Did Not Defeat the Claim

Spayd v. Secretary of Health and Human Services↗ (opens in new tab, external site), No. 23-1273V (Fed. Cl. Spec. Mstr. June 9, 2026) (ruling on entitlement and decision awarding damages).

What happened:

• The petitioner received a flu vaccine in his left shoulder at an annual physical in September 2021.
• The petitioner first sought care about seven weeks later. He reported that the shoulder pain had worsened since the vaccination and interfered with dressing, fastening a seatbelt, and performing exercises such as pushups.
• He described deep pain centered in the shoulder that sometimes extended into the upper arm, biceps, and shoulder blade.
• His medical records also noted that he had recently begun running and weight training.
• One record listed the wrong vaccination date, another contained an apparent typographical error, and an orthopedist recorded that the pain began two days after vaccination.
• His treatment included a steroid injection and 22 physical therapy sessions.

The government’s arguments against compensation:

• The government argued that the orthopedist’s reference to pain beginning two days “after” vaccination could place onset outside the required 48-hour period.
• It argued that pain extending into the upper arm, biceps, and shoulder blade meant that the symptoms were not limited to the vaccinated shoulder.
• It also argued that the petitioner’s running and weightlifting activities offered another possible explanation for the shoulder injury.

Why the Chief Special Master rejected those arguments:

• The Chief Special Master considered the incorrect vaccination date and apparent typographical error in the context of the entire record. The petitioner had repeatedly linked the onset of his shoulder pain to the vaccination, and the Vaccine Act permits a finding of timely onset even when a medical record contains an inaccurate date.
• The references to pain in nearby areas did not change where the injury originated and primarily manifested. The medical records consistently centered the petitioner’s pain, reduced motion, and treatment in the vaccinated shoulder.
• The exercise history also did not establish another cause. The records showed that the petitioner attempted to exercise to relieve the shoulder pain, and that the pain interfered with his ability to exercise, rather than showing that exercise caused the injury.

Gnanasundaram: “Arm Pain” Did Not Defeat a Claim Centered on the Vaccinated Shoulder

Gnanasundaram v. Secretary of Health and Human Services↗ (opens in new tab, external site), No. 23-0636V (Fed. Cl. Spec. Mstr. June 10, 2026) (ruling on entitlement).

What happened:

• The petitioner was 28 years old when she received an HPV vaccine in her left shoulder in February 2022.
• Petitioner reported that the injection felt too high and caused an immediate burning sensation. Within days, she had difficulty lifting the arm and driving.
• Insurance and access-to-care limitations affected petitioner’s treatment options. She first saw a physician 46 days after vaccination.
• The first treatment record documented left arm pain, tenderness at the vaccination site, and a visible divot in the muscle.
• An x-ray was normal, and an MRI showed only minimal findings.
• Some examination records described her range of motion as “intact,” while another documented reduced mobility and pain when she moved the arm above shoulder height.
• Her treatment consisted of several visits spread over approximately ten months, anti-inflammatory medication, and home stretching.
• She also reported that the injury prevented her from continuing the weightlifting she had regularly performed before vaccination.

The government’s arguments against compensation:

• The government argued that the medical records documented arm pain rather than shoulder pain.
• It argued that the record did not establish that the shoulder pain began within 48 hours of vaccination.
• It argued that the examinations did not contain sufficient objective evidence of reduced range of motion.
• The government also relied on the 46-day delay before the first appointment, the later treatment gaps, and the petitioner’s history of weightlifting to question the claim.

Why the Chief Special Master rejected those arguments:

• The Chief Special Master found that the petitioner and her provider used “arm” and “shoulder” interchangeably in the context of that record. The first treatment note tied the pain and tenderness directly to the vaccination site and recorded the petitioner’s report that the injection had been placed too high.
• The Chief Special Master found sufficient evidence of timely onset when the contemporaneous record was considered together with the petitioner’s account of the immediate burning sensation and the limitations that followed.
• The range-of-motion requirement was also satisfied. The record contained at least one supported instance of reduced motion, while the entries describing motion as “intact” did not explain whether the provider had assessed active motion, passive motion, or both.
• The delays and gaps in care did not outweigh the broader evidence of continuing symptoms. The Chief Special Master considered the petitioner’s limited access to treatment and the full course of the injury rather than treating the absence of frequent appointments as proof of recovery.
• The weightlifting history likewise did not establish that exercise caused the shoulder condition.

Tlomak: A 107-Day Delay and Competing Diagnoses Did Not Persuade the Chief Special Master

Tlomak v. Secretary of Health and Human Services↗ (opens in new tab, external site), No. 25-0942V (Fed. Cl. Spec. Mstr. June 18, 2026) (findings of fact).

What happened:

• The petitioner received an influenza vaccine in his right shoulder in September 2023. He later stated under oath that the vaccination site was sore, painful, and aching from the first day.
• Approximately two months later, before receiving shoulder-specific care, he suffered a heart attack, spent five days in the hospital, received a stent, and began cardiac rehabilitation.
• Hours before discharge, an occupational therapist recorded arm movement within functional limits during an evaluation that appeared focused on whether the petitioner was ready to return home and begin rehabilitation.
• The petitioner first received treatment directed specifically at his shoulder 107 days after vaccination.
• His medical history included years of neck pain, nerve testing suggesting cervical radiculitis, and an MRI showing arthritis, degenerative changes, a rotator cuff tear, and fluid around the shoulder.
• An orthopedist later found limited shoulder motion and concluded that the symptoms appeared to arise primarily from the shoulder rather than the cervical spine.

The government’s arguments against compensation:

• The government argued that the 107-day delay before shoulder treatment undermined the petitioner’s account that the pain began within 48 hours of vaccination.
• It relied on medical visits during that period in which the petitioner did not report shoulder pain.
• It also relied on the hospital screening that recorded functional arm movement.
• Finally, the government argued that the petitioner’s longstanding neck problems, abnormal nerve testing, arthritis, and degenerative findings offered other explanations for the symptoms.

Why the Chief Special Master rejected those arguments:

• From the petitioner’s first shoulder-specific visit onward, he consistently reported that the pain began on the vaccination date. His sworn testimony was consistent with those medical histories.
• The Chief Special Master found it understandable that the petitioner’s life-threatening heart attack, hospitalization, and cardiac rehabilitation took priority over the shoulder complaint.
• The occupational therapy entry was created during a hospital-discharge assessment, not a focused shoulder evaluation. Its reference to functional arm motion therefore received limited weight on the disputed SIRVA issues.
• The petitioner’s prior neck pain differed from the later shoulder condition in its location, character, severity, and effect on function.
• Although the nerve testing suggested cervical radiculitis, the orthopedist who examined the petitioner concluded that the symptoms were mainly shoulder-related and that the cervical spine was not involved.
• The arthritis and degenerative changes were likely present before vaccination without producing shoulder pain. Their presence on imaging did not, by itself, explain the new symptoms that followed vaccination.

What the Four Rulings Show

These decisions do not create categorical rules, and each turned on its own medical record. Read together, however, they show why isolated entries should not be separated from the purpose of the visit, the course of treatment, and the record as a whole.

In these four cases:

• Delayed treatment did not establish delayed onset.
• Silence in refill requests, unrelated appointments, or discharge screenings did not establish that shoulder pain was absent.
• Chart errors and imprecise wording were evaluated against the broader record.
• Pain extending into nearby areas did not defeat claims that remained centered on the vaccinated shoulder.
• Treatment gaps did not establish recovery when the prognosis, treatment plan, or access-to-care limitations explained the absence of appointments.
• Preexisting conditions and abnormal test results mattered only if they actually explained the new shoulder symptoms.

The larger point is not that these issues are unimportant. It is that none can be evaluated fairly in isolation. The relevant question is what the complete record shows about when the pain began, where the injury primarily manifested, how long the symptoms continued, and whether another condition actually explains them.

7. SIRVA Frequently Asked Questions

Must a person see a doctor within 48 hours of vaccination?

No. The 48-hour requirement concerns when the shoulder pain began, not when treatment started. In the four decisions discussed above, the first shoulder-specific visits occurred between 46 and 107 days after vaccination, and the Chief Special Master still found timely onset.

A delay in seeking treatment may nevertheless create a significant evidentiary issue. Whether onset can be established depends on the complete record.

Does a medical record describing “arm pain” instead of “shoulder pain” defeat a claim?

Not automatically. In Gnanasundaram, the Chief Special Master found that the petitioner and her provider used “arm” and “shoulder” interchangeably in the context of that record. The treatment note connected the pain and tenderness to the vaccination site even though it described the symptom as arm pain.

The meaning and significance of any particular chart entry depend on the surrounding medical record.

Does pain extending down the arm disqualify a SIRVA claim?

Not automatically. In Spayd and Starkey, the Chief Special Master found on those records that pain originating and primarily manifesting in the vaccinated shoulder could satisfy the Table requirements even though some symptoms extended into nearby areas.

Symptoms that are primarily located outside the shoulder, or findings suggesting a neurological condition, may require a different analysis.

Does a treatment gap end a SIRVA claim?

Not necessarily. A period without medical appointments does not, by itself, establish that the injury resolved.

In Starkey, an eleven-month treatment gap was consistent with the orthopedist’s prognosis, home-exercise plan, and instructions to return only as needed. In Gnanasundaram, limitations on access to care were part of the context considered by the Chief Special Master.

The significance of a treatment gap depends on the records before and after the gap, the treatment plan, and the other evidence concerning the duration of the symptoms.

Does a normal MRI or degenerative finding defeat a SIRVA claim?

Not automatically. The federal SIRVA definition does not require a particular imaging result.

In Gnanasundaram, a largely unremarkable MRI did not defeat the claim. In Tlomak, degenerative findings that were likely present before vaccination without causing shoulder pain did not explain the new post-vaccination symptoms.

Imaging remains part of the overall record and may be important when evaluating the shoulder condition or another possible explanation.

What if the medical history includes neck pain or an abnormal nerve study?

SIRVA is defined as a musculoskeletal shoulder injury rather than a neurological injury. The relevant question is whether the neck or neurological condition actually explains the post-vaccination shoulder symptoms.

In Tlomak, the Chief Special Master distinguished the petitioner’s prior neck symptoms from his later shoulder condition and credited the treating orthopedist’s conclusion that the cervical spine was not involved.

The presence of neck symptoms or abnormal nerve testing therefore requires careful review, but its significance depends on the individual medical record.

How long is the filing deadline?

An injury petition generally must be filed within 36 months after the first symptom or manifestation of onset, or the significant aggravation, of the vaccine-related injury.

For a typical Table SIRVA claim alleging a new shoulder injury, the relevant date is when the shoulder pain began, which must be within 48 hours of vaccination. The filing deadline therefore usually falls close to three years after the vaccination. It does not run from the date of diagnosis or from when the person first learns about the VICP.

Filing-deadline questions can be fact-specific, and a person should not assume that a deadline has been extended based on delayed diagnosis or delayed discovery of the VICP.

Disclaimer

These answers summarize general legal principles and selected, fact-specific decisions. They do not determine whether any individual has a compensable claim, do not constitute legal advice, and do not create an attorney-client relationship. Every claim depends on its own facts, medical records, and procedural history.

Additional information about the VICP are addressed in my vaccine injury FAQs and my guide to the VICP.

When Shoulder Pain After Vaccination Persists

A potential SIRVA claim turns on more than whether the shoulder still hurts. The vaccine received, when the pain began, the condition of the shoulder before vaccination, and the medical record as a whole can all affect whether the claim satisfies the VICP’s requirements.

Before founding Jani Law PLLC, I clerked in the U.S. Court of Federal Claims, Office of Special Masters, and later litigated VICP cases on behalf of the United States as a DOJ Trial Attorney. I now represent petitioners seeking compensation under the VICP.

If you are trying to determine whether persistent shoulder pain may qualify for compensation under the VICP, Jani Law PLLC offers a free, confidential consultation. Contact Jani Law PLLC online or call 202-899-2711.

Attorney advertising. This article is provided for general informational purposes only. It is not medical or legal advice, and reading it does not create an attorney-client relationship. Every claim depends on its own facts and records, and past results do not guarantee or predict future outcomes.