REISSUED FOR PUBLICATION
                                                                                     27 MAR 2017
                                                                                       OSM
                                                                           U.S. COURT OF FEDERAL CLAIMS

3Jn tbe mtntteb ~tates Id.

        Also on 
April 16, 2012, petitioner saw Dr. Marcus Simonich, an optometrist with Ronan
Optical. Med. recs. Ex. 4, at 14. Petitioner said she had migraines since April 11, 2012 mostly
every day. Reading, sound, and light seemed to trigger them. Petitioner received HPV, hepatitis
A, and Menactra vaccines on April 10, 2012. Petitioner's primary care physician Dr. Muzquiz
did not think petitioner's vaccinations caused her headaches. Petitioner obtained new glasses
two weeks prior to her vaccinations. Her visual acuity was good with her new prescription. She
said she did not have headaches until the prior week. 
Id. Dr. Simonich 
diagnosed petitioner with
headache, myopia, papilledema which was mild versus pseudo-papilledema, and referred her to a
neurologist. 
Id. at 19.
       On April 17, 2012, Dr. Simonich, the optometrist, telephoned petitioner's primary care
physician Dr. Muzquiz and said he noted some optic edema and recommended petitioner see a
neurologist to rule out pseudo-tumor cerebri. Med. recs. Ex. 2, at 5.

       On April 24, 2012, petitioner saw Dr. Gregory P. MacDonald, a pediatric neurologist,
complaining of headaches and papilledema. Med. recs. Ex. 5, at 3. Her headaches began April
11, 2012, the day after she received hepatitis A, meningitis, and Gardasil vaccinations. She had
new glasses the week before that. Loud noises triggered her headaches. They were associated

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with photophobia, sonophobia, dysequilibrium, increased sleeping, decreased appetite without
weight loss, and increased fatigue. She did not have nausea. She missed school three days in the
prior two weeks. She had seasonal allergic rhinitis. 
Id. at 4. 
Dr. MacDonald diagnosed
petitioner with pseudo-tumor cerebri. 
Id. at 5.
       On April 27, 2012, petitioner had a brain MRI done. 
Id. at 39. 
There were no masses or
hydrocephalus. She did not have dural sinus thrombosis. 
Id.

        On May 
22, 2012, petitioner saw Dr. MacDonald, who noted that her brain MRI and
MRV were normal. She did not have hydrocephalus, tumor, or Chiari malformation. 
Id. at 7.
On physical examination, her fundi showed clear improvement. Her papilledema had improved
but not resolved. Dr. MacDonald again diagnosed pseudo-tumor cerebri. 
Id. at 8.
       On July 12, 2012, petitioner saw Dr. MacDonald. 
Id. at 10. 
Petitioner's daily headaches
had subsided. She had increased appetite and weight gain. Both her parents were obese. 
Id. On
physical 
examination, petitioner's fundi showed normal optic nerves with sharp disc margins and
spontaneous venous pulses ("SVPs"). 
Id. at 11. 
Dr. MacDonald diagnosed petitioner with
pseudo-tumor cerebi. He noted petitioner's daily headaches and papilledema had resolved with
Diamox. 
Id.

       On August 
28, 2012, petitioner saw Dr. MacDonald. 
Id. at 13. 
Petitioner had
intermittent pulsatile headaches more consistent with migraine. 
Id.

        On March 
2, 2013, petitioner saw Dr. MacDonald. 
Id. at 71. 
He wrote that her pseudo-
tumor cerebri was in remission. When she had a lumbar puncture done on January 18, 2013, she
had a normal opening pressure. The funduscopic eye examination done that day was normal.
Petitioner had intermittent headaches once every three weeks without definite triggers. He
diagnosed petitioner with migraines and advised her to maintain hydration. 
Id.

        On April 
16, 2013, petitioner saw Dr. MacDonald, who stated her pseudo-tumor cerebri
was in remission with normal opening pressure on lumbar puncture. Med. recs. Ex. 3, at 45. On
physical examination, she had a normal funduscopic exam. 
Id. He states 
that anxiety and mental
stress seemed to trigger her headaches. She stayed up late and wanted to sleep in the morning.
She had a normal examination. 
Id. at 46.
        On October 17, 2013, petitioner saw Dr. MacDonald. Her pseudo-tumor cerebri had
returned, perhaps due to a recent urinary tract infection and the antibiotic she took to treat it.
Med. recs. Ex. 5, at 75. Petitioner's BMI was then almost 35 and presented serious health risks
for her in addition to likely exacerbating her pseudo-tumor cerebri. Her parents were also very
obese. 
Id. at 76. 
On physical examination, petitioner's fundi showed absent SVPs and grade 1
papilledema bilaterally. 
Id. at 78.
        On December 28, 2013, petitioner saw Dr. Bruce Mikesell, complaining of headaches for
the past two weeks. Med. recs. Ex. 3, at 210. She was previously diagnosed with pseudo-tumor

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cerebri, but Dr. Mikesell wrote that her documented workup did not support this diagnosis. 
Id.

       On April 
17, 2014, petitioner saw Dr. MacDonald. Med. recs. Ex. 5, at 80. She had
migraine not otherwise specified with intractable migraine, pseudo-tumor cerebi, and obesity.
On physical examination, her funduscopic eye examination looked normal. Her recent lumbar
puncture had an opening pressure within normal. When 5.5 mL were removed to yield a closing
pressure of 19.8 cm of water, petitioner said she felt instantly better and was headache-free for
four days. 
Id. at 81.
        On September 26, 2014, petitioner saw Dr. Marcus Wheeler, who notes: "I suspect given
the chronic nature of her symptoms and complaints of discomfort out of proportion to physical
manifestations bf discomfort that there is likely a significant psychological component to her
symptoms which will need to be addressed in the future." Med. recs. Ex. 19, at 27.

                                          DISCUSSION

       To satisfy her burden of proving causation in fact, petitioner must prove by preponderant
evidence: "(1) a medical theory causally connecting the vaccination and the injury; (2) a logical
sequence of cause and effect showing that the vaccination was the reason for the injury; and (3) a
showing of a proximate temporal relationship between vaccination and injury." Althen v. Sec'y
of HHS, 
418 F.3d 1274
, 1278 (Fed. Cir. 2005). In Althen, the Federal Circuit quoted its opinion
in Grant v. Secretary of Health and Human Services, 
956 F.2d 1144
, 1148 (Fed. Cir. 1992):

               A persuasive medical theory is demonstrated by "proof of a logical
               sequence of cause of and effect showing that the vaccination was
               the reason for the injury [,]" the logical sequence being supported
               by a "reputable medical or scientific explanation[,]" i.e., "evidence
               in the form of scientific studies or expert medical 
testimony[.]"

418 F.3d at 1278
.

       Without more, "evidence showing an absence of other causes does not meet petitioner's
affirmative duty to show actual or legal causation." 
Grant, 956 F.2d at 1149
. Mere temporal
association is not sufficient to prove causation in fact. 
Id. at 1148.
        Petitioner must show not only that but for her human papillomavirus, hepatitis A, and
Menactra vaccinations, she would not have pseudo-tumor cerebri, papilledema, and headaches,
but also that these vaccinations were a substantial factor in causing pseudo-tumor cerebri,
papilledema, and headaches. Shyface v. Sec'y of HHS, 
165 F.3d 1344
, 1352 (Fed. Cir. 1999).

        The Vaccine Act,§ 300aa-13(a)(l), prohibits the undersigned from ruling for petitioner
based solely on her allegations unsubstantiated by medical records or medical opinion. None of
petitioner's medical records supports her allegations. In fact, petitioner's personal care physician
Dr. Muzquiz informed Dr. Simonich, petitioner's optometrist, that she did not think petitioner's

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vaccinations caused her headaches. Petitioner has not filed a medical expert report in support of
her allegations even though her first attorney spent over a year and a second attorney Mr.
Rossbach spent months looking for an expert.

        The undersigned GRANTS petitioner's motion to dismiss.

                                            CONCLUSION

     This petition is DISMISSED. In the absence of a motion for review filed pursuant to
RCFC Appendix B, the clerk of the court is directed to enter judgment herewith. 2


IT IS SO ORDERED.


Dated: February 27, 2017                                            ~£2-~
                                                                       Laura D. Millman
                                                                        Special Master




2 Pursuant to Vaccine Rule I !(a), entry of judgment can be expedited by each party, either separately or
jointly filing a notice renouncing the right to seek review.
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