The Supreme Court/The Supreme Court.iso/pc/ascii/1994/94_372/94_372.zc

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SUPREME COURT OF THE UNITED STATES
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No. 94-372
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DONNA E. SHALALA, SECRETARY OF HEALTH
AND HUMAN SERVICES, PETITIONER v.
 MARGARET WHITECOTTON et al.
on writ of certiorari to the united states court
of appeals for the federal circuit
[April 18, 1995]

  Justice O'Connor, with whom Justice Breyer joins,
concurring.
  Margaret Whitecotton was born in 1975 with a
condition known as microcephaly, defined commonly (but
not universally) as a head size smaller than two stan-
dard deviations below the norm.  At the age of four
months, she received a diphtheria, pertussis, and tetanus
(DPT) vaccination.  Prior to receiving her vaccine,
Margaret had never had a seizure.  The day after
receiving her vaccine, she suffered a series of seizures
that required three days of hospitalization.  Over the
next five years, Margaret had intermittent seizures.  She
now has cerebral palsy and hip and joint problems and
cannot communicate verbally.  In 1990, Margaret's
parents applied for compensation for her injuries under
the National Childhood Vaccine Injury Act of 1986.  The
Special Master denied compensation, and the Court of
Federal Claims agreed.  The Court of Appeals for the
Federal Circuit reversed, 17 F. 3d 374 (1994), finding
that the Whitecottons had made out a prima facie case
for compensation.
  Although I join the Court's opinion rejecting the Court
of Appeals' reading of the pertinent statutory provision,
I write separately to make two points.  First, I wish to
indicate an additional factor supporting my conclusion
that the Court of Appeals' reading of 42 U. S. C.
300aa-11(c)(1)(C)(i) is inconsistent with congressional
intent.  Second, I wish to underscore the limited nature
of the question the Court decides.
   Examining the language of 300aa-11(c)(1)(C)(i), the
Court properly rejects the Court of Appeals' determina-
tion that a claimant may make out a prima facie -onset-
case simply by proving that she experienced a symptom
of a -table illness- within the specified period after
receiving a vaccination.  Ante, at 5-6.  To establish a
table case, the statute requires that a claimant prove by
a preponderance of the evidence either (1) that she
suffered the first symptom or manifestation of the onset
of a table condition within the period specified in the
table or (2) that she suffered the first symptom or
manifestation of a significant aggravation of a pre-exist-
ing condition within the same period.  As the Court
rightly concludes, proof that the claimant suffered a
symptom within the period is necessary but not suffi-
cient to satisfy either burden; the word -first- is signifi-
cant and requires that the claimant demonstrate that
the postvaccine symptom, whether of onset or of signifi-
cant aggravation, was in fact the very first such mani-
festation.
  The Court relies on a commonsense consideration of
the words -first- and -onset- in reaching this conclusion:
-[i]f a symptom or manifestation of a table injury has
occurred before a claimant's vaccination, a symptom or
manifestation after the vaccination cannot be the first,
or signal the injury's onset.-  Ante, at 6.  I find equally
persuasive the observation that the Court of Appeals'
reading deprives the -significant aggravation- language
in the provision of all meaningful effect.  The term
-significant aggravation- is defined in the statute to
mean -any change for the worse in a preexisting
condition which results in markedly greater disability,
pain, or illness accompanied by a substantial deteriora-
tion of health.-  42 U. S. C. 300aa-33(4).  If, as the
Court of Appeals determined, a claimant makes out an
-onset- case any time she can demonstrate that any
symptom occurred within the relevant period, all cases
in which children experience postvaccine symptoms
within the table period become -onset- cases.  The
phrase -significant aggravation,- and any limitations
Congress sought to impose by including language like
-markedly greater disability- and -substantial deteriora-
tion of health,- are altogether lost.
  To the extent possible, we adhere to -the elementary
canon of construction that a statute should be inter-
preted so as not to render one part inoperative.-
Department of Revenue of Oregon v. ACF Industries, Inc.,
510 U. S. ___, ___ (1994) (slip op., at 7) (internal
quotation marks omitted); Pennsylvania Dept. of Public
Welfare v. Davenport, 495 U. S. 552, 562 (1990).  The
construction adopted by the Court of Appeals contra-
venes this principle.  Our reading gives effect to the
-onset- and the -significant aggravation- language while
according -first- its commonsense meaning.
  Today's decision is quite limited.  The Court of
Appeals had no occasion to address the Whitecottons'
challenges to the Special Master's factual findings with
respect to their daughter's condition.  We assume,
arguendo, the soundness of his conclusions that Marga-
ret Whitecotton suffered a pre-existing encephalopathy
that was manifested by her prevaccine microcephaly.
But this may not be the case, and the Whitecottons of
course may challenge these findings as clearly erroneous
on remand.  The Court of Appeals also did not address
the Whitecottons' argument, rejected by the Special
Master, that their daughter suffered a significant
aggravation of whatever pre-existing condition she may
have had as a result of the vaccine.  This factual
challenge appears to be open as well, as does a chal-
lenge to the legal standard used by the Special Master
to define -significant aggravation.-
  We also do not pass the Secretary's argument that the
Court of Appeals misstated petitioner's burden under 42
U. S. C. 300aa-13(a)(1)(B) in rebutting a claimant's
prima facie case.  Given our holding with respect to the
claimant's burden, it is speculative at this time whether
any effort on our part to evaluate the Court of Appeals'
approach to the -facto[r] unrelated- standard will find
concrete application in this case.  That said, the ap-
proach taken by the Court of Appeals, under which the
Secretary may not point to an underlying condition that
predated use of a vaccine and obviously caused a
claimant's ill health, if the cause of that underlying
condition is unknown, may well warrant our attention in
the future.