mediastinal and abdominal lymph nodes about 38 per cent on the basis
of the known physical factors of the [clinic] radiation. The bone
matrow of the vertebral column because of the mineral structure of the
bone would have received a larger dose, on the order of 155 per cent.
The marrow of the posterior ribs and sacroiliac region would have
received perhaps somewhat more than the vetebral marrow.
x
&
&
In 1962 he was found to have chronic lymphatic leukemia. Because
chronic lymphatic leukemia often has an insidious course, it is quite
possible that this had been present for some years prior to 1962, perhaps
three or four, which would place the onset at the time of maximal onset
for radiation induced leukemia':?, A
targe series of patients with
spondylitis who have received X-radiation therapy has been studied in
the United Kingdom by Court-Brown and Doll. They found . . . no cases
of leukemia developing at less than 250 r, two cases between 250 and
500 1 delivered to the spinal marrow. They found four cases they called
lymphatic leukemia (probably acute).
that he received, (probable in 1948 and certain 1949) for a service
connected disability. Therefore, his leukemia might well be considered as
service connected.
Findings of the BVA and Basis for Decision: In deciding that service
connection for lymphocytic leukemia, secondary to rheumatoid spondylitis,
was established the Board noted:
In reviewing the medical literature, we found that a relationship
between radiation exposure and leukemia is recognized, that the
’ leukemia reported in this connection was usually of a type other than
lymphocytic leukemia. Nevertheless, lymphocytic leukemia was reported
in some of the cases after radiation exposure. [An expert] in thefield of
radiation exposure and its pathological effects... reviewed the evidence
and it is his opinion that a causal relationship between chronic
lymphocytic {or lymphatic) leukemia and previous radiation therapy
may not be ruled out in the instant case.
* * *
To summarize, the weight of evidence is against the hypothesis that
chronic lymphatic leukemia is ordinarily induced by either acute or
chronic exposure to radiation. On the other hand, in the cases of
spondylitis treated by ionizing radiation over the spine for the relief of
pain, the classic study of Court-Brown and Doll... indicates the
development of an excessive number of cases of lymphatic leukemia
(probably acute) above the expected .... They found four cases they
called lymphatic leukemia (probably acute). However, at least one may
have been of chronic type. They found one case which they consider to
be acute myeloid which was stated to have a count of 42,000 white
blood cells, mostly mature lymphocytes. This, therefore, may well have
been a case of chronic lymphatic leukemia, although they did not so
regard it.
Since the spondylitis from which [the Appellant] suffered has been
adjudged to be a service connected disability, since chronic lymphatic
leukemia developed within a reasonable time (less than 13 years) after
his radiation treatment for this disease and since an excess of lymphatic
leukemia cases (at least one of which may have been of chronic type) has
been reported to follow radiation treatment of spondylitis, one has to
assume in spite of other evidence to the contrary, largely derived from
nonspondylitics, that in [the Appellant's} case the chronic lymphatic
leukemia may well have developed as a result of the radiation therapy
'Court-Brown, W. M. and Doll, R,: Leukemia and Aplastic Anemia in Patients
Irradiated for Anklylosing Spondylitis. Medical Research Council Special Report Series
No, 295. London, 1957.
2 Warren, S. and Lombard, O. M.: New Data on the Exposure of the Human Population
to Fonizing Radiation. In press-proc. XI International Congress of Radiology.
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