CASE NO.28
Type of Injury: Carcinoma of the Cheek.
|. There is nothing to indicate that the diagnostic X-rays taken in
1964 focusing on the cervical and thoracolumbar spine and the chest
were either directed toward the face, or that the dose was carcinogenic.
Minimum dosages required for carcinogenesis are generally believed to be
well over 1000 r. Diagnostic radiation involves only-a small fraction of
this amount.
2. The time sequence noted is not consistent with the usual history
of post-radiation cancer. Intervals of many years, rather than a few
weeks, are the generalrule.
3. Had there been accidental delivery of such a massive dose of
radiation to the infraorbital region as to produce early malignant
BVA's Decision: Denial Affirmed.
Date of Decision: 1967.
Appellant's Allegation: That his carcinoma ofthe left cheek resulted from
X-ray burns during Administration hospitalization in 1964.
Facts: Veteran was in active service from June 1953 to June 1955. Military
medical records indicated that in February and March 1955 veteran was
hospitalized for surgical repair of an inguinal hernia and for minor surgery for
an unrelated condition. The hospital course was complicated by development
of post-surgical phlebitis and a pulmonary syndrome. After leaving the hospital
for temporarily restricted duty the veteran continued on outpatient treatment
until the following month and had complaints of persisting pain in the right
chest. On examination in June 1955 for release from active duty the veteran's
heart and vascular system were reported normal. The examination included a
chest X-ray which was negative. In subsequent years the patient experienced
repeated attacks of superficial phlebitis of both legs and the right arm and was
hospitalized at various times. Evidence indicated that chest X-rays were made
in January 1958, February 1963, June 1964 and October 1965. In June and
July 1964 when veteran was an Administration hospital patient, multiple view
X-rays were taken of the cervical, dorsal and lumbarspine in addition to chest
X-rays.
in January, 1965 the veteran was treated as an outpatient at a hospitalfor
basal cell carcinoma of the skin of the left cheek. The lesion was excised
without complication being reported. In September 1965 dermatological
examination was done. The surgical scar on the left side of the face was
described, and it was stated that there were no signs of any dermatoses on the
body except for numerous pigmented moleson the trunk and extremities.
Medical Evidence: The Board, in considering the veteran’s claim, requested
review of the medical evidence by an independent medical expert specializing
in dermatology. The specialist reported as follows:
degeneration, there must inevitably also have been produced the
characteristic signs of radiodermatitis. However, there was no evidence
of hair loss (lashes), pigmentation, atrophy, telangiectasia etc. on clinical
examination by a consulting dermatologist,....Onty a barely visible
surgical scar was noted. A transient pruritic erythema of the cheeks was
noted in the hospital records on July 7, 1964. It was possibly ofallergic
origin, responding to oral Benadry!.
4. Microscopic examination of biopsy slides showed only the usual
features of basal cell epithelioma, with no signs of radiodermatitis. {t
should be noted that squamous cell, rather than basal cell lesions are
more characteristic of radiation cancers.
Basal cell carcinoma of the face is a disease of ordinary life. No
evidence was found in detailed review of the data furnished to implicate
X-radiation as the causative factor in this case. In summary, it was
deemed unlikely that the area in question accidentally received any
significant dose of radiation, there was no physical evidence of radiation
injury to the skin, and the very brief interval between the use of
radiation and the onset of the condition invalidated any possible
etiologic connection.
Findings of the BVA and Basis for Decision: tn finding that compensation is
not payable for carcinoma of the left cheek as being the result of
Administration hospitalization, treatment or examination the Board said in
pertinent part:
The X-rays made during Administration hospitalization in 1964 were
for diagnostic purposes and would not ordinarily involve exposure to
such an extent as to risk injury from radiation. The detailed clinical
records do not suggest that any accidental over-exposure occurred. The
manifestation of carcinoma within a few months after the X-rays was
inconsistent with exposure being the cause of the tumor.
No evidence was found to support the claim that the basal cell
carcinoma of the face was due to or the result of X-rays taken during
hospitalization in June and July 1964. The bases for this conclusion are
as follows:
90
9)