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Sunday, March 6, 2011

Military Medical Boards : Mathematics or Medical science ?

The following appears in this month's 'Salute' magazine.

(Copyright : 'Salute to the Indian Soldier')

Military Medical Boards : Mathematics or Medical Science ?

Navdeep Singh

Disability benefits in the forces are contingent upon the declaration of a disability being either ‘attributable to, or aggravated by’ service conditions. Detailed Entitlement Rules promulgated by the Government further determine the question of attributability and aggravation. However, non-adherence to the ibid rules and a purely mathematical approach, as opposed to the desired medical one, is resulting in denial of benefits to the disabled and also overburdening judicial fora.

So who decides attributability and aggravation? Based on an artificial over-reliance on various judgements of the Supreme Court wherein it has been held that the opinion of medical boards has to be granted due weight, the system wrongly seems to believe that medical boards are supreme in this arena. They actually are not. Attributability and aggravation are determined under the rules and the boards are supposed to work within the four corners of these rules with proper application of medical and scientific procedures, not mathematical formulae. Primacy of medical opinion does not definitely imply that it would hold field even when rendered in contravention of the statute or when prima-facie perverse. Despite our progress, attributability of disabilities is still decided on primitive guidelines which reflect a strong disconnect with practical realities.

While the unpredictability of military service is universally appreciated, the Guide to Medical Officers published by the office of Director General of Armed Forces Medical Services, still prescribes that stress related disorders cannot be service-related unless a person spends a specific length of time in a field area and unless the symptoms arise within a period of some months after being posted out of field. Ignored is the fact that a solitary stressful incident in a single day can also trigger stress without any reference to length of service in a particular area, and as modern psychiatry has established, there can be a delayed onset of symptoms even 5 years after a stressful event. Then for example the requirement that the symptoms should manifest themselves within 3 months of being denied leave in case of the death of a parent when the individual happens to be the ‘only’ son. Would not a person be affected if he is not the ‘only’ son or if the symptoms arise after four months rather than the mathematical guideline of 3 months? What could also justify the basis of determining heart diseases on the basis of the ‘14 days charter of duties’ ? The service-connection of complicated heart problems in the Indian military is determined by activities a person had indulged in the last 14 days prior to the onset of the disease? It is common knowledge that heart diseases manifest over a long period of time, isn’t it time to shun these outdated practices and deal with such situations with a more scientific temperament on a case to case basis ?.

Claims of attributability and aggravation are rejected by one word terms such as ‘No’, ‘Constitutional’, ‘Unknown’, ‘idiopathic’ whereas the rules clearly stipulate that if the causes are unknown then presumption operates in favour of the claimant and attributability, or atleast aggravation, ‘shall’ be conceded.

In defence, naysayers harp on the argument that stress and lifestyle related disorders can happen to civilians too and thus have no link with military life. How wrong they are. Can one compare the stress levels of a soldier leading a strictly regimented life away from family under a strict disciplinary code 24 hours a day, 365 days a year, at times under the shadow of the gun, with a civil employee living with family, working from 9 to 5, enjoying weekends and holidays. Even seemingly trivial issues such as admission of children, property disputes and insignificant family rows can have a stressful impact on our soldiers especially those deployed away from families, irrespective of whether in peace or field, and to ignore such incidences of service as unrelated to stress related disorders would be the greatest disservice. Not may are aware that civilian employees have the protection of Section 47 of ‘Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995’ which provides that if an employee gets disabled, even when not on duty and due to own negligence, his or her service remains protected and if the said employee is not able to work, still he or she is kept on supernumerary strength and paid full pay and allowances till the age of 60 and pension thereafter. This protection is not available to defence personnel who can be invalided even for minor disabilities, and who, at the lower ranks, even in normal circumstances anyway do not have the protection of employment beyond their 30s.

It is a quivering double jeopardy for disabled soldiers. On one hand, our own medical boards follow a self-defeating hyper-technical approach, and on the other, the protection of employment as guaranteed to all other government employees is unavailable to defence personnel. In theory, 2011 may be the year of the disabled soldier; it remains to be seen how it works on ground.

Major Navdeep Singh is a practising Advocate in the Punjab & Haryana High Court at Chandigarh


Kaps said...

It has been the bane of Indian mindset. Not just in the AF, in any system, it appears the ones in power are always against the not so privileged and erect all sorts of rules/obstacles/barriers to ensure that the "not so privileged" remain like that. India might rid herself of the "caste system" but the mindset responsible for this is never going to change.

In this year of the disabled soldier, the best gift to the disabled soldier will be amendment of the Guide to Medical Officers and a definite push for an act of Parliament to have something in place like the Persons with Disabilities Act, 1995

Anonymous said...

A very apt article. All Medicos must read and circulate among themselves for implementation.Kudos to Maj Navdeep.Hope justice prevails on both side be it rationalisation of med board or implementation of DACP for AMC.

Anonymous said...

An article bringing out the plight of AF disabled . Wonder who makes these rules, perhaps once again our esteemed BABUs, sitting in those offices where they hardly venture outside to know the problems of dsabled Armed Forces personnel. They too need to be apprised of the difficulties faced by disabled.30 % parity has been issued . But the case regarding Broad Banding is still hanging fire , inspite of the fact that it has been favourably decided by AFT.May be the year of the disabled will bear fruits !


Anonymous said...

Let one thing be clear- the rules are followed by the medical board. who makes these rules? the AG Branch, not the medicos!!
i fully agree what navdeep has said. time that our own chaps woke up to reality, and change these outdated rules. stress today is more in peace areas rather than field areas.

Anonymous said...

It will be unfair to blame the medical boards alone. Actually it is the myopic views at the directorates who make such policies and tie the hands of the boards. Now a days there is hardly any discretion left in their hands. At the same time system is such that there is no provision for the approving authorities to make any changes in the board's decision. If they want any change in the decision, they return the board and force the board to align their opinion as per their wishes and put it up as decision of the board. All the paras of justification is over ruled with one line "Contention of the Board not agreed to" without any explaination and board members either agree or perish. Whenever you actually meet these high profile people involved in policy making they brush you arguments aside saying that is the policy you have to implement kind of attitude. Only those people reach that level who have learnt to fall in line. On one occasion one fought with the system to convice the authorities to grant aggravation to a soldier, a known case of hypertension, brought with sudden death during the night while on CL in station due to massive heart attack, and failed. Ultimately the board was changed with more amenable people and aggravation was denied as his hypertension had arisen in peace and he was on CL at the time of heart attack. Unfortunately all this correspondence is not on board papers and is lost to follow up and what remains is that the board gave such a inhumane decision.

Anonymous said...

Dear Maj Navdeep,
I fully agree with the point of view mentioned. I, as part time President Med Bds, have endeavoured and succeeded in awarding attributibility / aggravation for conditions like Hypertension, diabetes, osteo arthritis etc. to many a soldiers. However, the "higher authorities" ( Comdt, Brig Med etc.) have overruled at times which I have countered with scientific justification. At times I have succeeded. At times not. The problem is that in spite of a liberal and justified award of attributibility / aggravation, the seniors in the chain are charry of disagreeing with teir superiors (?IOs) and do not want to jeopardise their ACRs for a "puny" subordinate. I wish there were more offrs who do not work for acr and are more humane!

Anonymous said...

Our Chief has declared 2011 as year of disabled soldier. 2 months have passed and not one iota statement after the initial announcement. Let's see how the rest of the year pans out. Will he walk the talk?

The medical rules are drafted by the DGAFMS and thereaftre approved by the MoD. They can push for equality of disabled soldiers benefits with those enjoyed by civilian counterparts. But will they?

Rammohan said...


I am 100 percent disabled soldier discharged from service in 2001 and attributable to government service, wheelchair bound.

Will I get the compensation as per below reference of Budget 2011
Plz do clarify awaiting for your kind reply

FM's budget 2011 extract :
A lumpsum exgratia compensation of 9 lakh for 100 per cent disability to be granted for personnel of Defence and Para Military forces discharged from service on medical ground on account of disability attributable to government service.

Sgt.S.Kanthiah said...

Dear Major Sir,
It is wonderfull article. Every soldier shoul read and understand. The Armed Forces Medical Officers must read and do the justice to the Disabled defence personnels. The year is declared as Year of Disabled , it should be really follwed. You have used the right Legal words in many places . Hats off Sir.

Exwel Trust, Tirunelveli-Dist, Tamil Nadu.

Anonymous said...

couldn't agree more with you on this !


Dear Navdeep
Your wordings are so appropriate full of pain anguish and concern for the service people. God bless you and keep doing it your benefits will be his blessings and good will of the Armed Forces Fraternity

Anonymous said...

What can be done about it? My own case is like that. I have a total disability of 60% but only 30% is conidered attributable. My biggest problem is my PIVD L5-inS1 -a spinal condition, which is notconsidered even aggravated by service condition. I first reported it in 2000 and later became medical category in 2005 befeore I left in 2007.

Anonymous said...

AG of the Army and his counterparts in other two services are requested to initiate comprehensive changes in this regard before AFT starts calling them to !

Devendra said...

Sir, An eye opening article for all those sitting in higher hiarchy. AFT is sure to give a able justice to disabled. Med Offrs do need a guidance on this. Should not leave things to Nursing Asst. How many AMC Offrs or JCOs are without disability pension. Even for obesity, pry hpertension or diseases which have been aggravated sitting there in hospitals. Justice is to be done to our brae soldiers.

Anonymous said...

very well brought out ! Med offr and their superiors follow the GUIDE TO MEDICAL OFFERS blindly and to the extent they are to deny attribution/aggravation. however ,i would like to know the legal status if these Guides ( NOT directive) are not followed and common sense / medical prudence used to award attributability/aggravation..

Anonymous said...

PCDA(P)Allahabad circular on payment of pensionary awards to pre 1-1-06 retirees on percentage basis is still NOT availabl(P)..........

Velayudhan said...

Dear Maj Navdeep,

I had given my comment earlier also on this but doesnt appear.

However i would like to reiterate that if a civilian employee get invalidated even if he is on leave ,he gets compesation of his last drawn salaries up to the age of 60 and now its raised to 62 years of age and then the pension.
Why such facility is not available to Armed Forces Pers who is sacrificing the life for the Nation and he is invalidated at an early age and he is fighting for his disability pension in the courts.
Why the same rule which is applicable to civ be made applicable to AF pers also. Similarly officers selected for promotion and empanelled for higher ranks are sent home due to want of vacancies.Now time scale LTCol,cOL TS. THEN WHAT THE DIFFERENCE BETWEEN TS and Selection grade? Its high time that some one should seriously sort out these isues in the intrest of soldiers.

With regards

Mahesh Nair said...

Dear Major Navdeep Singh,
A very good article.
It is very unfair to board out armed forces personnel with injury not attributable to military service even if the injury was sustained during non duty hours or leave.
Imagine a person who takes part in a war and meets with an accident during his leavefor no fault of his is boarded out and that too four years after the injury was sustained with a 40% disability.In other words, he was fit to serve for four years after the accident and carry out all military duties as required of him,and then the medical board finds him unfit for military service and recommends his invalidment.His injury is neither attributable nor aggravated by military service.Don't you think his injury could have been aggravated by the service he put in after the accident.His percentage of disability remained the same.
This happened to me in 1981.
I managed to livee a decent life with dignity but there are many who have suffered because of this very dubious rule.
I feel if armed forces personnel meets with an accident whether on duty or not[as long as it is not self inflicted or because of drunken driving etc],his injury should be attributable to service.
If he is allowed to continue in service and carry out all duties as required in a normal unit,whether in peace area or not,and boarded out after a period of 2 years,it has aggravated only because of his military duties.Therefore,in all fairness,the mediacl board should make it aggravated by military service.
I would request your valued opinion.
Kind Regards
Mahesh Nair

bhupendra said...

Col(retd) B pant A M C, When i look back i realise that our seniors who taught us during our initial days felt as if we are doing favour to all these people by doing board. Most of the time we were being too strict and bookish.But when I became the Presiding officer i tried to do justice as per my learning while growing up.The babus at all levels use to put all silly observations.They were at times frustating and away from realities.The Guide to Med Officers has been made by people who have hardly seen difficult areas. It is beyond their thought process the life of a soldier.Like Babus they must be given the feel of high altitude,c i ops then only they will become liberal in awarding disability pension.

drdray3 said...

dear maj navdeep,i wonder why armed forces personnel are denied the benefits, given to civ govt pers ,under Persons with Disabilities Act 1995,and can the armed forces tribunals take suo moto action to remove this glaring discrepancy,or can a PIL be initiated in this matter?surely hundreds of disabled armed forces pers would stand to benefit.as regards the '14 day charter of duties'in disposal of myocardial infarction,IHD cases ...it is a well known fact that the underlying cause 'atherosclerosis' develops over years due to some known causes and many unknown/intangible causes ,so what is the logic of only considering the 14 days charter of duties!the guide to medical officers doing medical boards needs to be rectified urgently.col d ray

Anonymous said...

Dear Maj Navdeep,
After reading all this I 'm compelled to say that the very constitution of the bd is farcical. Except the PMB, the other members who are supposed to analyse/scrutinise or democratically disagree(!) with the board are merely rubber stamps. Most of the time these members are YOs and/or direct entry MOs who dare not "Q" the PMB or the "OC hosp". While reading ur art, I fully agree that the shrink is often than not premandated. The psychiatrist(shrink) is often guided by the rank he is wearing or the one he is pursuing than the "humane" approach he shud be taking. To top it he goes by the Form-10 which is initiated by the unit cdr which even DGAFMS agrees ; is used as a tool to "sort out" unwanted personnel. Not only does the med board hold sway,but even if second opinion is taken from the civil experts, it is never considered by the A(armed)F. By the time, if invaliding has been done, it is too late. well I have,being a non med SO, read some of the guidelines issued by the DGAFMS and realized that, the med board are sent up the medical channel wherein so called dir of med services or health( staff channel) merely stamp "perused" or "approved". The said boards are rarely returned beacuse of procedural lapses( diff from tech observation). I must end with emphasis on personal experience of interacting with MOs/specialists who are at the ground level unaware of implications of their sig- both legal as well as writing "epitaph" for a soldier!!
I shall writing some more on this.

Anonymous said...

dear maj navdeep
Thanks for this useful article. Can we hope that something will happen for disability pension to those disabled defence
personnel who were suffering with heart diseas etc termed as chronical disease neither attributable nor aggravated by service in this declared year of disabled soldiers.

Cdr(Retd) Birbal Singh said...

dear maj navdeep
Thanks for this useful article. Can we hope that something will happen for disability pension to those disabled defence
personnel who were suffering with heart diseas etc termed as chronical disease neither attributable nor aggravated by service in this declared year of disabled soldiers.
Cdr(Retd) Birbal Singh

Anonymous said...

A article which I hope will open the eyes of the Medicos. I am a disabled officer myself for a disease not attributable or aggravated by military service. After having served for approx 18 years in the army the disease hit me when I had completed 14 years of service. The instructions of the medicos relegated me to a position wherein serving in the forces became a farce.
I thus chose to retire voluntarily and have no regrets or claims to a pension. But having been told that I cannot be called a ex-serviceman was adding insult to injury. That was thanks to some archaic defnition by the AG's branch which nobody was aware of. ( Ignorance is no excuse!)

Look at the injustice of it. You serve in an organisation for 18 years but have no right to claim that you were a part of it ( Even if you saved the goverment a sizeable amount in salary and pensions). But if I had put in 2 more years in some desk job and bingo- I would have been called a VETERAN

As regards the Release Medical Board itself the less said the better. You are running from pillar to post within a hospital doing every test except for which you were disabled and of course without a serious meeting with a doctor- my comrade -in-arms! And lo and behold the release medical board proceedings arrive which is confidential (atleast in the 90's) and you are not even ruddy aware what it contains.
I am sure that they have changed and become more humane. In no way I am suggesting that they break the rules but atleast spend a lot of time interpreting it. You are judging a fellow soldier and duty demands that justice should be done to him or her. After all one day he may save you in battle

Hemant said...

Dear Navdeep,
Hope some sense prevail in our system and amongst our seniors who are also donning the same uniform as veterans use to be. Hope they will realise that one day they can also be at receiving end. I have been granted 20% disability by the Medical board during my RMB. Despite the Supreme Court ruling and lots of mouthful from judiciary our CDA(P)has still not changed and I have been given barely Rs 5000/ as disability pension. It seems that despite the instructions of COAS we are still having a mindset of giving full benefits to those who take the course of judiciary for seeking their entitlements Can you please take up such cases at your level and guide me as to what should I do rather than going to Court. Hope this article also brings sense in the minds of our policy and decision makers.
Lt Col H K Puri (Retd)

सप्त ॠषि सहगल said...

My father was Invalided out of army in 1976, with 5 years of service because of perceptive deafness, and disability was Attributable to his Military services at 20%. 2 RSMB were conducted after Initial board one after 2 years and then after 10 years and then his disability was sanctioned for life. In 1996 we approached PCDA (P) for RSMB as his hearing condition had deteriorated, but in reply they said that your award has been sanctioned for life and RSMB cannot be held. It was after continuous correspondance, DGAFMS wrote to Military Hospital Jabalpur for RSMB and papers were forwarded to PCDA(P) stating that disability has aggravated and now assessed at 80%, but PCDA(P) again declined that 20% has been sanctioned for life and disability has aggravated due to natural progression due to age.

My question, how many people in this world at the age of 62 have 80% deafness due to age?? can PCDA answer this.

Anonymous said...

Dear sir, I am a CPO serving in the indian navy. my initial engagement in navy was only ten years, however due to promotion requirements i have re engaged for ten more months. my release date is on Nov 2014. my further re engagement for 5 years has been approved by the navy and the agreement copy has been sent to me from our record office for my signature after which only the total re engagement formalities completes. when my re engagement was approved i was in shape 1, but when the agreement came to me for my signature i was brought down to temporary shape 3 due to my hearing problem and it was assessed as aggravated by service in my re categorisation board. My next recategorisation board is in Dec 13. if i would be given with a permanent low medical category of shape 3, then i cannot get a re engagement for the next 5 years for which earlier approval was accorded by the record office. please guide me whether i am eligible for a disability pension if i am sent out of service with a shape 3 category after my initial engagement of 10 years and 10 months as my disability is aggravated by service?

somvir said...

sir my service 9 year and i am suffering from paralysis and my half body part not workig lower side when i m going duty field area fallen from army vehicle after that i admit pathonkot mh and rr also.that time neuro hod fight with me and send psy ward then i took 5 days leave and osl from setember 2013.then i appeal in aft delhi orderered for medical treatment for medical board i know that what imb procass and time in my case howmany days to complete imb