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