Holding

The Supreme Court held that the Medical Board’s opinion is not beyond judicial review and the Tribunal’s refusal to examine it was unlawful, directing a Review Medical Board to reassess the appellant’s condition.

Summary

Veer Pal Singh, an Army signalman, was discharged after the Invalidating Medical Board diagnosed him with "Schizophrenic Reaction" and denied his claim for disability pension on the ground that the condition was not attributable to military service. He challenged the discharge and pension denial through successive writ petitions, which were eventually transferred to the Armed Forces Tribunal (AFT). The AFT held that the Medical Board’s opinion was binding and could not be reviewed, dismissing his application for a review medical board. The Supreme Court held that expert opinions, including those of medical boards, are not beyond judicial review and that the Tribunal erred by refusing to examine the board’s record. It observed that the board had merely endorsed the psychiatrist’s inchoate opinion without considering the appellant’s improvement after treatment. Consequently, the Court set aside the AFT orders and directed the government to constitute a Review Medical Board to reassess the appellant’s condition and entitlement to a disability pension.

Issues considered

The opinion of the Invalidating Medical Board is amenable to judicial review.
Whether the Armed Forces Tribunal can sit over and disregard the medical board’s findings.
Whether the appellant’s Schizophrenic Reaction was attributable to military service and thus makes him eligible for disability pension.
The proper procedure for reviewing a medical board’s decision in cases of premature discharge.

Legislation cited

Armed Forces Tribunal Act, 2007

Subjects

Armed ForcesMilitary dischargeDisability pensionJudicial reviewMedical boardSchizophrenic ReactionArmed Forces TribunalExpert opinionPremature releaseReview medical board

Judgment

[2013] 10 S.C.R. 579

VEER PAL SINGH A
v.
SECRETARY, MINISTRY OF DEFENCE
(Civil Appeal No. 5922 of 2012)
JULY 2, 2013
B
[G.S. SINGHVI, RANJANA PRAKASH DESAI AND
SHARAD ARVIND BOBDE, JJ.]

Armed Forces - Pre-mature release/discharge of
appellant from service for suffering from 'Schizophrenic C
Reaction' - Disability pension - Entitlement to - Expert
opinion - Opinion of Medical Board - Scope of judicial review
- Whether, on facts, the Medical Board had entirely relied upon
an inchoate opinion expressed by the Psychiatrist and no
effort was made to consider the improvement made in the D
degree of illness after the treatment - Held: Although, the
Courts and other judicial I quasi-judicial forums are ext~mely
loath to interfere with the opinion of the experts, they cannot,
in each and every case, refuse to examine the record of the
Medical Board - ·In the case at hand, the Invaliding Medical E
Soard simply endorsed the observation of the Psychiatrist
that the case of appellant was that of "Schizophrenic Reaction"
- Conclusion recorded by the Invaliding Medical Board was
not well founded and required review in the context of the
observation made by the Psychiatrist herself that with F
treatment, the appellant had improved - In the peculiar facts,
tl1e Tribunal should have ordered constitution of Review
Medical Board for re-examination of the appellant - However,
the Tribunal did not even bother to look into the contents of
the certificate issued by the Invalidating Medical Board and G
mechanically observed that it cannot sit in appeal over the
opinion of the Medical Board - Respondents directed to refer
the case of appellant to Review Medical Board for re-
assessing his medical condition and find out whether at the
579 H
580 SUPREME COURT REPORTS [2013] 10 S.C.R.

A time of discharge from service, he was suffering from a
disease which made him unfit to continue in service and
whether he would be entitled to disability pension.

The appellant was enrolled in the Army (Corps of
B Signals) in Medical Category "AYE". He was
subsequently downgraded to Medical Category "CEE"
(Temporary), and thereafter, on recommendations of the
Invaliding Medical Board, was discharged from service for
suffering from 'Schizophrenic Reaction'.
C The claim of appellant for disability pension was
rejected on the ground that the disease, i.e.,
Schizophrenic Reaction, which caused his discharge was
not attributable to military service. The appellant filed Writ
Petition before the High Court which directed the
D competent authority to decide the appellant's
representation. The representation filed by the appellant
having been rejected, he filed another W~it Petition
praying for directions to the respondents to constitute a
Review Medical Board to re-evaluate his disease.
E
Meanwhile the Armed Forces Tribunal Act, 2007 was
enacted and the second writ petition filed by the
appellant was transferred to the Armed Forces Tribunal.
The Tribunal held against the appellant observing that
F recommendations made by the Medical Board were
binding and could not be subjected to judicial review,
and therefore the present appeal.
Allowing the appeal, the Court
G HELD: 1~ Although, the Courts are extremely loath to
interfere with the opinion of the experts, there is nothing
like exclusion of judicial review of the decision taken on
the basis of such opinion. The opinion of the experts
deserves respect and not worship and the Courts and
H
VEER PAL SINGH v. SECRETARY, MINISTRY OF 581
DEFENCE
other judicial I quasi- judicial forums entrusted with the A
task of deciding the disputes relating to premature
release I discharge from the Army cannot, in each and
every case, refuse to examine the record of the Medical
Board for determining whether or not the conclusion
reached by it is legally sustainable. [Para 11) [597-G-H; B
598-A-B]
2. In the case at hand, at the time of enrolment in the
Army, the appellant was subjected to medical examination
and Recruiting Medical Officer found that he was fit in all C
respects. The doctor who examined the appellant i.e. the
Recruiting Medical Officer did not find any disease or
abnormality in the behaviour of the appellant. When the
Psychiatrist - Dr. (Mrs.) Lalitha Rao examined the
appellant, she noted he was quarrelsome, irritable and
0
impulsive but he had improved with the treatment. The
Invaliding Medical Board simply endorsed the
observation made by Dr. Rao that it was a case of
"Schizophrenic Reaction". [Para 12) [598-B-E]

Merriam- Webster Dictionary; Modi's Medical E
Jurisprudence and Toxicology (24th Edn. 2011) and "The
Theory and Practice of Psychiatry" (1966 Edn.) by
F.C.Redlich and Daniel X. Freedman - referred to.

3.1. The Tribunal did not even bother to look into the F
contents of the certificate issued by the Invalidating
Medical Board and mechanically observed that it cannot
sit in appeal over the opinion of the Medical Board. If the
members of the Tribunal had taken pains to study the
standard medical dictionaries and medical literature like G
"The Theory and Practice of Psychiatry" by F.C. Redlich
and Daniel X. Freedman, and Modi's Medical
Jurisprudence and Toxicology, then they would have
definitely found that the observation made by Dr. Lalitha
Rao was substantially incompatible with the existing H
582 SUPREME COURT REPORTS [2013] 10 S.C.R.

A literature on the subject and the conclusion recorded by
the Invaliding Medical Board that it was a case of
Schizophrenic Reaction was not well founded and
required a review in the context of the observation made
by Dr. Lalitha Rao herself that with the treatment the
B appellant had improved. Having regard to the peculiar
facts of this case, the Tribunal should have ordered
constitution of Review Medical Board for re- examination
of the appellant. [Para 17) [604-C-F]

c 3.2. The respondents are directed to refer the case
to Review Medical Board for reassessing the medical
condition of the appellant and find out whether at the time
of discharge from service he was suffering from a
disease which made him unfit to continue in service and
0 whether he would be entitled to disability pension. [Para
20) (605-C]

Controller of Defence Accounts (Pension) v. S.
Balachandran Nair (2005) 13 SCC 128: 2005 (4) Suppl.
E SCR 431 and Ministry of Defence v. A. V. Damodaran (2009)
9 SCC 140: 2009 (13) SCR 416 • distinguished.
Case Law Reference:
2005 (4) Suppl. SCR 431 distinguished Para 18
F 2009 (13) SCR 416 distinguished Para 18
CIVIL APPELLATE JURISDICTION : Civil Appeal No.
5922 of 2012.
From the Judgment & Order dated 19.12.2011 of the
G Armed Forces Tribunal, Lucknow in Misc. Application No. 73
of 2011 in Review Application No. 22 of 2011 in Transferred
Application No. 1431 of 2010.
Veer Pal Singh, in-person.
H Chandan Kumar, Sashank Bajpai for the Respondent.
VEER PAL SINGH v. SECRETARY, MINISTRY OF 583
DEFENCE
The Judgment of the Court was delivered by A

G.S. SINGHVI, J. 1. This appeal is directed against order
dated 19.12.2011 of the Armed Forces Tribunal, Lucknow
Bench (for short, 'the Tribunal') dismissing the application filed
by the appellant for grant of leave to file appeal against orders
8
dated 14.7.2011 and 16.9.2011 passed in Transferred
Application No.1431/2010 and Review Application No.22/2011
respectively.

2. The appellant was enrolled in the Army (Corps of
Signals) on 20.6.1972 in Medical Category "AYE". Before his C
enrolment, the appellant was subjected to medical examination,
the report (Annexure R-11) of which is reproduced below:

"PRIMARY MEDICAL EXAMINATION REPORT

1. Service No. 14289930 D

2. Name VEER PAL SINGH

3. Father's Name SUKHBIR SINGH

4. Date of birth 01.10.53 E

5. Appellant Age MA

6. Service/Corps/ SIGNALS
Air Force F
7. Permanent Village - Dhanor Tikkri Teh.
address & Dist. Sardhana, Meerut.

8. Identification
Marks G
1. A mole over middle of forehead

2. A mole 3 cm from Lt angle of mouth

9. Relevant family history NIL H
584 SUPREME COURT REPORTS [2013] 10 S.C.R.

A 10. Past medical NIL
history, Specially of
fits

11. EYES
B ·a. Distance Vision R-6/9
without Glass

Without Glass L-6/6
NIL
c Near Vision Any NIL
evidence of
trachoma or its
Complications
D 12. Hearing

a. R Ear 600 ems
L Ear

b. Any evidence of NAO
E
otitls media

13. Upper Limbs and (a) Upper Limbs NAO

Locomoter System (b) Locomotion NAO
F
14. Physical
Developments:
Height: 174 cm
Weight: ·54 Kgs.
G 15. Chest
Measurements

ta) Full expiration 81 ems
""--

(b) Range of expiration 5 ems
H
VEER PAL SINGH v. SECRETARY, MINISTRY OF 585
DEFENCE [G.S. SINGHVI, J.]

16.Urine A

(a) Albumen

(b) Sugar

(c) Other abnormalities B

17. Any evidence of NIL
skin

Venereal disease(s)
c
18. Cardio-vascular
system

(a) Pulse 76 pm
D
(b) BP (if necessary) NAO

19. Central Nervous NAO
system

20. Abdomen: NAO E
21. Liver: NP

22. Spleen: NP

23. Hernia: NIL F
24. Teeth:

(a} No dental points 16/16

(b) Condition
.
of gums
. Healthy G
25. Mental capacity and Emotional Stability

(a) Speech

(b) Evidence suggesting NORMAL H
586 SUPREME COURT REPORTS [2013] 10 S.C.R.

A i. Mental backwardness NIL

ii. Emotional Instability NIL

26. Slight Defects not sufficient of NIL
B
cause Rejection

27. Found fit in category A (AYE)

PLACE: MEERUT

c Date: 22/5/72

Sd/-
[RK Gupta]
Captain AMC
Recruiting Medical Officer"
D
3. After completion of training, the appellant was posted
in 54 Infantry Division Signals Regiment and his regular service
commenced with effect from 21.2.1974. After about two years,
he was admitted in Military Hospital, Secunderabad for the
E treatment of "INTESTINAL-COLIC". He was discharged from
the hospital on 18.2.1976. Between March, 1976 to October,
1977 he was treated in different Army Hospitals at Pune,
Secunderabad and Meerut. He was downgraded to Medical
Category "CEE" (Temporary) for a period of six months with
F effect from 3.1.1977. His case was considered on 14.11.1977
by the Invaliding Medical Board held at Military Hospital, Meerut
and on its recommendations, he was discharged from service.
His claim for disability pension was rejected by Principal
Controller of Defence Accounts (Pension), Allahabad on the
G ground that the disease, i.e., Schizophrenic Reaction, which
was the cause of his discharge was not attributable to the
military service.

4. The appellant challenged his discharge from military
service and rejection of his claim for disability pension in Civil
H Misc. Writ Petition No.42946/1997 filed before the Allahabad
VEER PAL SINGH v. SECRETARY, MINISTRY OF 587
DEFENCE [G.S. SINGHVI, J.]
High Court. He prayed that a fresh Medical Board be constituted A
to assess his disease and disability. The same was disposed
of by the Allahabad High Court vide order dated 26.3.1998 and
a direction was given to the competent authority to decide the
appellant's representation. Thereafter, the Government of India,
Ministry of Defence rejected th.e appellant's representation vide B
order dated 16.9.1998, paragraph 9 of which reads thus:

"You have been diagnosed as a case of
SCHIZOPHRENIC REACTION and not LUNATIC. As such
your request to produce you before a medical board to
examine you whether you are Lunatic or free from LUNACY C
does not arise. Therefore no resurvey medical board can
be held in your case."

5. The appellant challenged the aforesaid order in Writ
Petition No.40430/1999 and prayed that the respondents be D
directed to constitute a Review Medical Board to re-evaluate
his disease.

6. The second writ petition filed by the appellant remained
pending before the High Court for 13 years. On the E
establishment of Lucknow Bench of the Tribunal under the
Armed Forces Tribunal Act, 2007 (for short, 'the Act'), the same
was transferred to the Tribunal and was registered as
Transferred Application No.1431/2010. The Tribunal examined
the record of the Medical Board, referred to the judgment of this F
Court in Secretary, Ministry of Defence v. A.V. Damodaran
(2009) 9 sec 140 and dismissed the application by making
the following observations:

"In view of the aforesaid the Medical Board's opinion is to
be accorded supremacy. We in exercise of our jurisdiction G
can not sit over the opinion expressed by the Medical
Board which is an expert body. The disease that the
applicant was suffering from has been found to be
constitutional arid not aggravated by military service. We
can not hold anything contrary to the medical opinion." H
4·
·'
588 SUPREME COURT REPORTS [2013] 10 S.C.R.

A 7. The review application and the application filed by the
appellant for grant of leave to appeal were dismissed by the
Tribunal with a cryptic observation that the recommendations
made by the Medical Board are binding and the same cannot
be subjected to judicial review.
B
8. The appellant, who appeared in person, referred to
report dated 22.5.1972 of the Recruiting Medical Officer as
also report dated 14.11.1977 of the Invaliding Medical Board
and argued that in the absence of evidence about his disease,
C i.e., Schizophrenic Reaction at the time of enrolment, the opinion
of the Psychiatrist, who examined him, could not be relied upon
for recording a finding that his disease is constitutional and is
not attributable to military service. The appellant submitted that
mere irritability or quarrelsome nature cannot lead to an
inference that he was suffering from Schizophrenic Reaction
D and the Tribunal committed grave error by declining his prayer
for making a reference to the Review Medical Board. He also
invited the Court's attention to the averments contained in
paragraph 5 of the counter affidavit filed before this Court to
show that the disease had developed after entering the service
E and argued that it should be treated as directly attributable to
the military service.

9. Learned counsel for the respondent fairly stated that
except the opinion of the Psychiatrist-Major (Mrs.) N. Lalitha
F Rao, no other evidence is available to support the opinion of
the Medical Board that the appellant was suffering from
Schizophrenic Reaction. He also conceded that at the time of
enrolment, the appellant was not suffering from any disease but
argued that the Court cannot sit in appeal over the opinion
G formed by the experts who constituted Invaliding Medical Board.

10. We have considered the respective arguments. For the
sake of convenience, the relevant portions of the proceedings
of the Invaliding Medical Board which constituted the foundation
of the appellant's discharge from Army and denial of disability
H pension read as under:
VEER PAL SINGH v. SECRETARY, MINISTRY OF 589
DEFENCE [G.S. SINGHVI, J.]

"CONFIDENTIAL A

MEDICAL BOARD PROCEEDING INVALIDING ALL RANKS

Authority for Place Date
Board AO M.H. Meerut 14 Nov. 77
537/72 B

Name Service No. Rank/Rate Unit/Ship Date
Veerpal 14289930 SIG/MAN ip birth
Singh 676SIG 01.10.53
(04 c
C1056
APO

Service Army/Corps/ Total Service Total flying hours/
Branch/Trade Service afloat D
Permanent address: ViQ Identification marks: -
Dhanaura (Tikri) P.O. i Mole over middle, of
Dhanaura The. Sardhana forehead.
Dist. Meerut, U.P. ii. Mole over the It. cheek
E
Field/Operational/Overseas Service: Giving dates and place

To Place
NIL
I From To Place

PART-I
F

PERSONAL STATEMENT

(The questions should be answered in the individual's own
words. This statement will be checked from official records as G
far as possible)

1. Give particulars of previous service in ARMY/NAVY/
AIR/FORCE and state whether you were invalided H
590 SUPREME COURT REPORTS [2013] 10 S.C.R

A out of Service.

2. Give particulars of any diseases, wounds or injuries
from which you are suffering:-

B
Illness, First Stated Where Approxi
wound, treated mate
injury Date Place dates
Shizoph ·and ·
c Renie periods
Reaction treated

(295) Mar 76 Secunderbad MH 25.3.76 to
Secunde 12.5.76
-rabad
D
CHSE 13.5.76 to
Pune 5.9.76

23.11.76
E to5.1.77

MH 5.7.77 to
Secunde 30.8.77
rabad
F
MH 14.10.77
Mee rut to DATE

3. Did you suffer from any disability mentioned in
question 2 or anything like it before joining the
G
Armed Forces? If so give details and dates. NIL

4. Give details of any incidents during your service
which you think caused or made your disability
worse? NIL
H
VEER PAL SINGH v. SECRETARY, MINISTRY OF 591
DEFENCE [G.S. SINGHVI, J .]
CONFIDENTIAL A

5. In case of wound or injury, state now they happened
and whether or not (a) Medical Board or Court of
Inquiry was held, (b) Injury Report was submitted.
N.A.
B
6. Any other information you wish to give about your
health. NIL

I certify that I have answered as fully as possible all
the questions about my service and personal history
and that the information give is true to the best of
my knowledge.

Witness: Signature

Sd/- Sd/- 14289930

(In case of illiterate persons thumb and fingers impressions
of left hand will be taken here)
PART - II
STATEMENT OF CASE
{Not to be communicated to the Individual)
Disabilities Date of origin Place and unit
where serving at the
time

SCHIZOPHRENIC Mar. 76 676 SIG Coy C/056
Reaction - 295 APO

2. Clinical details

a. Give the salient facts of:-

i. Personal and relevant family history.

ii. Specialist report; and
592 SUPREME COURT REPORTS [2013] 10 S.C.R.

A iii. Treatment

b. State present condition in details.

c. In this statement and in answering questions in
Part-Ill the Board will differentiae carefully between
B the Individuals statement and the evidence recorded
in the medical documents.

CONFIDENTIAL
Sd/- Lt. Col.
c Chief Record Officer
Signals Records
SUMMARY OF THE CASE

NO. 14289930 Rank: Sigman:
D
Name: Veer Pal Singh Time 24 years
Unit: 676 Signal Coy
Clo 56 APO

E Diagnosis: SCHIZOPHRENIC
reaction (295)

=============================================
A case of Schizophrenic Reaction admitted for
F review after sick leave from MH Secunderabad. At present
he has no complaints.

Perusal of the documents show that this patient was
treated earlier at the following hospitals for the same
G illness:-

1. MH Secunderabad - 25.3.76 to 12.5.76

2. From to CH (SC) Pune - 13.5.76 to 5.9.76 sent on
sick leave
H
··.
VEER PAL SINGH v. SECRETARY, MINISTRY OF 593
DEFENCE [G.S. SINGHVI, J.]
3. CH (SC) Pune - N.ov. 76 Cat CEE Temp w.e.f. A
3.1.77. '
4. MH Secunderabad - 05.7.77 to 30.8.77 sick leave.

Observation in the Ward:-
B
Showed him to be irritable, impulsive quarrel some
with a tendency to suspect the staff and other
patients.

Past Illness:
Nil significant
c
Family History
Belong to U.P. Father - farmer - healthy. Mother
healthy. He has three brothers. No history of mental
illness to the family. D
Personal History:
Youngest, Studied up to BA. Unmarried Gives
history of heterosexual experience. Smokes but
does not rink.
E
Service:
6 years, Nil Punishment
On Exam:
GC fair, TPR - Normal, Lungs, Heart and F,
Abdomen-NAO
· Treatment: ·
Antipaychotic drugs-
-Improvement.~ Not maintained.

OPINION ·OF MAJOR (MRS) N LALITHA RAO; G
CLASSIFIED SPECIAL BT(PSYCHIATRY) MH MEERUT
DATED 09. NOV. 77.

Acase.of Schizophrenic Reaction (ICD 295) in cat 'CEE~
Temp w.e.f. 3.1.77 was admitted and treated at MH H
594 SUPREME COURT REPORTS (2013] 10 S.C.R.

A Secunderabad with self inflicted.

Injuries, in Jul 77, while in the hospital there, he had
become quarrels irritable and impulsive with treatment he
improved when he was sent in six weeks sick leave.
Review as admission, now shows him to be still irritable
B
and argumentative with persecutory delusions and
suspicious. Residual features of psychosis persist

- Therefore he is recommended invalidment from service.

c Recommended Cat 'CEE'
Sdt- xx xx
[N LALITHA RAO]
MAJOR, AMC
PSYCHIATRIST
D I view of the above, the individual is brought before
Invaliding Medical Board.
[N LALITHA RAO)
MAJOR, AMC
CONFIDENTIAL
E
PART- Ill
OPINION OF THE MEDICAL BOARD
(Not to be communicated to the Individual)
Note: Clear and decisive answers should be filed in by the
Board, Expressions such as 'night', 'may', probably', should
F
be avoided.

1. Did the disability/ies exist before entering service.
G NO

2. In respect of each disability the Medical Board on
the evidence before it will express its views as to
whether:-
H
VEER PAL SINGH \/. SECRETARY, MINISTRY OF 595
DEFENCE [G.S. SINGHVI, J.]
i. It is attributable to service during peace or A
under field service conditions; or

ii. It has been aggravated thereby and remains
so; or

iii. It is not connected with service. B

The Board should state fully the reasons in
regard to each disability on which its opinion
is based

Disability A B c c
SCHIZOP- NO NO NO
HREN IC
REACTION

b. In respect of each disability shown as attributable D
under A, the Board should state fully, the specific
condition and period in service which caused the
disability. N.A.
c. In respect of each disability shown as attributable
E
under A, the Board should state fully:- N.A.
i. The specific condition and period in service
which aggravated the disability. N.A.
ii. Whether the effects of such aggravation still
F
persist. N.A.
iii. If the answer to {ii} is in the affirmative,
whether effect of aggravation will persist for
a material period. N.A.
G
d. In the case of a disability under C, the Board
should state what exactly in their opinion is
the cause thereof.
The disease is constitutional and is
unconnected with service. H
596 SUPREME COURT REPORTS [2013] 10 S.C.R.

A 3. a. Was the disability, attributable to the individual's
own negligence or misconduct? If so, in what way?
·NO

b. If not attributable, was it aggravated by
negligence or misconduct? If so, in what way
8
and to what percentage of the total
disablement? N.A.

c. Has the individual refused to undergo
operation/treatment? If so, individual's
c reasons will be recorded.· N.A.

NOTE: In case of refusal of operation/treatment a
certificate from the individual will be attached.

d. Has the effect of refusal been explained to
D and fully understood by him/her, viz., a
reduction in, or the entire withholding of, any
disability pension to which he/she might
otherwise be entitled? N.A.

E e. Do the Medical Board consider it probable
that the operation/treatment would have cured
the disability or reduced its percentage? N.A.

f. If the reply to (e) is in affirmative, what is the
probable percentage to which the
F
disablement could be reduced .by operation/
treatment? N.A.

g. Do the Medical Board consider the operation
to be server and dangerous to life? N.A.
G
h. Do the Medical Board consider the
individual's refusal to submit to operation/
treatment reasonable? Give reasoAs in
support of the opinion specifying he
operation/treatment recommended. N.A. '
H
VEER PAL SINGH v. SECRETARY, MINISTRY OF 597
DEFENCE [G.S. SINGHVI, J.]
4. What is present degree of disablement as A
compared with a healthy person of the same age
and sex? {Percentage will be expressed as Nil or
as follows:-

1-5%, 6-19%, 11-14%, 15-90% and thereafter in
8
multiples of ten from 10% to 100%.

Disability Percentage Probable Composite
{as numbered of duration assessment
in question I, of this degree {all
part II) disablement of disablement disabilities) c
SCHIZOPHR- 30% THIRT't 2 YEARS 30% THIRT'Y
ENIC PERCENT PERCENT
REACTION (295)
D
CONFIDENTIAL

CERTIFICATE

No.14289930 Rank Sigman Name VEER PAL SINGH

The disability will not interfere with the performance of E
normal/sabentuary suitable civil employment.

Disability SCHIZOPHERNIC REACTION
Sd/-
[OM PRAKASH]
F
Lt. Col. AMC
President Medical Board
Dated: 14 Nov. 77"

11. Although, the Courts are extremely loath to interfere G
with the opinion of the experts, there is nothing like exclusion
of judicial review of the decision taken on the basis of such
opinion. What needs to be emphasized is that the opinion of
the experts deserves respect and not worship and the Courts
and other judicial I quasi-judicial forums en.trusted with the task H
598 SUPREME COURT REPORTS (2013] 10 S.C.R.

A of deciding the disputes relating to premature release I
discharge from the Army cannot, in each and every case, refuse
to examine the record of the Medical Board for determining
whether or not the conclusion reached by it is legally
sustainable.
B
12. A recapitulation of the facts shows that at the time of
enrolment in the Army, the appellant was subjected to medical
examination and Recruiting Medical Officer found that he was
fit in all respects. Item 25 of the certificate issued by the
Recruiting Medical Officer is quite significant. Therein it is
C mentioned that speech of the appellant is normal and there is
no evidence of mental backwardness or emotional instability.
It is, thus, evident that the doctor who examined the appellant
on 22.5.1972 did not find any disease or abnormality in the
behaviour of the appellant. When the Psychiatrist - Dr. (Mrs.)
D Lalitha Rao examined the appellant, she noted he was
quarrelsome, irritable and impulsive but he had improved with
the treatment. The Invaliding Medical Board simply endorsed
the observation made by Dr. Rao that it was a case of
"Schizophrenic Reaction".
E
13. In Merriam-Webster Dictionary "Schizophrenia" has
been described as a psychotic disorder characterized by loss
of contact with the environment, by noticeable deterioration in
the level of functioning in everyday life, and by disintegration of
F personality expressed as disorder of feeling, thought (as in
delusions), perception (as in hallucinations), and behavior -
called also dementia praecox; Schizophrenia is a chronic,
severe, and disabling brain disorder that has affected people
throughout history.

G 14. National Institute of Mental Health, USA has described
"Schizophrenia" in the following words:

"Schizophrenia is a chronic, severe, and disabling brain
disorder that has affected people throughout history.
H People with the disorder may hear voices other people
VEER PAL SINGH v. SECRETARY. MINISTRY OF 599
DEFENCE [G.S. SINGHVI, J.]
don't hear. They•may believe other people are reading their A
minds, controlling their thoughts, or plotting to harm them.
This can terrify people with the illness and make them
withdrawn or extremely agitated. People with
schizophrenia may not make sense when they talk. They
may sit for hours Without moving or talking. Sometimes B
people with schizophrenia seem perfectly fine until they talk
about what they are really thinking. Families and society
are affected by schizophrenia too. Many people with
schizophrenia have difficulty holding a job or caring for
themselves, so they rely or:i others for help. Treatment helps c
relieve many symptoms of-schizophrenia, but most people
who have the disorder cope with symptoms throughout
their lives. However, many people with schizophrenia can
lead rewarding and meaningful lives in their communities."

Some of the symptoms of schizophrenia are: D

Positive symptoms

Positive symptoms are psychotic behaviors not seen in healthy
people. People with positive symptoms often "lose touch" with E
reality. These symptoms can come and go. Sometimes they
are severe and at other times hardly noticeable, depending on
'whether the individual is receiving treatment. They include the
following: '

Hallucinations - "Voices" are the most common type of F
hallucination in schizophrenia. Hallucinations include seeing
people or objects that are not there, smelling odors that no one
else detects, and feeling things like invisible fingers touching
their bodies when no one is near.
G
Delusions - The person believes delusions even after other
people prove that the beliefs are not true or logical. They may
also believe that people on television are directing special
messages to them, or that radio stations are broadcasting their
thoughts aloud to others. Sometimes they believe they are
H
600 SUPREME COURT REPORTS [2013] 10 S.C.R.

A someone else, such as a famous historical figure. They may
have paranoid delusions and believe that others are trying to
harm them.

Thought disorders - are unusual or dysfunctional ways of
thinking. One form of thought disorder is called "disorganized
8
thinking". This is when a person has trouble organizing his or
her thoughts or connecting them logically, a person with a
thought disorder might make up meaningless words, or
"neologisms".

C Movement disorders - may appear as agitated body
movements. A person with a movement disorder may repeat
certain motions over and over. In the other extreme, a person
may become catatonic. Catatonia is a state in which a person
does not move and does not respond to others. Catatonia is
D rare today, but it was more common when treatment for
schizophrenia was not available.

Negative symptoms

Negative symptoms are associated with disruptions to normal
E emotions and behaviors. These symptoms are harder to
recognize as part of the disorder and can be mistaken for
depression or other conditions. These symptoms include the .
following:

F * "Flat affect" (a person's face does not move or he
or she talks in a dull or monotonous voice)

* Lack of pleasure in everyday life

* Lack of ability to begin and sustain planned
G activities
* Speaking little, even when forced to interact.
15. In Modi's Medical Jurisprudence and Toxicology (24th
Edn. 2011) the following varieties of Schizophrenia have been
H noticed:
VEER PAL SINGH v. SECRETARY, MINISTRY OF 601
DEFENCE [G.S. SINGHVI, J.]
Simple Schizophrenia - the illness begins in early A
adolescence. There is a gradual loss of interest in the outside
world, from which the person withdraws. There is an all round
impairment of mental faculties and he emotionally becomes flat
and apathetic. He loses interest in his best friends who are few
in number and gives up his hobbies. He has conflicts about sex, B
particularly masturbation. He loses all ambition and drifts along
in life, swelling the rank of chronically unemployed. Complete
disintegration of personality does not occur, but when it does,
it occurs after a number of years.

Hebephrenia- hebephrenia occurs at an earlier age than either C
the katatonic or the paranoid variety. Disordered thinking is the
outstanding characteristic of this kind of schizophrenia. There
is great incoherence of thought, periods of wild excitement
occur and there are illusions and hallucinations. Delusions which
are bizarre in nature, are frequently present. Often, there is D
impulsive and senseless conduct as though in response to their
hallucination or delusions. Ultimately the whole personality may
completely disintegrate.

Katatonia - katatonia is the condition in which the period of E
excitement alternates with that of katatonic stupor. The patient
is in a state of wild excitement, is destructive, violent and
abusive. He may impulsively assault anyone without the
slightest provocation. Homicidal or suicidal attempts may be
made. Auditory hallucinations frequently occur, which may be F
responsible for their violent be~aviour. Sometimes, they destroy
themselves because they hear God' voice commanding them
to destroy themselves. This phase may last from a few hours
to a few days or weeks, followed by stage of stupor.

The katatonic stupor begins with a lack of interest, lack of G
concentration and general apathy. He is negative, refuses to
take food or medi.cines and to carry out his daily routine
activities like brushing his teeth, taking bath or change his
clothes .... The activities are so very limited that he may confine
himself in one place and assume one posture however H
602 SUPREME
··-::. COURT REPORTS [2013) 10 S.C.R.

A uncomfortable, for hours together without getting fatigued. His
face is expressionless and his gaze vacant.. .. They may
understand clearly everything that is going on around them, and
sometime without warning and without any apparent cause, they
suddenly attack any person standing nearby.
B
Paranoid Schizophrenia, Paranoia and Paraphrenia -
Paranoia is now regarded as a mild form of paranoid
schizophrenia. The main characteristic of this illness is a well
elaborated delusional system in a personality that is otherwise
C well preserved. The delusions are of a persecutory type. The
true nature of the illness may go unrecognized for a long time
because the personality is well preserved, and some of these
paranoiacs may pass· off as social reformers or founders of
queer pseudo-religious sects. The classical picture is rare and
generally takes a chronic course.
D
Paranoid schizophrenia, in the vast majority of cases, starts in
the fourth decade and develops insidiously. Suspiciousness is
the characteristic symptom of the early stage. Ideas of reference
occur, which gradually develop into delusions of persecution.
E Auditory. hallucinations follow which in the beginning, start as
sounds or noises in the ears, but become fixed and definite,
to lead the patient to believe that he is persecuted by some
unknown person or some superhuman agency. He believes that
his food is being poisoned, some noxious gases are blown into
F his room and people are plotting against him to ruin him.
Disturbances of general sensation give rise to hallucinations,
which are attributed to the effects of hypnotism, electricity,
wireless telegraphy or atomic agencies. The patient gets very
irritated and excited owing to these painful and disagreeable
G hallucinations and delusions.

Since so many people are against him and are interested in
his ruin, he comes to believe that he must be a very important
man. The nature of delusions thus, may change from persecutory
to grandiose type. He entertains delusions of grandeur, power
H and wealth, and generally conducts himself in a haughty and
------------------=~= ---- ---·
·VEER PAL.SINGH v.. SECRETARY, MINISTRY OF 603
DEFENCE [G.S. SINGHVI, J.]
overbearing manner.The patient usually retains his money and A.
orientation and does not show signs of insanity, until the
conversation is directed to the particular type of delusion from /
which he is suffering; When delusions affect his behaviour, he
is often a source of danger to himself and others .. ·
,.~(· . . -.-:: . ' - . ,,. B;
The name paraphrenia has beeri given to those suffering from
paranoid psychosis who, in spite of various hallucinations and
more or ! less
.
systemized ~
' ••
delusions,
-.
retain their personality in -~ I•• ' ·•. • • • '
a relatively intact state. Generally, paraphrema begins later in
life than the other paranoid psychosis. .. . .
. •~.c :: ' .. • . . ,., . . - . ' / - •· c.
Schizo· Affective Psychosis - Schizo· affective psychosis is.
an atypical type of schizophrenia, in which there are moods or
affect disturbances unlike other varieties of schizophrenia,
where there is blunting or flattening of affect: Attacks of elation
or depression; unmotivated rage, anxiety. and panic occur in D.
this form of schizophrenic illness.. • · -' ··' ,.. '1
.... - ,. ,..,. ' -
'
11
111.
Pseudo-Neurotic Schizophrenia - schizophrenia may start
with overwhelmingly neurotic syinptoms, which are so prominent
that in the early stages, it may be diagnosed as neurosis. When .
E
schizophrenia begins in an obsessional personalitY. it may for
a long: time, remain disguised as' an. apparently obsessional '1'
illness. "•. ,_,,,. ,,. :> . ·-- · ., . . . ii'
- " ' ' . ,.,: I - . - - .
!1
·· · 16.'ln F.C.Redlich and Danie(X. Freedman in their book
titled "The Theory and Practice ofPsychiatr}t" (1966: Edn.) F i
observed::•. ·. -
. ·somii :~chizophrenic reactions, which ·we call
. psychoses; 'may be relatively inild and transient;' others;
- 1·.·' -~'j· -·<
' .. ~ • . ' .-- ·- •• - • ..,.

maY not interfere too· seriously with mahy aspects· of G
_ ·everyday living.:."(p: 252) ·· · : · · ' · · · · · · · : ,. ~
;;_:.; o:;.;_, ,, · . • i:..,tJ1.: .-:t'-·;,/ • ' .,_, ·.

. Are ttie 1'cha·racteristic ·remissions and relapses
.. eicpressioris' of endogenous 'processes, or are 'they
:. responses' to· psychosocial variables;·ior both? Some
patients' re'c'overf.apparently completely, when such H
\
604. SUPREME COURT REPORTS · [2013] 10 S.C.R
; : ' ' . . - ., '
' ' .- .. ' -·: .. ,I . '

A ·.·recovery· occurs .without treatment we. speak of.
spontaneous remission. The term need not imply an , .
independent endogenous process;:it is just as likely1that
the spontaneous remission is a response to non~eliberate ..
but nonetheless favourable psychosocial stimuli other.than
B specific therapeutic activity ..•. (p. 465)
• .., • ·. !

.. (emphasis supplied)

. 17. Unfortunately, the Tribunal did not even bother to look
into the contents of the certificate issued by tlie Invalidating .
C· Medical Board and mechanically obser\ted that it cannot sit iri
appeal over the opinion of the Medical Board., If the learned.
members of the Tribunal had taken pains to study the standard
medical dictionaries and medical literature like "The Theory and
Practice of Psychiatry" by F.C. Redlich and Daniel X. Freedman, .
D and Modi's Medical Jurisprudence and Toxicology,, then they:
would have definitely found that the observation made by Dr.
Lalitha Rao was
~ . .. substantially incompatible with
.
the existing -.
literature on the subject and the conclusion recorded by the ·
Invaliding Medical Board that it was a case of Schizophrenic
E Reaction was not well founded and· required a review in the ·
context of the observation·made by Dr. Lalitha Rao herself th.at·'
with the treatment the appellant had improved. ln'our cailsidered r
view, having regard to the peculiar facts of this case,'the
Tribunal should have ordered constitution of Review Medical
F ~oard for ~e-examination of the. appellant. ....

18.' In Controller of Defence Accounts (Pension) v. S.
Balachandran Nair(2005) 13 SCC 128 on which reliance has
. -- - '. . '.' - .
been placed by the Tribunal, this Court referred to _Regulations
173 and 423 of the Pension Regulations and held that the
G definite opinion formed by the Medical Board.that the disease
suffered by the respondent was constitutional and was''not
attributable to Military Service was binding and the. High Court
was not justified in directing. payment of disability pension to
the respondent.·Tlie same view was reiterated in Ministry of
H Defence v. A. V. Damodaran (2009) 9 SCC .140. However, in
VEER PAL SINGH v. SECRETARY, MINISTRY OF 605
DEFENCE [G.S. SINGHVI, J.]
neither of those cases, this Court was called upon to consider A
a situation where the Medical Board had entirely relied upon
an inchoate opinion expressed by the Psychiatrist and no effort
was made to consider the improvement made in the degree
of illness after the treatment.

19. As a corollary to the above discussion, we hold that B
the impugned order as also orders dated 14. 7 .2011 and
16.9.2011 passed by the Tribunal are legally unsustainable.

20. In the result, the appeal is allowed. The orders passed
by the Tribunal are set aside and the respondents are directed C
to refer the case to Review Medical Board for reassessing the
medical condition of the appellant and find out whether at the
time of discharge from service he was suffering from a disease
which made him unfit to continue in service and whether he
would be entitled to disability pension. D

B.B.B. Appeal allowed.