Gajendra Singh vs Union Of India And Others

Disability,Attributable to service,Aggravated by service,Not connected to service

PRIMARY OPEN ANGLE

GLAUCOMA WITH

ADVANCED

GLAUCOMATOUS OPTIC

ATROPHY BOTH EYES",NO,NO,YES

Detailed justification: Primary Open Angle Glaucoma (POAG) may be either acute or chronic. Its onset is unaffected by

service conditions; and the disease Is known to be associated with a variety of genetic linkages, with more than 20

genetic loci identified till date, the most prominent of which are the myocilin and optineurin genes. The onset of POAG

may be insidious and it may reveal its presence for the first time as an acutely painful eye, but in the absence of

evidence of undue mental or physical stress occasioned by war service, it cannot be considered that this disease is

attributable to or has been aggravated by service factors. Exposure to smoke, fumes, fuel or pollutants does not play a

role in the causation or aggravation of this disease. In the instant case, the individual presented with decreased vision

of insidious onset in Jun 2007, which was diagnosed as POAG in an advanced stage with optic atrophy both eyes; and

he was managed at INNS Asvini and Sankara Netralaya, which are apex tertiary eye care institutions. His management

in both service hospitals and Sankara Netralaya was appropriate. There were no adverse effects or complications of

treatment. In the absence of any undue physical or mental stress occasioned by war service, or any other service

related factors in the progression of his disability, the ID is conceded as neither attributable to nor aggravated by

military service in terms of Para 35, Chap VI, GINO 2002, amendment 2008.",,,

Opinion of Brig (Mrs) S. Patyal, Consultant Ophthalmology of Base Hospital Delhi Cantt dated 27 Dec 14 44 years old ex serviceman is a",,,

diagnosed case of Primary Open Angle Glaucoma with Advanced Optic Atrophy, Both eyes optd, who has reported for Appeal Medical",,,

Board. The individual reported with complaints of inability to see objects moving by his side and was diagnosed to be having advanced,,,

glaucoma in INKS Ash wini in 2007 Subsequently he underwent Trabeculotomia in both eyes at Shankar Netralaya, Chennai Ocular Exam .",,,

XX XX XX XX XX XX,,,

Patient has advanced Glaucomatous Neuropathic Both eyes clinically and visual fields corroborate the findings.,,,

The condition is constitutional and not related to his working environment. The patient's optic nerve damage is due to advanced glaucoma,,,

resulting in severely compromised visual fields,",,,

Learned counsel for the respondents has referred to the opinion of the Medical Board consisting of three senior consultants, including",,,

two of Major General rank, wherein it has been clearly stated that the onset of POAG is unaffected by service conditions and the disease is",,,

known to be associated with a variety of genetic linkages, with more than 20 genetic loci identified till date, the most prominent of which are",,,

myocilin and optineurin genes. Further, it has been clearly stated by the Medical Board that 'exposure to smoke, fuel or pollutants does not",,,

play a role in the causation or aggravation of this disease'. Thus, in the absence of evidence of undue mental or physical stress occasioned",,,

by war service, or adverse effects or complications of treatment, the applicant cannot be granted attributability/ aggravation and is not",,,

entitled to disability element of pension.,,,

Consideration:,,,

We have given careful consideration to the arguments made before us and find that the primary issue before us is, whether the applicant can be",,,

granted attributability/ aggravation to service conditions and entitlement to disability element of pension for the disability ""Primary Open Angle",,,

Glaucoma with Advanced Glaucomatous Optic Atrophy Both Eyes"", due to which he had been permanently downgraded to low medical category",,,

S3A3 during his service life, despite the fact that the RMB in 2010 and Review Medical Board in 2014 (on orders of AFT (RB), Mumbai) found that",,,

the aforesaid disability is NANA by military service.,,,

In our considered opinion, Para 35 of GMO (Military Pensions) 2008 is relevant to this case and is reproduced as under:",,,

Glaucoma,,,

(a) Primary Glaucoma. May be either acute or chronic. Its onset is generally speaking, unaffected by service conditions; but exceptionally,",,,

an acute attack may be brought on by worry, fatigue, or illness and, if any of these were considered to be the result of service, aggravation",,,

might have to be considered. The onset may be insidious and it may reveal its presence for the first time as an acutely painful eye, but in the",,,

absence of evidence of undue mental or physical stress occasioned by war service, it cannot be considered that this disease is attributable",,,

to or has been aggravated by service factors.,,,

(6) Secondary Glaucoma. This may be due to a service trauma and would be attributable. It may be caused by iritis and intra-ocular,,,

hemorrhage, and entitlement would, therefore, have to be considered in relation to the underlying cause. It may also be the result of an",,,

intraocular tumour.,,,

In general terms it may be said that, in the great majority of cases there is a disturbance of the intraocular circulation to which is frequently",,,

added an obstruction to the circulation of the Infra- ocular fluids. The factor common to all cases is the increase of intra -ocular pressure.,,,

In such cases, therefore, the primary condition which is responsible, for these changes or sequelae must be considered in relation to",,,

entitlement and not the glaucoma per se.,,,

Para 1 of Chapter II of the GMO (Military Pensions), 2002 on the responsibility of the Medical Board has been quoted at Para 25 of the decision",,,

in Dharamvir Singh (supra), which is reproduced as under:",,,

Although the certificate of a properly constituted medical authority vis-a-vis the invaliding disability, or death, forms the basis of",,,

compensation payable by the Government, the decision to admit or refuse entitlement is- not solely a matter which can be determined finally",,,

by the medical authorities alone. It may require also the consideration of other circumstances e.g. service conditions, pre and post-service",,,

history, verification of wound or injury, corroboration of statements, collecting and weighing the value of evidence, and in some instances,",,,

matters of military law and discipline. Accordingly, Medical Boards should examine cases in the light of the etiology of the particular",,,

disease and after considering all the relevant particulars of a case, record their conclusions with reasons in support, in clear terms and in a",,,

language which the Pension Sanctioning Authority, a lay body, would be able to appreciate fully in determining the question of entitlement",,,

according to the Rules. In expressing their opinion Medical officers should comment on the evidence both for and against the concession of,,,

entitlement. In this connection, it is as well to remember that a bare medical opinion without reasons in support will be of no value to the",,,

Pension Sanctioning Authority. (emphasis supplied),,,

Thus, the opinion of the Medical Board having been clearly articulated in this case, as is evident by the detailed reasons given for their opinion that",,,

the applicant's medical disability is neither attributable to nor aggravated by his service in the Navy, the 0.A is liable to be rejected.",,,

In the result, the 0.A lacks merit and is dismissed. No order as to costs.",,,

Pronounced in open Court on this the 20th day of March, 2020.",,,