Ex. Captain Vivek Chopra vs Union Of India (Uoi)
1998 Latest Caselaw 1001 Del

JUDGMENT

K. Ramamoorthy, J.

1. On the 1-8-1985, the Government of India passed an order staling that:

"I am directed to say that the disabilities viz. (i) "SCHIZOPHRENIA", (ii) "MULTIPLE INJURIES AND (iii) CLOSED HEAD INJURY", on account of which the above named officer was invalided out of service should be regarded as neither attributable to nor aggravated by his military service."

2. The petitioner issued notice under Section 80 CPC in May, 1986 and instituted a suit claiming the relief that he was not suffering from any ailment as stated in the order. In April, 1991, the petitioner withdrew the suit. What is stated now is that the petitioner was under hallucination that he had been offered compensation by the Chief of the Army Staff and under that mental state of mind he withdrew the suit.

3. The writ petition was filed on the 3rd of March, 1997. What is now claimed is that the petitioner is suffering from the disease "SCHIZOPHRENIA" and he was invalided out of service because of this ailment and he had suffered the ailment while in the military service and, therefore, he is entitled to disability pension. The Mexical Board which examined him had given the opinion that the ailment was not attributable to military service and the petitioner was consuming liquor excessively and he was also smoking 'Hashish'.

4. The learned counsel for the petitioner, Lt. Col. M.G. Kapoor, submitted that the petitioner was examined by Dr. Sunil Mittal of Delhi Psychiatry Centre and that Doctor had given his opinion on the 31st of December, 1997 and according to that opinion, the ailment "SCHIZOPHRENIA" was not due to any drug or alcohol, and that it might be due to the military service. The learned counsel for the petitioner, Lt. Col. M.G. Kapoor referred to the affidavit of Dr. Sunil Mittal which reads as under:

"I Dr. Sunil Mittal, son of Shri R.K. Mittal R/o 73, Gujarat Vihar, Delhi -110 092 do hereby solemnly affirm and declare as under:-

1. That I have been treating Ex-Captain Vivek Chopra S/o Shri H.L. Chopra since 13.03.92.

2. That Ex. Captain Vivek Chopra was hospitalized under my care at Delhi Psychiatric Centre the first time from 13.03.92 to 23.03.92. History of the case revealed that he had been unwell since 1983-84. He was diagnosed to be a case of Paranoid Schizophrenia (a subtype of schizophrenia) and treated with appropriate anti-schizophrenic drugs and a course of modified Electro Convulsive Therapy. Since then Ex-Capitan Vivek Chopra has been continuously under my treatment and has been subsequently hospitalised twice more under my care from 29.07.1995 to 27.08.1995 and then from 29.07.1997 to 07.08.1997. On both these occasions he had turned violent and had to be brought for hospitalization under police escort (1995) or with the help of hospital medical escort (1997).

3. That since I have been treating Ex-Captain Vivek Chopra continuously from 13.03.1992 and have examined him personally on various occasions at his follow up treatment. I am well versed with his medical case.

4. That 1 had the opportunity to observe Ex-Captain Vivek Chopra during his abstinence from drugs and alcohol for period upto 30 days as an indoor patient. I state that in the case of Ex Captain Vivek Chopra the psychotic symptoms had continued even when he had totally abstained from any drug or alcohol.

5. That in conclusion I state:

(i) That Ex-Captain Vivek Chopra is suffering from Paranoid Schizophrenia which is a type of Schizophrenia which is a type of Schizophrenia,

(ii) That his illness (Schizophrenia) has not been induced by any drug or alcohol. It is an independent illness.

(iii) Drug or alcohol use appears to have been a part of his Schizophrenia or may have occurred independently.

(iv) Schizophrenia (including paranoid Schizophrenia) can be precipitated by stress and life events including the rigours of Army life."

5. The medical opinion given by the Doctor Sunil Mittal is as under:-

"MEDICAL OPINION

"This Medical Opinion is being given on the request of Mr. H.L. Chopra and his son Mr. Vivek Chopra Whereas Mr. Vivek Chopra son of Mr. H.L. Chopra has been under my treatment for Paranoid Schizophrenia since March 13, 1992 now Mr. H.L. Chopra has approached me with certain specific queries which are being addressed in this Medical opinion.

Name of the Patient: Mr. Vivek Chopra

Name of the Querist: Mr. H.L. Chopra, father of Mr. Vivek Chopra Queries:

1. What is the Diagnosis of Mr. Vivek Chopra's illness?

2. What is the relationship between drug and alcohol abuse and Mr. Vivek Chopra's illness?

3. Could Mr. Vivek Chopra's illness have been caused by Drug Abuse?

OPINION

1. Dates of examination and familiarity with the cases:

I have been treating Mr. Vivek Chopra since March 13, 1992. He was hospitalised under my care at Delhi Psychiatry Centre the first time from 13.3.1992 to 23.3.1992. History of the case revealed that he had been unwell since 1983-84.

He was diagnosed to be case of Paranoid Schizophrenia (a subtype of schizophrenia) and treated with appropriate anti-schizophrenic drugs and a course of modified Electroconvusive therapy.

Since then he has been continuously under my treatment and has been subsequently hospitalised twice more under my care from 29.7.95 to 27.8.95 and then from 29.7.97 to 7.8.97. On both these occasions he had turned violent and had to be brought for hospitalisation under police escort (1995) or with the help of hospital medical escort (1997).

Since I have been treating Mr. Vivek Chopra continuously from 13.3.1992 I am well versed with his case. I have examined him personally on various occasions at his follow up treatment.

2. The Diagnosis:

The diagnosis of Mr. Vivek Chopra's illness is Paranoid Schizophrenia. This diagnosis has been apparently constant ever since it was first made in 1983.

3. The Relationship Between Drug Abuse and Paranoid Schizophrenia and can paranoid schizophrenia be caused by drugs/alcohol?

Mr. Vivek Chopra's illness is Paranoid Schizophrenia. This is characterised by auditory hallucinations (hearing voices), delusional thinking (false beliefs), and altered behaviour. All of these have occurred due to the schizophrenia and not due to drug abuse in his case.

Paranoid schizophrenia cannot be induced by drugs or alcohol. Drugs and alcohol may cause other psychotic conditions which are diagnosed as drug induced psychosis or alcoholic paranoia or alcoholic hallucinations all of which are different from paranoid schixophrenia.

Currently as accepted in psychiatric thinking and literature is the understanding that paranoid schizophrenia occurs due to a disturbance in the brain neuro transmitters (Chemicals) and due to other yet unknown internal disturbances. Environmental factors such as stressors and life-events, and socio-cultural factors are known to precipitate as well as exacerbated by life stressors including the rigours of army life.

It is also a well known psychiatric fact that during the early phase of schizophrenia a patient may use a drug or alcohol to relieve the psychotic anxiety that arises due to the schizophrenic illness. Such use may continue even later for the same reason. Thus, use of drugs or alcohol is often a part of and symptom of the schizophrenic illness.

4. Other Comments:

A diagnosis of paranoid schizophrenia once made by itself implies that it is not drug or alcohol induced psychosis. All current accepted diagnostic criteria make it clear that while diagnosing schizophrenia drug or alcohol induced psychosis needs to be ruled out. In case of alcohol or drug induced psychosis other appropriate diagnoses are made which are different from schizophrenia.

The ICD-10 (International Classification of Diseases 10th revision, WHO, Cieneva, 1992) clearly states that "...Schizophrenia should not be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be coded under FO6.2 and those induced by drugs under Flx.5." (both FO6.2 and Flx.5 are different diagnostic categories. The diagnostic category for paranoid schizophrenia is F 20.0).

The other internationally accepted diagnostic criteria, the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition of the American Psychiatric Association, 1994) also clearly states in the diagnostic criteria for schizophrenia (category 295) that while diagnosing schizophrenia substance abuse disorders need to be excluded. It states that "the disturbance (being diagnosed) is not due to the direct physiological effects of a substance (e.g. drug of abuse, medication)"

Infact the DSM-IV outlines that:

"Substance Induced psychotic Disorder, Substance-Induced Delirium, and Substance Induced Persisting Dementia are distinguished from schizophrenia by the fact that a substance (e.g. a drug of abuse, a medication, or exposure to a toxin) is judged to be etiologically related to the delusions or hallucinations. Many different types of Substance-Related Disorders may produce symptoms similar to those of schizophrenia. Based on a variety of features that characterise the course of Schizophrenia and Substance-Related Disorders, the clinician must determine whether the psychotic symptoms have been initiated and maintained by the substance use ideally, the clinician should attempt to observe the individual during a sustained period (e.g. 4 weeks) of abstinence. However, become such prolonged periods of abstinence are often difficult to achieve, the clinician may need to consider other evidence, such as whether the psychotic symptoms appear to be exacerbated by the substance and to diminish when it has been discontinued. The relative severity of psychotic symptoms, in relation to the amount and duration of substance use, and knowledge of the characteristic symptoms produced by a particular substance."

In the case of Mr. Vivek Chopra the psychotic symptoms have continued even when he has totally abstained from any drug or alcohol use and the undersigned has had the opportunity to observe him during such abstinence him as an indoor patient for periods unto 30 days.

5 Conclusions:

1. Mr. Vivek Chopra is suffering from Paranoid Schizophrenia (which is a type of Schizophrenia).

2. His illness has not been induced by any drug or alcohol. It is an independent illness.

3. Drug or alcohol use appear to have been a part of his schizophrenic illness and a symptom of schizophrenia, or may have occurred independently.

4. Schizophrenia (including paranoid schizophrenia) can be precipitated by stress and life events including the rigours of army life."

6. When the petitioner was examined by the Medical Board of the military authorities, they studied the entire history of the petitioner and came to the conclusion that it was not attributable to the military service. The respondents have filed annexure 'R-1', the opinion of Major K.R. Rajan. The same reads as under:-

"Diagnosis:- (1) Schizophrenia V67 293)

(2) Multiple Injuries

V67, E-819, E, 619

Diagnosis:-Schizophrenia:-

History of the present illness. This patient was earlier admitted to CH(SC) Pune on 12.11.83 fir grossly abnormal behaviour in the unit AFMSF 10 dated 12.11.83 mentioned that his behaviour was very abnormal and in consistent, his performance was deteriorating, he appeared to be depressed and he may be addicted to drugs/alcohol. Enquiry revealed that he was regularly taking large amounts of alcohol drinks and smoking "HASHISH" (Cannabis) from Nov 83, his behaviour was found abnormal in that he was uncooperative, his talk was irrelevant, his perceptions were disturbed. He was emotionally withdrawn. He had no insight. He was diagnosed to be a case of Schizophrenia precipitated by indulgence in Intoxicants like alcohol and cannabis and characterised by gradual withdrawal form reality, fantasy formations, ideas of reference, erratic and persecutory delusions which were rather fixed and systematised, disorganisation of thought process, disturbances of mood, episodic restlessness and violent behaviour. He was treated with Psychotropic drugs and psychotherapy. His response to treatment was satisfactory. He was discharged on 4/1/84. When he was sent on 8 weeks sick leave (Category 84 Tg) while on leave he met with a motor cycle accident on 23.1.84 and was admitted to Army Hospital Delhi Cantt. He was smelling of alcohol. He had sustained multiple injuries in the form of closed head injury, multiple lacertiems, fracture patella and fracture lower and radius (LT). Injury report was initiated on 25.1.84. He became fully conscious on 24.1.84, findings were consistent with defuse cerebral trauma. He was treated by patallectory for fracture patella and POP immobilisation for Calles fracture (LT). He recovered wall calles fracture united completely. Operative Scar knee also baled well knee was swollen with quadriceps wasting and there was restriction of flexicon by and 90 degress. He was recommended sick leave for 6 weeks. Medical Board was held on 30.4.84 and he was placed in S3 (T24) HA 4, (T.60P,). After leave he was admitted to AH Delhi Cantt. on 11.6.84 for review and was placed in A2 (T24) for multiple injuries and P2(T24) for closed head injury on 26.6.84. He was discharged to unit on 29.6.84.

On the present occasion, he was admitted to CG (SC) Pune on 16.9.84 with the following notes. Last night he went to one of the Officer's house and started behaving abnormally and would not move from there "Maj. A.K. Bali, one officer of the same unit who accompanied him and happened to know him well since July 84 stated that the officer often talked of topics which were incomprehensible viz : once you could arrange a cracker party". When further questioned he did not elaborate. He merely stated, you should be knowing and now, action will start". Can the king and the queen go together? Such abused talks often surprised Major Bali. It mostly happened after he had consumed alcohol although not drunk. Two weeks back, damaged tapes (Cassettes) from this officer. He believed that Major Bali had been spying on him and had tape-recorded all his conversations. No amount of would remove patients false belief and he kept on insisting on getting back the tapes. Patient often had disclosed to Major Bali that there was some secret organisation (KGB, Movement of African Unity) that were spying on him and wanted to harm him. Patient wanted to make a counter organisation to fix up his persecutors and protect himself. He often expressed desire to join intelligence corps to bring substantial reforms in that corps. About 4 days back he caught hold of a street dog and groomed it with his clothes and over provided with a raincoat. He gave no reason for this peculiar behaviour. Last night 15.9.84 he visited the house of another office and smoked "HASHISH" there. He was intoxicated and did not leave the place. The couple was scared. However, he did not misbehave with them."

Patient was reluctant to talk. He, however, admitted that he smoked "HASHISH" regularly and drank alcohol (1-2 pegs of Rum) daily. AFMSF-10 dated 21.9.84 was as under Officer is undergoing Signal Officers degree engineering course. An average officer who lacks efficiency. Has not been doing well in hi studies in college. Gets depressed withdrawn and preoccupied. Reportedly addicted to drinks and alcohol. His behaviour is erratic and abnormal. This appears to be a relapse. His retention in service is not recommended, in case he does not show reconable improvement. The officer has been generally remaining aloof. It is understood that the officer has been drinking heavily and also having drugs. He frequently misses his meals. He is obsessed with the idea that there exists an espionage organisation in CME which is troubling him. He wants to form a parallel organisation called "Sergeant Peppers lonely Hearts club Band". Around 19 Sep 84 he was observed by two officers while he was trying to put gears and pull over on to a pet dog belonging to another officer. He was also given to playing loud music at about 0100 hours to 0230 hours at full volume and would play the same number many a time. However he gave up this game, after his neighbouring officers pointed out the inconvenience to him. On the night of 15 Sept. he proceeded to the residence of a married officer, Lt. P. Sen and sat at the landing between the ground and the first floor. Capt Chopra talks in terms of crossing the red line and spoke of his parallel organisation. With great difficulty he was persuaded to go back at 0100 hours. On the morning of 16 Sept. 84, he returned to the residence of the same married officer at 0800 hours. He stated that he came to take over the reins and that everyone concerned should be summoned. He wanted to start his operations as head of the parallel organisation. Lt. Sen reported the matter to the authorities as also officer of 5130 OE his old course mates. The officer was persuaded to return to his room and was then taken to MI Room and referred to CE(SC) for admission. Where as during Nov. 83, the officer was partially violent and used threatening language while being taken to CH(SC) and resisted being taken there, this time the officer has not been violent, threatening or abusive. He was easily persuaded to come to the hospital.

Past History (1) MH Khadakwala 15.4.76 to 19.4.76 m Akkergue rages DTU (2) NG Jagadajwaskar 21.8.76 to 25.8.76 Head injury with contusion thigh (RT) Tr,. to CH(SC). (3) CH(SC) Pune 25.8.76 to 27.8.76 closed head injury with lacerated wound parietal and frontal area Tr, to MH Khadakwala (4) MH Khadakwala 27.8.76 to 6.9.76 Head injury (closed) with lacerated wound Rt paristal and frontal areas DTC (%) MH Khadakwala 16.9.76 to 21.9.76. Head injury (closed) Effects of Tr. to CH(SC) (6) CH(Sc) Pune 21.9.76 to 27.9.76. Head injury (closed) Effects of Rec. 4 weeks sick leave. Tr. Back to MH Khadakwala (7) MH Khadawasala 27.9.76 to 30.9.76. Head injury (closed) effects Rec.4 weeks sick leave and review at nearest MH (8) AG Delhi Cantt 25.10.76 to 27.11.76. Head injury Effects of Placed in P2 (T-24) DTU.(9) Mh Khadawasla 29.4.77 to 2.5.77. Head Injury effects of Tr. to CH(SC) Pune. (10) CH (SC) Pune 0.5.77 to 9.5.77. Upgraded to Shape I, DTU (ii) CH (SC) Pune 06.9.78 to 19.9.78. Fracture nasal boms. DTU (12) CH (SC) Pune 12.11.83 to 4.1.84 Schizophrenia,. Sick leave 8 weeks.(13) AH Delhi Cantt. 22.1.84 to 1.5.84. Multiple injuries and Schizophrenia, Rea cat/S3 (T-24) 8184 (T-5) (14) AH Delhi Cantt 11.6.84 to 29.6.84 (a) Multiple injuries (b) closed head injury (a) Schisophrenia. Bee Cat 83(T/24) HIAI (T-24) El.

Family History Father is alive and healthy. He is a retired Engineer. All India Basis, having a business of his own in electronic goods at Delhi, Mother died in 1973. She has one elder brother. Married, A Civil Engineer, works in Abu Dhabi. No sister. No history of mental illness in the family.

Personal History Child biyrituc traits buk, Education BSc Sex unmarried. Habits smokes about 40-50 cigarettes a day. Smokes 'Hashish' since last 3 years, since July 84 has been smoking it almost daily with cigarettes. Drinks daily 1*2 pegs of rum sometimes excessively.

On Examination

A tall slim averagely nourished individual pulse 84/mt. Temp 98*F, Bans 18/pm, BP 120/74 nn if Eg, Rt 185 cm, wt.58 kg. No pallor, cyanosis, Jaundies, Oodama, or lysphadenepathy, CMS, CVS, PS, Abdomen soft, liver and spleen not palpable.

Mentally, he was pensive, tense and worried and would keep on smoking cigarettes during interview and in the ward. He was exclusive and would not mix with other patients. He wear dark glasses' both by day and night. He was suspicious and said that he were the glasses for protection. He could watch others but they would not know that they were being watched. He said that he liked to smoke 'Hashish' (Cannabis) daily. Sometimes he was found to be smoking 'Hashish'. Once he volunteered to part with his stock of 'Hashish' and handed over a polythene packet containing 'Hashish'. Sometimes he was uncooperative, irritable and restless. He would demand a separate room for himself and also ask for out passes every now and then, so that he could have privacy to smoke Hashish and also relish the stock by going out of the hospital. He would keep on refiling in a vague fashion and talk about military intelligence, this read line, his desire to carry 'Begum' (one nursing officer) and so on. Content of speech showed suspiciousness, delusions of persecution and eroticism, impaired judgment and reasoning and ideas of reference. Samples of speech "I am here because I have bugged the Military intelligence. I wanted to take over military intelligence. There was full time operation of intelligence on me. I came out of it. I know this kind of operation in CME before. I identified one intelligence office in CME. He was after me. They tried to managed to escape. I think 1 was spotted as a talent for inducing intelligence Corps. Earlier also 1 played this game with them.

26 Hyb 84 He was biw reported for release medical board.

Present: Patient c/6 pain in (RT) knee on working and running out distances and inability to lift heavy weight with (LT) bami.

Re exanubatuib: (HT) Knee No deformity seen of operation well sealed. No evidence of effusion in the joint, waiting of present-3 cms at the level of 1.5 cms above the knee of joint line.

Extension full. Felxion terminal 15* retrieted. Lt. Wrist slight swelling present. No tenderness. Movement extension full. Felxion on restricted by .30*. Griep of hand satisfactory X-ray report pt knee (24651 dated 13.11.84). Patella no present. Small loose body in the knee joint. OA charger in Rt knee present. It wrist 24762 dated 15.11.84 shows old fracture of lower end of radius.

In view of this the patient is fit to be released in medical category A2 permanent.

(A Daltyari)

Colonel, Senior Adviser, Surgery

OPINION OF MAJOR K. UNNI BARAKKAL,

NEURO SURGEON OF CH(SC) PUNE,

DATED 26 MAY 84

An old case of Head Injury, first sustained in Aug 76 and later in January 84 too. Me had loss of consciousness as per his statement, on examination at AG Delhi Cantt. ten minutes after the accident he was noted to be stuperred and was responding to painful stimuli and obeying orders as per the notes, he was also smelling of alcohol. No basis fully conscious and orientive the next day of the accident. He also sustained other multiple injuries which were treated at AG Delhi. No list of bleeding from ear and nose or throat. He was a known case of Schizophrenia and he did not have any major deficit at that time. He was treated consecutively at AG Delhi Cantt and sent on sick leave and on review he was placed in P(T24).

In 1976 when he had head injury, he did not loose consciousness and had no PTA and was not having any neurological deficit as per the notes. He had only mild head ache.

No seizures. No weakness of limbs. On examination- Well build not anemic. Higher mental function- as recorded by Psychiatrist. Cranial nerves. Normal. Motor anxemity Sandery system- within normal limits. Raflexis All are normal. X ray skull old did not show any fracture. 50/794/3194 dated 22 Nov 84 is reported within normal limits. KKg done in Jan 84 is reported to have shown findings consistent with diffuse cerebral trauma. Fit to be released in P2 Permanent.

(K. UNNI PARKKAL)

Maj. AMC.

OPINION OF MAJOR K.R.RAJAN, GRADED SPECIALIST(MEDICINE) OF OF CH (SC) PUNE, DATED 24 NOV 84

This officer aged 26 years, who is being placed in category S5 for Schizophrenia has no clinical bioChemical or radiological evidence of an organic cause for symptomtology.

(K.R. RAJAN)

Major

Graded Specialist (Medicine)

In view of the above, the officer is being brought before an Invaliding Medical Board.

Sd/-

MO I/C D. Saldhana, Major AMC

Trainee in Psychiatry.

7. The learned counsel for the petitioner, Lt. Col. M.G. Kapoor, relied upon the judgment of this Court in "Ex. Gdr. Subash Chander v. Union of India and Ors.", 1995 1 AD (Delhi) 1305. The facts of that case do not resemble the facts of this case and the ratio laid down therein would not apply to the facts of this case. The question has to be considered in the light of the materials placed before Court and the disability would depend upon a variety of factors, namely, the constitution of the officer, his habits and the nature of the duties performed by him while in service. In my view, the respondents had taken into account all relevant factors. Therefore, I am not able to accept any of the submissions made by the learned counsel for the petitioner, and the petitioner cannot rely upon the judgment of this Court, referred to above.

8. Having regard to the opinion of the Medical Board, 1 am of the opinion that the order passed by the Government of India on the 1st of August, 1985 is in accordance with law and the petitioner has not made out any case for interference. Accordingly, the writ petition is dismissed.

9. There shall be no order as to costs.