Per Manmohan Sarin, CJ: 1. This is an appeal preferred by the Union of India assailing the judgment dated 11.05.2005 in SWP no. 991/2001, tilted Suram Singh vs. Union of India and another by which the learned Single Judge allowed the writ petition and directed the appellants to process and settle the case of the respondent for grant of disability pension within a period of three months. 2. The delay in filing the appeal was condoned vide order-dated 28th of January, 2008. The appeal had come up for admission on 20th of September 2008 when the appellants were required to produce the original medical opinion and records. Notice of default was also issued to the respondents counsel. With the consent of the parties, the appeal was taken up for hearing and disposal on 29th of September, 2008 and the judgment was reserved. 3. The facts giving rise to the present appeal are in a narrow compass and are briefly noted as under. 4. Respondent-Suram Singh permanent resident of Jammu and Kashmir State, had got enrolled in the Army on 19th of February 1996. The respondent, prior to his enrolment in the Army, was subjected to the rigorous medical check up and only upon being found fit, he was inducted into the Army. He was not found to be suffering from any constitutional, genetic or organic disease. He was invalidated out of the Army on 19.04.1998, i.e., after two years two months of service on the ground that he was found suffering from unspecified psychosis. The respondent was denied disability pension even though the disability was found to be over 40% on the ground that the Medical Board had found that the disease was neither attributable to nor aggravated by military service. It is this finding which had been assailed. 5. The learned Single Judge in his brief order recorded: The case of the petitioner is that disease with which petitioner was suffering has not been recorded at the time of his entry in the service, therefore, it is to be presumed that he contracted the disease during the Army service. The case of the respondents is that disease is constitutional in nature and not related to Army service. The disease with which petitioner has been found to be suffering has been determined by the respondents as Unspecified psychosis. The case of the respondents is that disease is constitutional in nature and not related to Army service. The disease with which petitioner has been found to be suffering has been determined by the respondents as Unspecified psychosis. In my view, Unspecified psychosis disease may be contracted due to many reasons, like stress and strain being a psychological disorder. The petitioner was rendering military service and going by nature of his duty stress and strain is normal attribution of the service. In this background, respondents were not justified in rejecting the claim of the petitioner for disability pension, as he is entitled thereto his disability being more than 40%. The writ petition of the petitioner is allowed and respondents are directed to process and settle the case of the petitioner for granting disability pension within a period of three months. 6. Learned counsel for the appellants, before us, has assailed the judgment of learned Single Judge urging that the learned Single Judge exceeded his jurisdiction in ignoring the opinion of the Medical Board that the disease "psychosis was neither attributable to military service nor aggravated by it. She submits, relying on Union of India and ors v. Surinder Singh Rathore reported at 2008 (2) Supreme 623 and Union of India and ors v. Keshar Singh reported at 2007 AIR SCW 2760, that Medical Boards opinion regarding the cause of the disease and whether it was attributable to Army service or aggravated by it was not to be ignored or substituted by the opinion of the Court. 7. Learned counsel next submitted that the nature of the respondents illness namely unspecified psychosis being such that the respondent cannot take any advantage of its non-detection at the time of recruitment. She submits that there are periods of normalcy in the said illness and its non-detection at the time of recruitment should not result in a presumption that it was non-existent or had been acquired during the service. 8. There is no quarrel with the proposition that, the opinion of the Medical Board is given primacy and is not normally to be substituted unless it is shown to be unsustainable or based on wrong premise. 9. Let us notice the legal position as it emerges from the judicial pronouncements and applicable provisions relating to grant of disability pension, before applying them to the facts of the instant case. 9. Let us notice the legal position as it emerges from the judicial pronouncements and applicable provisions relating to grant of disability pension, before applying them to the facts of the instant case. In Pritam Singh v. Union of India, 2000(2) SCT 862, a learned Single Judge of this Court, while considering the claim for disability pension of an army personnel, who was discharged after seven years of service in Army, on account of "Schizophrenic Psychosis Catatonic with disability assessed at 30%, was granted disability pension. The learned Single Judge found that there was no family history of the disease and he was not found to be suffering from it at the time of induction into the army. It was held that it could be safely concluded that the disease occurred due to stress and strain of army service. Reference is also invited to Division Bench decision of this Court in Balwant Singh v. Union of India, LPA no. 521/1998, decided on November 17, 1999, as also to Gurmukh Singh v. Union of India, 1999(3) SCT 139 - a decision of a Division Bench of the Punjab and Haryana High Court in this regard. Reference is also invited to a decision of Karnataka High Court in Ex. Naik M.S. Pemmaiah v. Union of India reported at 1998(3) SCT 755. Here again, the Court proceeded on the assumption that the disease had occurred on account of stress and strain of army service and attributable to military service, if the person was not found to be suffering from disease at the time of induction. 10. Learned counsel for the appellant on the other hand placed reliance on two recent decisions of the Supreme Court in Union of India v. Keshar Singh, 2007 AIR SCW 2760 and Union of India v. Surinder Singh Rathore, 2008 (2) Supreme Today 623. The Apex Court in Union of India v. Keshar Singh (supra), while interpreting the Army Pension Regulations of 1961, Appendix II, paras 7(b) and 7(c) read with Regulations 48, 173 and 185, held, relying on 7(b) and 7(c), that a disease would ordinarily be deemed to have arisen in service if no notice of it was made at the time of induction into the service. However, an exception was carved out if the medical opinion holds that for reasons to be stated that the disease could not have been detected on medical examination prior to acceptance for service, the disease will not be deemed to have arisen during service. By virtue of Para 7(c) it was held that even if it was accepted that the disease had arisen in service it must also be established that the conditions of military service determined or contributed to the onset of the disease and that the conditions were due to the circumstances of duty in military service. For facility of reference, Regulation 423 is reproduced: (a) For the purpose of determining whether the cause of a disability or death is or is not attributable to service, it is immaterial whether the cause giving rise to the disability or death occurred in an area declared to be a Field Service Active Service area or under normal peace conditions. It is, however, essential to establish whether the disability or death bore a causal connection with the service conditions. All evidence both direct and circumstantial will be taken into account and benefit of reasonable doubt, if any, will be given to the individual. The evidence to be accepted as reasonable doubt, for the purpose of these instructions, should be of a degree of cogency, which though not reaching certainty, nevertheless carry the high degree of probability. In this connection, it will be remembered that proof beyond reasonable doubt does not mean proof beyond a shadow of doubt. If the evidence is so strong against an individual as to leave only a remote possibility in his favor, which can be dismissed with the sentence of course it is possible but not in the least probable the case is proved beyond reasonable doubt. If on the other hand, the evidence be so evenly balanced as to render impracticable a determinate conclusion one way or the other, then the case would be one in which the benefit of doubt could be given more liberally to the individual, in cases occurring in Field Service / Army Service areas. (b) The cause of a disability or death resulting from wound or injury, will be regarded as attributable to service if the wound / injury was sustained during the Actual performance of duty in armed forces. (b) The cause of a disability or death resulting from wound or injury, will be regarded as attributable to service if the wound / injury was sustained during the Actual performance of duty in armed forces. In case of injuries, which were self inflicted or due to an individuals own serious negligence or misconduct, the Board will also comment how far the disability resulted from self-infliction, negligence or misconduct. (c) The cause of a disability or death resulting from a disease will be regarded as attributable to service when it is established that the disease arose during service and the conditions and circumstances of duty in the armed forces determined and contributed to the onset of the disease. Cases, in which it is established that service conditions did not determine or contribute to the onset of the disease but influenced the subsequent course of the disease, will be regarded as aggravated by the service. A disease which has led to an individuals discharge or death will ordinarily be deemed to have arisen in service if no note of it was made at the time of the individuals acceptance for service in the armed forces. However, if medical opinion holds, for reasons to be stated that the disease could not have been detected on medical examination prior to acceptance for service, the disease will not be deemed to have arisen during service. (d) The question, whether a disability or death is attributable to or aggravated by service or not, will be decided as regards its medical aspects by a medical board or by the medical officer who signs the death certificate. The medical board / medical officer will specify reasons for their / his opinion. The opinion of the medical board / medical, officer, in so far as it relates to the actual cause of the disability or death and the circumstances in which it originated will be regarded as final. The question whether the cause and -the attendant circumstances can be attributed to service will, however, be decided by the pension sanctioning authority. (e) To assist the medical officer who signs the death certificate or the medical board in the case of an invalid, the C. O. unit will furnish a report on: (i) AFMS F-81 in all cases other than v those due to injuries. (ii) IAFY-2006 in all cases of injuries other than battle injuries. (e) To assist the medical officer who signs the death certificate or the medical board in the case of an invalid, the C. O. unit will furnish a report on: (i) AFMS F-81 in all cases other than v those due to injuries. (ii) IAFY-2006 in all cases of injuries other than battle injuries. (f) In cases where award of disability pension or reassessment of disabilities is concerned, a medical board is `always necessary and the certificate of a single medical officer will not be accepted except in case of stations where it is not possible or feasible to assemble a regular medical board for such purposes. The certificate of a single medical officer in the latter case will be furnished on a medical board form and countersigned by the ADM3 (Army) / DMS (Navy) / DMS (Air). 11. In the cited cases (supra), the Supreme Court gave primacy to the medical boards opinion that the illness suffered was not attributable to the military service. It also held that the respondent had not produced any material to show that the conditions of military service determined or contributed to the onset of disease. Union of India v. Surinder Singh Rathore (supra) was a case when, the army personnel was diagnosed to be suffering from Maculopathy (RT) Eye resulting in diminished vision and disability was assessed at 30%. The medical boards opinion was clearly to the effect that the ailment suffered was not attributable to the military service. The Apex Court, therefore, held that in this view of the matter the Single Judge and the Division Bench of the High Court were not justified in holding that the same was attributable to the military service. The Supreme Court also noticed and laid emphasis on note to Appendix II providing that there must be a causal connection between the disablement or death and military service for attributability or aggravation to be conceded. 12. From the judicial pronouncements noticed above, it would be seen that the position that emerges. I. if the disease is not detected or noticed at the time of induction in army service, the presumption ordinarily would be that it has arisen during the military service. 12. From the judicial pronouncements noticed above, it would be seen that the position that emerges. I. if the disease is not detected or noticed at the time of induction in army service, the presumption ordinarily would be that it has arisen during the military service. An exception is carved out where the medical authorities specifically opine that the nature of disease was such that it could not have been detected or diagnosed during the medical check up at the time of induction in service; II. The opinion of medical board / medical officer, as the case may be, regarding the case and attributability of the disease to army service or its aggravation on account of military service or otherwise is to be given primacy and is to hold the field unless based on wrong premise or is otherwise not sustainable. III. In cases where there is a presumption that the disease had arisen during the period of military service, the causal connection of the disease being attributable to military service should also be shown. 13. In the instant case, let us examine and consider the facts as found by the medical board itself. We shall, thereafter, consider whether the respondent was entitled to the disability pension in terms of applicable provisions and the principles emanating from the judicial pronouncements noticed hereinabove. For facility of reference, the findings of the medical board are reproduced: The findings of the medical board about the entitlement and assessment of disability are only recommendatory in nature and subject to revision by the competent Med. authorities i. e. Medical Adviser (Pension) DAFMS (Pension) / Dy. DGAFMS (pension / DGFMS as defined in the amended rules to Casualty Pensionary Awards 1982. Name: Suram Singh DOA 19.02.1996 Unit 6 Mahar (Borders) Service 02 yrs R/o MAHAR SAUGOR (MP) Ht 173cms Wt 60 kg Diagnosis: UNSPECIFIED PSYCHOSIS (ICU-298) SUMMARY AND OPINION BY Lt Col S. CHAUDHURY CLASSIFIEDSPECIALIST (PSYCHGIATRY OR CH (NC) C/0 56 APO DT. 27.02.98 This 21 years old Sep having about 2 yrs of service is a case of Unspecified Psychosis. He was initially admitted for psychiatric, evaluation on 14-07-97. History revealed that while returning from A/L from his home at Jammu he felt very anxious and fearful. He was taken to the railway station by friend. After boarding the train he began hearing voices which threatened him and told him to run away. He was initially admitted for psychiatric, evaluation on 14-07-97. History revealed that while returning from A/L from his home at Jammu he felt very anxious and fearful. He was taken to the railway station by friend. After boarding the train he began hearing voices which threatened him and told him to run away. He was roaming aimlessly at the railway station when he was seen by a neighbor who took him back to his home. Later he was admitted to 166 MH on 06-07-97. Initially he was not talking. Later he became aggressive but later said somebody wanted to kill him and so patient wants to go to Mata Vaishno Devi temple. On 12-07-97 he absconded from the hospital but was traced at the bus stand brought back to hospital and transferred to CH (NC). Past history: No past history of head injury, fits, STD or mental illness. Family history: hails from middle class rural family. Father 50 yrs old farmer, Mother 45 yrs house wife. Eldest of 5 sibs. No family history of mental illness, fits, alcoholism or suicidal attempts. Personal history: Birth and development said to be normal No neurotic traits in childhood; was poor in studies and stopped after passing 8th class. He is unmarried. Service history: Joined army for a job. No punishments. Well motivated for further service. Habits: does not drink alcohol. Non-smoker. Denies any drug habits. On examination: averagely built & nourished. A febrile pulse - 82/min, BP-120/80 mm of Hg. No pallor cyanosis, icterus, edema, lymphadenopathy, Systemic examination-NAD. Mental status examination: ill kempt, not in touch with reality. Talk is vague as wooly. Affect is blunted. Has 2nd person auditory hallucinations and persecutory delusions. Memory & orientation unimpaired. Lacks insight, judgment impaired. Sleep & appetite reduced. Investigations: Blood Hb 13.5 gm %TLC-9,600/cmm p62L33M01E05 Urine RE-NAD, LFT-NAD. Blood sugar F-72mg%, PP-100mg% Blood urea-32mg%. Serum creatinine-1.1mg%. X ray skull-NAD. Fundoscopy-NAD. Treatment Antipsychotic drugs. ECT (5), Psychotherapy. Progress: Unsatisfactory, xxx Suram Sing of 6 Mahar (BORDER) OPINION: This 21 yrs old Sep/inf having about 2 yrs of service is a case of Unspecified Psychosis, manifesting with acute onset abnormal behavour, anxiety, fear, unprovoked violence, neglect of personal hygiene, vague and wooly talk, blunted affect, second person auditory hallucinations, persecutory delusions in a clear sensorium with impaired insight and disturbed biodrives. No organic cause was evident. No organic cause was evident. Despite prolonged and adequate treatment he has shown relapses and continues to have residual symptoms. He has low stress tolerance and is likely to relapse in future. In view of above he cannot be consider fir for further retention in service. Recommended medical category `EEE. Advised: 1) To continue Tab Chlorpromazine (100mg) 1-1-1 and Tab Nortriptyline (25mg) 2HS for further period of one year. 2) In case of relapse to report to nearest civil mental hospital." 14. It is note worthy that in part 3, i.e., in the opinion of Medical Board in response to the question; did the disability exist before entering service? The finding is no. Further, there is no response to the question; whether it was attributable to service during peace or under field service conditions: or it has been aggravated thereby. In conclusion it is stated; Psychiatric disorder not related with service. In response to question no. 4, disability has been shown as unspecified psychosis 40% and duration of this disease has been given as two years. 15. From the foregoing opinion as reproduced above, it would be seen that the respondent on returning from his annual leave was found to be suffering from delusions perceiving threats and hearing of voices etc. He was found to be aggressive and nurturing the belief that some body wanted to kill and therefore he wanted to visit Mata Vaishno Devi temple. Having been found at the Railway Station roaming aimlessly, he was taker to hospital and given treatment. 16. The opinion of the Psychiatrist and the summary of the findings of Medical Board clearly shows that there was no past history or family history of mental illness in the family. The respondent is a non smoker, does not drink alcohol and there is no addiction to drugs. These would eliminate most of the known causes of psychosis. The clinical and bio-chemical examinations including the blood, urine and biochemical examinations have revealed nothing abnormal. 17. It would, therefore be seen that the Medical Board itself has observed the absence of any family history, past history and illness of psychosis. He was found to be absolutely normal at the time of recruitment. It is significant that the Board in answer to the question whether disability existed before entering into service; answered it in the negative. 17. It would, therefore be seen that the Medical Board itself has observed the absence of any family history, past history and illness of psychosis. He was found to be absolutely normal at the time of recruitment. It is significant that the Board in answer to the question whether disability existed before entering into service; answered it in the negative. There is no finding recorded by the medical board that the disease was such that it could not be detected at the time of induction, if petitioner was suffering therefrom. The only general observation made is that it is constitutional in nature. Hence the disease being contracted during service is accepted. 18. From the foregoing analysis, inference to be drawn is clear that the disease was contracted during the period of Army service. We have examined the available Medical literature on "Psychosis". Psychosis is simply defined as a severe mental condition in which there is a loss of contact with reality. A person loses touch with reality, he/she may have disorganized thoughts, hallucinations and delusions and find it difficult to interact. The exact cause of psychosis is not known. However, there may be many possible causes such as use of alcohol and certain drugs; brain tumors; Dementia (including Alzheimers disease); epilepsy; bipolar\disorder; psychotic depression, schizophrenia or stroke etc. In the instant case, the findings as recorded by the medical board and the evaluation by the Psychiatrist, which have been reproduced hereinabove, demonstrate the absence of the above known causes. It is believed that some people have vulnerability to developing psychosis due to various biological and genetic risk factors and that stress in combination with this vulnerability, can bring on an episode of psychosis. Stress can be defined as a major life event such as bereavement, a change in life style, social circumstances etc. It is a significant factor at first onset and also at subsequent relapse psychosis. 19. In these circumstances, looking at the medical history as recorded by the Psychiatrist and opinion of the medical board, it would appear that this young man who had joined the Army fell to the disease on account of the exacting physical demands and strict schedule required to be maintained and this brought the condition of psychosis because of his inability to cope up with the stress and strain of the Army regulatory life and discipline. 20. 20. Considering the findings of the Board that the disease was not there at the time of entering service and the absence of any past family history of disease, biological and genetic factors and of the known causes of psychosis, the conclusion reached by the medical board that the psychosis disorder was not relatable to service is inconsistent with their own findings and observations, and not sustainable. During the two years of posting, the respondent was in the field area and in military service and was exposed only to military service. Hence, the disease was attributable to military service and, in any event, the onset of it or aggravation was attributable to military service. 21. In the light of aforesaid analysis, we are of the view that the conclusion reached by the learned Single Judge that the disability was attributable to and aggravated by military service can be logically arrived at and inferred from the details given in the opinion of the medical board itself as analysed hereinbefore. We are of the view that in the present case, the attendant circumstances are such that they call for a liberal interpretation to be given to the provisions of Appendix-II and being in field service the benefit of doubt, if any, is to go in favour of the employee. The appeal preferred by the Union has no merit and is, accordingly, dismissed.