Const AB Minj Ortho-Neuro board out case

CONFIDENTIAL CT AB Minj 1

CONFIDENTIAL

MEDICAL BOARD PROCEEDING: PART-I

1) Name : Akhil Binod Minj

2) Service No : 89003323

3) Rank : Constable

4) Unit : TC&S HZB.

5) Service : 26 Year

6) Branch : GD

7) Age : 48 Year

8) Home Address : Vill -Darijijari P.O. -Bishakhakhatananga

Dist -Ranchi State -Jharkhand

9) Authority of Board : CH BSF HZB O/No-Med/Medical

board/2015/595-604 Dated-05-02- 2015

10) Principal Disability (Diagnosis) : Effects of compound fracture of Right

Tibia & Fibula bones (lower 1/3rd) &

simple fracture of Left Tibia & Fibula

(middle 1/3rd)

11) Date and Place of origin : 24th Sep 1992 at Warangal (AP)

12) Other Disability, if any 1) Accelerated Hypertension, -Since 02-02-2012 -At CH Sgr.

2) Hemorrhagic CVA as:-

a) Rt/Hemiparesis with Slurred Speech, -Since 07-02-2013 -At CH Sgr b) Hypertensive white matter disease,

c) Old left lateral thalamic capsular haemorrhage &

d) Cerebral Atrophy (Vermis & Para Vermis) -Since 07/02/13. -At Apollo Ranchi

13) Give concisely the essential facts of the history of disability and present clinical conditions:- a) Chief Complaints

* Pain on walking during long distance & standing for long duration - Since 24-09-1992

* Hypertension - Since 02-02-2002 * Slurred nasal speech & Rt side weakness - Since 07-02-2013

b) History of Present Illness : i) History dates back to 24th Sep 1992 at around 1230 hrs at Warangal, Andhra

Pradesh in 3rd Bn BSF while he was on IS Duty, sustained injury resulting in compound

fracture of Right Tibia & Fibula bones (lower 1/3rd) & simple fracture of Left Tibia &

Fibula (middle 1/3rd) due to blast of the vehicle when he was returning back to his company after search operation duty. He became unconscious after blast. He remained unconscious for 2-3 days & remained under treatment in the hospital up to Nov’ 1992. His Right leg was operated & IM nailing was done in his Right Tibia bone. POP cast was applied in his both lower legs & then


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came back to unit. After the treatment his bones in both legs united with permissible degree of mal-union. There was 1 cm shortening in his right leg. He bones united well but he developed ulcer over the back of right leg for which he was re-admitted in the Warangal Hospital on 07-01-93 and was discharged on 17-01-93. As his unit was moving to Bharatpur Rajsthan, he was advised shifting to BH Kadamtala for treatment of his ulcer at right leg. He remained admitted at BH Kadamtala wef Aug 93 to Mar 94.

He was then posted to TC&S Hazaribag. At TC&S he was having ulcer in his injured right leg, for that he was then referred to RMCH Ranchi. On 06-06-96, Dr K. M. Ojha, HOD Ortho, RIMS Ranchi opined that there is discharging wound at right leg fracture site & nail is still there in tibia. Extraction of IM Nail was advised after complete healing of the ulcer.

On 10-08-96, his disability was assessed 30% by the Ortho Specialist Sadar Hospital Hazaribag for review medical board.

On 11-11-98 his IM nail was removed under G/A at Biraj Nurshing Home Ranchi. His medical category was reviewed on 29-04-99 & he was awarded CEE(P) as he was suffering from effects of fracture BB both legs as some degree of mal-union & stiffness in nearby joints. His medical category was reviewed regularly in 2001, 2003, 2005 and he was kept in low medical category S1H1A3(L)(P)P1E1 for this whole period. In Jun 2007 he was posted out from TC&S HZB to Firozpur in Punjab. He was reviewed at SGTB hospital Amritsar time to time & his medical category was reviewed in 2008 & 2010 for this problem and awarded to continue in same low medical category S1H1A3(L)(P)P1E1.

He was then posted to rear HQ at Labana in Rajsthan but his unit was deployed in Mohra in Kashmir, therefore his review medical board was convened at SHQ Baramulla on 28-09-10 where he was awarded S1H1A3(L)(P)P1E1. ii) On 02/02/2012, during the Annual Medical Examination at STC BSF Srinagar, his blood pressure was found high (200/120 mm Hg). He was referred to physician, CH BSF Srinagar where he was diagnosed as a case of “Accelerated Hypertension (BP 240/120 mm

Hg)” after relevant investigation he was kept admitted from 02/02/2012 to 21/02/2012. He was put on Salt Restricted Diet, Tab Erectel Trio 1 OD, Tab Pritol XL 1 OD. On 22/08/2012 he was again referred to physician CH BSF Srinagar where he has undergone CBC, KFT, ECG and urine examination & he was advised Tab Erectel 1 OD daily. Tab Metonce AM 1 OD for 2 weeks. iii) On 07-02-2013, he suddenly develops loss of speech & right sided weakness. He

was referred to SMHS Hospital Srinagar where he was diagnosed as a case of Hemorrhagic

CVA with Hypertension &Right hemiparesis . He remained admitted in CH BSF Srinagar from 07-02-13 to 02-03-13. He then proceeded on 56 days medical leave. His leave was again extended & he remained at home town near Hazaribag. On 30-05-13 he consulted Sadar Hospital Hazaribag where reviewed medicines for Hypertension & Right sided Hemiparesis. He was again reviewed for the same ailment at Sadar Hospital Hazaribag. He went to duty place in Srinagar in Sep 2013 where he was reviewed at CH BSF Srinagar. In Oct 2013, he got posted at TC&S BSF Hazaribag. On 14-11-2013 he was brought in CH Hazaribag as a hemiplegic patient, from there he was referred to Apollo Hospital Ranchi as an emergency case of Hemiplegia with Hypertension. At Apollo, he was diagnosed as a case of fracture of his right tibia & fibula (lower 1/3rd) & left tibia & fibula (middle 1/3rd)- since 24-

09-92. Hypertensive white matter disease-since 07/02/13, Old left lateral thalamic capsular haemorrhage-since 07/02/13, Cerebral Atrophy (Vermis & Para Vermis)-since 07/02/13. He remained admitted at Apollo Hospital Ranchi from 14-11-13 to 19-11-13 & given conservative treatment. He was then admitted at CH BSF Hazaribag wef 21-11-13 to 09-05-14. He was put on conservative medicines physiotherapy & regular follow up from Neurologist of Apollo hospital till Nov 2014. From Dec ’14 onward he is under regular follow up from Neurology RIMS Ranchi. Presently he is taking regular physiotherapy for slurred nasal speech & right hemiparesis at CH BSF HZB & taking regular follow up medication from Neurology RIMS Ranchi.

He is not put on any duty. This patient has suffered dual effects of compound

fracture of Right Tibia & Fibula bones & simple fracture of Left Tibia & Fibula and


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also effects of hemorrhagic CVA with Hypertension &Right hemiparesis. There is some degree of Mal-union & Stiffness in his ankle & knee joints of both legs. He is hardly able to walk, limping very slowly with support of stick & attender. Muscle power in his right hand is very week. Power in his left hand is better than right hand. His speech is slurred & nasalized sometimes hardly understood by the listeners.

c) Past History : No history of Hypertension, TB, Diabetes mellitus & Asthma.

d) Family History : No H/o Hypertension, Heart disease & Diabetes

mellitus in family.

e) Personal History : Married, Have 2 children, Non-smoker, Non-

vegetarian & Alcoholic.

f) Hospitalization : MGMC & Hosp Warangal. from 24-09-92 to 11-11-92

-do- from 07-01-93 to 17-01-93 NBMC & H, Siliguri from 05-08-93 to 02-12-93

–do- from 29-01-94 to 08-03-94 TC&S Hosp, HZB from 23-08-94 to 22-09-94 RMCH Ranchi from 05-11-98 to 12-11-98

CH BSF Srinagar from 02-02-12 to 21-02-12 CH BSF Srinagar from 07-02-13 to 02-03-13 Apollo Hospital Ranchi from 14-11-13 to 19-11-13

CH BSF Hazaribag from 21-11-13 to 09-05-14

g) Categorization : CEE(T) -w.e.f. 08-03-95 to 07-09-95 by Unit MO

CEE(P) -w.e.f. 10-08-96 to 09-08-98 by BSF Board HZB

CEE(P) -w.e.f. 29-04-99 to 28-04-01 by BSF Board HZB

S1H1A3(P)P1E1 -w.e.f. 03-02-03 to 02-02-05 by BSF Board HZB

S1H1A3(P)P1E1 -w.e.f. 13-05-05 to 12-05-07 by BSF Board HZB S1H1A3(L)(P)P1E1 -w.e.f. 03-04-08 to 02-04-10 by BSF Board HZB S1H1A3(L)(P)P1E1 -w.e.f. 30-10-12 to 29-04-13 by BSF Board HZB

h) Present condition :-

Presently this individual is of average built, conscious. He is hardly able to walk, limping very slowly with support of stick & attender. There is some degree of Mal-union & Stiffness in his ankle & knee joints of both legs. Muscle power in his right hand is very week. Power in his left hand is better than right hand. His speech is slurred & nasalized sometimes hardly understood by the listeners. i) Gen/Exam:

Icterus Wt - 80 Kg Pallor Ht - 170 Cms Clubbing Nil Temp - 99o F

Cyanosis Pulse - 74/min Pedal-Oedema - B/L +ve BP - 110/70 mmHg

Lymph/pathy - Nil- Resp / rate - 18/min

Record of BP

Date BP - mm Hg


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ii) Syst/Exam:

Chest - Trachea - Central - Breath sound - B/L vesicular

- Added sound - Rhonchi/Crapts

- Nil CVS - Apex beat - 5th I/C space

- Heart Sound - S1S2 audible normally.

- Murmur - Nil

Nervous System:-

Central Nervous System Examination Function Finding

Mood anxious Worried about self disease

Higher

Function

Memory Intelligence

Intact

Cranial

Nerves

Nerves Action Finding

1st Smell Intact B/L

2nd Vision Intact B/L

3rd Pupil-reaction, Upper Lid Other eye movt Intact B/L

4th Eye up & in Intact B/L

5th Clinching teeth, Opening mouth Intact B/L

6th Eye in movement Intact B/L

7th Smile Deglution Intact B/L

8th Balance & hearing Intact B/L

9th Deglutition Intact B/L

10th Soft palate larynx Egg sounds Eng,

Can’t cough

Cannot Cough

11th Shoulder elevation [R/Side-+] [L/Side-++++]

12th Tongue pushed to paralysed side Intact B/L

Motor

Function of

Cranial

nerve

muscles

Wasting Nil

Reflex Normal except coughing reflex which is still absent

Power All recovered except soft palate & laryngeal muscles

Co-

ordination

Romberg sign -ve

Past Pointing -ve

Sensory

Function

Touch Intact

Temp Intact

Pain Intact

Peripheral Nervous System

Examination Function Right Left

Inspection Wasting Nil Nil

Skin scar *L-shaped huge scar of injury in

lower 1/3rd of R/leg.

Tremor

Measurement *Shortening of R/Leg by 1 cm *Shortening - Nil

02-02-12 200/120

,, 240/120

03-10-12 138/92

30-05-13 160/100

11-03-15 114/72

12-03-15 114/70

13-03-15 110/70


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Deformity *Stiffness present (+++)

*Ankle stiffness – present (+)

Palpation Temp Normal Normal

Muscle feel Normal Normal

Numbness / Hyperasthesia

Nil Nil

Scar tenderness

Nil Nil

Sensation Pain

Temp

Touch

Vibration

Moto

r F

un

ctio

n

Tendon Reflex Reflex/Jerks Right Left

Biceps +++ ++

Triceps +++ ++

Knee +++ ++

Ankle Could not be elicited due

to swelling & stiffness of

ankle

Could not be elicited due to

swelling & stiffness of ankle

Babinski Present Present

Abdominal Not elicited Not elicited

Cremasteric Not elicited Not elicited

Power Grade Power Right Left

Shoulder Extensor 1/5 5/5

Shoulder Flexor 1/5 5/5

Elbow Extensor 1/5 5/5

Elbow Flexor 1/5 5/5

Hand Supination 0/5 5/5

Hand Pronation 1/5 5/5

Wrist Extensor 1/5 5/5

Wrist Flexor 1/5 5/5

Fingers Adduction 1/5 5/5

Fingers Abduction 1/5 5/5

Hip Extensor 0/5 0/5

Hip Flexor 0/5 0/5

Knee Extensor 0/5 0/5

Knee Flexor 0/5 0/5

Ankle Extensor 0/5 0/5

Ankle Flexor 0/5 0/5

ROM ROM Right Left

Shoulder Extensor 1/5 5/5

Shoulder Flexor 1/5 5/5

Elbow Extensor 1/5 5/5

Elbow Flexor 1/5 5/5

Wrist Extensor 1/5 5/5

Wrist Flexor 1/5 5/5

Hip Extensor 0/5 5/5

Hip Flexor 0/5 5/5

Knee Extensor 0/5 5/5


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Knee Flexor 0/5 5/5

Ankle Extensor 0/5 2/5

Ankle Flexor 0/5 2/5

Abd - Liver - Spleen Not palpable

- Kidney - Bowel sound - WNL

Musk/Sk - Hemiparesis in Rt side of body.

Gen/Urinary - NAD R/Eye - DV 6/6

NV N/6 CV CP/3

L/Eye D/V -6/6, N/V -N/6

ENT – -NAD

i) Investigation:- 24-09-92 X-ray Both lower limbs -Fracture of his right tibia & fibula

(lower 1/3rd) & left tibia & fibula

(middle 1/3rd)

24-08-10 X-ray Both lower limbs -Mal-united fracture BB lower limbs

15-11-13 MRI Brain -Hypertensive white matter disease , Old left lateral thalamic capsular haemorrhage &

Cerebral Atrophy (Vermis & Para Vermis)

18-02-15 X-ray Both lower limbs -Mal-united fracture BB lower limbs

18-02-15 HB- 13.8 gm% TLC- 9100 /cmm

DLC- 71/25/01/03/00 ESR 13 mm 1st hr

B/Sugar (F)- 86 mg/dl B/Sugar (PP)- 124 mg/dl B/Urea- 36 mg/dl

S.Creatinine 1.18 mg/dl Lipid Profile

S. cholesterol 147 mg/dl HDL 38 mg/dl LDL 76 mg/dl

VLDL 33 mg/dl S.TG 165 mg/dl

Urine NAD j) Treatment given :

29-09-1992 to Aug 2012 - Conservative treatment with Antibiotic &

Anti-inflamatory. - IM Nailing at MGMH Warangal.

- POP in Rt leg for 18 months. - POP in Lt leg for 07 months. - Extraction of IM Nail on 11-11-98.

02-02-12 to 21-02-12 - Tab Eretel trio 1 OD - Tab Pentas XL 1 OD


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16-08-12 - Tab Eretel trio 1 OD - Tab Metonce AM 1 OD

14-11-13 (Apollo Ranchi) - Tab Telista 40 mg 1 OD - Tab Vernace 500 mg 1 BID

- Tab Benfomet plus 1 OD - Tab Allegra 180 mg 1 HS - Tab Monlevo 1 HS

- Tab Citilin-P 1 BID - Tab Doxet 30 mg 1 BID

- Cap Felicita 1 OD - Cap caltrol 1 OD - Tab Novastat 10 mg 1 OD

- Elovera cream –locally - Physiotherapy

- Low salt, Low fat, high fibre diet. - BP monitoring.

- Review after 2 weeks.

12-03-15(RIIMS Ranchi) - Tab Galamer 800 mg 1 OD - Tab Vernace 500 mg 1 OD

- Tab Feliceta 1 OD - tab Telista 1 OD - Tab Novastal CV 1 OD

- Tab Caltrol 1 OD - Tab Duxet 300 mg 1 OD

- Paralytic oil k) Specialist opinion:- 04-12-15 Neurosurgeon, RIMS Ranchi, vide OPD No- 39835 opined as under:

- Follow up case of right sided weakness with slurred speech due to CVA (Hypertensive) on 07/02/13.

- MRI brain 15-11-13 -Hypertensive white matter disease,

Old left lateral thalamic capsular haemorrhage &

Cerebral Atrophy (Vermis & Para Vermis)

- Treated at Kashmir & Apollo Ranchi. - BP 110/90 mm Hg

- Adv, 1. Tab Galamer 800 mg 1 OD 2. Tab Vernace 500 mg 1 OD

3. Tab Feliceta 1 OD 4. tab Telista 1 OD

5. Tab Novastal CV 1 OD 6. Tab Caltrol 1 OD 7. Tab Duxet 300 mg 1 OD

8. Paralytic oil 23-02-15 Neurosurgeon, RIMS Ranchi, vide OPD No- 50748 opined as under:

- CVA with Right sided Hemiparesis on 07/02/13. - Bilateral ischemic changes, Hypointense lesion Left sub

thalmic area.

- Treated at Kashmir & Apollo Ranchi. - Opinion,

1. Patient has Right Hemiparesis.


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2. Can walk with support. 3. Can understand & communicate.

4. Speech slurred. 5. Patient Neurologically & Mentally stable with Right

Hemiparesis and slurring of speech. 6. Adv,

a) Tab Felista 40 mg 1 OD b) Tab Novastal CV 1 OD

c) Tab Duxet 300 mg 1 OD d) Tab Piramulin 1 OD for 2 months.

23-02-15 Orthopedic surgeon, RIMS Ranchi, vide OPD No- 50751 opined as under:

i) Case of Compound Mal-united fracture Tibia & Fibula both legs.

14) RECOMMENDATION OF UNIT MO :-

In view of the above, I consider the person is not fit for medical category

SHAPE-1 and recommended that he be placed in medical category S1 H1 A5(L) P5 E1.

(DR. C B Narayan)

CMO (SG) CH BSF HZB


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Appendix – “N”

REPORT ON ACCIDENTAL AND SELF INFLICTED INJURIES

1. Declaration by the injured person.

I, No-89003323, Rank-Const, Name-Akhil Binod Minj, of TC&S (Adam) Hazaribag (Number, rank, name and unit ) hereby declared that the injury sustained by me on 24-09-1992 occurred while I was in the performance of government duty.

[Dr. C B Narayan, CMO(SG)] (Akhil Binod Minj)

( Medical Officer before whom ( Injured person) the declaration is made )

Station - TC&S, HZB Date - 16-03-15 Station – TC&S, HZB Date - 16-03-15 2. Nature, location and severity of injury.

Sustained injuries on both lower limbs resulting in compound fracture of Right

Tibia & Fibula bones & simple fracture of Left Tibia & Fibula subsequent to IED

blast by militant while returning from operation in Warangal in Andhra Pradesh on

24-09-1992. Note :- Hospital to be notified at once if wound is believed to be self-inflicted.

(Medical Officer) 3. Short statement of the circumstances of the cases

(Signed statement of witnesses giving a detailed account of the accident must be attached to this Form. Place or sketch of place of accident and how it occurred in case of lorry, motor car or cycle accidents).

Sustained injuries on both lower limbs resulting in fracture of Tibia & Fibula

bones of both legs subsequent to their police vehicle blown by IED blast by militant

while returning from operation in Warangal in Andhra Pradesh on 24-09-1992.

4. Opinion of the Commandant/Head of Office

(a) (i) Was the individual in the course of performance of an official task or a task the failure to do which would constitute an offence triable under the disciplinary code applicable to him? (Indicate the nature of the task, by whom it was ordered and when)

Const Akhil Binod Minj was complying an operational duty in his

company as per the order of his company commander in Warangal, Andhra

Pradesh, where IED blast took place on 24-09-199. or

(ii) Did the accident occur during the journey of transport by a reasonable route under organized arrangements from the individual’s quarter to or back from an appointed place of duty? Cite and attached copies of standing instructions or other orders in support, officially organized, also a sketch showing the reasonable route from the individual’s quarter to the place of duty ________________

or (iii) Was the individual participating in recreation organized or permitted by service authorities? Indicate the nature of the recreation e.g. P.T. Exercises including games. In case of games and sports out of parade hours, cite and attach copy of


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official orders to indicate that it was organized or permitted by competent authority_________________

or (iv) Was the individual traveling either in a body or singly under organized arrangements? (Cite and attach a copy of official orders to indicate that the arrangements were organized by competent authority ).

or (v) Was the individual proceeding to his leave station on returning to duty from his leave station? In either case, was the journey at public expense or was performed on concession voucher or at individual’s own expense? (Give

(aa) The date of commencement and termination of the period of leave ; (ab) The name of the leave station: and (ac) Particulars of the direct routes from the place of duty to or from the leave station) __________________

(b) Was the accident due wholly/partially to :-

(i) Serious negligence - No

and/or (ii) Misconduct of the individual?

(Indicate the nature of the serious negligence or misconduct and the grounds on which the opinion is based) - No

(c) Was anyone else to blame for the accident? (If so, indicate how and to what extent)

- No

(d) Was the individual under the influence of intoxication drink or bring at the material time? - No

(e) Has any Court of Enquiry been held or will be held? (If so, indicate the date and the

place of the place of the enquiry, and attach the Enquiry Report (in original) Yes, an enquiry has been conducted in this respect on date 03-01-1993 by

DIG BSF 3rd AP. (As per copy of COI attached in the file LMC file) 5. The injury/disability/death occurred in peace/field/operational Area and is/is not attributable to

Government Service. - NA

Date – 16-03-2015 IG TC&S, Meru, HZB Station - TC&S HZB (Head of Office )

@ In all cases of death, Court of Inquiry must be held, so also in respect of disability exceeding 20%. + To be completed and signed by OC Unit if injury is not severe and no Court of Inquiry is held.


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Appendix – ‘O’

FORM FOR REPORT ON CASES (OTHER THAN THOSE DUE TO INJURIES)

WHICH HAVE ENDED FATALLY OR ARE PROPOSES FOR INVALIDING

PART-A

(To be filled by the MO)

Station TC&S Hazaribag

Date 16-03-2015

Name – Akhil Binod Minj Service No. - 89003323 Designation- Const

Unit - TC&S (Adm) Hazaribag Service - General Duty Force - Border Security Force other full service particulars and office address, etc.

Disability:- 1) Accelerated Hypertension, -Since 02-02-2012 -At CH Sgr.

2) Hemorrhagic CVA as:-

a) Rt/Hemiparesis with Slurred Speech, -Since 07-02-2013 -At CH Sgr

b) Hypertensive white matter disease, c) Old left lateral thalamic capsular haemorrhage &

d) Cerebral Atrophy (Vermis & Para Vermis )-Since 07/02/13.-At Apollo Ranchi

Outcome of the case, i.e. died or to be invalided _________________________________

( Medical Officer )

PART-B

(To be answered by the Officer Commanding Unit)

Circumstances of the case

1. Was the individual in your opinion of average physique and stamina when he joined the unit? - No, he was already suffering from effects of

Accelerated Hypertension & Hemorrhagic CVA.

2. (a) Was the individual, as far as you are aware, in his normal health prior to the onset

of the illness - No, he was already under low medical category due to

effects of compound fracture of Right Tibia & Fibula bones (lower 1/3rd) & simple

fracture of Left Tibia & Fibula (middle 1/3rd).

(b) If you are aware of any previous illness from which he suffered (which is not recorded in his medical history) state its nature and duration.

- Not reported.

3. Was the individual employed on sedentary duties/sheltered occupation? - Yes

If so-

(a) Head he to do P.T. and/or parades? - No


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(b) Was he doing it regularly prior to falling ill or had been exempted there from on account of ill health? If so, from which date?

- Since the date of injury ie wef 24-09-1992. 4. (a) (i) Mention any circumstances of exposure giving details thereof,

and/or - Nil (ii) State periods and conditions of service, at any particular place, which you

consider caused or aggravated the illness.

- Nil (b) (i) Give the nature of duties he had to perform in Government service.

- GD duty. (ii) Was he subject to stress and strain by such duties? If so, was it of an

exceptional nature? Give details.

- No (c) Diseases endemic to certain areas or disease due to infection: - NA

(i) If disability or death was due to infection, is there any evidence that the exposure was due to negligence or mis-conduct on his part? _________________________

(ii) Did he live in unit lines or was he permitted to live outside with his family?

(iii) How many out passes was he granted during the previous month and what was the date of the last out pass? (iv) Was the disease endemic to the area he was serving in and

during this period or immediately preceding it were there other cases of the same disease in the unit? If so, give the number of such cases, details of movements of

infected persons and state any other circumstances which might have been responsible for the disease. (v) Give the date of last leave of last leave and places where the

leave was spent. Did illness start during leave? If shortly after return from leave, state date on which the illness commenced”

(d) Venereal diseases (Further information on the points mentioned below ) :- NA

(i) When was it contacted? __________________________ (ii) Period of treatment _______________________________

(iii) Whether after treatment the man returned to full duty_______________ (iv) Whether after return to duty post hospital surveillance and treatment was

continued according to existing regulations.

(v) After return to duty, was the man subject to any stress of an exceptional nature? If so, mention the nature of exceptional stress

________________________

Date - 16-03-2015 IG TC&S, BSF, HZB

Station - TC&S HZB ( Head of Office )


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MEDICAL BOARD PROCEEDINGS PART-II

1. No. 89003323 Rank . Const- Name- Akhil Binod Minj Unit- TC&S(Adm) BSF

HZB has appeared this day of 16-03-2015 before the Medical Board.

Signature of Individual.

OPINION OF THE BOARD

01 Findings of the Board :-

The Board having examined No 89003323 Const Akhil Binod Minj of – TC&S(Adm), BSF, HZB are of the opinion that he is suffering from “dual effects

of (1) the fracture of his right tibia & fibula (lower 1/3rd) & left tibia & fibula (middle

1/3rd, (2) Hypertensive white matter disease , Old left lateral thalamic capsular

haemorrhage & Cerebral Atrophy (Vermis & Para Vermis )” and is considered unfit for further service.

02 Was the disability contracted in service?

Yes

03 Was it contracted in circumstances over which he had no control?

Yes

04 Is it directly attributable to conditions of service?

- ‘Yes’ for (1) (Copy of COI attached)

but

- ‘No’ for (2)

05 If so, by what specific conditions? (1) Due to effects of compound

fracture of Right Tibia & Fibula

bones & simple fracture of Left

Tibia & Fibula and also

06 If not directly attributable to service, was it aggravated thereby and if so, by

what specific conditions? (2) -Effects of hemorrhagic CVA with

Hypertension &Right hemiparesis.

07 Medical category recommended

S1 H1 A5(L) P5 E1

08 Percentage of disability 90 (Ninety) % permanent

09 Period for which the above medical category is recommended

Permanent

10 Further treatment/investigation

required.- NA

11 Period of leave recommended (If Any)

NA

12 Next Board due on

NA

12 Fit/Unfit civil employment

NA

Place : CH BSF HZB

Date : 16-03-2015

Presiding Officer : ________________________ [ Dr. (Mrs.) S. B. Soreng, CMO(SG), CAPFs, CH BSF HZB]

Member –I : ____________________________ [Dr (Mrs.) Tarnija Singh, AC/MO, STC BSF Hazaribag]

Member-II : _______________________ [Dr Rajat Chakrabertty, GD/MO (on contt), CAPFs, CH BSF]


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PART - III FROM-23

(SEE CCS PENSION RULE 38 (3)

“Certified that we have carefully examined No. 89003323

Rank - Const Name – Akhil Bonod Minj S/O - (Late) Shree Stanishlas Minj Of – TC&S(Adm), BSF, HZB. His age by his own

statement is – 48 years and by appearance about - 48 years. We consider No. 89003323 Rank Const Name – Akhil

Bonod Minj of - TC&S(Adm), BSF, HZB to be completely and permanently incapacitated for further service of any kind in BSF in consequence of –

“Dual effects of compound fracture of Right Tibia & Fibula bones & simple

fracture of Left Tibia & Fibula and also effects of hemorrhagic CVA with Hypertension

&Right hemiparesis.”

His percentage of disability is – (1) 30 % assessed by BSF Medical Board on 10-08-1996

for illness ‘1st’ (2) 90 (Ninety) % Permanent for illness ‘2nd’

His incapacitation does not appear to us to have been caused by

irregular or intemperate habits.

Place : TC&S, BSF, HZB

Date : 16-03-2015

Presiding Officer : ________________________ [ Dr. (Mrs.) S. B. Soreng, CMO(SG), CAPFs, CH BSF HZB]

Member –I : ____________________________ [Dr (Mrs.) Tarnija Singh, AC/MO, STC BSF Hazaribag]



CONFIDENTIAL

FORM “C”

From to be used by the medical board when reporting on injuries/disease/death

(Rule 13 (4) (iii)

PROCEEDINGS OF THE MEDICAL BOARD

Proceedings of the medical board assembled by the order of – CH BSF HZB O/No-Med/Medical board/2015/595-604 Dated-05-02- 2015 for the purpose of examining and reporting on.

(a) The present state of the Injury & Diseases sustained by No 89003323 Const Akhil Binod

Minj suffering from –

“Dual effects of :-

1. Compound fracture of Right Tibia & Fibula bones & simple fracture of Left

Tibia & Fibula resulting in mal-union of Right Tibia & shortening of right

leg, and also

2. Effects of hemorrhagic CVA with Hypertension &Right hemiparesis.”

or

(b) Death of, Shri/Shrimati - NA (please give date, month and year)

(i) State briefly the circumstances under which the Injury/Disease was/were sustained/contracted or occurred and the date thereof :-

For 1st illness const Akhil Binod Minj was complying an operational

duty in his company as per the order of his company commander in Warangal, Andhra

Pradesh, where IED was blown by extremists on 24-09-1992.

(ii) What is the Government servant’s present condition : - There is some degree of Mal-union in his right leg bone & Stiffness in his ankle &

knee joints of both legs. He is hardly able to walk, limping very slowly with support of stick &

attender. Muscle power in his right hand is very week. Power in his left hand is better than

right hand. His speech is slurred & nasalized sometimes hardly understood by the listeners.

(iii) Is the Government servant’s Present condition – “Some degree of Mal-union in his right leg bone & Stiffness in his ankle & knee joints

of both legs. He is hardly able to walk, limping very slowly with support of stick & attender.

Muscle power in his right hand is very week. Power in his left hand is better than right hand.

His speech is slurred & nasalized sometimes hardly understood by the listeners.”

aa) (wholly due to Injury/Disease and reason as claimed? If so please explain fully

how? If not, please state to what other causes the same is/are attributable)

-No, this present condition of const Akhil Binod Minj is due to dual

effects of:-


Tibia & Fibula resulting in mal-union of Right Tibia & shortening of right

leg, (Attributable to Government Service)and also,

2. Effects of hemorrhagic CVA with Hypertension &Right hemiparesis. (Non-

Attributable)”


CONFIDENTIAL

or (ab) Death - NA

(iv) From which date it appears that the govt servant was incapacitated on that extent.

- For ‘1’ - Since 24-09-1992

- For ‘2’ - Since 07-02-2013

The opinion of the Board upon the questions below is as follows: -

The board having examined No: 89003323 CT Akhil Binod Minj of TC&S

BSF Hazaribag, are of the opinion that he is suffering from dual effects of:-


Tibia & Fibula resulting in mal-union of Right Tibia & shortening of right leg,

(Attributable to Government Service) for this 30% disability was assessed by

previous BSF Medical Board on 10-08-1996. and also,

2. Effects of hemorrhagic CVA with Hypertension & Right hemiparesis. (Non-

Attributable)” for this current percentage of disability assessed by this board is ---

% and considered UNFIT for further service in BSF.

PART-A. FIRST EXAMINATION

1. The percentage of disability due to injury (ies)/Disease(s) = 30 %

(THIRTY PERCENT) 2. For what period from the date of Injury(i.e)/Disease(s). (a) Has the Government servant been unfit for duty ? Since 24 Sep 1992

(b) the Government servant is likely to remain unfit for duty ?

No: 89003323 CT Akhil Binod Minj of TC&S BSF Hazaribag

is UNFIT for further service in BSF. Other relevant information, if any. - NIL

PART-B- SUBSEQUENT EXAMINATION

1. If the original degree of disability of govt sevant has changed, what is the percentage of

disability now: ( please here detail of justification of your views along with all further medical and hospital documents in full )

This present condition of const Akhil Binod Minj is due to dual effects of:-


Tibia & Fibula resulting in mal-union of Right Tibia & shortening of right leg,

(Attributable to Government Service) for this 30% disability was assessed by

previous BSF Medical Board on 10-08-1996. and also,

4. Effects of hemorrhagic CVA with Hypertension & Right hemiparesis. (Non-

Attributable)” for this current percentage of disability assessed by this board is 90

(Ninety) %

2. For what period from the date of Injury/Disease or Injuries/Diseases


CONFIDENTIAL

(a) Has the Govt servant unfit for duty? -Yes, from- 24-09-1992 to- till date.

(b) Is the Govt servant likely to remain unfit for duty ? - Yes, from – 16-03-2015 onward.

Presiding Officer : ________________________ Place : TC&S, BSF, HZB [ Dr. (Mrs.) S. B. Soreng, CMO(SG), CAPFs, CH BSF HZB]

Date : 16-03-2015 Member –I : ____________________________ [Dr (Mrs.) Tarnija Singh, AC/MO, STC BSF Hazaribag]


.


CONFIDENTIAL

No/Med/Med,Board/CH/2013/___ CAPF’s CH BSF HZB, TC&S Merucamp, Hazaribag, Jharkhand

SUITABILITY CERTIFICATE

1. IRLA / Regt No 89003323

2 Rank Const

3 Name Akhil Binod Minj

4 Unit TC&S, (Adm), BSF HZB

5 Date of Birth 16-05-1966

6 Date of Enrolment 20-02-1989

7 Total Length of service 26 Years

8 Since when in LMC 24-09-1992

9 Present medical category with date S1H1A3(L)(P)P1E1 wef 30-10-2012

10 Category as per Dte L/No 14/52/01-Rectt/BSF/33172-471 dated 29-10-

2010 (A.B.C.&E.)

Category-E Attributable to Govt – duty (Mine explosion by extremist while

returning from operational area.)

11 Brief history of the case of disability / disease

Under LMC since Aug 1996, Attributable to Govt. Service. Despite prompt & continued treatment since the injury

incidence in Sep 1992, his condition is not improving rather further complicated by

additional complication of 1) Accelerated Hypertension -Since 02-

02-2012

2) Rt/Hemiparesis with Slurred Speech.

-Since 07-02-2013

3) Hypertensive white matter disease,

Old left lateral thalamic capsular

haemorrhage,

& Cerebral Atrophy (Vermis & Para

Vermis) -Since 07/02/13.

& now stable as a hemiparetic patient with limpimg gate & slurred speech. He is hardly able to walk, limping very

slowly with support of stick & attender. Muscle power in his right hand is very

week. Power in his left hand is better than right hand. His speech is slurred & nasalized sometimes hardly understood by

the listeners.

Medical Officer


CONFIDENTIAL

11. Recommendation of the Competent Authority:-

He/She cannot be suitably employed consistent to his/her Medical category /illness.

(Or)

He/She can be suitably employed consistent to his/her Medical category /illness ( Subjec t

to evaluation by the medical board with regard to his / her percentage of disability and recommendation

made thereof as per guidelines contained in para 8(b) & 8(c) of pers Dte Rectt Section l/no 14/52/01-

Rectt/BSF/1830-2130 dated 30th January 2003.

Place- TC&S, BSF HZB (P.C.Sharma) Date - Inspector General

TC&S, BSF HZB


CONFIDENTIAL

No - 89003323 Rank - CT Name – Akhil Binod Minj Unit – TC&S (Adm) Hazaribagh Age 48 Yrs Sex – Male

Mark of Identification – (1)- Scar over forehead (2)- Tiny mole on right little finger.

Injury/Disease :- “dual effects of - 1. Compound fracture of Right Tibia & Fibula bones & simple fracture of Left Tibia & Fibula resulting in mal -union of Right Tibia &

shortening of right leg, (Attributable to Government Service) and also 2. Effects of hemorrhagic CVA with Hypertension & Right hemiparesis. (Non-Attributable)” 1. MOBILITY COMPONENT (Total Value 90%) FOR LOWER EXTEREMITY

Regd No.

Date Joint Component

Normal

Value (degree)

Rt. Side Lt. Side

Loss of %

(Rt Side)

Loss of %

( Lt Side)

Mean% Loss

Rt Lt

Mean × 0.3

Rt Lt

Combining

v alue

Rt Lt

% Summary v alue of

mobility component

a + b(90 – a)

90

I

Range o

f M

ovem

ent

(Active)

90%

HIP 30%

1. Flexion-Extension arc 0 - 140O 100 120 29 14 32 34 9.6 10.2 69.6

52.2

Mobility component total

v alue f or Rt – side:- a= 78.4

b= 69.6

= 78.4 + 69.6(90-78.4)

90

= 87.3 = (87) Mobility component total

v alue f or Lt – side:-

a= 52.2 b= 0

= 52.2 + 0(90-52.2)

90

= 52.2 = (52) Combining total v alue f or Lower Limbs:-

a= 87

b= 52

= 87 + 52(90-87)

90

= 89

2. Abd - Add arc 0 - 90 O 80 90 11 0 3. Rotation 0 - 90 O 50 80 56 89

KNEE 30% 1. Flexion-Extension arc 0 - 125O 0 80 100 64 100 65 30 19.5

ANKLE 30%

&

FOOT

1. Dorsi - Planterf lexion arc

0 - 70 O 0 60 100 86 100 76 30 22.8

2. Inv ersion - Ev ersion arc 0 -60 O 0 40 100 67

II

Mu

scle

Str

ength

90%

HIP 30%

1. Flexor Muscles 0 - 5 2 5 60 0 68 0 20.4 0

78.4

0

2. Extensor Muscles 0 - 5 2 5 60 0 3. Abductor Muscles 0 - 5 2 5 60 0 4. Abductor Muscles 0 - 5 2 5 60 0 5. Rotator Muscles

External –Internal 0 - 5 0 5 100 0

KNEE 30% 1. Flexor Muscles 0 - 5 1 5 80 0 80 0 24 0

2. Extensor Muscles 0 - 5 1 5 80 0

ANKLE 30%

&

FOOT

1. Planterf lexor Muscles 0 - 5 0 5 100 0 100 0 30 0

2. Dorsif lexor Muscles 0 - 5 0 5 100 0 3. Inv ertor Muscles 0 - 5 0 5 100 0 4. Ev ertor Muscles 0 - 5 0 5 100 0

II BASED ON CLINICAL METHOD OF EVALUATION (STABILITY)

Normal

Value +nt Loss%

1. Walking on plain surface 10 0 10

2. Walking on slope 10 0 10

3. Climbing stairs 10 0 10


CONFIDENTIAL

III. Additional Weightage (10%) - To be given to the following factors:

Disability

%

I Infection +ve 0

II Deformity +ve 1

III Loss of Sensation +ve 0

IV Pain +ve 0

V Shortening Nil 1

VI Complications +ve 0

Total 2

These features were noted to be continuous &

persistent despite treatment for sufficient period

(about 18 years).

Total % of Disability = Stability + Mobility (by combining formula) + Additional weightage

a - (Mobility) = 89, b - (Stability) = 88

= 89+ 88 (90-89)

90 = 89.97 %

Additional weightage = 2 %

= 89.97+2 = 91.97 Rounded off to = 92 (Ninety Two ) %

4. Standing on both legs 10 2 8

5. Squatting on floor 10 0 10

6. Standing on affected leg 10 0 10

7. Sitting cross leg 10 0 10

8. Kneeling 10 0 10

9. Taking turns 10 0 10

Total 90 88


CONFIDENTIAL

ASSESMENT PROFORMA FOR UPPER EXTEREMITY

No - 89003323 Rank - CT Name – Akhil Binod Minj Unit – TC&S (Adm) Hazaribagh Age 48 Yrs Sex – Male

Mark of Identification – (1)- Scar over forehead (2)- Tiny mole on right little finger

Injury/Disease :- “dual effects of - 1. Compound fracture of Right Tibia & Fibula bones & simple fracture of Left Tibia & Fibula resulting in mal-union of Right Tibia & shortening of right leg, (Attributable to Government Service) and also 2. Effects of hemorrhagic CVA with Hypertension & Right hemiparesis. (Non-Attributable)”

Arm Component (Total value 90%)- 88 %

Arm Compone

nt

Component Normal value

Rt Side

Lt Side

% Loss (Rt

Side)

% Loss

Lt Side

Mean% Loss

SUM of % Loss x 0.30

Combining Value

% Summary Value Of Arm

component a+b(90-a)

90

Rt Lt RT Lt Rt Lt

Ran

ge o

f M

ov

em

en

t(A

CT

IV

E)

Valu

e

9

0%

Shoulder 1. Flexion –Extension arc 2. Rotation-arc 3. Abduction- Adduction arc

0-220 0-180 0-180

10 0 40

220 180 180

96

100

22

0

0

0

72 0 21 0

81

26


v alue f or Rt – side:- a= 81

b= 66

= 81 + 66(90-81) 90

= 87.6 = (87) Mobility component total

v alue f or Lt – side:-

= 26


v alue f or Arm Component of Upper

Limb:-

a= 87

b= 26

= 87 + 26(90-87)

90

= 87.8 = (88)

Elbow 1. Flexion –Extension arc 2. Supination-Pronation arc

o-150 0-180

0 0

150 150

100

100

0

0 100 0 30 0

Wrist 1. Dorsi-Planter-flexion arc 2. Radial Ulnar-deviation arc

0-160 0-55

0 0

14050

100 100

88 91

100 89

30 26

Mu

scle

Str

en

gth

Shoulder 1. Flexion 2. Extension 3. Rotation-Ext 4. Rotation-Int 5. Abduction 6. Adduction

0-V Gde (100-0%)

3/5 3/5 2/5 2/5 2/5 2/5

5/5 5/5 5/5 5/5 5/5 5/5

40

40

60

60 60

60

0

0

0

0 0

0

53 0 16 0

66 0

Elbow 1. Flexion 2. Extension 3. Pronation 4. Supination

0-V Gde (100-0%)

2/5 2/5 0/5 2/5

5/5 5/5 5/5 5/5

60

60

100 60

0

0

0 0

70 0 21 0

Wrist 1. Dorsi Flexion 2. Palmar Flexion 3. Radial Deviation 4. Ulnar Deviation

0-V Gde(100-

0%)

0/5 0/5 0/5 0/5

5/5 5/5 5/5 5/5

100

100

100

100

0

0

0

0

100 0 30 0


CONFIDENTIAL

Co

-Ord

inate

ted

A

cti

vit

ies

V

alu

e -

90

%

1. Lifting overhead objects Remove and Placing at the same place

2. Touching nose with end of the Extremity

3. Eating Indian Style 4. Combing and plating 5. Putting on a shirt/kurta 6. Ablution Indian style 7. Drinking glass of water 8. Buttoning 9. Tie Nara Dhoti 10. Writing

9%

9%

9% 9% 9% 9% 9% 9% 9% 9%

3 3 3 0 0 0 4 4 0 0

9 9 9 9 9 9 9 9 9 9

66

66

66

100

100 100

56

56

100

100

0

0

0

0

0 0

0

0

0

0

81 0 81 81

HAND COMPONENT (Total Value 90% )

1)

3

0%

Pre

hen

sio

n

1 hand

Component

Movement Normal

Value

Rt Lt % loss

Rt

% Loss

Lt

SUM of %

loss

Rt Lt

SUM of %

Loss x 0.30

Rt Lt

SUM of

Rt + Lt

A.Opposition

(8%)

1. Index

2. Middle

3. Ring

4. Little

2

2

2

2

2 2 2

2

2 2 2

2

33 0 66 0 20 0 20 20

B. Lateral Pinch Key Holding 5% 1 5

C. Cylindrical

grasp

A Large Object (1”)

B Small Object (1”)

3

3

3 2

5 5

D.Spherical

Grasp

A Large Object (1”)

B Small Object (1”)

3

3

2 2

5 5

E. Hook Grasp Lifting bag 5% 2 5

2) Sensation 30% 1 Radial side Thumb

2 Ulnar side

3 Radial

4 Ulnar each fingers

4.1

1.2

1.2 x-4

4.8

6

24

6

24

0 0

3) Strength 30 % 1 Grip Strength

2 Pinch Strength

20%

10%

15 5

20 10

33 0

Summary value for upper ext -> summary value for upper extremity is calculated by arm component and hand component


CONFIDENTIAL

Values Add 4% for dominant extremity 10% additional weightage to be given to infection deformity, malalignment , contrac ture,

cosmetic appearance and abnormal mobility.

88+ 81X2 = 89.8

90

89.8+ 20X1.2 = 90 (Upper Extremity)

90

Combining it with 92 % (Lower Extremity)

92+ 90 X (-2) = 90 (Ninety) %

90

PO- Dr. (Mrs.) S. B. Soreng, M1- Dr (Mrs.) Tarnija Singh, M2- Dr Rajat Chakrabertty,

CMO(SG), CAPFs, CH BSF HZB, AC/MO, STC BSF Hazaribag, GD/MO (on contt), CAPFs, CH BSF


CONFIDENTIAL

ANNEXURE – B

Certificate No - -- Date – 16-11-2015

CERTIFICATE FOR THE PERSONS WITH DISABILITY

This is to certify that Shri/Smt/Kum – Const Akhil Binod Minj

son/wife/daughter of (Late) Stanishlas Minj Age - 48 yrs old male/female,

Reg No - 89003323 is a case of - “dual effects of (1) the fracture of his right tibia &

fibula (lower 1/3rd) & left tibia & fibula (middle 1/3rd, (2) Hypertensive white matter disease , Old

left lateral thalamic capsular haemorrhage & Cerebral Atrophy (Vermis & Para Vermis )” &

presently in low medical category S1H1A5(L)(P)P5E1]. He/She is physically disabled /visual disabled / speech & hearing disabled & has – 90 % ( Ninety -

percent ) permanent ( physical/visual/speech & hearing impairment) in

relation to his/her – power, tone & movement of both lower limbs, Right

upper limb & speech muscles.

Note :-

1. This condition is progressive/likely to improve/ not likely to improve.*

2. Reassessment is not recommended / recommended after a period of -

months/years.*

* - Strike out whichever is not applicable.

Sd/- Sd/- Sd/- PO- Dr. (Mrs.) S. B. Soreng, M1- Dr (Mrs.) Tarnija Singh, M2- Dr Rajat Chakrabertty,

CMO(SG), CAPFs, CH BSF HZB, AC/MO, STC BSF Hazaribag, GD/MO (on contt), CAPFs, CH BSF

Signature/Thumb impression

of the patient.

Countersigned by the

DIG(Med)/Medical Superintendent

CMO/Head of Hospital(with seal)


CONFIDENTIAL

To, Date, the ____Mar, 2015. The DIG (Med) CAPF’s CH BSF HZB

Sub : FORWARDING OF MEDICAL BOARD PROCEEDING, PART-I

ALONG WITH MEDICAL DOCUMENTS .

Kindly ref your HQ order no- CH BSF HZB O/No-Med/RMB(TK)/2013/ 4863-67 Dated-05-10- 2013

2. The medical board proceedings Part-I in respect of No. 08002877 Constable T Kujur of TC&S, BSF HZB is hereby forwarded to your office for your further necessary action please.

Encl : - 1) Suitability certificate – signed by DIG, TC&S 2) Appendix- ‘N’ – signed by Unit MO & DIG TC&S. 3) Med Board Proceeding – signed by Unit MO & the board. 4) LMC file of Const T Kujur – consisting pages - .

(Dr. C.B.Narayan) Chief Medical Officer (SG)

CAPF’s CH BSF HZB

Const AB Minj Ortho-Neuro board out case

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Transcript of Const AB Minj Ortho-Neuro board out case