CAROLINA CLEMENTE, PETITIONER, VS. GOVERNMENT SERVICE INSURANCE SYSTEM DEPARTMENT OF HEALTH­ DAGUPAN CITY) AND EMPLOYEES’ COMPENSATION COMMISSION, RESPONDENTS.

This is a petition to review the decision of the Employees’ Compensation Commission in ECC Case No. 0509
which affirmed the decision of the Government Service Insurance System (GSIS)
and denied the claim for death benefits filed by Carolina Clemente, widow of
the late Pedro Clemente.

The undisputed facts of the case are summarized in the memorandum
for the respondent Government Service Insurance System, as follows:

“Petitioner’s husband, the late Pedro Clemente, was for ten
(10) years a janitor in the Department of Health (Dagupan City), assigned at
the Ilocos Norte Skin Clinic, Laoag City. 
He was hospitalized from November 3 to 14, 1976 at the Central Luzon
Sanitarium, Tala Sanitarium, Tala, Caloocan City, due to his ailment of
‘nephritis’, as per medical certification of his attending physician, Dr.
Winifredo Samson.  He was also found to
be suffering from such ailments as portal cirrhosis and leprosy, otherwise
known as Hansen’s Disease.

“On November 14, 1976, Pedro Clemente died of uremia due to
nephritis.  Thereafter, petitioner filed
with the GSIS a claim for employees’ compensation under the Labor Code, as
amended.

“On February 4, 1977, the GSIS denied the claim of the
petitioner because the ailments of her husband are not occupational diseases
taking into consideration the nature of his work and/or (sic) or were not in
the least causally related to his duties and conditions of work.

“On March 9, 1977, petitioner requested for reconsideration of
the GSIS’ denial of her claim, stating that the ailments of her husband were
contracted in the course of employment and were aggravated by the nature of his
work.  Petitioner alleged that her
husband, as janitor of the Ilocos Norte Skin Clinic (Laoag City), worked in
direct contact with persons suffering from different skin diseases and was
exposed to obnoxious dusts and other dirt which contributed to his ailment of Hansen’s disease.  Citing further the cases of Seven-Up Bottlinq Co., of the Phil., v. Rimerata, L-24349, December 24, 1968 and Avana v. Quisumbing, L-23489, March 27, 1968. 
Petitioner stated that her husband’s ailment recurred in the course of
employment presumably due
to his direct contact with persons suffering from this ailment.

Acting upon petitioner’s request for reconsideration, the GSIS, on
April 11, 1977, reiterated its previous denial of her claim.

“On April 14, 1977, treating the request for reconsideration
as an appeal, the GSIS forwarded the records of the petitioner’ claim for
review by the ECC.

“On October 26, 1977, respondent ECC affirmed the GSIS’ action
of denial and rendered its own decision dismissing petitioner’s claim (ECC Case
No. 0509).

“Respondent ECC’S decision was anchored upon the findings that
the ailments are not listed as occupational diseases; that there was no
substantial evidence of causal connection; and that, in fact, the evidence was
that the deceased had already contracted the Hansen’s disease before his
employment.  In the exact words of the
ECC:

” ‘In the case at bar, since the deceased’s ailments are not
listed as occupational diseases, appellant herein must prove that such ailments
were caused by deceased’s employment and that the risk of contracting the same
was increased by his working conditions in order to be compensable.

“‘A mere cursory reading of the evidences on record, however,
will disclose that appellant failed to submit the required proof of
causation.  There is no substantial proof
in the record from which we could draw
the conclusion that indeed the nature of deceased’s employment as
Janitor of Ilocos Norte Skin Clinic could be traced as the direct cause of his
ailment.  Hence, in the absence of such
evidence, we are not disposed to disturb
on appeal the findings of the respondent System.

“‘On the contrary, we find the records that the deceased,
prior to his employment in this office, was already suffering from his ailment
of Hansen’s disease.  This proves that
his working conditions did not increase the risk of his contracting the same.  If at all, his employment merely aggravated
his ailments.  Unfortunately, however,
aggravation of a pre-existing illness, a rule under the old law, is not anymore
a ground for compensation under the new law. 
Thus, the cases cited by the appellant cannot be raised as authorities to
support her claim.”

“Petitioner now seeks a review of the ECC decision.” (pp.
76-78, Rollo)

There is no question that
the claim falls under the provisions of the Labor Code, as amended.  Under Article 167(L) of the Labor Code
and Section 1(b) Rule III of the Amended Rules on Employees’ Compensation, for
the sickness and the resulting disability or death to be compensable, the
sickness must be the result of an occupational disease listed under Annex
“A” of the Rules with the conditions therein satisfied; otherwise,
proof must be shown that the risk of contracting the disease is increased by
the working conditions (De Jesus v. Employees’ Compensation Commission, 142
SCRA 92, 96).

As the illnesses of the deceased are admittedly, not listed under
Annex “A” of the Rules as occupational diseases, the petitioner bases
her claim under the theory of increased risk. 
She alleges that the deceased, as janitor of the Ilocos Norte Skin
Clinic, was exposed to patients suffering from various kinds of skin diseases,
including Hansen’s disease or leprosy. 
She avers that for ten years, the deceased had to clean the clinic and
its surroundings and to freely mix with its patients.  She claims that it was during this time that
he was attacked by other dreadful diseases such as uremia, cancer of the liver,
and nephritis.

On the other hand, the respondent Employees’ Compensation
Commission contends that the petitioner failed to prove by substantial evidence
that the deceased’s ailments were indeed caused by his employment.  It maintains that the deceased merely had a
recurrence of a pre-existing illness aggravated possibly by the nature of his
employment and that there is no evidence on record showing that the nature of
the deceased’s employment was the
direct cause of any of his illnesses.

The respondent Government
Service Insurance System concurs with the views of the respondent
Commission.  It, however, argues that it
should be dropped as a party respondent in this case.  It claims that the petitioner has no cause of
action against it, the subject of judicial review being the adverse decision of
the respondent Commission.

We rule for the
petitioner.

In Sarmiento v.
Employees’ Compensation Commission  (144 SCRA 421, 426), we held that:

“Strict rules of
evidence are not applicable in claims for compensation (San Valentin v.
Employees’ Compensation Commission, 118 SCRA 160; Better Building, Inc., v.
Pucan, 135 SCRA 62).  There are no
stringent criteria to follow.  The degree
of proof required under P.D. 626, is merely substantial evidence which means, ‘such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion’ (Cristobal
v. Employees’ Compensation Commission, supra, citing Ang Tibay v. Court
of Industrial Relations and National Labor Union, Inc., 69 Phil. 635; and
Acosta v. Employees’ Compensation Commission, 109 SCRA 209).  The claimant must show, at least, by
substantial evidence that the development of the disease is brought largely by
the conditions present in the nature of the job.  What the law requires is a reasonable
workconnection and not a direct causal relation (Cristobal v. Employees’ Compensation Commission, supra; Sagliba
v. Employees’ Compensation Commission, 128 SCRA 723; Neri v. Employees’
Compensation Commission, 127 SCRA 672; Juala v. Employees’ Compensation
Commission, 128 SCRA 462; and De Vera v. Employees’ Compensation Commission,
133 SCRA 685).  It is enough that the
hypothesis on which the workmen’s claim is based is probable.  Medical opinion to the contrary can be
disregarded especially where there is some basis in the facts for inferring a
working connection (Delegente v.
Employees’ Compensation Commission, 118 SCRA 67; and Cristobal v. Employees’
Compensation Commission, supra). 
Probability not certainty is the touchstone (San Valentin v. Employees’
Compensation Commission, supra).

In this case, we find
sufficient evidence on record to sustain the petitioner’s view.  The records disclose that in resisting the
petitioner’s claim, the respondent Commission cited the following medical
authorities:

“Uremia refers to the toxic
clinical condition associated with renal insufficiency and retention in the
blood of nitrogenous urinary waste products (azotemia).  Renal insufficiency may be due to (1)
nephritis, bilateral pyelonephritis, polycystic kidney disease, uretral or bladder
obstruction, SLE, polyarteritis, amyloid disease, or bilateral cortical
necrosis; (2) acute tubular necrosis resulting
from transfusion reaction, shock, burns, crushing injuries, or poisons;
(3) sulfonamides precipitated in the kidneys or ureters; (4) nephrocalcinosis resulting from extreme alkalosis,
diabetic acidosis, dehydration, or congestive heart failure may result in
azotemia, or may predipitate (sic) severe uremia in the presence of already
damaged kidneys.

Reference:  Lyght, Charles E.:  The Merk Manual of
Diagnosis and Therapy; M.S. & D. Research Lab.; 11th
Edition, 1966, pp. 257-258.

“Portal Cirrhosis: A
chronic disease characterized by increased connective tissue that spreads from the
portal spaces, distorting liver architecture and impairing liver
functions.  Etiology, Incidence and
pathology:  Portal cirrhosis occurs
chiefly in males in late middle life. 
Malnutrition is believed to be a predisposing if not a primary etiology factor.  The role of alcohol is not clearly
established.  Alcohol probably exerts a
direct toxic effect on the liver, and also increases malnutrition by providing
calories without essential nutrients. 
Cirrhosis has been produced in animals by diets low in protein and
specifically low in choline.  The
addition of choline to these diets prevents cirrhosis.  Chronic poisoning
with carbon tetrachloride or phosporus produces changes similar to those
from portal cirrhosis.  The liver is
diffusely nodular, scarred and dense. 
Microspic section shows parenchymal degeneration cellular infiltration, proliferation or scar tissue and
areas of regeneration.  Fatty changes are
present in the early states.

Reference:  Lyght, C.E.: 
The Merk Manual of Diagnosis and Therapy:  M.S. & D. N.J. 11th Edition, 1966, p. 928.

“Hepatoma (Liver cancer) refers to malignant
primary tumor of the liver destroying the parenchyma arise (sic) from both
liver cell and bile duct elements.  It
develops most frequently in the previous cirrhosis liver.  A higher fraction of patients with post
necrotic cirrhosis develop hepatoma than those with portal alcoholic
cirrhosis.  This may reflect the more
active necrotic and regenerative processes in the post necrotic cirrhosis
liver.  Most large series indicate that
60% or more of hepatomas develop in a previously cirrhotic liver.  The cirrhosis of hemochromatosis seems
particularly liable to hepatomas as high a fraction as 20% of patients with
hemochromatosis die from this cause.

Reference:  Harrison, T.R.:  Principles of Internal Medicine;
McGraw Hill; N. Y., 5th Ed.; 1966, p. 1072.

“Leprosy is
a chronic, mildly contagious, infectious disease characterized by both
cutaneous and constitutional symptoms and the production of various deformities
and mutilations.  The causative organism
is an acid fast rod.  Mycobacterium
leprae, first described by Hansen in 1874. 
The mode of transmission is obscure, although infection by direct
contact appears likely.  The disease is
found predominantly in tropical and sub?tropical Asia, Africa, and South
America.  It is endemic in the Gulf
States of the USA, Hawaii, the Philippines and Puerto Rico.

Reference:  Lyght, C.E.: 
The Merk Manual of Diagnosis and
Therapy;” M.S. & D.; 11th Ed.; 1966,
p. 847.

The nature of nephritis,
however, was discussed by Mr. Daniel Mijares, GSIS Manager Employees’
Compensation Department, in his letter dated February 4, 1977, denying
petitioner’s claim, as follows:

“Nephritis is an acute, diffuse inflammation of the glomeruli
or kidneys.  It usually follows previous
streptoccocal infection mostly in the upper respiratory tract.  Because of this, it is always thought that
nephritis is the result of an auto-immune or allergic reaction to infection,
usually streptococcal.” (Rollo, p. 20)

The foregoing discussions support rather than negate the theory of increased risk.  We note that the major ailments of the
deceased, i.e. nephritis, leprosy, etc., could be traced from bacterial and
viral infections.  In the case of
leprosy, it is known that the source of infection is the discharge from lesions
of persons with active cases.  It is
believed that the bacillus enters the body through the skin or through the
mucous membrane of the nose and throat (Miller and Keane, Encyclopedia and
Dictionary of Medicine and Nursing, (1972), p. 530).

On the other hand,
infectious diseases which give rise to nephritis are believed to be as follows:

“Table 294-1

“Causes of acute glumerulonephritis

“Infectious diseases

“A. Post
streptococcal glumerulonephritis

“B. Non-Post streptococcal
glumerulonephritis

“1. Bacterial:
Infective endocarditis, ‘Shunt nephritis,’ sepsis, pneumococcal pneumonia,
typhoid fever, secondary syphillis, meningococcemia

“2.   Viral: 
Hepatitis B, infectious menoneucleosis, mumps, measles, varicella,
vaccinia, echovirus, and coxsackievirus

“3.   Parasitic:  Malaria, taxoplasmosis”

(Harrison’s Principles of Internal
Medicine, 10th edition, p. 1633)

The husband of the
petitioner worked in a skin clinic.  As
janitor of the Ilocos Norte Skin Clinic, Mr. Clemente was exposed to different
carriers of viral and bacterial diseases. 
He had to clean the clinic itself where patients with different
illnesses come and go.  He had to put in
order the hospital equipments that had been used.  He had to dispose of garbage and wastes that accumulated
in the course of each working day.  He
was the employee most exposed to the dangerous concentration of infected
materials, and not being a medical practitioner, least likely to know how to
avoid infection.  It is, therefore, not unreasonable
to conclude that Mr. Clemente’s working conditions definitely increased the
risk of his contracting the aforementioned ailments.  This Court has held in appropriate cases that
the conservative posture of the respondents
is not consistent with the liberal interpretation of the Labor Code and the
social justice guarantee embodied in the Constitution in favor of the workers
(Cabanes v. Employees’ Compensation Commission, et al., L-50255, January 30,
1982; and Cristobal v. Employees’ Compensation Commission, et al., supra).  It clashes with the injunction in the Labor
Code (Article 4, New Labor Code) that, as a rule, doubts should be resolved in
favor of the claimant-employee (Mercado, Jr., v. Employees’ Compensation
Commission, 139 SCRA 270, 277).

The respondents admit there may have been aggravation of an
existing ailment but point out that aggravation is no longer a ground for
compensation under the present law.  They
contend that the compensable factor of increased risks of contracting the
disease is not present in this case.

The fallacy in this theory lies in the failure to explain how a
sick person was able to enter the government service more than ten years before
he became too ill to work and at a time when aggravation of a disease was compensable.  There is no evidencee to show that Mr.
Clemente was hired inspite of having an existing disease liable to become
worse.

The petitioner’s arguments of recurrence of an already cured
disease or the contracting of the disease due to increased risks become more
plausible.  When there are two or more possible explanations regarding an
issue of compensability that which favors the claimant must be chosen.

We also do not find merit in the respondent GSIS’ contention that
it should be dropped as a party in this case. 
This Court has passed upon this issue on several occasions.  Thus, in the case of Cabanero
v. Employees‘ Compensation Commission, (111 SCRA 413, 419) this Court citing La
O v. Employees’ Compensation Commission
(97 SCRA 782), held:

xxx                   xxx                   xxx

“x x x [T]his Court is of the opinion
that respondent System, as the ultimate implementing agency of the ECC’s
decision, is a proper party in this case. 
The fact that this Court chose to require respondent GSIS to comment is
an indication that it is a necessary party. 
It must be noted that the law and the rules refer to the said System in
all aspects of employee compensation (including enforcement of decisions (Article 182 of Implementing Rules.” (at
p. 793).

WHEREFORE, in view of the foregoing, the decision
appealed from is hereby SET ASIDE and the respondent Government Service
Insurance System is hereby ordered to pay the petitioner:

1)   The sum of TWELVE THOUSAND PESOS
(P12,000.00)as death benefits; and

2)   The sum of ONE THOUSAND TWO HUNDRED PESOS
(P1,200.00) as attorney’s fees.

SO ORDERED.

Fernan, (Chairman), Feliciano, Bidin, and Cortes, JJ., concur.