RODOLFO MONSALE, FOR HIMSELF AND HIS MINOR CHILDREN ERROL AND ARDEN, BOTH SURNAMED MONSALE, PETITIONERS, VS. REPUBLIC OF THE PHILIPPINES (DEPARTMENT OF HEALTH) AND WORKMEN’S COM…

This is a petition for review^[1]
of the decision of the Workmen’s Compensation Commission reversing the decision
of the Hearing Officer of Regional Office No. 7, Iloilo City, ordering
respondent Republic of the Philippines (Department of Health) to pay the
petitioner the sum of P5,400.00 as death compensation benefits and burial
expenses plus the corresponding attorney’s fees and the administrative
fee.  The petitioner herein, Rodolfo Monsale is the surviving husband and petitioners Errol and
Arden, both surnamed Monsale are the legitimate minor
children of the late Zenaida M. Monsale.

It appears that Zenaida M. Monsale during her lifetime was employed in the Department
of Health assigned to the Regional Health Office No. 5, Iloilo
City starting July 1, 1964 as a temporary vaccinator up to July 5, 1964.  On January
5, 1965, she was appointed as a nurse attendant in a temporary
capacity and worked as such up to June
30, 1965.  On September 15, 1965, she was appointed Midwife II in a
provisional capacity, working as such up to September 14, 1966. 
Finally on September 15, 1966
she was given a permanent appointment as Midwife II, continuously serving in
such capacity up to her last day of service on July 1, 1970 with the salary of P2, 952.00 per annum.  As Midwife II, Zenaida
M. Monsale was stationed in Barrio Nalumban, Guimbal, Iloilo
which was four or five kilometers away from her residence located in Miag-ao, Iloilo.  Her main duties consisted of cleaning the
barrio clinics, attending and administering medicines to patients everyday,
answering to calls of patients, making house to house immunization work and
delivering babies even at night time whenever summoned.  She performed these duties six (6) days a
week, two days in the town of Guinabad
I and four days at the clinics in the barrios. 
In making her house to house immunization campaign, she was often
delayed in her meals and forced to take lunch in the house which she visited.  She used to report for duty in the barrio
clinic in the morning, most often by foot for lack of transportation.

On July 9, 1972,
Zenaida M. Monsale entered
the Iloilo Provincial
Hospital, Iloilo
City for an ailment which later on
was diagnosed as “Portal Cirrhosis”. 
At the time of her admission, she was found to be suffering from
enlargement of the liver, loss of weight, loss of energy, presence of dispeptic disturbance with no pain and presence of fluid in
the abdominal cavity.  On July 12, 1970, after being discharged
from the hospital upon her own request, she died of “C.A.
of the liver.”^[2]

After her death, the petitioner herein filed a Notice of Claim
for Compensation with the Workmen’s Compensation Unit in Iloilo
City for compensation benefits on
his behalf and on behalf of the minor children. 
Respondent employer controverted the claim
after which a hearing on the merits was conducted
before the Workmen’s Compensation Unit, Iloilo City.

On September
9, 1971, the Hearing
Officer of Regional Office No. 7, Iloilo City rendered a decision the dispositive
portion of which reads as follows:

“WHEREFORE, judgment is hereby rendered ordering the
respondent to pay:

(a)                
To the claimants, thru this
Office, the aggregate sum of FIVE THOUSAND FOUR HUNDRED PESOS (P5,400.00) as
death compensation and reimbursement of burial expenses;

(b)                
Attorney’s fees to counsels for
claimants, Attys. Efrain B. Treñas and Sergio D. Mabunay, equivalent to 5% of the compensation or the sum of
TWO HUNDRED SIXTY PESOS (P260.00); and

(c)                
To this Office, the sum of FIFTY
FIVE PESOS (P55.00) as administrative fees as required by Sec. 55 of the Act.

SO ORDERED.”

A
motion for reconsideration of the foregoing decision was denied by the Hearing
Officer who on October 11, 1971 elevated the records of the case to the
respondent Workmen’s Compensation Commission.

On April
16, 1975, the
respondent Commission set aside the decision of the Hearing Officer on the
ground that the illness which caused the death of the deceased, Zenaida M. Monsale, had no causal
relation with her employment.

Hence, this petition for
review.

In reversing the decision
of the Hearing Officer of Regional Office No. 7, Iloilo City on the ground that the illness of Zenaida M. Monsale which caused
her death has no causal relation to her employment, the respondent Com­mission
mainly based its decision on the evaluation report and findings of the
Evaluation Division of the Commission to wit:

“Portal Cirrhosis is a chronic disease of the liver
characterized by increased connective tissue that spreads from the portal
spaces, with distortion of the liver; architecture, and impairment of liver
functions.  Malnutrition is believed to
be the primary etiologic factor.  Fatty
infiltration (accumulation of fat in the liver) messenchymal
inflamatory reaction, fibrosis and parenchymatous changes combine to produce in the usual
course of events, a large hard and diffuse­ly modular level.  In many cases the enlargement persists until
death.

Portal cirrhosis is not inherent in the deceased’s work as a
nursing attendant or midwife, therefore, her ill­ness could not have been
directly caused by her work.  We could
also say that the nature of claimant’s work could not have aggravated her
illness because from the physiopathogenesis of portal
cirrhosis, medical authorities believe that the destruction of the liver cells
are caused by the pressure of intercellular fat droplets on the liver cells
obstructing sinusoidal circulation sufficiently to cause anexic
damage centrilobular tissues, and that fibrous
deposits forming about extracellular fatty cysts condense
into fibrotic trabeculae.  Knowing this, we are of the opinion that
progress of the disease is not influenced by the nature of her work nor by the
activities she performed.”

Obviously, the respondent Commission only
took note of the foregoing evaluation report and findings of its Evaluation
Division but not the testimony of Dr. Innocencio Aparicio to the effect
that the nature of the employment of the deceased did not preclude the
possibility that the illness of Zenaida M. Monsale could have been brought about by the nature of her
work.  Thus, part of his testimony reads:

“Q.   Can
this sickness of Zenaida Monsale
be caused also by infection?

A.        
Portal cirrhosis, one of the
causes is infection.

Q.       
And this infection which may have
caused her sickness may be due to the water or food that she may have been
taking in the barrios that she was assigned.

A.     That is possible.”^[3]

It has been established at the hearing as
Midwife II that she had to attend to the cleaning of the barrio clinics, visiting
her patients, going from house to house for immunization work, answering calls
of patients even at night and delivering of babies whenever summoned.  According to the testimony of Dr. Aparicio the infection might have been made possible by her
going from house to house performing immunization work or from the fact that
because of her uncertain schedule she was often delayed in taking her meals
which she had to take oftentimes the house of her patients.  Could it not be possible that she could have acquired her illness in those
places where she has to take her meals or drink?  Likewise, the very nature of her work
which can easily be described as a strenuous one could have contributed to a
general weakening of her bodily condition and the lessening of her resistance
to the progress of whatever illness she has at the time.  While the illness which about the enlargement
of the liver, loss of weight, loss brought of energy, presence of dispeptic disturbance with no pain and acitis
or presence of fluid in the abdominal cavity all of which amount to cancer of the liver, may not have been caused
directly by her employment nor the result of the nature of her employment, it
certainly can hardly be doubted that it
could have been at least aggravated by the nature of her employment and
therefore compensable under Section 2 of the Workmen’s Compensation Act.^[4] In one case, it was held that medical
cause of the illness is not legally significant as long as the illness
supervened in the course of employment. 
The presumption of causation or aggravation then applies and the
function for the presumption is precisely to dispense with the need of proof
and the burden to overthrow the presumption and to disconnect, by substantial
evidence, the injury or sickness from employment is laid by the statute at the
door of the employer.^[5]

It cannot be disputed that the deceased Zenaida
M. Monsale acquired her illness in the
course of her employment. 
Well-established is the jurisprudence that in the absence of substantial
evidence to the contrary it is presumed under the law that an illness or injury
sustained by an employee or worker was caused by or aggravated in the course of her
employment.  Even assuming that the
employee’s illness which caused the death may be ruled out as an occupational
disease or
that the causal link between the nature of his employment and his ailment has
been insufficiently shown, nevertheless, it is to be presumed as mandated by
Section 44 of the Workmen’s Compensation Act^[6]
that the employee’s illness which supervened during the employment either arose
out of or at least aggravated by said employment.  And with this legal presumption the burden of
proof shifts to the employer and the employee relieved of the burden to show
causation.^[7]
In the case before Us the conclusion arrived at by the respondent Commission
that the death of Zenaida M. Monsale
has no causal relation with her employment was not based on any substantial
evidence presented during the trial before the hearing officer.  The evaluation report and findings of the
Evaluation Division relied upon by the respondent Commission in its decision
was vigorously opposed by the petitioner on the ground that, not having been
presented during the trial of the case before the Hearing Officer, petitioner was
not able to confront the person who made the report and rebut the
evidence.  In effect the petitioner
claims that the action of the respondent Commission in making the said report
as the basis of its conclusion denied him his day in court.  In a situation such as this an evaluation
report not presented during the trial should not prevail over the substantial
evidence established during the hearing of the case.^[8]

IN VIEW OF THE FOREGOING, the judgment of the respondent
Commission is hereby reversed and set aside and the decision of the Hearing
Officer of Regional Office No. 7, of Iloilo
City is reinstated with the
modification that the attorney’s fees are increased to P540.00.  Without pronouncement as to costs.

SO ORDERED.

Teehankee, (Chairman), Makasiar, Muñoz Palma, Fernandez, and Guerrero, JJ., concur.

^[1]
Treated as Special Civil Action as per Resolution of this Court dated June 27, 1975.

^[2]
Exhibit F.

^[3]
T.S.N., p. 26, Calantas.

^[4]
SEC. 2. Grounds for compensation. – When
an em­ployee suffers personal injury from any accident arising out of and in the course of his employment, or contracts
tuberculosis or other illness directly caused by such employment, or either
aggravated by or the result of the nature of such employ­ment, his employer
shall pay compensation in the sums and to the person hereinafter
specified.  The right to compensation as
provided in this Act shall not be defeated or impaired on the ground that the
death, injury or disease was due to the negli­gence of a fellow servant or
employee, without prejudice to the right of the employer to proceed against the
negligent party.

^[5]
Magalona vs. WCC and National Shipyards Steel
Corp., G.R. No. L-21849, Dec. 11,
1967.

^[6]
SEC. 44. Presumption. – In any proceeding for the enforcement
of the claim for compensation under this Act, it shall be presumed in the
absence of substantial evidence to the contrary –

1.      
That the claim comes within the
provisions of this Act;

2.      
That sufficient notice thereof was
given;

3.      
That the injury was not occasioned
by the wilful intention of the injured employee to ring about the injury or death of
himself or of another;

4.      
That the injury did not result
solely from the in­toxication of the injured employee while on duty; and

5.      
That the contents of verified medical
and surgical reports introduced in evidence by claimants for compensa­tion are
correct.

^[7]
Vda. de De Laron vs. WCC, No. L-43344, Sept. 29, 1976, 73 SCRA
85; See also Talip vs. WCC, L-42574, May 31,
1976; Aranzanso vs. Associate Commissioner Samit, L-40658, June 30, 1976; Mercado vs. WCC,
L-42451, July 30, 1976; Jacob vs. WCC, L-43302, Aug. 31, 1976; Pros vs.
WCC, L­43348, Sept. 29, 1976; Leorna vs. WCC,
L-42543, Sept. 30, 1976; Ayuso vs. WCC,
L-42893, Sept. 30, 1976; and Caparas vs. WCC,
L-42450, Sept. 30, 1976.

^[8]
Concepcion Uy vs.
WCC, et al., G.R. No. L-38096, May 14,
1975.