GOVERNMENT SERVICE INSURANCE SYSTEM, PETITIONER, VS. SALVADOR A. DE CASTRO, RESPONDENT.

Government Service Insurance System versus De Castro

The Case

This is a petition for review on certiorari brought by the Government Service Insurance System, or GSIS, against Salvador A. De Castro, a retired soldier of the Philippine Air Force. De Castro filed a claim for permanent total disability benefits after he was discharged from the service on account of coronary artery disease and hypertensive cardiovascular disease. The GSIS and the Employees' Compensation Commission, or ECC, denied the claim on the ground that his ailments were not work-related, pointing to his smoking and drinking habits. The case matters because the Supreme Court uses it to fix the correct approach to compensability of occupational diseases: the listing of a disease in the rules, the totality of the claimant's circumstances, and the rule of reasonable work connection rather than direct causal relation.

Procedural History

De Castro filed his claim for permanent total disability benefits with the GSIS. In a decision dated June 20, 2006, the GSIS denied the claim, finding that his illnesses were non-occupational. De Castro appealed to the ECC. At its meeting on June 11, 2007, the ECC Board affirmed the GSIS ruling and dismissed the claim for lack of merit, although it observed that coronary artery disease is a form of cardiovascular disease included in the list of occupational diseases. De Castro then went to the Court of Appeals through a petition for review under Rule 43 of the Rules of Court. The Court of Appeals granted the petition, reversing the ECC and the GSIS and holding that his illnesses were compensable. The GSIS then came to the Supreme Court through the present petition for review on certiorari under Rule 45 of the Rules of Court.

Facts

Salvador De Castro served in the Philippine Air Force from April 1, 1974 until his retirement on March 2, 2006. On December 22, 2004, he was admitted at the V. Luna General Hospital, AFP Medical Center, due to chest pains. A 2-D echocardiography in January 2005 revealed a dilated left atrium, eccentric left ventricular hypertrophy, and left ventricular dysfunction. His full diagnosis consisted of hypertensive cardiovascular disease, dilated atrium, eccentric left ventricular hypertrophy and left ventricular dysfunction, and old anterior wall myocardial infarction. A coronary angiogram also showed significant simple vessel coronary artery disease. On August 15, 2005, he was again confined in the same hospital and diagnosed with coronary artery disease and hypertensive cardiovascular disease.

De Castro retired from the service on March 2, 2006 with a Certificate of Disability Discharge. That certificate stated that his ailments were aggravated by active service, were incident to service, were not incurred while on absence without leave, never existed prior to his entry into military service, were not due to misconduct, were not incurred by private avocation, and were incurred in line of duty. The military medical findings were reviewed by the AFP Disability and Separation Board before his discharge for disability was approved.

On the basis of that certificate, De Castro filed a claim for permanent total disability benefits with the GSIS. The GSIS denied the claim, and the ECC affirmed the denial. The ECC acknowledged that coronary artery disease is listed as an occupational disease, but still denied the claim because of what it called the presence of factors which are not work-related, such as smoking and alcohol consumption. It also noted that manifestations of cardiomyopathy in his echocardiography results could be related to his drinking habits. The Court of Appeals reversed, and the GSIS elevated the matter to the Supreme Court.

Issues

• Whether or not the petition for review on certiorari under Rule 45 of the Rules of Court is the proper remedy, considering that it supposedly raises questions of fact rather than questions of law.
• Whether or not the Court of Appeals erred in reversing the decisions of the ECC and the GSIS denying De Castro's claim for disability benefits.
• Whether or not De Castro proved that his heart ailments are work-related or were precipitated by his duties with the Armed Forces of the Philippines.

Applicable Provisions

Item Number 18 of Annex A of the Amended Rules of the Employees' Compensation Commission, on heart diseases, provides:

Any of the following conditions: If the heart disease was known to have been present during employment, there must be proof that an acute exacerbation was clearly precipitated by the unusual strain by reasons of the nature of his work. The strain of work that brings about an acute attack must be of sufficient severity and must be followed within 24 hours by the clinical signs of a cardiac insult to constitute causal relationship. If a person who was apparently asymptomatic before being subject to strain at work showed signs and symptoms of cardiac injury during the performance of his work and such symptoms and signs persisted, it is reasonable to claim a causal relationship.

This is the provision the GSIS invoked to demand strict proof of unusual strain and causal relation, and which De Castro read as laying down alternative, not concurrent, conditions because of the phrase any of the following conditions.

Rule 2, Section 1 of the ECC Rules of Procedure for the Filing and Disposition of Employees' Compensation Claims, on jurisdiction, provides:

The GSIS in the public sector and the Social Security System in the private sector have original and exclusive jurisdiction, and the ECC, the appellate jurisdiction, to settle any dispute with respect to coverage, entitlement to benefits, collection, and payment of contributions and penalties.

The GSIS relied on this to argue that the findings of the military disability board cannot bind the agencies tasked by law with the employees' compensation program.

Ruling

On the first issue, the Court held that the petition is the proper remedy. A question of law exists when doubt arises on what the law is or how it applies to a given set of facts, while a question of fact exists when the doubt arises on the truth or falsehood of given facts. Here the facts are largely undisputed: De Castro experienced chest pains while on duty, was diagnosed with coronary artery disease and hypertensive cardiovascular disease, and was separated from the service with a certificate of disability. What remained was whether the Court of Appeals drew the correct legal conclusion of compensability from those given facts, and that is a question of law.

On the second and third issues, the Court found no merit in the petition and held that De Castro's ailments are work-connected and compensable. The Court stressed that the status of the ailments is undisputed: coronary artery disease and hypertensive cardiovascular disease are occupational diseases, and the ECC itself confirmed that coronary artery disease is a form of cardiovascular disease included in the list of occupational diseases, while essential hypertension is listed under Item 29 of Annex A. The Court faulted the GSIS and the ECC for singling out smoking and drinking as the factors that rendered an otherwise listed occupational disease non-compensable, when the ECC's own decision listed many major and minor causes of coronary artery disease, including age, gender, lipid disorder, hypertension, diabetes, family history, obesity, physical inactivity, stress, and alcohol. The Court warned against reading the ECC ruling as holding that smoking and drinking by themselves bar compensability.

The Court also held that the GSIS and the ECC cannot claim infallibility, and that in determining compensability the nature and characteristics of the job are as important as raw medical findings and the claimant's personal and social history. They should not have brushed aside the military disability certification, which was itself reviewed by the AFP Disability and Separation Board, and which certified that his ailments were aggravated by active service, incident to service, not incurred while on absence without leave, never existed prior to entry into service, not due to misconduct, not incurred by private avocation, and in line of duty. The Court noted that De Castro entered the service as a fit and healthy soldier and served for thirty-two years, earning medals, awards, and commendations, and that his positions, the last being First Sergeant, carried stresses and pressures. The Court quoted with approval the observation of the Court of Appeals:

Intoxication which does not incapacitate the employee from following his occupation is not sufficient to defeat the recovery of compensation, although intoxication may be a contributory cause to his injury. While smoking may contribute to the development of a heart ailment, heart ailment may be cause by other factors such as working and living under stressful conditions. Thus, the peremptory presumption that petitioner's habit of smoking heavily was the wilfull act which causes his illness and resulting disability, without more, cannot suffice to bar petitioner's claim for disability benefits.

The Court closed with the governing standard: what the law requires is a reasonable work connection and not direct causal relation; probability, not the ultimate degree of certainty, is the test of proof in compensation proceedings; and any doubt in the interpretation and application of the law must be resolved in favor of labor.

Doctrine

A claimant suffering from a disease listed as occupational in Annex A of the Amended ECC Rules is entitled to the presumption of compensability, and the employer or the compensation agencies cannot defeat the claim by isolating one non-work-related factor such as smoking or drinking while ignoring the other listed causes and the nature of the claimant's work. Compensability requires only a reasonable work connection, not direct causal relation; probability, not ultimate certainty, is the test of proof in compensation proceedings. In assessing compensability, the agencies must weigh the totality of the circumstances, including the nature and characteristics of the job, the claimant's health upon entry into service, and the findings of the home agency's disability board, and any doubt must be resolved in favor of labor.

Disposition

The Supreme Court denied the petition for lack of merit and affirmed the decision and resolution of the Court of Appeals, holding that De Castro's coronary artery disease and hypertensive cardiovascular disease are work-connected and compensable.

Remember This

Memorize the line: what the law requires is a reasonable work connection and not direct causal relation, and probability, not ultimate certainty, is the test of proof in compensation proceedings. Examiners use this case to test whether a listed occupational disease stays compensable despite smoking or drinking, and whether the findings of a home agency's disability board may simply be brushed aside by the GSIS and the ECC.