FLAVIANO NEMARIA, PETITIONER, VS. EMPLOYEES’ COMPENSATION COMMISSION AND GOVERNMENT SERVICE INSURANCE SYSTEM (MINISTRY OF EDUCATION AND CULTURE), RESPONDENTS.

This is a petition for review on certiorari seeking to set
aside the decision of the Employees’ Compensation Commission in ECC Case No. 1398 affirming the decision of
respondent Government Service Insurance System, denying petitioner’s claim for
compensation benefits.

Petitioner Rosario Nemaria was
appointed classroom teacher in November, 1948. 
She was first assigned in the poblacion of Badian, Cebu.  Later she was transferred to the municipality
of Ronda, Cebu. 
From September 8-25, 1978,
Rosario Nemaria was confined at the Southern
Islands’ Hospital, Cebu
City, for on and off severe
abdominal pains, aneroxia, weight loss and jaundice
indicative of cancer of the liver, duodenal ulcer and cancer of the breast.  These ailments did not respond to medications
and she died on October 16, 1978.  She was at the time of her death 58 years of
age (Rollo, p. 31). 
The service record of the decedent shows that she rendered government
service for about thirty years (Rollo, p. 4).

Alleging that the cause of his wife’s death was due to her
employment as a classroom teacher, herein petitioner filed with the respondent
Government Service Insurance System (GSIS) a claim for death benefits under
Presidential Decree No. 626 as amended.

Subsequently, the GSIS through
its medical evaluation and underwriting denied the claim.  Upon receipt of the order of denial,
petitioner appealed his case to the now respondent Employees Compensation
Commission for review.

On August 13, 1980,
respondent Employees Compensation Commission affirmed the decision of
respondent GSIS denying the petitioner’s claim for death benefits under
Presidential Decree No. 626 as amended,
the dispositive portion of which reads:

“For all the foregoing, the decision appealed from should be, as it
is hereby affirmed and the instant case dismissed.

“SO ORDERED.” (Rollo, p. 31)

In a letter-appeal dated October 13, 1980, the petitioner
expressed his desire to appeal his case to the Supreme Court, but he could not
come to Manila nor could be hire a lawyer because he was very poor (Rollo, p. 1).

In the resolution of November
19, 1980, the Second Division of this Court referred petitioner’s
case to the Citizens Legal Assistance Office, Ministry of Justice, for possible
legal assistance (Rollo, p. 12).

Hence, this
petition.

Upon manifestation of counsel for petitioner, the latter was
allowed to litigate as pauper in the resolution of August 26, 1981 (Rollo,
p. 5).  In the resolution of September 21, 1981, this Court
without giving due course to the petition required the respondents to comment
thereon (Rollo, p. 52).  In compliance therewith, respondent
Government Service Insurance System filed its comment on November 19, 1981 (Rollo,
pp. 65-77), and respondent Employees Compensation Commission on February 2, 1982 (Rollo,
pp. 84-91).

Acting upon the petition for review on certiorari as well
as all subsequent pleadings filed, the Court resolved in the resolution dated
August 30, 1982 to give due course to the petition (Rollo,
p. 97).  Petitioner’s brief was filed on January 20, 1983 (Rollo,
pp. 105-108) while the Solicitor General’s brief as counsel for respondent
Employees Compensation Commission was filed on April 8, 1983 (Rollo, p.
110).  Finally, petitioner filed his reply-brief on June 1, 1983 (Rollo, pp. 120-126).

The sole issue in the instant case is whether or not petitioner’s
wife’s death is compensable
under Presidential Decree No. 626.

The petition is impressed with merit.  A careful review of the records shows that
the question must be answered in the affirmative.

It is not disputed that the ailments of the deceased were not
listed/enumerated under Annex “A” of the Amended Rules on Employees
Compensation with respect to public school teachers but petitioner anchors his
claim under the theory of “increased risks”, that is, when said
illness is caused by employment subject to proof that the risk of contracting
the same is increased by the working conditions (Brief for Petitioner, pp.
3-4).

Respondents, however, insist that the causes of the decedent’s
death, which are cancer of the liver, duodenal ulcer and cancer of the breast,
had nothing to do with her work as a teacher and, therefore, do not fall within
the compensable coverage of the law. 
They pointed out in particular that hepatoma
is not an occupational disease in the decedent’s particular employment (Rollo, p. 87).  They
further claim that the predisposing factors deemed largely responsible for the
development of the decedent’s ailments which resulted in her death were not
inherent in or peculiar to her employment as a classroom teacher.  Cancer of the liver has something to do with
liver cirrhosis, while predisposition to duodenal ulcer is traceable to one
afflicted with cancer of the liver (Rollo, p. 89).

To establish compensability of the claim under the theory of
increased risk under Section 1 (b) Rule 111 of P.D. 626, the claim must show proof of reasonable work connection and not necessarily a direct
casual relation.  Impliedly, the degree
of proof required is merely substantial, which means “such relevant
evidence as a reasonable mind might accept as adequate to support a
conclusion.” (Cristobal v. Employees Compensation Commission,
103 SCRA 330 [1981]).  Strict
rules of evidence are not applicable in claims for compensation.  There are no stringent criteria to
follow.  The degree of proof required
under P.D. 626 is merely substantial evidence
(Sarmiento v. E.C.C. et al., G.R. No. 68648, Sept. 24, 1986).  Thus, it has been ruled that a reasonable
work-connection is all that is required or that there was a showing that the
risk of contracting the disease is increased by the working conditions (San Valentin v. E.C.C., 118 SCRA 160 [1982]).

The Court ruled further, that the uncertainty as to whether or
not the disease was caused or the risk of contracting the same was increased by
the decedent’s working conditions cannot eliminate the probability that the
ailment was work-connected (Cristobal v. E.C.C., supra).

Both petitioner and respondents are in accord that although the
cause of liver cancer is not known, still it has been found to be mostly associated with liver cirrhosis, which in turn
is caused by alcoholic ingestion plus impaired nutrition; that a high
percentage of hepatoma has been discovered also in
Asia and Africa which was found to be due to certain hepatic carcinogens
ingested in food stuffs.  (Brief of Petitioner, p. 3).

The decedent, a public
school teacher assigned in a municipality several kilometers away from the
provincial capital, rendered her services for more or less twenty-nine (29) years.  She started in November 1948 as classroom
teacher assigned in the poblacion of Badian, Cebu
and from thence she was assigned to the Municipality
of Ronda, Cebu, which is a blighted area, where she
continued to discharge her duties as classroom teacher (Rollo,
p. 68).  Under those circumstances, the
possibility would not be remote, that she suffered impaired nutrition and while
working in a far-flung rural area where foodstuffs are not closely examined
before being eaten, it is not too far-fetched to consider that she was exposed
to hepatic carcinogens which reportedly were ingested therein (ibid.).

Corollary thereto, it is
undisputed that the deceased was in good health when she entered the
government service, otherwise, she would not have been accepted for insurance
purposes by the Government Service Insurance System.  The conclusion is therefore inevitable, that
the decedent’s ailments developed during her employment while working under
conditions which predisposed her thereto.

“It is enough that hypothesis on which the workmen’s claim
is based is probable.  Medical opinion to
the contrary may be disregarded especially where there is some basis in the
facts for inferring a work-connection. 
Probability not certainty is the touchstone” (Sarmiento
v. E.C.C. et al.,
supra).

Respondent Employees Compensation Commission in its decision based its conclusion
merely on the findings of the Medical Evaluation and Underwriting Group and the
medical opinion on references in medical etiology (Rollo,
p. 38), concluding that no direct cause factors triggered the contraction of
her ailments resulting in death (Rollo, p. 42).  What the law requires is a reasonable
work-connection and not a direct causal relation (Sagliba
v. E.C.C., 128 SCRA 723; Guevara v. E.C.C., 146 SCRA 64-72).

In the case of Marte v. E.C.C., 96 SCRA
884, the Court ruled:  “x x x.  The findings, however, of the doctors and the
Chief Medical Officer of the GSIS and ECC respectively are not binding on this
Court as they are not considered
experts.  Opinion of
the Medical Rating Officer who did not physically examine the claimant cannot
be relied upon” (Nuguid v. WCC, 93 SCRA 374).

The Labor Code is clear that it does not only confine compensable
diseases to those enumerated therein as occupational.  It also contemplates illness caused by
employment where the risk of contracting the same is increased by the working
conditions thereof (2nd paragraph, Art. 208, P.D. 626).  The Court has ruled that cancer of the liver
though not an occupational disease, may be deemed
work-connected (Abadiano v. GSIS, 111 SCRA 509, Jan.
30, 1982).  Moreover, in the case of Abana v. Quisumbing, 22 SCRA
1279, the Court held that under the law, it is not required that the employment
be the sole factor in the growth development or acceleration of claimant’s
illness to entitle him to the benefits provided for.  It is
enough that his employment had contributed even in a small degree.

The
Supreme Court applied a liberal interpretation in the case of Mercado, Jr. v.
Employees Compensation Commission, 139 SCRA 270 citing Cristobal
v. ECC, 103 SCRA 329, as follows:

“While the presumption of compensability and the theory of
aggravation espoused under the Workmen’s Compensation Act may have abandoned
under the New Labor Code (the constitutionality of such abrogation may still be
challenged), it is significant that the liberality of the law in general still
subsists.

“x x x As
agents charged by the law to implement social justice guaranteed and secured by both
1935 and 1973 Constitutions, respondents should adopt a more liberal attitude in deciding
claims for compensability especially where there is some basis in the facts for inferring a
work connection, 103 SCRA 329, 336).

“x x x
Where however, the causes of an ailment are unknown to and or undetermined even
by medical science, the requirement of proof of any casual link between the
ailment and the working conditions should be liberalized so that those who have
less in life will have more in law x x x.

“x x x The
point is that it is grossly inequitable to require as a condition for an award
of compensation that the claimant demonstrate that his ailment – the cause or
origin of which is unknown to and undetermined even by medical science – was, in fact
caused or the risk of contracting the same enhanced by his working
conditions.  Plainly, the condition would
be an impossible one, specially considering that said claimant is most probably
not even conversant with the intricacies of medical science and the claimant invariably
bereft of the material resources to employ medical experts to demonstrate the
connection between the cause and the disease. 
Considering the liberal character of employment compensation schemes,
the impossible condition should be deemed as not having been intended and/or imposed.  (139 SCRA, pp. 275-276).

“x x x As an employee, he had contributed to the funds of
respondent for 34 years until his forced retirement.  In turn respondent should comply with its
duty to give him the fulllest protection, relief and
compensation benefits as guaranteed by law.” (Ibid.,
p. 277).

Thus, the requirement that the disease was caused or aggravated
by the employment or work applies only to an illness where the cause can be
determined or proved.  Where cause is
unknown or cannot be ascertained, no duty to prove the link exists.  For certainly, the law
cannot demand an impossibility.

Moreover, cancer being a disease which is often discovered when
it is too late, the possibility that its onset was even before the effectivity of the New Labor Code cannot be
discounted.  As a consequence the
presumption of compensability and the theory of aggravation under the Workmen’s
Compensation Act cannot be totally disregarded.

PREMISES CONSIDERED, the petition is hereby GRANTED, The decision of the respondent
Employees Compensation Commission
is SET ASIDE and another is rendered ordering the respondents to pay the herein
petitioner the full amount of compensation under Presidential Decree No. 626 as
amended.

SO ORDERED.

Teehankee, C.J., Narvasa,
Cruz, and Gancayco,
JJ., concur.