G.R. No. 60642. February 20, 1984
FLORA C. NERI, PETITIONER, VS. EMPLOYEES COMPENSATION COMMISSION AND GOVERNMENT SERVICE INSURANCE SYSTEM, RESPONDENTS.
MAKASIAR, J.:
Compensation Commission (ECC) dated March 4, 1982 (Annex “A”, Decision,
pp. 13-17, rec.) in ECC Case No. 1517, which affirmed the decision of
respondent Government Service Insurance System (GSIS), denying
petitioner’s claim for death benefits under Presidential Decree No. 626,
as amended.
The undisputed facts are as follows:
Petitioner is the widow of the late Blasito P. Neri, who joined the
government service on August 6, 1948 as clerk-messenger in the Office of
the City Assessor of Ozamiz City.On September 1, 1959, the deceased was transferred to the Ozamiz
Branch of the Development Bank of the Philippines (DBP) as emergency
clerk-typist.The deceased rose from the ranks and on April 18, 1974, he was
appointed cashier of the bank, the position he held at the time of his
death on October 19, 1979.Sometime in 1977, the first symptoms of his ailments were manifested
in the form of off-and-on epigastric pains. The pain was at the time
relieved by food intake and antacids or anti-spasmodic tablets. He used
to consult the DBP retainer physician, Dr. Adolfo S. Murallon, who
advised him to submit to a G.I. Series (Comment of respondent, pp.
37-46, ECC rec.).By 1979, Neri’s condition had already worsened, the epigastric
pains became frequent and were accompanied by nausea and vomiting. He
became jaundiced and exhibited occasional high fever. Likewise, he had
severe melena and developed ascites (Annex “A”, Decision, pp. 13-17,
rec.).On September 6, 1979, the deceased submitted himself to a G.I.
Series conducted by one Dr. Alejo A. Tiu, a radiologist at the Cebu
Doctors Hospital. The results of the examination was negative, thereby
ruling out the diagnosis of peptic ulcer and leaving the diagnosis of
the ailments for hepatoma and liver cirrhosis (Annex “A”, Decision, pp.
13-17, rec.).When he started to bleed, he was brought to the Misamis Community
Hospital on October 3, 1979 and was transferred after six days to the
Cebu Doctor’s Hospital. Blasito P. Nari thereafter died on October 18,
1979.On account of his death, the surviving spouse, herein petitioner,
filed a claim for death benefits under P.D. 626, as amended. The
respondent System denied the claim on the basis of its medical findings
negating any causal relationship between the subject diseases and the
deceased’s employment.The said decision was affirmed by respondent Employees Compensation
Commission in its decision dated March 4, 1982, stating among others:“x x x x x x.
“After a careful review of the records of the case, we affirm respondent’s decision disallowing the instant claim. x x x.
“Hepatoma, according to medical authorities, is a primary tumor
of the liver destroying the parenchyma arising from both liver cell and
bile duct elements. It develops most frequently in the previous
cirrhotic liver. A higher fraction of patients with postnecrotic
cirrhosis develop hepatoma than that with postal 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 seen particularly liable to hepatomas; as
high as 20% of patients with hemochromatotis die from this cause. (Harrison Principles of Internal Medicine, 5th edition, p. 1072).“On the other hand, cirrhosis is a term often used loosely by
physician to mean any form of chronic liver disease with scarring. To
qualify as cirrhosis to the pathologist, a condition must involve
extensive destruction of the liver with diffuse fibrosis and
regeneration that destroys the normal lobular architecture. Etiology of
liver cirrhosis are: (a) alcoholic or portal (b) postnecrotic (c)
biliary (d) congestive (e) inherited. Bleeding from ruptured esophageal varices occur as complication. (The Merck Manual of Diagnosis and Therapy; 11th ed.; p. 929).“Postnecrotic cirrhosis – this form of chronic liver disease is
the most common type of cirrhosis on a worldwide basis. The cause of
postnecrotic cirrhosis is still unknown, but epidemiological and
serological evidence suggest that viral hepatitis is an antecedent
factor in many instances. A small percentage of cases stems from
documented intoxications with industrial chemicals, poisons or drugs.
Postnecrotic cirrhosis should be suspected in non-alcoholic patients
with evidence of chronic liver diseases. (Barrison, Principles of Internal Medicine, 7th edition, p. 1543).“It is evident from the aforequoted medical report that the
predisposing factors for the development of the deceased’s ailments are
manifestly not inherent or peculiar to his employment or employment
conditions as cashier in the DBP Ozamiz branch. Medical experts
enumerate alcoholism, malnutrition, exposure to chemicals, drug
poisoning and heredity as possible causes of liver cirrhosis.“x x x x x x x x x” (Decision, pp. 13-17, rec., Italics supplied).
On June 4, 1982, petitioner, assisted by counsel, filed the instant
petition, the only pertinent issue being whether or not her husband’s
death from hepatoma and postnecrotic cirrhosis is compensable under the
law.
The petitioner contends that her husband’s death is compensable and that
respondent Commission erred in not taking into consideration the
uncontroverted fact that when the deceased entered into the DBP in
1959, he was found to be physically and mentally healthy. She further
contends that when her husband was holding the position of “cashier” at
the DBP from April 18, 1974 until he died, he had been counting money
paper bills which undeniably contained germs of various kinds that
caused his illness which eventually led to his death (Petition, pp. 2-9,
rec.). Moreover, petitioner submits that the deceased has always been
sent to different places during his employment with the DBP to effect
collection and campaign for depositors and it was during the course of
his travels that he must have contracted the illnesses which caused his
death.
The respondent Commission, on the other hand, maintains that no
reasonable finding nor logical conclusion may be drawn from the fact
that the deceased employee’s provincial trips directly resulted in his
illnesses or that the risk of contracting them was likewise increased.
It also maintained that medical findings of the ECC do not substantiate
the fact that exposure to germs while handling paper money bills caused
the illness of the deceased. Thirdly, it is argued that such medical
findings strengthen the stand of respondent Commission on the
non-compensability of the instant claim, as cancer of the liver is
compensable only among vinyl chloride and plastic workers (Memorandum,
pp. 53-63, rec.).
WE find the petitioner’s claim meritorious.
In the case of Laron vs. Workmen’s Compensation Commission, (73 SCRA
90), WE held, citing Schmidt’s’ Attorney’s Dictionary of Medicine; 165
Sup. 143; Beerman vs. Public Service Coordinated Transport, 191 A 297,
299; Words and Phrases, 6 Permanent Edition 61, “The English word
‘cancer’, is derived from the Latin word ‘cancer’ which means ‘crab’; in
the medical sense, it refers to a malignant, usually fatal, tumor or growth
(underscoring supplied). The decision of the Employees Compensation
Commission shows that hepatoma is a primary tumor of the liver. WE have
ruled in the case of Dator vs. Employees Compensation
Commission (111 SCRA 634 L-57416, January 30, 1982) that “[U]ntil now,
the cause of cancer is not known.” Indeed, the respondent has provided
an opening through which petitioner can pursue and did pursue the
possibility that the deceased’s ailments could have been caused by the
working conditions while employed with the DBP.
Medical authorities support the above decision that the etiology or
cause of cancer and postnecrotic cirrhosis is still unknown as provided
for in the following:
“The cause of postnecrotic cirrhosis is still unknown, but epidemiologic and serologic evidence suggests that viral hepatitis is an antecedent factor in many instances. x x x
“Some patients have bouts of upper abdominal pain, the sudden onset of unexplained
ascites, episodes of hepatic encephalopathy, or massive variceal
hemorrhage as the major or initial clinical feature. The signs and
symptoms of postnecrotic cirrhosis resemble those of alcoholic
cirrhosis and reflect the loss of liver cell reserve, advancing portal
hypertension, and disorders of salt and water metabolism” (Harrison, Principles of Internal Medicine, 9th Edition, 1980 p. 1476; Italics supplied).“Although the etiology of cancer in humans cannot yet be explained
at the molecular level, it is clear that genetic composition of the
host is important in cancer induction. Related immunologic factors may
predispose the host to a putative carcinogen. There is some evidence that viruses may play a role in the neoplastic process. In addition, both environmental and therapeutic agents have been identified as carcinogens” (Harrison, Principles of Internal Medicine, 9th Edition, 1980, p. 1584).“Cancer may be associated with, or lead to, an altered host immune response; however, the cause-and-effect relationship remains to be determined” (Harrison, Principles of Internal Medicine, 10th Edition, 1983, p. 755).
“What emerges from such concepts is the belief that cancers in man do not appear suddenly ‘but of the blue‘.
They represent the unhappy endpoint of a long, dynamic process of
evolution having its origin years or even decades before the first
clinical evidence of the neoplasm appears. Moreover, there need not be a single etiology or pathogenesis. Many influences may be at work during the evolution of the lesion and many pathways may be involved. Indeed, the term cancer may embrace a multiplicity of diseases of diverse origins” (Robbins, Pathologic Basis of Disease, 2nd Edition, 1979, p. 185, underscoring supplied).
It is indubitable that the causes of the illnesses of the deceased,
specifically, hepatoma and postnecrotic cirrhosis, are still unknown and
may embrace such diverse origins which even the medical sciences cannot
tell with reasonable certainty. Scientists attending the World Genetic
Congress in New Delhi, India, have warned that about 25,000 chemicals
used around the world could potentially cause cancer, and Lawrence
Fishbein of the US National Center for Toxilogical Research pointed out
that humans were daily exposed to literally hundreds of chemical agents
via air, food, medication, both in their industrial home and
environments (Evening Post, December 16, 1983, p. 3, cols. 2-3).
This Court applies the theory of increased risk under Section 1(b) Rule III of P. D. 626, which states that:
“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 these Rules with the conditions set therein
satisfied; otherwise, proof must be shown that the risk of contracting
the disease is increased by the working conditions.”
This Court had the occasion to interpet the theory of increased risk under the above-mentioned law in the case of Cristobal vs. Employees Compensation Commission (103 SCRA, 336-337, L-49280, February 26, 1981):
“To establish compensability under the said theory, the claimant
must show proof of work-connection. Impliedly, the degree of proof
required is merely substantial evidence, which means ‘such relevant
evidence to support a decision’ (Ang Tibay vs. The Court of Industrial
Relations and National Labor Union, Inc., 69 Phil. 635) or clear and
convincing evidence. In this connection, it must be pointed out that
the strict rules of evidence are not applicable in claims for
compensation. Respondents however insist on evidence which would
establish direct causal relation between the disease rectal cancer and
the employment of the deceased. Such a strict requirement which even
medical experts cannot support considering the uncertainty of the nature
of the disease would negate the principle of the liberality in the
matter of evidence. Apparently, what the law merely requires is a reasonable work-connection and not a direct causal relation.
This kind of interpretation gives meaning and substance to the liberal
and compassionate spirit of the law as embodied in Article 4 of the new
Labor Code which states that ‘all doubts in the implementation of the
provisions of this Code, including its implementing rules and
regulations shall be resolved in favor of labor.’“x x x As the agents charged by the law to implement the social
justice guarantee secured by both 1935 and 1973. Constitutions,
respondents should adopt a more liberal attitude in deciding claims for
compensation especially when there is some basis in the facts inferring a
work-connection. This should not be confused with the presumption
of compensability and theory of aggravation under the Workmen’s
Compensation Act. While these doctrines may have been 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 (Italics supplied).
The sweeping statement of the Employees Compensation Commission to the
effect that the “predisposing factors for the development of the
deceased’s ailments are manifestly not inherent or peculiar to his
employment or employment conditions as cashier in the DBP Ozamiz Branch
(p. 16, rec.) is untenable and not in accordance with the facts on
record. From a position of uncertainty, one cannot draw a conclusion of
certainty.
WE are dealing with possibilities and medical authorities have given
credence to the possibility that the deceased developed hepatoma and
postnecrotic cirrhosis while working as cashier in the DBP branch in
Ozamiz City.
The records show that the deceased was found to be physically and
mentally healthy when he entered the bank as emergency clerk-typist in
1959. WE cannot discount the fact that in his position, physical
contact with various chemicals in the form of carbon paper, erasing
fluids and other materials is inevitable. When the deceased was
promoted to the position of bank cashier, he was often assigned to
follow up accounts and solicit deposits. This fact was even admitted by
respondent Employees Compensation Commission. Such assignments
invariably involved irregular working hours and exposure to different
working conditions, body fatigue, not to mention psychological stress
and other similar factors, which influenced the evolution of his
ailments. WE add to this the possibility that the deceased could have
contracted his illnesses from contact with germs while counting paper
money bills.
In the case of San Valentin vs. Employees Compensation Commission (118 SCRA 160, L-56909, November 2, 1982), this Court, speaking through, Mr. Justice de Castro, held:
“x x x x x x x x x.
“In compensation cases, strict rules of evidence are not
applicable. 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.”
Moreover, WE do not see any reason to depart from the ruling of this Court in the case of Abadiano vs. Government Service Insurance System and Employees Compensation Commission (111 SCRA 509, L-52254, January 30, 1982) citing Cristobal vs. Employees Compensation Commission (97 SCRA 473) that:
“x x x x x x x x x.
“…..It is palpable that the respondent ECC recognizes, as it is
duty bound to, the policy of the State to afford maximum aid and
protection to labor. Therefore, to require the petitioner to show the
actual causes or factors which led to the decedent’s rectal malignancy
would not be consistent with this liberal interpretation.”
This is in line with the avowed policy of the State as mandated by the
Constitution (Article II, Section 9) and embodied in the new Labor Code
(Article 4), to give maximum aid and protection to labor.
WE have repeatedly held that respondent Commission should remain
vigilant as to its obligation at all times to give meaning and substance
to the constitutional guarantees in favor of the working man (Cristobal vs. Employees Compensation Commission, 97 SCRA 473, citing Santos vs. WCC, 75 SCRA 371).
WHEREFORE, THE DECISION APPEALED FROM IS HEREBY SET ASIDE AND THE GOVERNMENT SERVICE INSURANCE SYSTEM IS ORDERED
1. TO PAY THE PETITIONER THE SUM OF TWELVE THOUSAND (P12,000.00) PESOS AS DEATH BENEFITS;
2. TO REIMBURSE THE PETITIONER’S MEDICAL AND HOSPITAL EXPENSES DULY SUPPORTED BY PROPER RECEIPTS;
3. TO PAY THE PETITIONER THE SUM OF ONE THOUSAND TWO HUNDRED (P1,200.00) PESOS FOR BURIAL EXPENSES; AND
4. TO PAY THE PETITIONER THE SUM OF ONE THOUSAND TWO HUNDRED (P1,200.00) PESOS AS ATTORNEY’S FEES.
SO ORDERED.
Concepcion, Jr., Guerrero, Abad Santos, De Castro, and Escolin, JJ., concur.
Aquino, J., no part.