CARMEN SANTOS, PETITIONER, VS. EMPLOYEES’ COMPENSATION COMMISSION AND GOVERNMENT SERVICE INSURANCE SYSTEM (PHILIPPINE NAVY), RESPONDENTS.

Is liver cirrhosis an illness which is compensable? This is the question put forth by
petitioner, Carmen Santos, whose husband died of liver cirrhosis while still a
civilian employee of the Philippine Navy.

Francisco Santos was employed as welder at the Philippine Navy and its Naval Shipyard as early as March 22,
1955. He spent the last 32 years of his
life in the government service, the first year as a welder helper and the last
two years as shipyard assistant.

On December 29, 1986, Francisco was admitted at the Naval Station
Hospital in Cavite City, on complaint that he was having epigastric pain and
been vomiting blood 2 days prior to his hospitalization. His case was diagnosed as bleeding Peptic
Ulcer disease (PUD), cholelithiasis and diabetes mellitus. On January 11, 1987, he died, the cause of
which as indicated in the Death Certificate was liver cirrhosis.

Mrs. Carmen A. Santos filed a claim for the death benefit of her
husband, Francisco, on January 28, 1987, pursuant to Presidential Decree No. 626,
as amended. However, on a letter dated
April 30, 1987, the Government
Service Insurance System (GSIS), denied the claim on the ground that upon
proofs and evidence submitted, Francisco’s ailment cannot be considered an
occupational disease as contemplated under P.D. 626, as amended.

Mrs. Santos then sought the assistance of the Commander of
NASCOM, PN, who in turn wrote the GSIS requesting for a favorable action on her
claim. Said letter also substantiated
petitioner’s claim that her husband’s duties as Senior Welder, assigned at the
Structural Branch of the Naval Shipbuilding Facility, required him to perform
delicate welding jobs inside compartments of naval vessels, like
compartmentation bulk heads; CIC rooms; officers and PO’s quarters; fuel, lube oil and fresh water tanks,
where he was exposed to heat and inhalation of burning chemical substances and
gas fumes coming from burning welding electrodes.

Despite such endorsement, petitioner’s motion for reconsideration
was likewise denied, upon claim of the GSIS that Francisco’s job as a welder
would instead cause lung disease rather than liver cirrhosis.

On appeal to the Employees’ Compensation Commission (ECC), the
Commission affirmed the denial of the GSIS on petitioner’s claim relying on the
fact that the diagnosis on Francisco’s illness did not specify the type of
cirrhosis which caused his death. Nevertheless, the Commission took cognizant of the fact that the
deceased employee did not have a previous history of alcoholism, hepatitis or a
previous history of biliary condition which could give a clue to the nature of
cirrhosis he had.

We find merit in this petition.

The law defines compensable sickness as any illness definitely
accepted as occupational disease listed by the Commission, or any illness caused
by employment subject to proof that the risk of contracting the same is
increased by the working conditions. For sickness and the resulting death of an employee to be compensable,
the claimant must show either: (1) that
it is a result of an occupational disease listed under Annex A of the Amended
Rules on Employees’ Compensation with the conditions set therein satisfied; or
(2) if not so listed, that the risk of contracting the disease is increased by
the working conditions.^[1]

Where the claimant’s illness is not listed in the Table of
Occupational Diseases embodied in Annex A of the Rules on Employees’
Compensation, said claimant must positively prove that the risk of contracting
the disease is increased by the working conditions.^[2]

Cirrhosis of the liver is not listed as an occupational
disease. Nevertheless, in the very
recent case of Librea v. Employees’ Compensation Commission^[3]
We took a liberal stand and based on the evidence presented, pronounced the
said sickness compensable. In the cited
case, a Division Physical
Education Supervisor, who likewise spent the last 32 years of his life in
public service was adjudged entitled to the benefits of the ECC, upon his death due to liver cirrhosis.

In the said case, the ECC denied the claim of the heirs on the
ground that the abundant stress and strain experienced by the deceased employee
were too farfetched to cause the development of liver cirrhosis. According to the medical research made by
the Commission in the case, portal cirrhosis or cirrhosis of the liver occurs
chiefly in males in their late middle life. Malnutrition is believed to be a predisposing factor if not the primary
etiologic factor, and may account for its prevalence among alcoholics. This chronic disease characterized by increased connective tissue that
spreads from the portal spaces, distorts the liver architecture thereby
impairing liver functions.^[4]

In granting the petition, the Court correlated the fact that the
deceased experienced untold sufferings in the course of his inspection of
barrio schools and that he became malnourished because of the scarcity of food
in the places he travelled to. All
these factors were found to have contributed to the weakening of his health
rendering him susceptible to malnutrition and eventually to contracting liver
cirrhosis.

In the case at bar, the Commission said that liver cirrhosis may
be classified by a mixture of etiologically and morphologically defined
entities as follows:

1)      Alcoholic cirrhosis,
chronic alcoholism is a major cause of alcohol cirrhosis. The amount and duration of ethanol ingestion
rather than the type of alcoholic beverage of the pattern of ingestion, appear
to be an important determinant of liver injury. Nutritional factors may augment the detrimental effects of
chronic alcohol ingestion on the liver.

2)      Post necrotic
cirrhosis is the final pathway of many types of advanced liver injury of both
specific and unknown causes. Viral
hepatitis, (hepatitis B, Non A, Non B) may be an antecedent. Other causes are drugs, toxins and alcoholic
liver disease and primary biliary cirrhosis.

3)      Biliary cirrhosis
results from injury to or prolonged obstruction of either the intrahepatic or
extrahepatic biliary system.

4)      Cardiac cirrhosis –
prolonged severe right-sided congestive heart failure may lead to chronic liver
injury and cardiac cirrhosis.

5)      Metabolic, hereditary,
drug-related and other types.

We do not pretend to be an expert in the realm of medical
discipline. However, We cannot discount
the fact that the cause of death of petitioner’s
husband could very well be related to his previous working conditions. Even the Commission volunteered the theory
that post necrotic cirrhosis show that of the many types of advanced liver
injury, one cause may be due to toxins.

As a welder, Francisco was exposed to heat, gas fumes and
chemical substances coming from the burning electrodes caused by welding. Generally, the metal burned is iron. In the course thereof, other compounds and
oxides, such as carbon monoxide, carbon dioxide, sulfur and phosphorus, may be emitted in the process of welding,
depending on the kind of material used and extent of corrosion of the metal
worked on. These vaporized metals are
inhaled by the welder in the
process and significantly in this case, Francisco had to do welding jobs within
enclosed compartments.

Research shows that ingestion or inhalation of small amounts of
iron over a number of years may lead to siderosis. Acute poisoning brings about circulatory collapse which may occur
rapidly or be delayed to 48 hours with liver failure.^[5] These
are industrial hazards to which Francisco was exposed. And in the long course of time, 32 years at
that, his continuous exposure to burned electrodes and chemicals emitted
therefrom would likely cause poisoning and malfunction of the liver.

The leading doctrine on compensability is that laid down in the
case of Raro v. Employees’
Compensation Commission,^[6] where
this Court said:

“There is a widespread misconception
that the poor employee is still arrayed against the might and power of his rich
corporate employer. Hence, he must be
given all kinds of favorable presumptions. This is fallacious. It is now
the trust fund and not the employer which suffers if benefits are paid to
claimants who are not entitled under the law. The employer joins the employee in trying to have their claims
approved. The employer is spared the
problem of proving a negative proposition that the disease was not caused by
employment.”

The decision of this Court in Raro in effect supersedes
the cases with conclusions different from that stated therein, such as Nemaria
v. ECC, 155 SCRA 166 (1987); Ovenson v. ECC, 156 SCRA 21 (1987); Mercado v.
ECC, 127 SCRA 664 (1984).

The reason behind the present doctrine is that the New Labor Code
has abolished the presumption of compensability for illness contracted by a worker during employment. To be entitled to disability benefits, the
claimant has to present evidence to prove that his ailment was the result of,
or the risk of contracting the same were aggravated by working conditions or the nature of his work.^[7]

However, while the presumption of compensability and theory of
aggravation under the Workmen’s Compensation Act may have been abandoned under
the new Labor Code, the liberality of the law in general in favor of the
working man still prevails.^[8] The
Employees’ Compensation Act is basically a social legislation designed to
afford relief to the working man and woman in our society. The Employees’ Compensation Commission, as
the agency tasked with implementing the social justice mandate guaranteed by
the Constitution, should be more liberal in resolving compensation claims of
employees especially where there is some basis in the facts for inferring a
work connection to the cause of death.^[9]

This 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 and
interpretation of the provisions of the Labor Code including its implementing
rules and regulations shall be resolved in favor of labor.”^[10]

The policy is to extend the applicability of PD 626 to a greater
number of employees who can avail of the benefits under the law, which is in
consonance with the avowed policy of the state to give maximum aid and
protection to labor.^[11]

Premises considered, We find the petition meritorious. Liver cirrhosis, although not one among
those listed as compensable ailment, is considered in the case at bar as
covered under the Act, on the ground that the nature of the work of
petitioner’s husband, exposed him to the risk of contracting the same.

WHEREFORE, petition is hereby GRANTED and the decision of
the Employees’ Compensation Commission is REVERSED.

SO ORDERED.

Narvasa, C.J., (Chairman), Padilla, Regalado, and Campos, Jr., JJ., concur.

^[1]
Quizon v. Employees Compensation Commission, G.R. No. 87590, 203 SCRA
426 (1991).

^[2]
De Guia v. Employees Compensation Commission, G.R. No. 95595, 198 SCRA
834 (1991).

^[3]
G.R. No. 58879, 203 SCRA 545 (1991).

^[4]
Id. at p. 548

^[5]
Gradwohl’s Legal Medicine, 2^nd
Edition, Bristol: John Wright
& Sons Ltd. (1968).

^[6]
G.R. No. 58445, 172 SCRA 845 (1989).

^[7]
Naval v. Employees’ Compensation Commission, G.R. No. 83568, 199 SCRA
388 (1991).

^[8]
Nitura v. Employees Compensation Commission, G.R. No. 89217, 201 SCRA
278 (1991).

^[9]
Lazo v. Employees’ Compensation Commission, G.R. No. 78617, 186 SCRA 569
(1990).

^[10]
Nitura, supra.

^[11]
Carbajal v. Government Service Insurance System, G.R. No. 46654, 164
SCRA 204 (1988).