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PHILIPPINE SUPREME COURT DECISIONS

SECOND DIVISION

[G.R. No. 64802. March 29, 1984.]

VENUSTO PANOTES, Petitioner, v. EMPLOYEES’ COMPENSATION COMMISSION, GOVERNMENT SERVICE INSURANCE SYSTEM (Ministry of Education and Culture), Respondents.

Roger Panoles for Petitioner.

Solicitor General for Respondents.


SYLLABUS


1. LABOR AND SOCIAL LEGISLATION; LABOR CODE; EMPLOYEES’ COMPENSATION COMMISSION; COMPENSABILITY OF AILMENTS; CANCER OF THE COLON, ORIGIN STILL UNKNOWN. — It is evident that the cause of colonic malignancy is still unknown. Predisposing factors which may cause the fatal disease have been mentioned but all these have been qualified as probabilities. As in other cancer diseases, medical experts are still in the process of finding out the exact nature of the disease, what causes it and what may cure it. In its decision, however, respondent ECC was definite in its conclusion that the fatal disease is traceable to factors which are not attributable to employment but rather to multiple polyposis or ulcerative colitis. This indeed, is a sweeping conclusion which is devoid of any merit. Respondent cannot state definite conclusions from an unknown or uncertain premise. It must be pointed out that medical authorities have always qualified their discussion of the subject with a statement that "the cause of the disease (cancer of the colon) is still unknown."cralaw virtua1aw library

2. ID.; ID.; ID.; ID.; THEORY OF INCREASED RISK, APPLICATION JUSTIFIED IN CASE AT BAR. — In the case of Acosta v. ECC (109 SCRA 210), this Court recognized such fact and commented: ". . . it is generally accepted that the exact origin of practically all types of cancer is not yet determined. Scientists and medical experts are still in the process of discovering the most effective cure for that malady. With this backdrop, one should not expect ordinary persons like petitioner to prove the real cause of the ailment of the deceased when the experts themselves are still in the dark." This pronouncement by the high court indeed justifies petitioner’s allegation that the nature and the working conditions of his wife’s employment increased the risk of contracting the fatal disease.

3. ID.; ID.; ID.; ID.; WHERE CAUSE OF DEATH IS UNKNOWN, RIGHT TO COMPENSATION SUBSISTS; STRICT RULES OF EVIDENCE NOT APPLICABLE; CASE AT BAR. — Thus, where the cause of employees’ death is unknown, the right to compensation subsists, the reason being that the Workmen’s Compensation Act is a social legislation, designed to give relief to the workingman, and therefore, to effectuate its purposes, it must be liberally construed (Najera v. ECC, 122 SCRA 697). In compensation cases, strict rules of evidence are not applicable. Proof of actual cause of the ailment is not necessary. The test of evidence or the relation of the disease with the employment is probability and not certainty (San Valentin v. ECC, 118 SCRA 160). To be compensable, it is enough that the hypothesis on which workmen’s claim is based is probable. Medical opinion to the contrary can be disregarded (Delegente v. ECC, 118 SCRA 67).


D E C I S I O N


MAKASIAR, J.:


This is an appeal by certiorari, seeking the review of the decision of respondent Employees’ Compensation Commission in ECC Case No. 1963, dated June 16, 1983, affirming the decision of respondent Government Service Insurance System denying the claim of petitioner Venusto Panotes for compensation benefits under P.D. 626, as amended, for the death of his wife, Agustina Garfin Panotes, on the ground that the cause of death, colonic malignancy or cancer of the colon, is not compensable.

The GSIS, however, paid the petitioner gratuity benefits under C.A. No. 186, as amended, in the amount of P28,405.22, in lieu of compensation benefits. The GSIS, also, will refund to the petitioner the total retirement premiums paid by his deceased wife (with interest) and the corresponding government share (without interest) [Comment, p. 20, rec.].

For more than 30 years, from 1949 to 1980, the deceased worked as an elementary school teacher of the Ministry of Education and Culture, her last assignment being with the Francisco Balagtas Elementary School in Sta. Cruz, Manila (p. 6, rec.).

On October 25, 1979, she was admitted in the UST Hospital, complaining of vomiting and severe abdominal pains. The attending physician, Dr. Rafael Ferrer, diagnosed her ailment as colonic malignancy or cancer of the colon. She underwent two operations. On May 23, 1980, she died of the same ailment at the age of fifty.

Upon her death, the petitioner filed with respondent GSIS a claim for compensation benefits under P.D. 626, as amended. The System denied his claim on the ground that colonic malignancy was not work-connected. Petitioner asked for reconsideration but the same was denied, with respondent GSIS reiterating that "there is no proof that the deceased’s ailment was the direct result of the nature of employment" (p. 6, rec.). On February 12, 1982, petitioner then wrote to President Marcos, which letter was considered as an appeal to the Employees’ Compensation Commission. The respondent ECC affirmed the GSIS’ denial of the claim, on the basis, to wit:jgc:chanrobles.com.ph

"Carcinoma of the colon, medical experts say, is one of the most common types of cancer. The disease is slightly more common in females than in males. It is particularly common in colon involved by multiple polyposis or by ulcerative colitis. If cancer is encountered before the fourth decade, it usually is associated with one of these diseases. Symptoms are quite variable, depending upon the primary location of the tumor. In the right colon, the symptoms consist of flatulence distention to cramp-like pains, secondary anemia and change in bowel habit. In the left colon the symptoms are constipation and bleeding with bowel movement is common (Christopher’s Textbook of Surgery, Davis, 7th edition, pp. 708-709).

"From the foregoing medical discussion, it is evident that carcinoma of the colon is traceable to factors which are not attributable to employment but rather to multiple polyposis or ulcerative colitis. It is likewise shown that gastric influence is an important predisposing factor. Therefore, we cannot give weight to appellant’s arguments that his wife’s irregular meals in the course of her employment gave rise to her ailment. This supposition lacks medical basis.

"Moreover, we note that the deceased in her entire career as a teacher was never exposed to toxic chemicals and radioactive substances, exposure to which has been found by cancer experts to be contributory factors in the development of cancer.

"Much as we desire to help herein appellant, we cannot do so because the facts and the evidence on record negate compensability under P.D. 626" (pp. 21-22, rec.)

The only issue is whether or not colonic malignancy or cancer of the colon is compensable under P.D. No. 626, as amended.

Petitioner contends that the ailment which took the life of his wife is not an occupational disease, nevertheless, he asserts that the risk of contracting the same was increased by the nature and the working conditions of his wife’s employment. He further contends that the deceased was in perfect health when she started teaching in 1949. Because of the meetings and other school activities, she missed her meals occasionally which weakened her and made her susceptible to diseases. He also contends that by the nature of her job and precisely because of her employment her disease worsened resulting in her early demise.chanrobles.com:cralaw:red

Respondent ECC, on the other hand, contends that cancer of the colon is not listed as an occupational disease and no proof was shown that the risk of contracting the same was increased by the working conditions. Furthermore, ECC contends that the doctrine of compensability and the principle of aggravation have been abandoned under the New Labor Code. Respondent Commission also submits that "the New Labor Code is an entirely new social insurance scheme, vastly different in philosophy and approach from the old law where the employer shoulders by himself alone, the responsibility of paying liability compensation. It was and still is envisioned to compensate only purely work-connected sickness, disability or death, to restore a sensible quilibrium between the employer’s obligation to pay workmen’s compensation and the employees’ right to receive reparation for work-connected disability or death" (p. 40, rec.).

WE find for the petitioner.

The disease cancer of the colon, has been described as follows:jgc:chanrobles.com.ph

"A malignant new growth of the colon. This type of cancer is made up of cells which tend to infiltrate the surrounding tissues and give rise to metastasis. It usually grows to a large size and produces constipation and ulceration with bleeding. This type of cancer is believed to have a close relationship between lesions of the large intestines such as polyps chronic inflammatory disease of the colon as seen in ulcerative colitis. Familial tendency of the diseases is also well documented" (p. 21, rec.)

"Cancer of the Colon. Etiology. The cause of colon cancer is unknown. The greater incidence in Western Society suggests that dietary factors may be involved . . . As mentioned above, while there is a possibility that adenomatous polyps may become malignant, villous adenomas are definitely associated with cancer. It appears that a colon bearing a polyp may develop a cancer elsewhere. Congenital multiple polyposis of the colon has an astonishingly high malignant potential; ulcerative colitis also seems to potentiate or stimulate the development of carcinoma in the diseased bowel. Other lesions of the large intestine seem to bear no causal relations to cancer (pp. 1563-1564, Harrison, Principles of Internal Medicine, 8th Edition; Emphasis supplied).

"Carcinoma of the large bowel is fairly common at any age, but 75% of the cases are discovered in the sixth, seventh and eighth decades of life. Males and females are affected about equally. All colonic cancers tend to be more aggressive in younger patients, resulting in a sharp reduction in the five year survival rate. The question of a familial tendency with respect to these lesions has long been a controversial issue. While a few reports have cited a higher attack rate in blood relatives of a proband, other reports have disagreed. In any event, if any familial tendency exists, it is indeed equivocal.

"It is well to remember that certain conditions predispose to the development of carcinoma of the colon. These include chronic ulcerative colitis, multiple familial polyposis, villous adenomas and previous colonic carcinoma. In about 4% of the cases two carcinomas occur either concomitantly or successively. Stated in another way, the patient with a primary colonic carcinoma has a severalfold increased likelihood of developing a completely independent second tumor . . . It is now appreciated that carcinoma of the colon pre-exist for a considerable time before it produces clinical symptoms. It begins in all probability as an `in situ’ lesion and then later becomes a small mucosal area of asymptomatic cancerous transformation. In all likelihood it requires years to become an overt tumor. . . ." (pp. 881-183, Pathology by Robins, 3rd edition; Emphasis supplied).

"Carcinoma of the colon, medical experts say, is one of the most common types of cancer. The disease is slightly more common in females than in males. It is particularly common in colon involved by multiple polyposis or by ulcerative colitis. If cancer is encountered before the fourth decade, it usually is associated with one of these diseases. Symptoms consist of flatulence distention to cramp-like pains, secondary anemia and change in bowel habit. In the left colon the symptoms are constipation and bleeding with bowel movement is common" (Christopher’s Textbook of Surgery, Davis, 7th edition, pp. 708-709, as cited by respondent in its decision, p. 13, rec.; Emphasis supplied).

Based on the foregoing, it is evident that the cause of colonic malignancy is still unknown. Predisposing factors which may cause the fatal disease have been mentioned but all these have been qualified as probabilities. As in other cancer diseases, medical experts are still in the process of finding out the exact nature of the disease, what causes it and what may cure it.

In its decision, however, respondent ECC was definite in its conclusion that the fatal disease is traceable to factors which are not attributable to employment but rather to multiple polyposis or ulcerative colitis. This indeed, is a sweeping conclusion which is devoid of any merit. Respondent cannot state definite conclusions from an unknown or uncertain premise. It must be pointed out that medical authorities have always qualified their discussion of the subject with a statement that "the cause of the disease (cancer of the colon) is still unknown."cralaw virtua1aw library

Cancer is still an unanswered question in medical science. Its nature and cause are vague even to the most respected experts in the medical field and its characteristic fatality and uncertainty are unfortunately the only feature which are certain and definite. Thus, in the case of Acosta v. ECC (109 SCRA 210), this Court recognized such fact and commented: ". . . it is generally accepted that the exact origin of practically all types of cancer is not yet determined. Scientists and medical experts are still in the process of discovering the most effective cure for that malady. With this backdrop, one should not expect ordinary persons like petitioner to prove the real cause of the ailment of the deceased when the experts themselves are still in the dark." This pronouncement by the high court indeed justifies petitioner’s allegation that the nature and the working conditions of his wife’s employment increased the risk of contracting the fatal disease.

The deceased worked as an elementary school teacher from 1949 until she contracted the fatal disease in 1979. She entered the service in perfect health. As a teacher, she was not simply confined to the four corners of her classroom but instead was made to attend meetings and other school activities. She must have been assigned in other places in the course of her service, a natural occurrence in the life of an elementary public school teacher. This exposed her to far and dirty places where she could have contracted viruses and parasites. Her constant exposure to chalk and dust, to the vagaries of nature when attending school activities, would naturally take its toll on her health.

She was constantly under physical, mental and emotional pressure. She does not only teach children but had to take care of them too, thus, entailing a very big responsibility on her shoulders. She must stay in the classroom throughout the class hours and must wait until recess time or until the class is over before she could relieve herself whenever the need for it arises, which was of course very detrimental to the health, adding to the sad fact that most comfort rooms in public schools are quite unhygienic.

She had loads of work to do which surely made her miss her meals, as alleged. The tension and the pressure which every teacher must go through in order to finish the papers and the grades of at least forty pupils on time, aside from the fact that they have to attend to other school activities, cannot be discounted. These factors would likely weaken her bodily condition and make her susceptible to diseases.chanrobles virtualawlibrary chanrobles.com:chanrobles.com.ph

In the case of Abandiano v. GSIS (111 SCRA 509) citing the case of Meñez v. ECC (97 SCRA 87), this Court expressed concern for public school teachers, thus:jgc:chanrobles.com.ph

"x       x       x

"Finally, Republic Act 4670, otherwise known as the Magna Charta for Public School Teachers, recognized the enervating effects of these factors (duties and activities of a school teacher certainly involve physical, mental and emotional stresses) on the health of school teachers when it directed in one of its provisions that `Teachers shall be protected against the consequences of employment injury in accordance with existing laws. The effects of physical and nervous strain on the teacher’s health shall be recognized as compensable occupational diseases in accordance with laws’" (Pantoja v. Republic, Et Al., L-43317, December 29, 1978).

As correctly alleged by petitioner, the theory of increased risk is applicable in this case. Section 1 (b), Rule III of P.D. 626, as amended, states:jgc:chanrobles.com.ph

"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."cralaw virtua1aw library

Construing the above provision in the case of Cristobal v. ECC (103 SCRA 329), this Court stated the following:jgc:chanrobles.com.ph

"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 v. The Court of Industrial Relations and National Labor Union, Inc., 69 Phil. 656) 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.’

". . . 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 the 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 . . ." (Emphasis supplied).

Considering the uncertainty of the cause of cancer diseases, the Court has ruled that:chanroblesvirtualawlibrary

". . . (I)t is possible that the disease must have supervened before the Amended Labor Code took effect. Even if the illness occurred after the Amended Labor Code had taken effect, the illness of the deceased should be considered as compensable" (Dator v. ECC, 111 SCRA 632; Cristobal v. ECC, 103 SCRA 329).

Finally, it must be reiterated that the deceased died of a disease (colonic malignancy) the etiology or cause of which is still unknown. Taking this fact into consideration, this Court has enunciated the following ruling in the case of Dator v. ECC, Et. Al. (111 SCRA supra) as cited in the case of De Leon v. ECC (118 SCRA 544):jgc:chanrobles.com.ph

"We have ruled that until now the cause of cancer is still unknown. Despite this fact, however, the ECC has listed some kinds of cancer as compensable. There is no reason why cancer of the lungs should not be considered as a compensable disease" (Emphasis supplied).

Thus, where the cause of employees’ death is unknown, the right to compensation subsists, the reason being that the Workmen’s Compensation Act is a social legislation, designed to give relief to the workingman, and therefore, to effectuate its purposes, it must be liberally construed (Najera v. ECC, 122 SCRA 697). In compensation cases, strict rules of evidence are not applicable. Proof of actual cause of the ailment is not necessary. The test of evidence or the relation of the disease with the employment is probability and not certainty (San Valentin v. ECC, 118 SCRA 160). To be compensable, it is enough that the hypothesis on which workmen’s claim is based is probable. Medical opinion to the contrary can be disregarded (Delegente v. ECC, 118 SCRA 67).

In the case of Cristobal v. ECC (103 SCRA 329), as cited in the case of Abadiano v. GSIS (111 SCRA 509), this Court had the occasion to qualify the compensability of borderline cases in the New Labor Code and the social justice guarantee under this new set-up, thus:chanrobles lawlibrary : rednad

"x       x       x

"In the instant case, it is evident that rectal cancer is one of those borderline cases. Like, it is clear that the purpose of the resolution is to extend the applicability of the provisions of P.D. 626, thereby affording a greater number of employees the opportunity to avail of the benefits under the law. This is in consonance with the avowed policy of the State, as mandated by the Constitution and embodied in the New Labor Code, to give maximum aid and protection to labor. The Employees’ Compensation Commission, like the defunct Court of Industrial Relations and the Workmen’s Compensation Commission, is under obligation at all times to give meaning and substance to the constitutional guarantees in favor of the working man, more specially, the social justice guarantee; for otherwise, these guarantees would be merely `a lot of meaningless patter’ (Santos v. WCC, 75 SCRA 371, 1977).

"As pointed out by no less than the respondent ECC itself in its Comment dated January 5, 1978 —

‘It may not be amiss to mention that the ECC has time and again expanded the list of occupational diseases. This comes about after continuing studies made by the ECC. Indeed, cancer has already been included as a qualified occupational disease in certain cases — . . .’

"Worth noting is the fact that the above types of cancer have no known etiology. Yet they are regarded as occupational. The clear implication is that the law merely requires a reasonable work connection (pp. 59-60, rec.)

"From the foregoing statements, 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. It is of universal acceptance that practically all kinds of cancer belong to the class of clinical diseases whose exact etiology, cause or origin, is unknown. . . . (Id., pp. 479-480)" [Emphasis supplied].

WHEREFORE, THE DECISION APPEALED FROM IS HEREBY SET ASIDE AND THE GOVERNMENT SERVICE INSURANCE SYSTEM IS HEREBY 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 FUNERAL 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.

Separate Opinions


AQUINO, J., dissenting:chanrob1es virtual 1aw library

I dissent. The disease was not work-connected. I vote for affirmance of the ECC decision.

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