THIRD DIVISION
|
GOVERNMENT
SERVICE INSURANCE SYSTEM (GSIS), Petitioner, -
versus - EMMANUEL P. CUNTAPAY,
Respondent. |
G.R.
No. 168862 Present: YNARES-SANTIAGO, J., Chairperson, AUSTRIA-MARTINEZ, CHICO-NAZARIO, NACHURA, and REYES, JJ. Promulgated: April 30, 2008 |
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DECISION
NACHURA, J.:
This petition for review stems from the Court of
Appeals’ Decision[1] dated May 17, 2005, and
Resolution dated July 8, 2005, which granted the respondent’s claim for
compensation under Presidential Decree (P.D.) No. 626, as amended, or the
Employees’ Compensation Law.
Respondent Emmanuel P. Cuntapay entered the government
service on
promoted on
(1)
Supervises, coordinates, and provides direction and work assignments in the
Division;
(2)
Does final review and checking of
projects/papers from the Division prior to [submission] to higher authorities;
(3)
Provides direction in the formulation of architectural
design guidelines and standards, architectural/sanitary design specifications,
terms of reference and other pertinent documents for architectural and related
engineering design services;
(4)
Confers/meets with representative of using
agencies regarding the project requirements for the architectural and
engineering design services;
(5)
Prepares and recommends action on cases referred
to the Division regarding the implementation of the National Building Code
(NBC);
(6)
Participates in the deliberation in the
formulation and information dissemination of the implementing rules and
regulations of the NBC; and,
(7) Performs such other duties and functions that may be assigned from time to time.[2]
Aside from being the Chief of the Architectural
Division of the Bureau of Design, the respondent was also designated Overall
Head of the Technical Staff of the National Building Code Development Office
(NBCDO) in a concurrent capacity. In addition, he was designated Representative
to the National Steering Committee for the National Urban Development and
Housing Framework 1999-2004, and Alternate Representative to the National
Council for the Welfare of Disabled Persons Board.[3]
On
Dr.
Jose G. Abad-Santos, the respondent’s attending physician, diagnosed his
illness as acute myocardial infarction. The respondent then underwent
“aortocoronary bypass” operation. He was discharged from the hospital on P411,127.00 for his hospital bills and other
medical expenses.
Consequently, the respondent filed with the petitioner
Government Service Insurance System (GSIS) a claim for compensation benefits
under Presidential Decree (P.D.) No. 626, as amended. However, in a letter
dated
Upon denial of his request for reconsideration by the
GSIS, the respondent interposed an appeal with the Employees’ Compensation Commission
(ECC).
In its
A circumspect review of the records however failed to show
any causal link between his present occupation and his ailment. As explained
medically, the development of IHD or otherwise termed as CAD is caused by
atherosclerosis, the hardening of the inner lining of arteries. Smoking,
hypertension, diet and diabetes are factors that cause atherosclerosis.
Based on the etiology established by medical science, hypertension is the sole risk factor in the development of CAD to be considered as work-related. Under Annex A of the Implementing Rules on Employees’ Compensation, hypertension is compensable provided it causes end-organ damage to the heart, eyes, brain or kidneys and is substantiated by diagnostic and laboratory test results. As regard (sic) appellant’s case, however, nowhere in the records is there a showing that he has a history of hypertension that could predispose him to contract his cardiovascular disease.[7]
On appeal, the CA reversed the decision of the ECC,
thus:
UPON THE VIEW WE TAKE OF THIS CASE, THUS,
the petition for review is GRANTED. The
SO ORDERED.[8]
In so ruling, the appellate court stressed that the
law only requires a reasonable work connection and not direct causal connection,
and that it is enough that the hypothesis on which the claim is based is
probable. It then held that the probability existed that the respondent’s
illness was due to work-related stress considering his assigned duties at that
time.[9]
On
Thus, this petition raising the following issues:
I. WHETHER OR NOT PETITIONER’S AILMENT — CORONARY ARTERY DISEASE (CAD), S/P, MYOCARDIAL INFARCTION —MAY BE CONSIDERED WORK-CONNECTED.
II. WHETHER OR NOT RESPONDENT HAS PRESENTED POSITIVE PROOF, THROUGH A REAL AND SUBSTANTIAL EVIDENCE, THAT THE NATURE OF HIS WORK AND HIS WORKING CONDITIONS AS ARCHITECT V HAS (sic) INCREASED THE RISK OF CONTRACTING HIS CLAIMED AILMENT.[11]
The petition is meritorious.
For a sickness to be
compensable, the claimant must prove either (1) that the sickness is the result of an
occupational disease listed under the Rules on Employees’ Compensation and the
conditions set therein are satisfied; or (2) that the risk of contracting the
disease was increased by the claimant’s working condition.[12]
ECC Resolution No. 432
dated
(a) 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/her work.
(b) 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 [injury] to
constitute causal relationship.
(c) If a person who was
apparently asymptomatic before being subjected to strain at work showed signs
and symptoms of cardiac injury during the performance of his/[her] work and
such symptoms and signs persisted, it is reasonable to claim a causal
relationship.
In a number of cases,[13]
the Court already declared that myocardial infarction is included in this
category. Myocardial infarction is the clinical term for a heart attack. It is caused by
occlusion (blockage) of the coronary artery
(atherosclerosis) or a blood
clot (coronary thrombosis), resulting in the partial or total blockage of one
of the coronary arteries. When this occurs, the heart muscle (myocardium) does
not receive enough oxygen.[14]
The petitioner argues, on one
hand, that the respondent’s case does not fall under any of the three instances
enumerated in ECC Resolution No. 432 because there was no showing that he was
suffering from a heart disease, or that the strain of work prior to the 24-hour
period of time when he suffered the heart attack was of sufficient severity, or
that he was asymptomatic to the subject ailment.[15]
On the other hand, the respondent avers that the circumstances of his illness
satisfy the conditions under paragraphs (b) and (c) of ECC Resolution No. 432.[16]
He points out that the allegation that he has no history of hypertension is
belied by the clinical abstract which shows that prior to his confinement he
experienced three episodes of chest pain.[17]
We agree with the
petitioner, considering that there was, indeed, no proof that any of said
conditions has been satisfied. In particular, there was no evidence to show that
respondent was previously diagnosed with a heart ailment or that he was under a
severe strain of work sufficient to have caused the heart attack since a board
meeting could hardly inflict such a severe strain. Moreover, from the evidence
at hand, we cannot safely conclude that the respondent’s case falls under
paragraph (c). While it is true that the clinical abstract showed that on the
day prior to the incident respondent experienced three episodes of chest pains,
this alone would not satisfy the requirements of paragraph (c), more specifically
the condition that the claimant must have shown signs and symptoms of cardiac
injury during the performance of his work
and such symptoms and signs persisted.
To successfully recover compensation for his heart
ailment, the respondent must therefore prove, through substantial evidence,
that the risk of contracting the disease was increased by the nature of his work
and working conditions. Thus, the respondent posits that the underlying cause of his illness is stress
caused by the performance of his numerous duties as Chief of the Architectural
Division of the Bureau of Design and as representative to different committees.
To show how stressful his work was, he submitted in evidence minutes of the
meetings that he attended since January 2000. The petitioner disputes this allegation on the
ground that, based on respondent’s diagnostic test result which showed that he
had a high cholesterol level, the cause of the heart attack was
hypercholesterolemia — the main cause of atherosclerosis resulting in coronary artery
disease and myocardial infarction.[18]
Six primary risk factors
have been identified with the development of atherosclerotic coronary artery
disease and myocardial infarction: hyperlipidemia or high blood cholesterol,
diabetes mellitus, hypertension or high blood pressure, smoking, male gender,
and family history of atherosclerotic arterial disease.[19]
In Government
Service Insurance System v. Cuanang,[20]
while the Court recognized stress as one of the predisposing factors of
myocardial infarction, it also noted that “stress appears to be associated with
elevated blood pressure.” The ECC, for its part, does not seem to treat stress
as a separate risk factor for myocardial infarction. In fact, in its decision,
it stated that hypertension is the sole risk factor in the development of a
coronary artery disease that is considered work-related.[21]
Some references,[22]
however, include stress as a risk factor, distinct from hypertension. [23]
Noticeably, the
record is devoid of any medical information on the cause of respondent’s acute
myocardial infarction which could help the Court determine whether there was a
causal link between the respondent’s allegedly stressful work and his ailment. A physician’s report would have
been the best evidence of work-connection of workmen’s ailments.[24] Medical evidence is particularly
vital where the causal connection is not clearly apparent to an ordinary person[25] or readily observable or
discoverable without medical examination[26] for
it is not our task to determine where the connection lies.
The claimant must show, at least, by substantial evidence
that the development of the disease was brought about largely by the conditions
present in the nature of the job. What the law requires is a reasonable work connection and not a direct causal relation. It is enough
that the hypothesis on which the workmen’s claim is based is probable.[27] Probability, not the ultimate degree of certainty, is the test of proof in
compensation proceedings.[28]
And probability must be reasonable;[29] hence,
it should, at least, be anchored on credible
information. Moreover, a mere possibility will not suffice; a claim will fail
if there is only a possibility that the employment caused the disease.[30]
The absence of any medical information stating that
the respondent’s illness could have been caused by stress and not by any other
factor reduces the respondent’s claim of work connection to a mere possibility.
Such deficiency restrains the Court from concluding that the respondent’s
illness is compensable. Contrarily, in Cuanang,
the expert opinion of a physician was presented in evidence and it was specifically
stated therein that the employee’s acute myocardial infarction could be the
consequence of her chronic hypertension vis-à-vis
her rheumatic heart disease. This expert opinion, together with the information
that stress appears to be associated with elevated blood pressure, provided the
Court with the link that tied the employee’s sickness to her work as a teacher.
Finally, we reiterate here that, with prudence and
judicial restraint, a tribunal’s zeal in bestowing compassion should yield to
the precept in administrative law that absent a showing of grave abuse of discretion, courts are loathe to interfere with and should
respect the findings of quasi-judicial agencies in fields where they are deemed
and held to be experts due to their special technical knowledge and training.[31] Compassion for the
victims of diseases not covered by the law ignores the need to show a greater
concern for the trust fund to which the tens and millions of workers and their
families look for compensation whenever covered accidents, diseases and deaths
occur.[32]
WHEREFORE, premises considered, the petition is GRANTED. The Decision of the
Court of Appeals in CA-G.R. SP No. 88038 dated May 17, 2005, and Resolution
dated July 8, 2005 are REVERSED and SET ASIDE. The Decision of the
Employees’ Compensation Commission dated
SO ORDERED.
ANTONIO EDUARDO
B. NACHURA
Associate
Justice
WE
CONCUR:
CONSUELO YNARES-SANTIAGO
Associate
Justice
Chairperson
|
MA. ALICIA AUSTRIA-MARTINEZ Associate
Justice |
MINITA V. CHICO-NAZARIO Associate
Justice |
RUBEN T. REYES
Associate
Justice
A T T E S T A T I O N
I
attest that the conclusions in the above Decision had been reached in
consultation before the case was assigned to the writer of the opinion of the
Court’s Division.
CONSUELO
YNARES-SANTIAGO
Associate
Justice
Chairperson,
Third Division
C E R T I F I C A T I O N
Pursuant to Section 13,
Article VIII of the Constitution and the Division Chairperson's Attestation, I
certify that the conclusions in the above decision had been reached in
consultation before the case was assigned to the writer of the opinion of the
Court’s Division.
REYNATO
S. PUNO
Chief
Justice
[1] Penned by Associate Justice Renato C. Dacudao, with Associate Justices Noel G. Tijam and Jose C. Reyes, Jr. concurring; rollo, pp. 33-42.
[2] Rollo, p. 126.
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12] Limbo v. Employees’ Compensation Commission, 434 Phil. 703, 706 (2002).
[13] Government Service Insurance System v. Villareal, G.R. No. 170743, April 12, 2007, 520 SCRA 741; Rañises v. Employees’ Compensation Commission, G.R. No. 141709, August 16, 2005, 467 SCRA 71; Government Service Insurance System v. Cuanang, G.R. No. 158846, June 3, 2004, 430 SCRA 639; Obra v. Social Security System, 449 Phil. 200 (2003).
[15] Rollo, pp. 262-263.
[16]
[17]
[18] Rollo, pp. 261-266.
[19] Christopher T. Bajzer, M.D., Acute Myocardial Infarction,
[20] Supra note 13.
[21] Rollo, p. 47.
[22] See Heart Attack (Myocardial
Infarction) <http://www.nyp.org/health/heart-attack.html> (visited
[23] “Medical researchers are n[o]t
sure exactly how stress increases the risk of heart disease. Stress itself might
be a risk factor, or it could be that high levels of stress make other risk
factors (such as high cholesterol or high blood pressure) worse. For example,
if you are under stress, your blood pressure goes up, you may overeat, you may
exercise less and you may be more likely to smoke.
“If stress itself is a risk factor for heart disease, it
could be because chronic stress exposes your body to unhealthy, persistently
elevated levels of stress hormones like adrenaline and cortisol. Studies also
link stress to changes in the way blood clots, which increases the risk of
heart attack.” (Hypertension: Easing Stress <http://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-easing-stress>)
[24] Limbo
v. Employees’ Compensation Commission, G.R. No. 146891,
[25]
[26] Scotty’s Inc. v. Jones, 393 So.2d 657, 659 (1981).
[27] Salmone v. Employees’ Compensation Commission, 395 Phil. 341, 347 (2000).
[28] Government Service Insurance System v. Baul, G. R. No. 166556, July 31, 2006, 497 SCRA 397, 404.
[29] Dowell
v. Ochsner Clinic of
[30]
[31] Government
Service Insurance System v. Fontanares, G.R. No. 149571,
[32] Government
Service Insurance System v. Court of Appeals, 357 Phil. 511, 529 (1998).