Bautista vs. Elburg Shipmanagement Philippines, Inc. et al.

A seafarer's cardiovascular disease is compensable as an occupational disease under Section 32-A(11)(c) of the 2000 POEA-SEC when he was apparently asymptomatic before being subjected to the strain of work, showed signs and symptoms of cardiac injury during the performance of his work, and such signs and symptoms persisted; this creates a disputable presumption of compensability that the employer must overcome with countervailing evidence. It is enough that the seafarer's employment contributed, even in a small degree, to the development of the disease.

Jose Rudy L. Bautista was engaged by Elburg Shipmanagement Philippines, Inc., for its foreign principal Augustea Shipmanagement Italy, as Chief Cook on board MV Lemno under a nine-month contract of employment. Their relations were governed by the 2000 POEA-SEC, which is deemed incorporated in every seafarer's contract, and by a Collective Bargaining Agreement covering officer disability benefits. The Labor Code, in relation to the rules implementing Title II, Book IV, and Section 32-A of the POEA-SEC, provides the framework for compensability of work-related illnesses and lists cardiovascular disease as an occupational disease under specified conditions.

On August 7, 2008, Jose Rudy L. Bautista entered into a nine-month Contract of Employment with Elburg Shipmanagement Philippines, Inc., on behalf of its foreign principal Augustea Shipmanagement Italy, as Chief Cook on board the vessel "MV Lemno." Before embarkation, he underwent a Pre-Employment Medical Examination and was certified fit for sea duty by the company-designated physician. He boarded the vessel on August 14, 2008.

During his employment, Bautista complained of breathing difficulty, weakness, severe fatigue, dizziness, and grogginess. Upon referral to a portside hospital, he was suspected to have "thoracic aneurysm" and was recommended for medical repatriation. Following repatriation on May 8, 2009, he was referred to Elburg's designated physicians at the Metropolitan Medical Center for further evaluation and treatment. After several tests, he was diagnosed with "Hypertensive Cardiovascular Disease" and "Diabetes Mellitus II," while thoracic aneurysm was eventually ruled out.

On September 4, 2009, the company-designated physician, Dr. Melissa Co Sia, issued a working impression that Bautista was suffering from "Hypertension," "Dyslipidemia," and "Chronic Obstructive Pulmonary Disease," declaring that he would be cleared to return to his duties as a seafarer once his blood pressure and lipid levels stabilized. On September 16, 2009, Bautista filed a complaint against Augustea, Elburg, and Elburg's President, Captain Antonio S. Nombrado, seeking disability benefits applicable to officers amounting to US$118,800.00 under their Collective Bargaining Agreement, as well as damages and attorney's fees. He alleged that his illnesses were occupational diseases developed, enhanced, and aggravated by the nature of his work and the jobsite environment, and that he was unable to return to work within 120 days, rendering his disability permanent and total.

Respondents maintained that Bautista's Diabetes Mellitus II was familial or genetic and not work-connected, and that his Hypertensive Cardiovascular Disease was a mere complication thereof and thus also not work-related. Bautista thereafter submitted the January 6, 2010 medical certificate and evaluation of his own physician, Dr. Efren R. Vicaldo, who opined that his illnesses—"Hypertensive atherosclerotic cardiovascular disease" and "Diabetes mellitus"—rendered him unfit to work as a seaman in any capacity and were work-related or aggravated. These documents were attached only in Bautista's reply during the proceedings before the Labor Arbiter.

The Labor Arbiter found that Bautista's condition was contracted during the term of his contract, gave more credence to Dr. Vicaldo's medical certificate, and upheld the presumption of incapacity because the ailment subsisted for more than 120 days. The NLRC found that while Diabetes Mellitus II was not an occupational disease, the diagnosis included Hypertensive Cardiovascular Disease, which is listed under Section 32-A of the POEA-SEC; that the medical reports did not state that Bautista suffered from Diabetes Mellitus II with Hypertensive Cardiovascular Disease; and that absent any showing of a pre-existing illness, the reasonable presumption was that he obtained his illnesses during employment and that they were aggravated by his work as Chief Cook. The Court of Appeals found that Bautista failed to prove through substantial evidence that his Hypertension and Cardiovascular Disease were suffered during the effectivity of his employment or connected to his work as Chief Cook, gave no probative weight to Dr. Vicaldo's evaluation because he attended to Bautista only once, conducted no medical tests, limited himself to a medical history review and physical examination, and was consulted four months after the complaint was filed. It was not disputed that from the time of his repatriation until the filing of the present petition, Bautista was not able to return to his customary work.

• Occupational Disease: Petitioner argued that his illnesses were occupational diseases because they were developed, enhanced, and aggravated by the nature of his work and the environment at the jobsite.
• Permanent and Total Disability: Petitioner maintained that he was unable to return to work within 120 days, rendering his disability permanent and total, and sought US$118,800.00 in disability benefits applicable to officers under the CBA, plus damages and attorney's fees.
• Medical Evidence: Petitioner relied on the January 6, 2010 medical certificate and evaluation of Dr. Efren R. Vicaldo, who opined that his illnesses—"Hypertensive atherosclerotic cardiovascular disease" and "Diabetes mellitus"—rendered him unfit to work as a seaman in any capacity and were work-related or aggravated.

• Diabetes Mellitus II: Respondents maintained that petitioner's Diabetes Mellitus II was familial or genetic in nature and thus not work-connected.
• Hypertensive Cardiovascular Disease: Respondents averred that petitioner's Hypertensive Cardiovascular Disease was a mere complication of his Diabetes Mellitus II and, as such, was also not work-related.

• Grave Abuse of Discretion: Whether the CA correctly ruled that the NLRC committed grave abuse of discretion in granting petitioner's claim for total and permanent disability benefits.
• Occupational Disease — Cardiovascular Disease: Whether petitioner's Hypertensive Cardiovascular Disease is compensable as an occupational disease under Section 32-A(11)(c) of the 2000 POEA-SEC.
• Presumption of Compensability: Whether respondents overcame the disputable presumption of compensability in favor of petitioner.

• Grave Abuse of Discretion: No. The CA incorrectly ruled that the NLRC committed grave abuse of discretion; the NLRC's award of total and permanent disability benefits was supported by substantial evidence.
• Occupational Disease — Cardiovascular Disease: Yes. Section 32-A(11)(c) of the 2000 POEA-SEC considers Cardiovascular Disease an occupational disease where an asymptomatic seafarer showed signs and symptoms of cardiac injury during work and they persisted.
• Presumption of Compensability: No. Respondents' bare assertion that the disease was a complication of Diabetes Mellitus II did not overcome the disputable presumption; the burden rested on the employer.

• Grave Abuse of Discretion: The CA's grant of certiorari was reversible error because the NLRC's award of total and permanent disability benefits was amply supported by substantial evidence. Entitlement of overseas seafarers to disability benefits is governed not only by medical findings but also by law and contract. The applicable framework includes Articles 197 to 199 of the Labor Code in relation to Section 2, Rule X of the Rules implementing Title II, Book IV, and the 2000 POEA-SEC, the CBA, and the employment agreement. Since the employment contract was executed on August 7, 2008, the 2000 POEA-SEC governed. Under Section 20(B)(6), two elements must concur: the injury or illness must be work-related, and it must have existed during the term of the seafarer's employment contract. The NLRC's conclusion that these elements were satisfied was supported by the records, so no grave abuse of discretion attended its award.

• Occupational Disease — Cardiovascular Disease: Section 20(B)(6) and the definition of work-related illness require that the sickness result in disability or death as a result of an occupational disease listed under Section 32-A with the conditions therein satisfied. Section 32-A(11) expressly considers Cardiovascular Disease as an occupational disease if contracted under any of three instances: (a) if the heart disease was known to have been present during employment, proof that an acute exacerbation was clearly precipitated by unusual strain by reason of the nature of work; (b) if the strain of work bringing about an acute attack was of sufficient severity and was followed within 24 hours by clinical signs of cardiac insult to constitute causal relationship; or (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 work and such symptoms and signs persisted, it is reasonable to claim a causal relationship. Petitioner was apparently asymptomatic before deployment; he manifested no signs or symptoms of cardiac injury prior to boarding MV Lemno and was declared fit for sea duty after his PEME. During his duties as Chief Cook, he complained of breathing difficulty, weakness, severe fatigue, dizziness, and grogginess, necessitating portside medical intervention and repatriation. Shortly after repatriation, he was diagnosed with Hypertensive Cardiovascular Disease, a heart condition caused by high blood pressure, and this diagnosis was recognized by both the company-designated doctors and his own physician and was well-documented. Because there was no showing of a pre-existing cardiovascular ailment prior to embarkation, the reasonable presumption was that he acquired the disease in the course of his employment under Section 32-A(11)(c), which recognizes a causal relationship between a seafarer's CVD and his job and qualifies it as an occupational disease.

• Presumption of Compensability: Section 32-A(11)(c) establishes in favor of the seafarer a presumption of compensability. A party in whose favor a legal presumption exists may rely on and invoke it to establish a fact in issue, and the effect of the presumption upon the burden of proof is to create the need of presenting evidence to overcome the prima facie case created; if no contrary proof is offered, the presumption prevails. Respondents offered only a bare and self-serving assertion that petitioner's Hypertensive Cardiovascular Disease was a mere complication of his Diabetes Mellitus II; no countervailing evidence was introduced to overcome the disputable presumption. It was not required that petitioner's employment as Chief Cook be the sole factor in the development of his hypertensive cardiovascular disease; it sufficed that his employment contributed even in a small degree to its development. The nature of his work as Chief Cook exposed him to constant temperature changes, stress, and physical strain, so it was safe to presume that his employment at least contributed to the aggravation of his illness. The diagnosis of Diabetes Mellitus II did not defeat compensability because the incidence of a listed occupational disease, whether or not associated with a non-listed ailment, is enough basis for compensation. Section 20(B)(4) of the 2000 POEA-SEC likewise establishes a disputable presumption of compensability in favor of the seafarer and places the burden on the employer to overcome it, which respondents failed to discharge. It was not disputed that from repatriation until the filing of the petition, petitioner was unable to return to his customary work.

• Compensability of work-related illness under the 2000 POEA-SEC — For an injury or illness to be compensable under Section 20(B)(6) of the 2000 POEA-SEC, two elements must concur: (1) the injury or illness must be work-related; and (2) the work-related injury or illness must have existed during the term of the seafarer's employment contract. A "work-related illness" is any sickness resulting in disability or death as a result of an occupational disease listed under Section 32-A of the contract, with the conditions set therein satisfied. In this case, these requisites were applied to petitioner's Hypertensive Cardiovascular Disease and found satisfied.

• Cardiovascular Disease as an occupational disease under Section 32-A(11) — Section 32-A(11) of the 2000 POEA-SEC considers Cardiovascular Disease an occupational disease if contracted under any of three instances: (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 unusual strain by reason of the nature of the work; (b) the strain of work bringing about an acute attack must be of sufficient severity and must be followed within 24 hours by clinical signs of cardiac insult to constitute causal relationship; or (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 work and such symptoms and signs persisted, it is reasonable to claim a causal relationship. Petitioner's case fell within the third instance because he was asymptomatic before deployment, showed symptoms during work, and was diagnosed with Hypertensive Cardiovascular Disease shortly after repatriation.

• Disputable presumption of compensability — Section 32-A(11)(c) establishes in favor of the seafarer a presumption of compensability of his cardiovascular disease. A party in whose favor a legal presumption exists may rely on and invoke it to establish a fact in issue; the effect of the presumption is to create the need of presenting evidence to overcome the prima facie case created, and if no contrary proof is offered, the presumption prevails. The employer's bare assertion that the disease was a complication of Diabetes Mellitus II did not overcome the presumption.

• Contribution, not sole causation — It is not required that the seafarer's employment be the sole factor in the development of his hypertensive cardiovascular disease; it suffices that the employment contributed, even in a small degree, to the development of the disease. Petitioner's exposure as Chief Cook to constant temperature changes, stress, and physical strain supported the presumption that his employment at least contributed to the aggravation of his illness.

• Concurrence of a listed occupational disease with a non-listed ailment — The incidence of a listed occupational disease, whether or not associated with a non-listed ailment, is enough basis for compensation. Petitioner's diagnosis of Diabetes Mellitus II, a non-listed ailment, did not negate the compensability of his Hypertensive Cardiovascular Disease.

• Employer's burden under Section 20(B)(4) — Section 20(B)(4) of the 2000 POEA-SEC establishes a disputable presumption of compensability in favor of the seafarer and places the burden on the employer to overcome the statutory presumption. Respondents failed to discharge this burden.

• "Consequently, for CVD to constitute as an occupational disease for which the seafarer may claim compensation, it is incumbent upon said seafarer to show that he developed the same under any of the three conditions identified above." — This states the threshold requirement for cardiovascular disease compensability under Section 32-A(11) of the 2000 POEA-SEC.

• "Thus, absent any showing that petitioner had a pre-existing cardiovascular ailment prior to his embarkation, the reasonable presumption is that he acquired his hypertensive cardiovascular disease in the course of his employment pursuant to Section 32-A (11) (c) of the 2000 POEA-SEC, which recognizes a "causal relationship" between a seafarer's CVD and his job, and qualifies his CVD as an occupational disease." — This is the ratio decidendi applying the third instance of Section 32-A(11) to the petitioner's case.

• "Verily, it is not required that the employment of petitioner as Chief Cook should be the sole factor in the development of his hypertensive cardiovascular disease so as to entitle him to claim the benefits provided therefor. It suffices that his employment as such had contributed, even in a small degree, to the development of the disease." — This defines the causation standard for compensability of a seafarer's occupational disease.

• "The fact that petitioner was also diagnosed as having Diabetes Mellitus II was of no moment since the incidence of a listed occupational disease, whether or not associated with a non-listed ailment, is enough basis for compensation, although modern medicine has in fact recognized that diabetes, heart complications, hypertension and even kidney disorders are all inter-related diseases." — This explains why the presence of a non-listed ailment did not defeat the compensability of the listed occupational disease.

• Jebsen Maritime Inc. vs. Ravena, G.R. No. 200566, September 17, 2014, 735 SCRA 494, 507 — Cited for the rule that the entitlement of overseas seafarers to disability benefits is governed not only by medical findings but also by law and contract, and for the applicable statutory and contractual framework.
• Magsaysay Maritime Services vs. Laurel, G.R. No. 195518, March 20, 2013, 694 SCRA 225, 238, 244, 245 — Cited for the two elements of compensability, for the rule that employment need only contribute even in a small degree to the development of the disease, and for the employer's burden to overcome the presumption of compensability.
• Nisda vs. Sea Serve Maritime Agency, 611 Phil. 291, 317 (2009) — Cited with Magsaysay Maritime Services vs. Laurel for the two elements required for an injury or illness to be compensable.
• Jebsens Maritime, Inc. vs. Undag, 678 Phil. 938, 946 (2011) — Cited for the requirement that, for cardiovascular disease to be considered an occupational disease, the seafarer must show that he developed it under any of the three conditions in Section 32-A(11).
• Leviste vs. Social Security System (Solid Mills, Inc.), 564 Phil. 110, 117 (2007) — Cited for the definition of "asymptomatic" as symptomless and presenting no subjective evidence of disease.
• Angeles vs. Angeles-Maglaya, 506 Phil. 347, 356 (2005) — Cited for the rule that a party in whose favor a legal presumption exists may rely on and invoke such presumption to establish a fact in issue.
• Lastrilla vs. Granda, 516 Phil. 667, 686 (2006) — Cited for the effect of a presumption upon the burden of proof, which creates the need to present evidence to overcome the prima facie case created.
• Government Service Insurance System vs. Villareal, 549 Phil. 504, 510 (2007) — Cited for the principle that the incidence of a listed occupational disease, whether or not associated with a non-listed ailment, is enough basis for compensation, and that diabetes, heart complications, hypertension, and kidney disorders are inter-related diseases.

• Articles 197 to 199, Labor Code — Cited as the statutory provisions governing entitlement to disability benefits, in relation to Section 2, Rule X of the Rules implementing Title II, Book IV. Article 198(c)(1) deems temporary total disability lasting continuously for more than 120 days as total and permanent, except as otherwise provided in the Rules.
• Section 2, Rule X, Rules Implementing Title II, Book IV, Labor Code — Cited for the period of entitlement to temporary total disability income benefit, including the 120-day and 240-day periods and the System's authority to declare total and permanent status after 120 days of continuous temporary total disability.
• Section 20(B)(6), 2000 POEA-SEC — Provides that the employer is liable when the seafarer suffers a work-related injury or illness during the term of his contract, and that permanent total or partial disability caused by injury or illness is compensated according to the schedule of benefits. The Court used it to derive the two elements of compensability.
• Section 32-A, 2000 POEA-SEC — Lists occupational diseases and the conditions for compensability. Section 32-A(11) specifically treats Cardiovascular Disease as an occupational disease under any of three instances, including the third instance applied to petitioner.
• Section 20(B)(4), 2000 POEA-SEC — Establishes a disputable presumption that illnesses not listed in Section 32 are work-related; the Court cited it as establishing a disputable presumption of compensability in favor of the seafarer and placing the burden on the employer to overcome it.

Sereno, C.J. (Chairperson), Leonardo-De Castro, Bersamin, and Perez, JJ., concur.