Ledesma vs. C.F. Sharp Crew Management, Inc., et al.

A seafarer claiming disability benefits must prove by substantial evidence that the illness is work-related or work-aggravated; mere diagnosis or inclusion in the Sec. 32-A list of occupational diseases does not ipso facto entitle the seafarer to total and permanent disability benefits. A seafarer's letter-request for a third doctor that states his chosen physician's contrary assessment of fitness to work or disability rating sufficiently initiates the third-doctor process even without attaching the medical certificate; if the employer fails to act, labor tribunals and courts may resolve the conflicting medical opinions based on the totality of evidence.

Raegar B. Ledesma was engaged as Chief Fireman by C.F. Sharp Crew Management, Inc., for and on behalf of its principal Prestige Cruise Services, LLC/Prestige Cruise Holdings, Inc., under a seven-month employment contract governed by the 2010 POEA-SEC. The POEA-SEC governs the disability benefits of Filipino seafarers, defines occupational diseases and the conditions for compensability under Sec. 32-A, creates a disputable presumption of work-relatedness for unlisted illnesses under Sec. 20(A)(4), and provides a third-doctor mechanism under Sec. 20(A)(3) when the company-designated physician and the seafarer's chosen physician disagree.

On September 15, 2014, Raegar B. Ledesma signed a seven-month employment contract under the POEA-SEC with C.F. Sharp Crew Management, Inc., for and on behalf of its principal Prestige Cruise Services, LLC/Prestige Cruise Holdings, Inc., to serve as Chief Fireman on M/V Regatta. His duties included serving as firefighting team leader, maintaining firefighting equipment, responding to medical emergencies, preparing fire drills and training, conducting fire prevention familiarization, ensuring fire-extinguishing appliances were operational, evaluating fire hazards, and conducting crew cabin inspections. Before deployment, he underwent a pre-employment medical examination and was declared fit for sea duty; he boarded the vessel on September 17, 2014.

Sometime in March 2015, Ledesma experienced drowsiness, lightheadedness, easy fatigability, shortness of breath, clogged nose, and sore throat, and his crewmates reported loud snoring. The ship doctor diagnosed obstructive sleep apnea, hypertension, and probable congestive heart failure and gave medications. On April 7, 2015, at a port in South Miami, Florida, he was sent to South Miami Hospital, where after evaluation and laboratory tests he was diagnosed with diabetes mellitus and prescribed medications; he was then repatriated for medical reasons.

Upon arrival in the Philippines on April 13, 2015, Ledesma reported to company-designated physician Dr. Esther G. Go of Marine Medical Services. He was found to have diabetes mellitus, hypertension, and chronic tonsillitis with features of obstructive sleep apnea; he was recommended for bilateral tonsillectomy and prescribed medications. He was endorsed to another company-designated physician at Cardinal Santos Medical Center, where he underwent bilateral tonsillectomy via Ellman radiofrequency and closure of pillars and oropharynx. After a sleep study, he was confirmed to have severe obstructive sleep apnea-hypoapnea syndrome and REM-related parasomnia; he was recommended for CPAP therapy, provided a CPAP machine, and advised to continue medications, exercise, and avoid caffeine, tobacco, alcohol, and large meals near bedtime.

On July 31, 2015, Dr. Go issued a Final Medical Report clearing Ledesma from a diabetologic standpoint, advising continued maintenance medications and CPAP use. The report stated that the specialist opined he had reached maximum medical improvement and was not unfit for further sea duties due to risk of apneic episode and cardiac arrhythmia for obstructive sleep apnea; if entitled to disability, his suggested grading was Grade 12 – slight residual or disorder. On August 6, 2015, Dr. Go issued another Medical Report stating that diabetes mellitus is usually familial or hereditary, obstructive sleep apnea is caused by airway obstruction with risk factors including overweight/obesity, small receding jaw, and short neck, and chronic tonsillitis is a recurrent infection that can aggravate obstructive sleep apnea; she opined these conditions were neither work-related nor work-aggravated, and that hypertension is multifactorial and not work-related, though it could be work-aggravated if work involved strenuous or extraordinary activities that increase blood pressure.

Dissatisfied, Ledesma consulted private cardiologist Dr. May S. Donato-Tan. On September 10, 2015, Dr. Donato-Tan issued a Medical Certificate stating that Ledesma still felt drowsy after waking, had shortness of breath, somnolence, loud snoring, and erratic blood pressure despite Amlodipine, and declared him permanently disabled as he could not perform his job effectively, efficiently, and productively as a seaman. On September 15, 2015, Ledesma's counsel, Atty. Simplicio B. Bermejo, Jr., wrote C.F. Sharp Crew Management, Inc. that an independent medical expert had declared Ledesma totally and permanently unfit for sea duties, invited a third medical opinion, and requested a copy of his final medical assessment and medical records under Sec. 20(F) of the POEA-SEC.

The demand letter went unheeded, and Ledesma filed a complaint before the PVA for total and permanent disability compensation, moral and exemplary damages, and attorney's fees. Mandatory conferences were held without settlement, and the parties filed their position papers, reply, and rejoinder. The PVA found for Ledesma, while the CA reversed; the CA emphasized that Dr. Go had examined Ledesma 19 times, declared him fit to resume work within 120 days, and that the conflicting medical opinions were never referred to a third doctor.

• Work-Relatedness and Work-Aggravation: Petitioner argued that his illnesses were work-related or at least work-aggravated, and that the company-designated physician failed to make a full, complete, and final categorical assessment of his condition.
• Fitness to Work: Petitioner maintained that he remained unfit to work despite continued suffering from his illnesses.
• Third-Doctor Referral: Petitioner faulted the CA for penalizing him for respondents' refusal to avail of the conflict-resolution provision under the POEA-SEC and the collective bargaining agreement on referral to a third medical opinion.
• Hypertension and Diet: Petitioner asserted that his hypertension was work-related because the company-designated physician herself identified high salt intake and poor lifestyle as risk factors, and that he was more vulnerable to an unhealthy diet aboard the vessel due to unlimited food servings and lack of control over food choices consisting mostly of high dietary meat and fat.
• Chronic Tonsillitis: Petitioner insisted that his chronic tonsillitis, described as recurrent infection leading to hypertrophic tonsils, was compensable under Sec. 32-A, paragraph 6 of the POEA-SEC on "infections resulting in complications necessitating repatriation."
• Probable Congestive Heart Failure: Petitioner claimed that the company-designated physician failed to give medical assessment and treatment to his probable congestive heart failure even after 240 days.
• Third Medical Opinion: Petitioner argued that respondents ignored his demand for a third doctor despite his chosen physician's declaration of permanent disability.

• Non-Disclosure of Contrary Assessment: Respondents countered that petitioner failed to duly and fully disclose the contrary assessment of his chosen physician by attaching the same to his demand letter before filing the complaint.

• Work-Relatedness/Work-Aggravation: Whether petitioner proved by substantial evidence that his hypertension, diabetes mellitus, chronic tonsillitis, obstructive sleep apnea, and probable congestive heart failure were work-related or work-aggravated.
• Hypertension and Diabetes: Whether hypertension and diabetes ipso facto warrant permanent and total disability benefits.
• Chronic Tonsillitis: Whether chronic tonsillitis is compensable as an "infection resulting in complications necessitating repatriation" under Sec. 32-A of the POEA-SEC.
• Probable Congestive Heart Failure: Whether probable congestive heart failure was treated and assessed with finality by the company-designated physician.
• Third-Doctor Referral: Whether petitioner's demand letter, without attaching his chosen physician's medical certificate, sufficiently set in motion the third-doctor referral process under Sec. 20(A)(3) of the POEA-SEC, and whether the labor tribunals and courts may resolve conflicting medical opinions when the employer fails to act.
• Fitness to Work / Final Assessment: Whether the company-designated physician's July 31, 2015 Medical Certificate was a full, complete, and categorical assessment of petitioner's fitness to work despite the suggested Grade 12 disability rating.

• Work-Relatedness/Work-Aggravation: No. Petitioner failed to prove by substantial evidence that his illnesses were work-related or work-aggravated; mere diagnosis or inclusion in Sec. 32-A does not automatically entitle him to disability benefits.
• Hypertension and Diabetes: No. Hypertension and diabetes do not ipso facto warrant permanent and total disability benefits; hypertension requires organ impairment and resulting permanent disability, while diabetes is not listed and does not indicate work-relatedness.
• Chronic Tonsillitis: No. It is not compensable as an infection under Sec. 32-A because petitioner did not prove it was contracted under the specified risk conditions, such as work with infected animals or handling animal carcasses.
• Probable Congestive Heart Failure: No. The company-designated physician treated and assessed it with finality through referrals, diagnostics, and cardiologist evaluations; petitioner's lone medical certificate did not refute those findings.
• Third-Doctor Referral: Yes. The demand letter stating the chosen physician's contrary assessment of unfitness sufficed to set in motion the third-doctor process even without attaching the medical certificate; because respondents failed to act, the Court may resolve the conflicting opinions on the totality of evidence.
• Fitness to Work / Final Assessment: Yes. The July 31, 2015 Medical Certificate, issued on the 107th day after 18 progress reports, effectively certified petitioner as fit for sea duties; the Grade 12 suggestion was a superfluity without basis under Sec. 32.

• Work-Relatedness/Work-Aggravation: Under Sec. 20(A) of the 2010 POEA-SEC, as explained in Ilustricimo vs. NYK-FIL Ship Management, Inc., compensability requires that the injury or illness be work-related and that it existed during the term of employment. A work-related illness is one resulting from an occupational disease listed under Sec. 32-A with the conditions satisfied; illnesses not listed under Sec. 32 are disputably presumed work-related under Sec. 20(A)(4), but Dionio vs. ND Shipping and Allied Services, Inc. clarifies that this presumption does not automatically grant benefits—the seafarer must still prove work-relatedness by substantial evidence. Although Ledesma was medically repatriated for hypertension, diabetes mellitus II, chronic tonsillitis, obstructive sleep apnea, and congestive heart failure, and Sec. 32-A includes heart failure, these circumstances alone do not justify an award. Ledesma failed to present substantial evidence that his illnesses were work-related or work-aggravated. His claim that unhealthy diet aboard the vessel caused his conditions was rejected under Jebsens Maritime, Inc. vs. Babol, where a similar dietary-factor theory was held insufficient absent credible proof of causal relationship; he also admitted vegetables were consumed before spoilage and frozen meat and fish were served, and did not dispute that hypertension is multifactorial. Compensation cannot rest on speculations, presumptions, and conjectures.
• Hypertension and Diabetes: In C.F. Sharp Crew Management, Inc. vs. Santos, the Court ruled that hypertension and diabetes do not ipso facto warrant permanent and total disability benefits. Essential hypertension, though listed in Sec. 32-A, requires three successive occurrences: contracting essential hypertension; organ impairment arising from it; and permanent disability arising from that impairment. Diabetes is not among the listed occupational diseases; it is a metabolic and familial disease predisposed by heredity, obesity, or old age, and does not indicate work-relatedness. Sec. 32-A also recognizes that a seafarer may still be employed with hypertension or diabetes if compliant with maintenance medications and doctor-recommended lifestyle changes. Here, Dr. Go's August 6, 2015 Medical Certificate stated the conditions were not work-related or work-aggravated, while noting hypertension could be work-aggravated only if work involved strenuous or extraordinary activities increasing blood pressure. Ledesma neither proved such work nor showed that his hypertension was grave or severe.
• Chronic Tonsillitis: Sec. 32-A, paragraph 6 of the POEA-SEC treats infections as compensable occupational diseases only when contracted under conditions involving risk of work in connection with animals infected with anthrax, handling animal carcasses or parts thereof, including hides, hoofs, and horns, Hepatitis A, Norwalk, or Salmonella. Ledesma failed to provide substantial evidence that his chronic tonsillitis was contracted while working under those risk conditions aboard M/V Regatta. His claim that it was an "infection resulting in complications necessitating repatriation" was therefore rejected.
• Probable Congestive Heart Failure: The company-designated physician's records showed that probable congestive heart failure was treated and assessed with finality. Dr. Go's July 31, 2015 Medical Certificate, issued on the 107th day of treatment, noted that cardiac diagnostic tests revealed no cardiac structural anomaly except hypertension and venous insufficiency of both lower extremities. The medical certificates detailed referrals to a cardiologist, 12-lead ECG and x-rays, treadmill stress echocardiogram, 24-hour Holter monitoring, venous duplex scan, and multiple consultations with medications and advice. By contrast, Dr. Donato-Tan's lone certificate was based on a single checkup, did not review complete medical records, and hardly mentioned probable congestive heart failure as a basis for permanent disability. The company-designated physician's findings, supported by extensive assessments, were more credible.
• Third-Doctor Referral: Sec. 20(A)(3) of the POEA-SEC provides that if the seafarer's doctor disagrees with the company-designated physician's assessment, a third doctor may be agreed jointly and the third doctor's decision is final and binding. Bahia Shipping Services, Inc. vs. Constantino held that the seafarer bears the burden to notify the company of a contradictory finding, after which the company must respond by setting in motion the third-doctor process. Carcedo vs. Maine Marine Philippines, Inc. laid down the procedure: the seafarer manifests intention to resolve the conflict by referral to a third doctor, and upon notification the company carries the burden of initiating the referral. Benhur Shipping Corporation vs. Riego clarified that the seafarer need not attach his doctor's medical report; it is enough that the letter-request indicates the seafarer's doctor's assessment of fitness to work or disability rating contrary to the company-designated physician's assessment. Here, the September 15, 2015 demand letter stated that an independent expert declared Ledesma totally and permanently unfit for sea duties, which was contrary to Dr. Go's July 31, 2015 assessment that he was "not unfit for further sea duties." Although Dr. Donato-Tan could not have refuted the company assessment because no complete medical records were available at that time, and Sec. 20(F) requires the employer to furnish records only upon request, the demand letter sufficiently disclosed the contrary assessment. Respondents failed to respond, so the Court was constrained to resolve the conflicting findings. Under Benhur Shipping Corporation, when the employer fails to act on a valid request for referral to a third doctor, labor tribunals and courts are empowered to assess the conflicting medical opinions based on the totality of evidence. The employer cannot insist on the conclusiveness of the company-designated physician's opinion when its own disregard prevented the third-doctor referral. On a final note, the Court suggested that the NCMB adopt a policy similar to NLRC Resolution No. 08-14 (Series of 2014) directing labor arbiters to give parties periods to secure a third doctor and for the third doctor to submit reassessment, to mandate availment of Sec. 20(A)(3) and finally determine entitlement.
• Fitness to Work / Final Assessment: Petitioner faulted respondents for not providing a full, complete, and categorical certification because Dr. Go's July 31, 2015 Medical Certificate stated he had reached maximum medical improvement, was not unfit for further sea duties due to risk of apneic episode and cardiac arrhythmia for obstructive sleep apnea, and suggested Grade 12 – slight residual disorder if entitled to disability. The Court held that while there was no express "fit for sea duties" finding, the implied meaning was the same: he was fit because he had reached maximum medical improvement. There was no evidence that respondents rejected his deployment as chief fireman due to his illnesses or declared him unfit in a subsequent pre-employment medical examination. The certificate was issued on the 107th day of treatment and preceded by 18 medical progress reports, showing close supervision since repatriation on April 13, 2015. As in Magsaysay Maritime Corporation vs. Verga, it was not a hastily issued missive but the product of months of consultations, examinations, treatments, and assessments. Compared to Dr. Donato-Tan's certificate, issued after only a physical examination without review of complete medical records, Dr. Go's certification was more credible; as between the company-designated physician with all records and the seafarer's chosen physician who examined him for a day as an outpatient, the former's findings must prevail under Ranoa vs. Anglo-Eastern Crew Management Phils., Inc. The Grade 12 suggestion was a superfluity because it had no basis under Sec. 32 of the 2010 POEA-SEC, as Grade 12 pertains to illness affecting intra-abdominal organs resulting in impairment of nutrition, slight tenderness, and/or constipation or diarrhea, which petitioner did not have. The July 31, 2015 Medical Certificate was therefore full, complete, and categorical insofar as it effectively certified petitioner as fit for sea duties.

• Substantial Evidence for Seafarer Disability Claims — A seafarer claiming disability benefits must establish by substantial evidence that the illness is work-related or work-aggravated; mere allegation that the illness is listed as an occupational disease under Sec. 32-A of the POEA-SEC is insufficient. The Court applied this to reject Ledesma's claims because he presented no credible proof connecting his hypertension, diabetes, chronic tonsillitis, obstructive sleep apnea, or probable congestive heart failure to his work or working conditions.
• Occupational Disease Compensability under Sec. 32-A — For an occupational disease and resulting disability to be compensable, all of the following must be satisfied: (1) the seafarer's work must involve the risks described; (2) the disease was contracted as a result of exposure to the described risks; (3) the disease was contracted within a period of exposure and under such other factors necessary to contract it; and (4) there was no notorious negligence on the part of the seafarer. The Court applied these requisites in rejecting chronic tonsillitis as an infection because the specified risk conditions were not shown.
• Disputable Presumption of Work-Relatedness for Unlisted Illnesses — Under Sec. 20(A)(4) of the POEA-SEC, illnesses not mentioned under Sec. 32 are disputably presumed work-related, but this does not automatically entitle the seafarer to benefits; substantial evidence of work-relatedness is still required. The Court cited Dionio vs. ND Shipping and Allied Services, Inc. in holding that Ledesma's unlisted conditions did not thereby become compensable.
• Hypertension and Diabetes Do Not Ipso Facto Warrant Permanent Total Disability — Essential hypertension requires contracting of the disease, organ impairment arising from it, and permanent disability arising from that impairment; diabetes is not listed and is often familial or lifestyle-related. The Court applied this to deny benefits despite Ledesma's diagnoses.
• Third-Doctor Referral under Sec. 20(A)(3) of the POEA-SEC — When the seafarer's chosen physician disagrees with the company-designated physician, a third doctor may be agreed jointly and the third doctor's decision is final and binding. The seafarer must notify the company of the contrary finding; the company then bears the burden to initiate the referral. A letter-request indicating the seafarer's doctor's assessment of fitness to work or disability rating suffices even without attaching the medical certificate. If the employer fails to act, labor tribunals and courts may resolve the conflicting opinions based on the totality of evidence. The Court applied this to find that Ledesma's demand letter triggered the process, but because respondents ignored it, the Court assessed the conflicting findings itself.
• Credibility of Company-Designated Physician's Assessment — The company-designated physician's assessment, when based on extensive records, repeated examinations, and specialist consultations, is more credible than the seafarer's chosen physician's opinion based on a single consultation without complete records. The Court applied this to uphold Dr. Go's certification over Dr. Donato-Tan's certificate.
• Liberal Construction in Favor of Seafarers — The POEA-SEC is construed liberally in favor of seafarers, but such liberality is not a license to disregard the evidence on record or to award compensation based on surmises. The Court invoked this principle while denying Ledesma's claim.
• Duty of Voluntary Arbitrators to Conciliate and Mediate / Refer to Third Doctor — Voluntary arbitrators are mandated to provide an expeditious, impartial, inexpensive, and effective mode of resolving labor disputes; when medical opinions conflict and the third-doctor option has not been availed of, or the seafarer's request was refused or ignored, they should refer the parties to a third doctor. The Court suggested that the NCMB adopt a policy similar to NLRC Resolution No. 08-14 (Series of 2014) to mandate availment of Sec. 20(A)(3).

• "It is not sufficient for seafarers to merely allege that their illness is listed as an occupational disease under Section 32-A of the Philippine Overseas Employment Administration-Standard Employment Contract (POEA-SEC). They are required to establish by substantial evidence that their illness is either connected to their work, or aggravated by their working conditions to validly claim for compensation." — This passage states the threshold evidentiary rule for seafarer disability claims and frames the Court's central reason for denying Ledesma's claim.
• "Manifestly, hypertension and diabetes do not ipso facto warrant the award of permanent and total disability benefits to a seafarer. Notably, Sec. 32-A of the POEA-SEC recognizes that a seafarer can still be employed even if he has hypertension and/or diabetes provided that he shows compliance with the prescribed maintenance medications and doctor-recommended lifestyle changes." — This passage articulates the rule that a diagnosis of hypertension or diabetes, standing alone, does not establish entitlement to permanent total disability benefits.
• "Accordingly, what is required from the medical opinion of the seafarer's chosen physician is that there be a statement regarding the seafarer's fitness to work OR the disability rating. Consequently, as long as the seafarer's letter-request for referral to a third doctor sent to the employer indicates the seafarer's doctors' assessment of the seafarer's fitness to work or disability rating, which is contrary to the company-designated physician's assessment, then that suffices to set in motion the process of choosing a third doctor." — This passage defines the sufficiency of the seafarer's letter-request for a third doctor and is central to the Court's ruling that no attachment of the medical certificate is required.
• "when the employer fails to act on the seafarer's valid request for referral to a third doctor, the [labor] tribunals and courts are empowered to conduct its own assessment to resolve the conflicting medical opinions of the company-designated physician and the seafarer's chosen physician based on the totality of evidence." — This passage supplies the consequence of the employer's failure to act and authorizes the tribunal's independent assessment of conflicting medical opinions.

• Ilustricimo vs. NYK-FIL Ship Management, Inc., 834 Phil. 693 (2018) — Cited for the rule that compensability under Sec. 20(A) of the 2010 POEA-SEC requires two elements: the injury or illness must be work-related, and it must have existed during the term of the seafarer's employment contract; also defines work-related illness.
• Dionio vs. ND Shipping and Allied Services, Inc., 838 Phil. 953 (2018) — Cited for the rule that the disputable presumption of work-relatedness for illnesses not listed under Sec. 32 does not automatically grant compensation; the seafarer must still prove entitlement by substantial evidence.
• C.F. Sharp Crew Management, Inc. vs. Santos, 838 Phil. 82 (2018) — Cited for the rule that hypertension and diabetes do not ipso facto warrant permanent and total disability benefits; essential hypertension requires organ impairment and permanent disability, while diabetes is not listed and does not indicate work-relatedness.
• Jebsens Maritime, Inc. vs. Babol, 722 Phil. 828 (2013) — Cited to reject the seafarer's theory that a high-risk dietary factor aboard the vessel aggravated his illness; the assertion was not substantial evidence of causal relationship, and the Court refused to take judicial notice of such assertions in light of the 2006 Maritime Labor Convention.
• Bahia Shipping Services, Inc. vs. Constantino, 738 Phil. 564 (2014) — Cited for the rule that the seafarer bears the burden to notify the company of a contradictory finding by his own physician, after which the company must respond by setting in motion the third-doctor process.
• Carcedo vs. Maine Marine Philippines, Inc., 758 Phil. 166 (2015) — Cited for the procedure when the seafarer's physician conflicts with the company doctor: the seafarer manifests intention to refer to a third doctor, and the company bears the burden of initiating the referral.
• Benhur Shipping Corporation vs. Riego, G.R. No. 229179, March 29, 2022 — Cited for the rule that the seafarer need not attach his doctor's medical report to the letter-request; it suffices that the letter indicates the seafarer's doctor's assessment of fitness to work or disability rating contrary to the company-designated physician's assessment; also that if the employer fails to act, labor tribunals and courts may assess conflicting opinions on the totality of evidence.
• Magsaysay Maritime Corporation vs. Verga, 841 Phil. 926 (2018) — Cited for the principle that the company-designated physician's certification is not a hastily issued missive but the product of months of consultations, examinations, treatments, and assessments.
• Ranoa vs. Anglo-Eastern Crew Management Phils., Inc., G.R. No. 225756, November 28, 2019, 926 SCRA 526 — Cited for the rule that as between the company-designated physician, who has all the medical records for the duration of treatment, and the seafarer's chosen physician, who merely examined him for a day as an outpatient, the former's findings must prevail.
• Loadstar International Shipping, Inc. vs. Yamson, 830 Phil. 731 (2018) — Cited for the rule that while probability is the test in compensation proceedings, an award cannot rest on speculations, presumptions, and conjectures.
• Bright Maritime Corporation vs. Racela, 852 Phil. 536 (2019) — Cited for the rule that compensability is a factual issue; factual findings may be reviewed when the CA's findings are inconsistent with the labor tribunals; and liberality in favor of seafarers is not a license to disregard evidence.

• Section 32-A, 2010 POEA-SEC — Defines occupational diseases and conditions for compensability; requires work risks, contraction from exposure, period of exposure, and no notorious negligence. The Court applied it to reject chronic tonsillitis as an infection because the risk conditions were not shown, and to note heart failure is listed but does not alone justify benefits.
• Section 20(A)(3), 2010 POEA-SEC — Provides third-doctor mechanism when seafarer's doctor disagrees with company-designated physician; third doctor's decision final and binding. The Court applied it to hold that Ledesma's demand letter triggered the process and that respondents' failure to act allowed judicial assessment.
• Section 20(A)(4), 2010 POEA-SEC — Provides that illnesses not mentioned under Sec. 32 are disputably presumed work-related. The Court applied it through Dionio to hold the presumption is not automatic and substantial evidence is still required.
• Section 20(F), 2010 POEA-SEC — Requires employer, upon request, to furnish seafarer a copy of all pertinent medical reports or records at no cost. The Court applied it to note that the duty arises only upon request and that Ledesma requested records only in his September 15, 2015 letter.
• Articles 191, 192, and 193, Labor Code, in relation to Rule X, Rules and Regulations Implementing Book IV — Govern disability benefits for overseas seafarers. The Court cited them as part of the statutory framework governing entitlement.
• Revised Procedural Guidelines in the Conduct of Voluntary Arbitration Proceedings, Rule V and Rule VI — Provide duties of voluntary arbitrators to conciliate and mediate, powers to resolve disputes, and initial conference procedure. The Court cited them in discussing the duty to provide expeditious settlement and to refer conflicting medical opinions to a third doctor.
• NLRC Resolution No. 08-14 (Series of 2014) — Directs labor arbiters to give parties 15 days to secure a third doctor and 30 days for the third doctor to submit reassessment. The Court suggested the NCMB adopt a similar policy for seafarer disability claims.

Hernando, Zalameda, and Rosario, JJ., concur. Marquez, J., was on official leave.

• MVA George A. Eduvala (Panel of Voluntary Arbitrators) — Dissented from the PVA majority, opining that the assessment given by the company-designated physician as to petitioner's fitness to work and whether his illnesses were work-related carried more weight, and that petitioner failed to offer evidence showing the relation between his illnesses and his work on board the vessel.