Makabali vs. Employees' Compensation Commission

An illness that supervened during employment before January 1, 1975 is governed by the Workmen's Compensation Act, under which compensability is presumed and aggravation by employment is compensable. Once onset prior to the New Labor Code was shown, the employer bore the burden of rebutting the presumption by substantial evidence, and the cause of the ailment became immaterial so long as it occurred or was aggravated in the course of employment.

Paz L. Makabali served as a public elementary classroom teacher at Del Pilar Central School, San Fernando, Pampanga, while the Government Service Insurance System administered her compensation claim and the Employees' Compensation Commission reviewed denials as successor of the defunct Workmen's Compensation Commission. Compensation for injury, sickness, disability or death occurring on or after January 1, 1975 fell under P.D. No. 626, as amended, while earlier accruals remained under the Workmen's Compensation Act with its presumption of compensability and aggravation principle.

Paz L. Makabali served as classroom teacher at Del Pilar Central School, San Fernando, Pampanga, from 1946 until she retired on August 21, 1975 under the disability retirement plan under R.A. 660. According to the certification of Dr. Benicio Torralba, her illness began in 1971 as headache and blurring of vision. On August 24, 1972, while teaching her class, she collapsed with the back of her head hitting the floor; co-teachers Purificacion P. Bondoc and Dominador T. Bondoc, who were in the adjoining classroom, found her semiconscious face upward surrounded by pupils and rushed her to the Makabali Clinic in San Fernando where she was examined and given aid. She reported for duty the following day but complained of pains in the back of her head and eyes, and thereafter often complained of recurring headache and painful eyes.

Thereafter she was treated for glaucoma at the Pampanga Eye, Ear, Nose, Throat and General Hospital under Dr. Romeo Galang, in April 1976 by Dr. Benicio Torralba for the same ailment, and in 1978 by Dr. Delfin Rosales of the Philippine Eye Research Institute at the P.G.H. compound. On April 10, 1976, Dr. Torralba diagnosed absolute glaucoma OD (right eye) and simple chronic glaucoma OS (left eye); on November 10, 1976, Dr. Galang found vision O.D. negative and O.S. of 1/2 foot, with cataractous lens O.D. and cupping of the disc (glaucomatous) O.S. By the time of those 1976 examinations she had already lost one eye to absolute glaucoma, the last stage of primary glaucoma, with the other eye seriously impaired by primary simple chronic glaucoma. She had rendered almost 29 years of teaching service, more than half in the barrio of San Rafael, Mexico, Pampanga, certified by Barrio Captain Julian Quillar on May 25, 1979 as still without electricity, under conditions involving large classes, extensive paperwork after office hours, and discipline of young pupils.

Because of the ailment she was forced to retire on August 21, 1975, short of the compulsory retirement age, and on June 19, 1976 filed her claim for disability benefits under P.D. No. 626, as amended, for glaucoma contracted during employment from 1946 to 1975. The GSIS denied the claim on the ground that glaucoma was not an occupational disease, describing it as common in middle and advanced life between 40 and 70 years with increased intraocular pressure and predisposing factors of arteriosclerosis and hereditary characteristics. On reconsideration the GSIS admitted the ailment supervened in the course of employment as elementary grade teacher but found no showing it directly arose therefrom or resulted from its nature. The ECC sustained the denial, finding the record devoid of positive proof of direct causal link or increased risk, noting even the attending physician's certification did not state the illness was directly caused by duties and working conditions, and relying on its medical officer's view that the disease had no causal relationship with employment as elementary school teacher.

• Applicable Law and Accrual: Petitioner maintained that her cause of action accrued as early as 1971 when headache and blurring of vision began, so the governing law was the Workmen's Compensation Act, as amended, and not P.D. No. 626, as amended, pursuant to the doctrine in Corales vs. ECC, et al.
• Disability Despite Continued Work: Petitioner maintained through counsel that approval of optional retirement foreclosed the question of disability, and that she continued working through sheer determination despite rapidly deteriorating vision and should be rewarded rather than deprived of compensation for devotion to duty.

• Applicable Law: Respondent Commission countered through the Solicitor General that P.D. No. 626, as amended, applied because it covers injury, sickness, disability or death occurring on or after January 1, 1975 under Art. 208 of the Labor Code.
• Accrual and Wage-Loss: Respondent GSIS argued that the applicable law was P.D. No. 626, as amended, because petitioner's claim for permanent total disability could not have accrued in 1971 since she continued working thereafter and could not have been awarded disability then, relying on Legaspi vs. Province of Negros Occidental that disability compensation implies compensation for loss or diminution of salary.
• Burden of Proof and Non-Occupational Disease: Respondents maintained that glaucoma, not being listed as an occupational disease, required substantial evidence of direct causal relationship or increased risk from working conditions, and that the presumption of compensability and doctrine of aggravation were inapplicable.

• Applicable Law: Whether petitioner's glaucoma claim is governed by the Workmen's Compensation Act, as amended, or by P.D. No. 626, as amended.
• Compensability and Presumption: Whether glaucoma supervening and aggravated in the course of employment as public elementary teacher is compensable under the presumption of compensability and aggravation principle.
• Disability Despite Continued Service: Whether continued work after onset and absence of immediate wage-loss defeat a claim for disability compensation.

• Applicable Law: Yes. The Workmen's Compensation Act governs, the ailment having had its onset in 1971 and been discovered after the 1972 fall, long before the New Labor Code took effect.
• Compensability and Presumption: Yes. Compensability was presumed upon supervision during employment, unrebutted by substantial evidence, with aggravation by work strain sufficient and cause immaterial.
• Disability Despite Continued Service: No. Continued work through determination and approval of disability retirement do not negate disability; wage-loss is not indispensable to medical and disability benefits.

• Applicable Law: The time of contracting the ailment determines the applicable law. Headache and blurring began in 1971 after almost 25 years of service, were aggravated after the August 24, 1972 collapse, and by 1976 had progressed to absolute glaucoma in one eye and chronic simple glaucoma in the other, a disease described as so insidious it is often unnoticed until one eye is almost lost. Thus accrual preceded January 1, 1975, invoking Corales vs. ECC, et al. and reiterating cases, and displacing P.D. No. 626.
• Compensability and Presumption: Under Section 44 of the Workmen's Compensation Act a rebuttable presumption arises that illness supervening during employment arose out of or was aggravated by employment, becoming conclusive absent substantial contrary evidence. No employer evidence rebutted it; the ECC medical officer's etiology opinion could not prevail over the presumption where causation was not definitely determinable, and Dr. Delfin Rosales certified that work and eye strain could have contributed significantly to aggravating the glaucoma. Long rural service without electricity, heavy class loads, paperwork, tension from disciplining young pupils, and recognized physical and nervous strain on teachers supported aggravation, consistent with R.A. No. 4670.
• Disability Despite Continued Service: Disability combines medical incapacity and inability to work with the same ease and competency or loss of earning power, and an employee pronounced disabled may persist through determination and ingenuity. Section 13 does not require wage-loss for medical benefits, and approved optional retirement before compulsory age requires proof of physical incapacity for sound and efficient service, foreclosing the disability question.

• Presumption of Compensability under the Workmen's Compensation Act — Under Section 44, once illness supervened during employment, a rebuttable presumption arises that it arose out of employment or was at least aggravated thereby, placing on the employer the burden of rebuttal by substantial evidence; unrebutted, the presumption becomes conclusive. Applied here to hold glaucoma presumed work-connected absent employer proof to the contrary.
• Aggravation Principle — The cause of the ailment is immaterial; what matters is that it occurred or was aggravated in the course of employment. Applied through Dr. Rosales's certification and working-conditions evidence to find work strain significantly aggravated petitioner's glaucoma.
• Accrual Determines Governing Compensation Law — Compensability hinges on the approximate point when the ailment was contracted; claims accruing before the New Labor Code are governed by the Workmen's Compensation Act with its presumption, aggravation, attorney's fees and administrative fees, which the ECC as successor of the Workmen's Compensation Commission must apply. Applied to hold the 1971 onset invoked the old Act per Corales vs. ECC, et al.
• Medical and Wage-Loss Aspects of Disability — Disability is the combination of partial or total physical incapacity and inability to work, or inability to work with the same ease and competency as before, or loss of earning power; medical shattering may coexist with contrived subsistence, and apparent ability to work may coexist with de facto wage-loss from employer refusal. Applied to reject the argument that continued teaching until 1975 negated disability in 1971.
• Optional Retirement as Proof of Disability — Approval of optional retirement before compulsory age, allowed under Memorandum Circular No. 133 only upon proof of physical incapacity to render sound and efficient service, forecloses the question of disability. Applied to confirm petitioner was disabled upon disability retirement under R.A. 660.
• Liberal Construction in Favor of Labor — Compensation claims are viewed on a broader perspective under constitutional precepts of social justice and protection to labor. Invoked to resolve the claim in favor of the teacher.

• "It then becomes unquestionable that once the illness supervened at the time of the employment, there is a rebuttable presumption that such illness arose out of the employment or was at least aggravated by such employment" — States the operative presumption triggering employer burden once supervision during employment is shown.
• "the cause of the ailment is immaterial; what is important is that it occurred or was aggravated in the course of employment" — Defines the aggravation principle making etiology immaterial to compensability under the old Act.
• "Disability, as a basis for compensation, is the combination of partial or total physical incapacity and of inability to work, or inability to work with the same case and competency as before the injury, or the loss, total or partial, of earning power from the injury (Corpus Juris, Section 535, p. 813)." — Provides the canonical two-aspect definition of disability used to reject the wage-loss defense.
• "Petitioner's claim having accrued prior to the New Labor Code, the presumption of compensability, the principle of aggravation, the award of attorney's fees and the payment of administrative fees must be observed and applied." — Declares the consequences of finding pre-Code accrual and the ECC's duty as successor to apply them.

• Corales vs. ECC, et al., 88 SCRA 547 [1979] — Controlling precedent for accrual rule and application of presumption of compensability, aggravation, attorney's fees and administrative fees to pre-Code claims; followed.
• Lao vs. ECC, et al., 97 SCRA 780 [1980] — Held employer's medical report cannot constitute substantial evidence to defeat presumption where cause is not definitely determinable; followed.
• Calvero vs. ECC, et al., 117 SCRA 452 [1982] — Held presumption cannot be overcome by employer opinion and recognized physical and nervous strain on teachers as compensable under R.A. No. 4670; followed.
• Segismundo vs. GSIS, et al., 121 SCRA 304 [1983] — Held presumption places burden on employer and becomes conclusive absent rebuttal; followed.
• Panangui, et al. vs. ECC, et al., G.R. No. 56259 [1983] — Emphasized liberal construction under social justice and restated rebuttable presumption upon supervision during employment; followed.
• Romero vs. WCC, et al., 77 SCRA 480 [1977]; Gonzales vs. WCC, et al., 81 SCRA 709 — Enunciated medical and wage-loss balancing in disability; followed to reject continued-work defense.
• Legaspi vs. Province of Negros Occidental, L-43066, December 29, 1978 — Cited by GSIS for proposition that disability compensation implies loss or diminution of salary; not sustained as bar to claim.
• Villones vs. ECC, et al., 92 SCRA 320 [1979]; Delos Angeles vs. ECC, et al., 94 SCRA 308 [1979]; Balatero vs. ECC, et al., 95 SCRA 608 [1980]; Evangelista vs. ECC, et al., 111 SCRA 66 [1982]; Menez vs. ECC, et al., 97 SCRA 87 [1980]; Faicol vs. WCC, et al., 93 SCRA 811 [1979]; Canonero vs. WCC, 81 SCRA 712 — Reiterated accrual, presumption, aggravation, and optional-retirement doctrines; cited as consistent authority.

• Section 44, Workmen's Compensation Act — Establishes rebuttable presumption of compensability; applied to shift burden to employer and render presumption conclusive absent substantial contrary evidence.
• Section 13, Workmen's Compensation Act — Requires employer or carrier to provide services, appliances and supplies immediately after injury or sickness during disability to restore maximum physical capacity; cited to show wage-loss is not required for medical benefits.
• Article 208, Labor Code; P.D. No. 626, as amended — Limits new compensation program to injury, sickness, disability or death occurring on or after January 1, 1975; held inapplicable because onset was in 1971-1972.
• R.A. No. 660 — Disability retirement plan under which petitioner retired August 21, 1975; used to confirm disability status.
• R.A. No. 4670, Magna Charta for Public School Teachers — Mandates protection against employment injury and recognition of physical and nervous strain effects as compensable occupational diseases; invoked to support compensability of teacher's aggravated ailment.

Concepcion Jr., Guerrero, Abad Santos, De Castro and Escolin, JJ., concur. Aquino, J., took no part.