Republic of the Philippines

SUPREME COURT
Manila
THIRD DIVISION
G.R. No. 168862 April 30, 2008
GOVERNMENT SERVICE INSURANCE SYSTEM GSIS!, petitioner,
vs.
EMMANUE" P. CUNTAPAY, respondent.
D E C I S I O N
NACHURA, J.#
This petition for review stems from the Court of Appeals' Decision
1
dated Ma 1!, "##$, and
Resolution dated %ul &, "##$, which 'ranted the respondent's claim for compensation under
Presidential Decree (P.D.) *o. +"+, as amended, or the ,mploees' Compensation -aw.
Respondent ,mmanuel P. Cuntapa entered the 'overnment service on *ovember 1!, 1.!$ as an
Architectural Draftsman of the Department of Public /or0s and 1i'hwas (DP/1). 1e rose
from the ran0s and was promoted on 2ctober "", 1... as Architect 3 (Chief, Architectural
Division, 4ureau of Desi'n of the DP/1). An Architect 3 'enerall performs the followin'
duties5
(1) 6upervises, coordinates, and provides direction and wor0 assi'nments in the Division7
(") Does final review and chec0in' of pro8ects9papers from the Division prior to
:submission; to hi'her authorities7
(<) Provides direction in the formulation of architectural desi'n 'uidelines and standards,
architectural9sanitar desi'n specifications, terms of reference and other pertinent
documents for architectural and related en'ineerin' desi'n services7
(=) Confers9meets with representative of usin' a'encies re'ardin' the pro8ect
re>uirements for the architectural and en'ineerin' desi'n services7
($) Prepares and recommends action on cases referred to the Division re'ardin' the
implementation of the *ational 4uildin' Code (*4C)7
(+) Participates in the deliberation in the formulation and information dissemination of
the implementin' rules and re'ulations of the *4C7 and,
(!) Performs such other duties and functions that ma be assi'ned from time to time.
"
Aside from bein' the Chief of the Architectural Division of the 4ureau of Desi'n, the respondent
was also desi'nated 2verall 1ead of the Technical 6taff of the *ational 4uildin' Code
Development 2ffice (*4CD2) in a concurrent capacit. ?n addition, he was desi'nated
Representative to the *ational 6teerin' Committee for the *ational @rban Development and
1ousin' Aramewor0 1...B"##=, and Alternate Representative to the *ational Council for the
/elfare of Disabled Persons 4oard.
<
2n April &, "##<, while attendin' a meetin' of the *ational 4uildin' Code 4oard of Consultants
at the DP/1 Architectural Division, the respondent suddenl eCperienced difficult in
breathin'. @pon the advice of Dr. 6hirle Rees, the DP/1 resident phsician, the respondent
underwent electrocardio'ram (,CD) test at the DP/1 clinic. The ,CD test disclosed that there
was an irre'ularit in the respondent's heartbeat. Aor this reason, Dr. Rees advised the
respondent to see0 hospital services. 1eedin' the advice, the respondent immediatel proceeded
to the Philippine 1eart Center where he was admitted at about two o'cloc0 in the afternoon of the
same da.
=
Dr. %ose D. AbadB6antos, the respondent's attendin' phsician, dia'nosed his illness as acute
mocardial infarction. The respondent then underwent Eaortocoronar bpassE operation. 1e was
dischar'ed from the hospital on April 1&, "##<.
$
Afterwards, he underwent cardiac rehabilitation
on an outBpatient basis. All in all, the respondent spent P=11,1"!.## for his hospital bills and
other medical eCpenses.
Conse>uentl, the respondent filed with the petitioner Dovernment 6ervice ?nsurance 6stem
(D6?6) a claim for compensation benefits under Presidential Decree (P.D.) *o. +"+, as amended.
1owever, in a letter dated Aebruar 1+, "##=, the D6?6 denied the claim on the 'round that there
was no substantial proof that the nature of his 8ob increased the development of the claimed
illness.
+
@pon denial of his re>uest for reconsideration b the D6?6, the respondent interposed an appeal
with the ,mploees' Compensation Commission (,CC).
?n its *ovember 1", "##= Decision, the ,CC affirmed the findin's of the D6?6 and subse>uentl
dismissed the respondent's appeal. The ,CC held that
A circumspect review of the records however failed to show an causal lin0 between his
present occupation and his ailment. As eCplained medicall, the development of ?1D or
otherwise termed as CAD is caused b atherosclerosis, the hardenin' of the inner linin'
of arteries. 6mo0in', hpertension, diet and diabetes are factors that cause
atherosclerosis.
4ased on the etiolo' established b medical science, hpertension is the sole ris0 factor
in the development of CAD to be considered as wor0Brelated. @nder AnneC A of the
?mplementin' Rules on ,mploees' Compensation, hpertension is compensable
provided it causes endBor'an dama'e to the heart, ees, brain or 0idnes and is
substantiated b dia'nostic and laborator test results. As re'ard (sic) appellant's case,
however, nowhere in the records is there a showin' that he has a histor of hpertension
that could predispose him to contract his cardiovascular disease.
!
2n appeal, the CA reversed the decision of the ,CC, thus5
@P2* T1, 3?,/ /, TAF, 2A T1?6 CA6,, T1@6, the petition for review is
DRA*T,D. The *ovember 1", "##= Decision of the ,mploees' Compensation
Commission in ,CC Case *o. DMB1+=&!B#&#<B#= is R,3,R6,D and 6,T A6?D,. The
respondent Dovernment 6ervice ?nsurance 6stem is 2RD,R,D to pa petitioner
,mmanuel P. Cuntapa's full claim for compensation benefits under PD *o. +"+, as
amended. /ithout costs in this instance.
62 2RD,R,D.
&
?n so rulin', the appellate court stressed that the law onl re>uires a reasonable wor0 connection
and not direct causal connection, and that it is enou'h that the hpothesis on which the claim is
based is probable. ?t then held that the probabilit eCisted that the respondent's illness was due to
wor0Brelated stress considerin' his assi'ned duties at that time.
.
2n %ul &, "##$, the CA denied the petitioner's motion for reconsideration for lac0 of merit.
1#

Thus, this petition raisin' the followin' issues5
?. /1,T1,R 2R *2T P,T?T?2*,R'6 A?-M,*T B C2R2*ARG ART,RG D?6,A6,
(CAD), 69P, MG2CARD?A- ?*AARCT?2* BMAG 4, C2*6?D,R,D /2RFB
C2**,CT,D.
??. /1,T1,R 2R *2T R,6P2*D,*T 1A6 PR,6,*T,D P26?T?3, PR22A,
T1R2@D1 A R,A- A*D 6@46TA*T?A- ,3?D,*C,, T1AT T1, *AT@R, 2A 1?6
/2RF A*D 1?6 /2RF?*D C2*D?T?2*6 A6 ARC1?T,CT 3 1A6 (sic)
?*CR,A6,D T1, R?6F 2A C2*TRACT?*D 1?6 C-A?M,D A?-M,*T.
11
The petition is meritorious.
Aor a sic0ness to be compensable, the claimant must prove either (1) that the sic0ness is the
result of an occupational disease listed under the Rules on ,mploees' Compensation and the
conditions set therein are satisfied7 or (") that the ris0 of contractin' the disease was increased b
the claimant's wor0in' condition.
1"

,CC Resolution *o. =<" dated %ul "#, 1.!! includes cardioBvascular or heart diseases in the list
of occupational diseases and enumerates the conditions under which the are considered wor0B
related and, thus, compensable, viH.5
(a) ?f the heart disease was 0nown to have been present durin' emploment, there must
be proof that an acute eCacerbation was clearl precipitated b the unusual strain b
reasons of the nature of his9her wor0.
(b) The strain of wor0 that brin's about an acute attac0 must be of sufficient severit and
must be followed within "= hours b the clinical si'ns of a cardiac :in8ur; to constitute
causal relationship.
(c) ?f a person who was apparentl asmptomatic before bein' sub8ected to strain at wor0
showed si'ns and smptoms of cardiac in8ur durin' the performance of his9:her; wor0
and such smptoms and si'ns persisted, it is reasonable to claim a causal relationship.
?n a number of cases,
1<
the Court alread declared that mocardial infarction is included in this
cate'or. Mocardial infarction is the clinical term for a heart attac0. ?t is caused b occlusion
(bloc0a'e) of the coronar arter (atherosclerosis) or a blood clot (coronar thrombosis),
resultin' in the partial or total bloc0a'e of one of the coronar arteries. /hen this occurs, the
heart muscle (mocardium) does not receive enou'h oC'en.
1=
The petitioner ar'ues, on one hand, that the respondent's case does not fall under an of the three
instances enumerated in ,CC Resolution *o. =<" because there was no showin' that he was
sufferin' from a heart disease, or that the strain of wor0 prior to the "=Bhour period of time when
he suffered the heart attac0 was of sufficient severit, or that he was asmptomatic to the sub8ect
ailment.
1$
2n the other hand, the respondent avers that the circumstances of his illness satisf the
conditions under para'raphs (b) and (c) of ,CC Resolution *o. =<".
1+
1e points out that the
alle'ation that he has no histor of hpertension is belied b the clinical abstract which shows
that prior to his confinement he eCperienced three episodes of chest pain.
1!

/e a'ree with the petitioner, considerin' that there was, indeed, no proof that an of said
conditions has been satisfied. ?n particular, there was no evidence to show that respondent was
previousl dia'nosed with a heart ailment or that he was under a severe strain of wor0 sufficient
to have caused the heart attac0 since a board meetin' could hardl inflict such a severe strain.
Moreover, from the evidence at hand, we cannot safel conclude that the respondent's case falls
under para'raph (c). /hile it is true that the clinical abstract showed that on the da prior to the
incident respondent eCperienced three episodes of chest pains, this alone would not satisf the
re>uirements of para'raph (c), more specificall the condition that the claimant must have shown
si'ns and smptoms of cardiac in8ur during the performance of his work and such smptoms
and si'ns persisted.
To successfull recover compensation for his heart ailment, the respondent must therefore prove,
throu'h substantial evidence, that the ris0 of contractin' the disease was increased b the nature
of his wor0 and wor0in' conditions. Thus, the respondent posits that the underlin' cause of his
illness is stress caused b the performance of his numerous duties as Chief of the Architectural
Division of the 4ureau of Desi'n and as representative to different committees. To show how
stressful his wor0 was, he submitted in evidence minutes of the meetin's that he attended since
%anuar "###. The petitioner disputes this alle'ation on the 'round that, based on respondent's
dia'nostic test result which showed that he had a hi'h cholesterol level, the cause of the heart
attac0 was hpercholesterolemia B the main cause of atherosclerosis resultin' in coronar arter
disease and mocardial infarction.
1&

6iC primar ris0 factors have been identified with the development of atherosclerotic coronar
arter disease and mocardial infarction5 hperlipidemia or hi'h blood cholesterol, diabetes
mellitus, hpertension or hi'h blood pressure, smo0in', male 'ender, and famil histor of
atherosclerotic arterial disease.
1.
?n Government Service Insurance System v. Cuanang,
"#
while
the Court reco'niHed stress as one of the predisposin' factors of mocardial infarction, it also
noted that Estress appears to be associated with elevated blood pressure.E The ,CC, for its part,
does not seem to treat stress as a separate ris0 factor for mocardial infarction. ?n fact, in its
decision, it stated that hpertension is the sole ris0 factor in the development of a coronar arter
disease that is considered wor0Brelated.
"1
6ome references,
""
however, include stress as a ris0
factor, distinct from hpertension.
"<

*oticeabl, the record is devoid of an medical information on the cause of respondent's acute
mocardial infarction which could help the Court determine whether there was a causal lin0
between the respondent's alle'edl stressful wor0 and his ailment. A phsician's report would
have been the best evidence of wor0Bconnection of wor0men's ailments.
"=
Medical evidence is
particularl vital where the causal connection is not clearl apparent to an ordinar person
"$
or
readil observable or discoverable without medical eCamination
"+
for it is not our tas0 to
determine where the connection lies.
The claimant must show, at least, b substantial evidence that the development of the disease
was brou'ht about lar'el b the conditions present in the nature of the 8ob. /hat the law
re>uires is a reasonable wor0 connection and not a direct causal relation. ?t is enou'h that the
hpothesis on which the wor0men's claim is based is probable.
"!
Probabilit, not the ultimate
de'ree of certaint, is the test of proof in compensation proceedin's.
"&
And probabilit must be
reasonable7
".
hence, it should, at least, be anchored on credible information. Moreover, a mere
possibilit will not suffice7 a claim will fail if there is onl a possibilit that the emploment
caused the disease.
<#
The absence of an medical information statin' that the respondent's illness could have been
caused b stress and not b an other factor reduces the respondent's claim of wor0 connection to
a mere possibilit. 6uch deficienc restrains the Court from concludin' that the respondent's
illness is compensable. Contraril, in Cuanang, the eCpert opinion of a phsician was presented
in evidence and it was specificall stated therein that the emploee's acute mocardial infarction
could be the conse>uence of her chronic hpertension visBIBvis her rheumatic heart disease. This
eCpert opinion, to'ether with the information that stress appears to be associated with elevated
blood pressure, provided the Court with the lin0 that tied the emploee's sic0ness to her wor0 as
a teacher.
Ainall, we reiterate here that, with prudence and 8udicial restraint, a tribunal's Heal in bestowin'
compassion should ield to the precept in administrative law that absent a showin' of 'rave
abuse of discretion, courts are loathe to interfere with and should respect the findin's of >uasiB
8udicial a'encies in fields where the are deemed and held to be eCperts due to their special
technical 0nowled'e and trainin'.
<1
Compassion for the victims of diseases not covered b the
law i'nores the need to show a 'reater concern for the trust fund to which the tens and millions
of wor0ers and their families loo0 for compensation whenever covered accidents, diseases and
deaths occur.
<"
$HERE%ORE, premises considered, the petition is GRANTED. The Decision of the Court of
Appeals in CABD.R. 6P *o. &&#<& dated Ma 1!, "##$, and Resolution dated %ul &, "##$ are
REVERSED and SET ASIDE. The Decision of the ,mploees' Compensation Commission
dated *ovember 1", "##= is A%%IRMED.
SO ORDERED.
ANTONIO EDUARDO &. NACHURA
Associate %ustice
$E CONCUR#
CONSUE"O YNARES'SANTIAGO
Associate %ustice
Chairperson
MA. A"ICIA AUSTRIA'
MARTINE(
Associate %ustice
MINITA V. CHICO'NA(ARIO
Associate %ustice
RU&EN T. REYES
Associate %ustice
A T T E S T A T I O N
? attest that the conclusions in the above Decision had been reached in consultation before the
case was assi'ned to the writer of the opinion of the Court's Division.
CONSUE"O YNARES'SANTIAGO
Associate %ustice
Chairperson, Third Division
C E R T I % I C A T I O N
Pursuant to 6ection 1<, Article 3??? of the Constitution and the Division Chairperson's
Attestation, ? certif that the conclusions in the above Decision had been reached in consultation
before the case was assi'ned to the writer of the opinion of the Court's Division.
REYNATO S. PUNO
Chief %ustice
%oo)*o)+,
1
Penned b Associate %ustice Renato C. Dacudao, with Associate %ustices *oel D. Ti8am
and %ose C. Rees, %r. concurrin'7 rollo, pp. <<B=".
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EMedical researchers are n:o;t sure eCactl how stress increases the ris0 of heart
disease. 6tress itself mi'ht be a ris0 factor, or it could be that hi'h levels of stress ma0e
other ris0 factors (such as hi'h cholesterol or hi'h blood pressure) worse. Aor eCample, if
ou are under stress, our blood pressure 'oes up, ou ma overeat, ou ma eCercise
less and ou ma be more li0el to smo0e.
E?f stress itself is a ris0 factor for heart disease, it could be because chronic stress eCposes
our bod to unhealth, persistentl elevated levels of stress hormones li0e adrenaline
and cortisol. 6tudies also lin0 stress to chan'es in the wa blood clots, which increases
the ris0 of heart attac0.E (1pertension5 ,asin' 6tress
Khttp599www.webmd.com9hpertensionBhi'hBbloodBpressure9'uide9hpertensionBeasin'B
stressL)
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