SECOND DIVISION

[G.R. No. 58176. March 23, 1984.]

RUTH JIMENEZ, Petitioner, v. EMPLOYEES’ COMPENSATION COMMISSION and GOVERNMENT

SERVICE INSURANCE SYSTEM, Respondents.

Isidro Pasana for Petitioner.

The Solicitor General for Respondents.

SYLLABUS

1. LABOR AND SOCIAL LEGISLATION; LABOR CODE; EMPLOYEES COMPENSATION

COMMISSION; COMPENSABILITY OF ILLNESS; CANCER OF THE LUNGS, A BORDERLINE CASE
REQUIRING STUDY OF CIRCUMSTANCES OF CASE. — Admittedly, cancer of the lungs (bronchogenic
carcinoma) is one of those borderline cases where a study of the circumstances of the case is mandated
to fully appreciate whether the nature of the work of the deceased increased the possibility of contracting
such an ailment. WE have ruled in the case of Dator v. Employees Compensation Commission (111
SCRA 634, L-57416, January 30, 1982) that" (U)ntil now, the cause of cancer is not known." Indeed, the
respondent has provided an opening through which petitioner can pursue and did pursue the possibility
that the deceased’s ailment could have been caused by the working conditions while employed with the
Philippine Constabulary. Respondents maintain that the deceased was a smoker and the logical
conclusion is that the cause of the fatal lung cancer could only be smoking which cannot in any way be
justified as work-connected. However, medical authorities support the conclusion that up to now, the
etiology or cause of cancer of the lungs is still largely unknown.

2. ID.; ID.; ID.; ID.; CONCLUSION OF COMMISSION NOT IN ACCORDANCE WITH MEDICAL
AUTHORITIES AND FACTS ON RECORD. — The sweeping conclusion of the respondent Employees
Compensation Commission to the effect that the cause of the bronchogenic carcinoma of the deceased
was due to his being a smoker and not in any manner connected with his work as a soldier, is not in
accordance with medical authorities nor with the facts on record. No certitude can arise from a position of
uncertainty. WE are dealing with possibilities and medical authorities have given credence to the stand of
the petitioner that her husband developed bronchogenic carcinoma while working as a soldier with the
Philippine Constabulary. The records show that when the deceased enlisted with the Philippine
Constabulary in 1969, he was found to be physically and mentally healthy. A soldier’s life is a hard one.
As a soldier assigned to field duty, exposure to the elements, dust and dirt, fatigue and lack of sleep and
rest is a common occurrence. Exposure to chemicals while handling ammunition and firearms cannot be
discounted. WE take note also of the fact that he became the security of one Dr. Emilio Cordero of
Anulung, Cagayan, and he always accompanied the doctor wherever the latter went (p. 26, rec.). Such
assignment invariably involved irregular working hours, exposure to different working conditions, and body
fatigue, not to mention psychological stress and other similar factors which influenced the evolution of his
ailment.

3. ID.; ID.; ID.; ID.; THEORY OF INCREASED RISK. — The theory of increased risk is applicable in the
case at bar. In the case of Cristobal v. ECC (103 SCRA, 336-337) where the Court held that "to establish
compensability under the said theory, the claimant must show proof of work-connection. Impliedly, the
degree of proof required is merely substantial evidence, which means ‘such relevant evidence to support
a decision’ (Ang Tibay v. The Court of Industrial Relations and National Labor Union, Inc., 69 Phil. 635) or
clear and convincing evidence. In this connection, it must be pointed out that the strict rules of evidence
are not applicable in claims for compensation. Respondents however insist on evidence which would
establish direct causal relation between the disease rectal cancer and the employment of the deceased.
Such a strict requirement which even medical experts cannot support considering the uncertainty of the
nature of the disease would negate the principle of the liberality in the matter of evidence. Apparently,
what the law merely requires is a reasonable work-connection and not a direct causal relation. This kind of
interpretation gives meaning and substance to the liberal and compassionate spirit of the law as
embodied in Article 4 of the new Labor Code which states that ‘all doubts in the implementation of the
provisions of this Code, including its implementing rules and regulations shall be resolved in favor of
labor."

4. ID.; ID.; ID.; STRICT RULES ON EVIDENCE NOT APPLICABLE; STATE POLICY OF LIBERALITY
TOWARDS LABOR MUST BE MAINTAINED. — In San Valentin v. ECC (118 SCRA 160), the Court held
that "In compensation cases, strict rules on evidence are not applicable. A reasonable work-connection is
all that is required or that the risk of contracting the disease is increased by the working condition." This is
in line with the avowed policy of the State as mandated by the Constitution (Art. II, Sec. 9) and restated in
the New Labor Code (Art. 4) to give maximum aid and protection to labor.

DECISION

MAKASIAR, J.:

This is a petition to review the decision of respondent Employees Compensation Commission (ECC)
dated August 20, 1981 (Annex "A", Decision, pp. 10-12, rec.) in ECC Case No. 1587, which affirmed the
decision of respondent Government Service Insurance System (GSIS), denying petitioner’s claim for
death benefits under Presidential Decree No. 626, as amended.

The undisputed facts are as follows:chanrob1es virtual 1aw library

Petitioner is the widow of the late Alfredo Jimenez, who joined the government service in June, 1969 as a
constable in the Philippine Constabulary (p. 2, rec.)

After rendering service for one year, he was promoted to the rank of constable second class. On
December 16, 1974, he was again promoted to the rank of sergeant (p. 26, rec.)

Sometime in April, 1976, he and his wife boarded a bus from Tuguegarao, Cagayan, to Anulung,
Cagayan. While on their way, Sgt. Jimenez, who was seated on the left side of the bus, fell down from the
bus because of the sudden stop of the vehicle. As a result, he was confined at the Cagayan Provincial
Hospital for about one (1) week, and thereafter, released (comment of respondent ECC, pp. 25-36, rec.).
He was again confined for further treatment from November 7, 1978 to May 16, 1979 at the AFP Medical
Center in Quezon City.

While on duty with the 111th PC Company, Tuguegarao, Cagayan, he was assigned as security to one
Dr. Emilio Cordero of Anulung, Cagayan (ECC rec., Proceedings of the PC Regional Board, June 6,
1980). In compliance with his duty, he always accompanied the doctor wherever the latter went (p. 26,
rec.)chanroblesvirtualawlibrary

On November 7, 1978, the deceased was again confined at the Cagayan Provincial Hospital and then
transferred to the AFP V. Luna Medical Center at Quezon City for further treatment. He complained of off-
and-on back pains, associated with occasional cough and also the swelling of the right forearm. The
doctors found a mass growth on his right forearm, which grew to the size of 3 by 2 inches, hard and
associated with pain, which the doctors diagnosed as "aortic aneurysm, medrastinal tumor" (p. 27, rec.)

His condition improved somewhat after treatment and he was released on May 16, 1979. He was advised
to have complete rest and to continue medication. He was then given light duty inside the barracks of their
company.

Unfortunately, his ailment continued and became more serious.

On May 12, 1980, he died in his house at Anulung, Cagayan, at about 9:00 o’clock in the evening. He was
barely 35 years old at the time of his death.

The cause of death, as found by the doctors, is "bronchogenic carcinoma" which is a malignant tumor of
the lungs.

On June 6, 1980, an administrative hearing was conducted before the PC Regional Board. It was their
official findings that the subject enlisted man "died in line of duty" ; that the deceased was a PC member
of the 111th PC Company at Tuguegarao, Cagayan; that he died due to "bronchogenic CA" ; and that he
"died not as a result of his misconduct and did not violate any provisions of the Articles of War" (ECC rec.,
Proceedings of the PC Regional Board, June 6, 1980).

The Board recommended "that all benefits due to or become due subject EP be paid and settled to his
legal heirs" (ECC rec., Proceedings of the PC Regional Board, June 6, 1980). Thus, as per records of the
GSIS, petitioner was paid benefits due to her deceased husband under Republic Act No. 610 (Comment
of respondent ECC, p. 27, rec.)

Nevertheless, petitioner filed a claim for death benefits under PD No. 626, as amended with the
respondent GSIS. Said claim was denied by the GSIS on the ground that her husband’s death is not
compensable "for the reason that the injury/sickness that caused his death is not due to the
circumstances of the employment or in the performance of the duties and responsibilities of said
employment" (Letter of denial by the GSIS dated July 14, 1980, ECC rec.)

The said decision was affirmed by respondent Employees Compensation Commission in its decision
dated August 21, 1981, stating among others:chanrob1es virtual 1aw library

x x x

"After an exhausted (sic) study of the evidences (sic) on record and the applicable law on the case, we
conclude that the law has been properly applied by the respondent System. . . .

"Bronchogenic carcinoma, medical authorities disclose, is the most common form of malignancy in males
reaching a peak between the fifth and seventh decades and accounting for one in four male cancer
deaths. The sex incidence is at least 5 to 1, male to female. Extensive statistical analysis by medical
authorities have confirmed the relationship between lung cancer and cigarette smoking. Other factors that
may have potential roles are exposure to ionizing radiation, exposure to chromates, metallic iron and iron
oxides, arsenic, nickel, beryllium and asbestos (Harrison’s Principles of Internal Medicine by Wintrobe, Et
Al., 7th Edition, p. 1322).

"Although Presidential Decree No. 626, as amended, was envisioned to give relief to workingmen, who
sustain an injury or contract an ailment in the course of employment and that to best attain its lofty
objective, a liberal interpretation of the law should pervade in its implementation, this precept, however,
may not be invoked as not even a slight causal link between the development of the ailment and the
decedent’s (sic) duties and working conditions as a PC sergeant could be deduced from the records of
this case. The respondent System’s ruling that appellant’s claim does not fall within the beneficiant
provisions of Presidential Decree No. 626, as amended, and therefore the same should be denied, is in
full harmony with the law and the facts obtaining herein.
. . ." (Decision, pp. 10-12, rec.)

On September 28, 1981, Petitioner, assisted by counsel, filed the instant petition, the only pertinent issue
being whether or not her husband’s death from bronchogenic carcinoma is compensable under the law.

The petitioner contends that her husband’s death is compensable and that respondent Commission erred
in not taking into consideration the uncontroverted circumstance that when the deceased entered into the
Philippine Constabulary, he was found to be physically and mentally healthy. She farther contends that as
a soldier, her husband’s work has always been in the field where exposure to the elements, dust and dirt,
fatigue and lack of sleep and rest was the rule rather than the exception. The nature of work of a soldier
being to protect life and property of citizens, he was subject to call at any time of day or night.
Furthermore, he was even assigned as security to one Emilio Cordero and always accompanied the latter
wherever he went. Exposed to these circumstances for several years, the deceased’s physical
constitution began to deteriorate, which eventually resulted to his death from bronchogenic carcinoma
(Petition, pp. 2-9, rec.)

On the other hand, respondent Commission maintains that while the deceased soldier may have been
exposed to elements of dust and dirt and condition of lack of rest and continued fatigue by virtue of his
duties to protect the life and property of the citizens, such conditions have no causal relation to his
contraction of bronchogenic carcinoma. It is also the opinion of the respondent that since there is
evidence of the deceased to be a smoker, "the late Sgt. Jimenez may have indulged heavily in smoking
and drinking, not merely ‘occasionally’. And it has been demonstrated medically that the more cigarettes a
person smokes, the greater the risk of developing lung cancer" (Memorandum, p. 62, rec.). In short, the
respondent alleges that the deceased was responsible to a large degree for his having contracted
bronchogenic carcinoma that led to his demise.

WE find the petitioner’s claim meritorious.

Primary carcinoma of the lung is the most common fatal cancer and its frequency is increasing (The
Merck Manual, 13th Edition, p. 647). Admittedly, cancer of the lungs (bronchogenic carcinoma) is one of
those borderline cases where a study of the circumstances of the case is mandated to fully appreciate
whether the nature of the work of the deceased increased the possibility of contracting such an ailment. In
the case of Laron v. Workmen’s Compensation Commission (73 SCRA 90), WE held, citing Schmidt’s
Attorney’s Dictionary of Medicine, 165 Sup. 143; Beerman v. Public Service Coordinated Transport, 191 A
297, 299; Words and Phrases, 6 Permanent Edition 61, "The English word ‘cancer’ means ‘crab’, in the
medical sense, it refers to a malignant, usually fatal, tumor or growth." Findings of fact by the respondent
points out that bronchogenic carcinoma is a malignant tumor of the lungs. WE have ruled in the case of
Dator v. Employees Compensation Commission (111 SCRA 634, L-57416, January 30, 1982) that" (U)ntil
now, the cause of cancer is not known." Indeed, the respondent has provided an opening through which
petitioner can pursue and did pursue the possibility that the deceased’s ailment could have been caused
by the working conditions while employed with the Philippine Constabulary.

Respondents maintain that the deceased was a smoker and the logical conclusion is that the cause of the
fatal lung cancer could only be smoking which cannot in any way be justified as work-connected.
However, medical authorities support the conclusion that up to now, the etiology or cause of cancer of the
lungs is still largely unknown as provided for in the following:

"Although the etiology of cancer in humans cannot yet be explained at the molecular level, it is clear that
genetic composition of the host is important in cancer induction. Related immunologic factors may
predispose the host to a putative carcinogen. There is some evidence that viruses may play a role in the
neoplastic process. In addition, both environmental and therapeutic agents have been identified of
carcinogens" (Harrison, Principles of Internal Medicine, 9th Edition, 1980, p. 1584).

"Considerable attention has been directed to the potential role of air pollution exposure to ionizing
radiation and numerous occupational hazards, including exposure to chromates, metallic iron and iron
oxides, arsenic, nickel, beryllium and asbestos" (Harrison, Ibid, p. 1259).

"The lungs are the site of origin of primary benign and malignant tumors and receive metastases from
many other organs and tissues. Specific causes have not been established but a strong dose-related
statistical association exists between cigarette smoking and squamous cell and undifferentiated small
(oat) cell bronchogenic carcinomas. There is suggestive evidence that prolonged exposure to air pollution
promotes lung neoplasms" (The Merck Manual, 13th Edition, p. 647).

"What emerges from such concepts is the belief that cancers in man do not appear suddenly ‘out of the
blue’. . . . Moreover, there need not be a single etiology or pathogenesis. Many influences may be at work
during the evolution of the lesion and many pathways may be involved. Indeed, the term cancer may
embrace a multiplicity of diseases of diverse origins" (Robbins, Pathologic Basis of Disease, 2nd Edition,
1979, p. 185, Emphasis supplied).

WE cannot deny the fact that the causes of the illness of the deceased are still unknown and may
embrace such diverse origins which even the medical sciences cannot tell with reasonable certainty.
Indeed, scientists attending the World Genetic Congress in New Delhi, India, have warned that about
25,000 chemicals used around the world could potentially cause cancer, and Lawrence Fishbein of the
U.S. National Center for Toxilogical Research pointed out that humans were daily exposed to literally
hundreds of chemical agents via air, food, medication, both in their industrial home and environments
(Evening Post, December 16, 1983, p. 3, cols. 2-3).

The theory of increased risk is applicable in the instant case. WE had the occasion to interpret the theory
of increased risk in the case of Cristobal v. Employees Compensation Commission (103 SCRA, 336-337,
L-49280, February 26, 1981):

"To establish compensability under the said theory, the claimant must show proof of work-connection.
Impliedly, the degree of proof required is merely substantial evidence, which means ‘such relevant
evidence to support a decision’ (Ang Tibay v. The Court of Industrial Relations and National Labor Union,
Inc., 69 Phil. 635) or clear and convincing evidence. In this connection, it must be pointed out that the
strict rules of evidence are not applicable in claims for compensation. Respondents however insist on
evidence which would establish direct causal relation between the disease rectal cancer and the
employment of the deceased. Such a strict requirement which even medical experts cannot support
considering the uncertainty of the nature of the disease would negate the principle of the liberality in the
matter of evidence, Apparently, what the law merely requires is a reasonable work-connection and not a
direct causal relation. This kind of interpretation gives meaning and substance to the liberal and
compassionate spirit of the law as embodied in Article 4 of the new Labor Code which states that ‘all
doubts in the implementation of the provisions of this Code, including its implementing rules and
regulations shall be resolved in favor of labor.’

". . . As the agents charged by the law to implement the social justice guarantee secured by both 1935
and 1973 Constitutions, respondents should adopt a more liberal attitude in deciding claims for
compensation especially when there is some basis in the facts inferring a work-connection. This should
not be confused with the presumption of compensability and theory of aggravation under the Workmen’s
Compensation Act. While these doctrines may have been abandoned under the New Labor Code (the
constitutionality of such abrogation may still be challenged), it is significant that the liberality of the law, in
general, still subsists. . . ." (Emphasis supplied)

The sweeping conclusion of the respondent Employees Compensation Commission to the effect that the
cause of the bronchogenic carcinoma of the deceased was due to his being a smoker and not in any
manner connected with his work as a soldier, is not in accordance with medical authorities nor with the
facts on record. No certitude can arise from a position of uncertainty.
WE are dealing with possibilities and medical authorities have given credence to the stand of the
petitioner that her husband developed bronchogenic carcinoma while working as a soldier with the
Philippine Constabulary. The records show that when the deceased enlisted with the Philippine
Constabulary in 1969, he was found to be physically and mentally healthy. A soldier’s life is a hard one.
As a soldier assigned to field duty, exposure to the elements, dust and dirt, fatigue and lack of sleep and
rest is a common occurrence. Exposure to chemicals while handling ammunition and firearms cannot be
discounted. WE take note also of the fact that he became the security of one Dr. Emilio Cordero of
Anulung, Cagayan, and he always accompanied the doctor wherever the latter went (p. 26, rec.). Such
assignment invariably involved irregular working hours, exposure to different working conditions, and body
fatigue, not to mention psychological stress and other similar factors which influenced the evolution of his
ailment.

WE held in the case of San Valentin v. Employees Compensation Commission (118 SCRA 160) that:

"x x x

"In compensation cases. strict rules of evidence are not applicable. A reasonable work-connection is all
that is required or that the risk of contracting the disease is increased by the working conditions."

In the case of Dator v. Employees Compensation Commission

(L-57416, January 30, 1982), WE held the death of Wenifreda Dator, a librarian for 15 years, caused by
bronchogenic carcinoma compensable. Being a librarian, "she was exposed to duty books and other
deleterious substances in the library under unsanitary conditions" (Ibid., 632). WE do not see any reason
to depart from the ruling in the said case, considering that a soldier’s duties and environment are more
hazardous.

This is in line with the avowed policy of the State as mandated by the Constitution (Article II, Section 9)
and restated in the new Labor Code (Article 4), to give maximum aid and protection to labor.

WHEREFORE, THE DECISION APPEALED FROM IS HEREBY SET ASIDE AND THE GOVERNMENT
SERVICE INSURANCE SYSTEM IS HEREBY ORDERED.

1. TO PAY THE PETITIONER THE SUM OF TWELVE THOUSAND (P12,000.00) PESOS AS DEATH
BENEFITS;

2. TO REIMBURSE THE PETITIONER’s MEDICAL AND HOSPITAL EXPENSES DULY SUPPORTED

BY PROPER RECEIPTS; AND

3. TO PAY THE PETITIONER THE SUM OF ONE THOUSAND TWO HUNDRED (P1,200.00) PESOS
FOR BURIAL EXPENSES.

SO ORDERED.

Concepcion, Jr., Guerrero, Abad Santos, De Castro and Escolin, JJ., concur.