Gatus v. SSS (G.R. No. 174725; January 26, 2011)


FACTS: Gatus worked at the Central Azucarera de Tarlac beginning on January 1, 1972. He was a covered member of the SSS. He optionally retired from Central Azucarera de Tarlac upon reaching 30 years of service on January 31, 2002, at the age of 62 years.By the time of his retirement, he held the position of Tender assigned at the Distillery Cooling Tower.

Sometime in 1995, he was diagnosed to be suffering from Coronary Artery Disease (CAD): Triple Vessel and Unstable Angina. His medical records showed him to be hypertensive for 10 years and a smoker.

On account of his CAD, he was given by the SSS the following EC/SSS Permanent Partial Disability (PPD) benefits: (a) 8 monthly pensions effective September 1, 1994 and (b) 4 monthly pensions effective January 3, 1997. He became an SSS retirement pensioner on February 1, 2002.

Sometime in 2003, an SSS audit revealed the need to recover the EC benefits already paid to him on the ground that his CAD, being attributed to his chronic smoking, was not work-related. He was notified thereof through a letter dated July 31, 2003.

Convinced that he was entitled to the benefits, he assailed the decision but the SSS maintained its position. The SSS also denied his motion for reconsideration.

Gatus then elevated the case to the Employers Compensation Commission, which held that although his CAD was a cardiovascular disease listed as an occupational disease under Annex A of the Implementing Rules on Employees Compensation, nothing on record established the presence of the qualifying circumstances for responsibility; that it was incumbent upon him to prove that the nature of his previous employment and the conditions prevailing therein had increased the risk of contracting his CAD; and that he had failed to prove this requisite.

The Court of Appeals also agreed with the Employees Compensation Commission despite petitioner Gatus's allegation that his ailment was caused by his exposure to harmful fuel and smoke emissions due to the presence of methane gas from a nearby biological waste as well as a railway terminal where diesel-fed locomotive engines spewed black smoke. This allegation, according to the findings, was not backed up by any scientific and factual evidence.ISSUE: Did the Court of Appeals commit grave abuse of discretion in affirming the finding of the ECC that petitioners ailment is not compensable under Presidential Decree No. 626, as amended?

HELD: Social Security System Benefits - As found by the Court of Appeals, petitioner failed to submit substantial evidence that might have shown that he was entitled to the benefits he had applied for. The Supreme Court affirmed the findings of the CA that according to Section 1, Rule III of the Amended Rules on Employees' Compensation, a ground for compensability is that for the sickness and the resulting disability or death be compensable, the sickness must be the result of an occupational disease listed under Annex "A" of the said rules with the conditions set therein satisfied. Otherwise, proof must be shown that the risk of contracting the disease is increased by the working conditions.

Moreover, according to the Annex "A" of the Amended Rules, for an occupational disease and the resulting disability or death to be compensable, all of the following conditions must be satisfied:

1. The employee's work must involve the risks described herein;
2. The disease was contracted as a result of the employee's exposure to the described risks;
3. The disease was contracted within a period of exposure and under such other factors necessary to contract it;
4. There was no notorious negligence on the part of the employee.

Cardiovascular diseases are considered as occupational when contracted under any of the following conditions:

(a) If the heart disease was known to have been present during employment there must be proof that an acute exacerbation clearly precipitated by the unusual strain by reason of the nature of his work.
(b) The strain of work that brings about an acute attack must be of sufficient severity and must be followed within twenty-four (24) hours by the clinical signs of a cardiac insult to constitute causal relationship.
(c) If a person who was apparently asymptomatic before subjecting himself 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.

The petitioner failed to submit substantial evidence that might have shown that he was entitled to the benefits he applied for. The quantum of proof needed in this case is substantial evidence, which means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Gatus did not discharge the burden of proof imposed under the Labor Code to show that his ailment was work-related. While he might have been exposed to various smoke emissions at work for 30 years, he did not submit satisfactory evidence proving that the exposure had contributed to the development of his disease or had increased the risk of contracting the illness. Neither did he show that the disease had progressed due to conditions in his job as a factory worker. In fact, he did not present any physicians report in order to substantiate his allegation that the working conditions had increased the risk of acquiring the cardiovascular disease. DENIED.