769 Phil. 474
DEL CASTILLO, J.:
Patient was repatriated due to skin lesions incurred last July 2007 x x x.
He had his follow-up today. The skin lesions are minimal and resolving. Our dermatologist have [sic] cleared him to go back to work.
DIAGNOSIS:
Nummular Eczema,
Psoriasis
RECOMMENDATION:
He is fit to work effective January 31, 2008
Lesions are resolving but due to inability to procure meds, residual lesions are present. Patient may resume work at this time but is advised to continue medications so as to completely resolve lesions and to continue treatment while on board.
This is in response to your query about the above patient.[14]
Our dermatologist said that the patient's condition was due to the sensitivity of his skin. The dermatologist also noted that there was recurrence and flare-up of lesions even when the patient is not on board ship.
During the patient's last follow-up, when he was cleared for work, the lesions were minimal and are resolving hence he was advised to continue his medication while on board for the lesion to completely resolve.
The main issue to be resolved is whether or not complainant is entitled to disability benefit and attorney's fees.
The Panel of Voluntary Arbitrators herein supports complainant's view.
Indeed Complainant's illness manifested during the term of his employment with respondents as messman as he was exposed to surfactant, alkaline, phosphates, acids, complexing agents, bleaching agents, enzymes and other strong chemical substances. Complainant was also constantly exposed to stress and strain because of long hours of work and low staffing level thus contributing to the decline of his health and resistance to the illness.
Our own research confirms that complainant's illness can be reasonably related to his work as messman and not everyone who has the gene mutations gets nummular eczema or dermatitis as there are several forms of eczema or dermatitis that people can develop. Certain "environmental triggers" play a role in causing skin disorder in people who have the gene mutations. Also, psychological stress has long been understood as a trigger for skin flares, but scientists are still unclear about exactly how this occurs. Studies do show that not only can a sudden, stressful event trigger a rash or worsen; daily hassles of life can also trigger a flare. In addition, one study showed that people who are categorize [sic] as "huge worriers" were almost two times less likely to respond to treatment compared to "low worriers." Sometime [sic] even mild injuries to the skin such as abrasions can trigger skin flares. This is called the koebner[20] phenomenon.
The Panel of Voluntary Arbitrators finds no convincing evidence to show that complainant's illness was caused by genetic predisposition or drug addiction. Having ruled out these reasons, what remain [sic] is the environmental factor such as complainant's constant exposure to chemicals while on board the vessel such as surfactant, alkaline, phosphates, acids, complexing agents, bleaching agents, enzymes and other strong chemical substances that caused the skin injury in addition to the stress and strain which are present in his work area.
While treatment can help control symptoms of Nummular Eczema/Psoriasis, there is yet no cure for the illness. Complainant's continued employment on board is deleterious to his health because he will again be exposed to factors that increases [sic] the risk of further recurrence and aggravation of the skin problem such as strong chemical substances, stress and including changes in season and climate.
This office finds merit in the contention of complainant that as a result of his work-connected illness, he suffered permanent disability as he could not return to his work as messman and earn wages in the same kind of work of similar nature [sic] that he was trained for. In awarding disability compensation, it is not the injury which is compensated, but rather the incapacity to work resulting in the impairment of one's earning capacity.
The High Tribunal consistently ruled that neither is it necessary, in order for an employee to recover compensation, that he must have been in perfect condition or health at the time he recurred the injury [sic], or that he be free from disease. Every workingman brings with him to his employment certain infirmities, and while the employer is not the insurer of the health of his employees, he takes them as he finds them, and assumes the risk of having a weakened condition aggravated by some injury which might not hurt or bother a perfectly normal, healthy person (More Maritime Agencies, Inc. vs. NLRC, 307 SCRA 189).
As ruled in Marcopper Manning Corporation vs. NLRC, 200 SCRA 167, the Arbitration Branch is mindful that all labor legislation and all labor contracts shall be construed in favor of the safety and decent living for the laborer, contractual rights and duties, such as these arising from the provisions of the POEA Standard Employment Contract and/or the Collective Bargaining Agreement, should be voluntarily stipulated in good faith and must constitute the law between the parties.
Despite the inability to resume sea duty, this Panel award [sic] Grade 5 disability only to complainant. He is still physically capable of performing other tasks or jobs besides being a messman even with the skin disorder although not of the same position as messman. To this panel, despite declaration of fitness to resume work by the company-designated physician in his 11th report, there is no concrete evidence indicated that respondent allowed him to resume sea duty on January 31, 2008. Likewise, both the company-designated physician and the independent dermatologist consulted by complainant agree that the illness is recurrent and would be considered as unemployable as this illness would entail lifetime treatment. With that, we considered his inability to resume x x x sea duty as justification to award x x x disability compensation based on Grade 5 as evaluated by his attending physician.
For having been compelled to litigate and incur expenses, complainant's claim for attorney's fees is also granted. Other claims however are dismissed for lack of factual and legal basis.
WHEREFORE, premises considered, respondents are hereby ordered to pay complainant jointly and severally the amount of US$29,480.00 representing his disability benefit based on the POEA Standard Employment Contract plus (10%) ten percent attorney's fees, Philippine Currency or the amount of US$2,948.00 at the rate of exchange prevailing at the time of actual payment. All other claims are dismissed.
SO ORDERED.[21] (Underscoring in the original.)
Entitlement of seamen on overseas work to disability benefits is a matter governed, not only by medical findings, but by law and contract. Articles 191 to 193 of the Labor Code of the Philippines provide the basis for the worker's entitlement to disability benefits. The said provisions equally [apply] to employees actually working in the Philippines and to seafarers. The respondent claims permanent disability, hence, we should refer to Article 192(c)(l) of the Labor Code which provides:ART. 192. Permanent Total Disability, x x xBy contract, the Philippine Overseas Employment Administration -Standard Employment Contract (POEA-SEC), as provided under Department Order No. 4, Series of 2000 of the Department of Labor and Employment, and the parties' Collective Bargaining Agreement (CBA) bind the seaman and his employer to each other. Section 20 (B) of the 2000 POEA-SEC governs the compensation and benefits to which a seafarer is entitled in case of injury or illness, viz[.]:
(c) The following disabilities shall be deemed total and permanent:
(1) Temporary total disability lasting continuously for more than one hundred twenty days, except as otherwise provided for in the Rules;"Section 20-B. Compensation and Benefits for Injury or Illness.
The liabilities of the employer when the seafarer suffers work-related injury or illness during the term of his contract are as follows:
xxxx
3. Upon sign-off from the vessel for medical treatment, the seafarer is entitled to sickness allowance equivalent to his basic wage until he is declared fit to work or the degree of permanent disability has been assessed by the company-designated physician but in no case shall this period exceed one hundred twenty (120) days.
xxxx
6. In case of permanent total or partial disability of the seafarer caused by either injury or illness the seafarer shall be compensated in accordance with the schedule of benefits enumerated in Section 32 of this Contract. Computation of his benefits arising from an illness or disease shall be governed by the rates and the rules of compensation applicable at the time the illness or disease was contracted."
To be entitled to compensation and benefits under the foregoing provision, it is not sufficient to establish that the seafarer's illness or injury has rendered him permanently or partially disabled, it must also be shown that there is a causal connection between the seafarer's illness or injury and the work for which he had been contracted. Work-related injury is defined under the 2000 POEA-SEC as an injury resulting in disability or death arising out of or in the course of employment. Work-related illness, on the other hand, is any sickness resulting in disability or death as a result of an occupational disease listed under Section 32-A of this contract with the conditions set therein satisfied.
Whether the illness of the respondent is work-related x x x does not seem to be an issue in the instant case. As x x x can be gathered from the pleadings of the petitioners and the position papers submitted by them before the labor tribunal, what they are only after is the proper determination of the degree of disability of the respondent. Moreover, the company-designated physician himself did not categorically state that the illness of the respondent is not work-related.
Be that as it may, the records will show that the respondent was treated of nummular dermatitis by the company-designated physician Nicomedes Cruz.
Dermatitis is listed as an occupational disease under Section 32-A. It is appreciated as an occupational disease if the nature of employment involves the use or handling of chemical agents which are skin irritants and sensitizers.
The respondent alleged that M/V Sunny Napier II is a chemical tanker[, fjhat he worked therein as a Messman. That being such, he was in charged [sic] of washing clothes and dishes, cleaning the area on board, the general sanitation using cleaning agents such as surfactant, alkaline, phosphates, acids, complexing agents, bleaching agents, enzymes, and other strong chemical substances. The petitioners did not seem to have ever disputed the said claims of the respondent. Based on the foregoing, it cannot be denied that there is causal connection between the nature of job of the respondent and the illness he contracted while employed with the petitioners.
The respondent was first seen by the company-designated physician on August 30, 2007. In the course of his treatment, the respondent was asked several times to return for follow-up check-ups so that his progress could be monitored. On January 31, 2008, he was finally declared fit to work. But despite the pronouncement of the company-designated physician, it appears that the illness of the respondent was not completely healed since he had to consult two physicians afterwards. One of the physicians that he consulted, Dr. Glenda A. Fugoso, contradicted the findings of the company-designated physician and declared the respondent unfit to work. It was further added that his condition might require a lifetime treatment. In view thereof, the respondent claims permanent total disability benefits from the petitioners.
Permanent total disability means disablement of an employee to earn wages in the same kind of work or work of a similar nature that he was trained for or accustomed to perform, or any kind of work which a person of his mentality and attainment can do. It does not mean state of absolute helplessness but inability to do substantially all material acts necessary to the prosecution of a gainful occupation without serious discomfort or pain and without material injury or danger to life. In disability compensation, it is not the injury per se which is compensated but the incapacity to work.
Permanent total disability refers to the inability of a worker to perform his job for more than 120 days, regardless of whether he loses the use of any part of his body. Otherwise stated, what determines the worker's entitlement to permanent disability benefits is his inability to work for more than 120 days.
In this jurisdiction, jurisprudence abounds holding that failure of the company-designated physician to pronounce a seafarer fit to work within 120 days entitles the latter to permanent total disability. This was the very ruling in Abante v. KJGS Fleet Management Manila:[23]"It is gathered from the documents emanating from the Office of Dr. Lim that petitioner was seen by him from July 24, 2000 up to February 20, 2001 or a total of 13 times; and except for the medical reports dated February 5, 2001 and February 20, 2001 (when the doctor finally pronounced petitioner fit to work), Dr. Lim consistently recommended that petitioner continue his physical rehabilitation/therapy and revisit clinic on specific dates for re-evaluation, thereby implying that petitioner was not yet fit to work.
Given a seafarer's entitlement to permanent disability benefits when he is unable to work for more than 120 days, the failure of the company-designated physician to pronounce petitioner fit to work within the 120-day period entitles him to permanent total disability benefit in the amount of US$60,000.00."
The same ruling is echoed in the case of Oriental Shipmanagement Co., Inc. v. Bastol:[24]"In all, after his repatriation on March 7, 1997, Bastol went to see Dr. Peralta on March 8, 1997, and until the last examination by Dr. Lim on October 28, 1997, he had been treated by these company-designated doctors for a period spanning around seven months and 20 days or for approximately 230 days. Clearly then, the maximum period of 120 days stipulated in the SEC for medical treatment and the declaration or assessment by the company-designated physician of either being fit to work or the degree of permanent disability had already lapsed. Thus, by law, if Bastol's condition was with the lapse of the 120 days of post-employment medical examination and treatment, which actually lasted as the records show for at least over eight months and for over a year by the time the complaint was filed, without his being employed at his usual job, then it was certainly total permanent disability."
In the case at bar, the respondent was under the treatment of the company-designated physician for five (5) months, or 154 days to be exact, from the time he was taken to the latter for an examination on August 30,2007 until he was declared fit to work on January 31, 2008. Applying the foregoing jurisprudence in the case at bar, there is no doubt that the respondent is entitled to permanent total disability benefits. The petitioners cannot take advantage of the pronouncement of the company-designated physician that the respondent was already fit to work to evade their liability. Indeed, the respondent has been eventually declared fit to work but the same came only after more than 120 days. The law and jurisprudence is very clear on the matter, if the company-designated physician failed to declare the seafarer fit to [work] within 120 days, the latter is entitled to a permanent total disability benefits [sic].
For obvious reason, the company-designated physician did not determine the degree of disability of the respondent. But being the expert on the matter, we defer to the finding of the public respondent that the respondent is entitled to permanent disability benefits equivalent to Grade 5 disability under the POEA contract.
The Court also sustains the award of attorney's fees in favor of the respondent. The claim for attorney's fees is granted following Article 2208 of the New Civil Code which allows its recovery in actions for recovery of wages of laborers and actions for indemnity under the employer's liability laws. The same fees are also recoverable when the defendant's act or omission has compelled the plaintiff to incur expenses to protect his interest as in the present case following the refusal by the petitioners to settle the respondent's claims. Pursuant to prevailing jurisprudence, the respondent is entitled to attorney's fees of ten percent (10%) of the monetary award.
WHREFORE [sic], premises considered, the instant petition for review is DISMISSED for lack of merit.
SO ORDERED.[25]
1. Whether x x x the Court of Appeals had legal basis in awarding US$29,480.00.
2. Whether x x x petitioners are liable to private respondent for disability benefits amounting to US$29,480.00 despite the fact that he was declared fit to work by the company-designated physician.
3. Whether x x x the medical findings of the company-designated physician should be given more weight than that of the physician appointed by the seafarer.
4. Whether x x x the private respondent is entitled to attorney's fees.[27]
The 2000 POEA-SEC defines "work-related illness" as "any sickness resulting to disability or death as a result of an occupational disease listed under Section 32-A of this contract with the conditions set therein satisfied."
In interpreting the said definition, the Court has held that for disability to be compensable under Section 20(B) of the 2000 POEA-SEC, it is not sufficient to establish that the seafarer's illness or injury has rendered him permanently or partially disabled; it must also be shown that there is a causal connection between the seafarer's illness or injury and the work for which he had been contracted.
The Court has likewise ruled that the list of illnesses/diseases in Section 32-A does not preclude other illnesses/diseases not so listed from being compensable. The POEA-SEC cannot be presumed to contain all the possible injuries that render a seafarer unfit for further sea duties. This is in view of Section 20(B)(4) of the POEA-SEC which states that "those illnesses not listed in Section 32 of this Contract are disputably presumed as work-related."
Concomitant with such presumption is the burden placed upon the claimant to present substantial evidence that his working conditions caused or at least increased the risk of contracting the disease. Substantial evidence consists of such relevant evidence which a reasonable mind might accept as adequate to justify a conclusion that there is a causal connection between the nature of his employment and his illness, or that the risk of contracting the illness was increased by his working conditions. Only a reasonable proof of work-connection, not direct causal relation is required to establish compensability of a non-occupational disease.
x x x x
Psoriasis comes from the Greek word "psora" which means itch. It is a common disfiguring and stigmatising skin disease associated with profound impaired quality of life. People with psoriasis typically have sharply demarcated erythematous plaques covered by silvery white scales, which most commonly appear on the elbows, knees, scalp, umbilicus, and lumbar area. Chronic plaque psoriasis (psoriasis vulgaris) is the most common type of the disease which manifests thru plaques of varying degrees of scaling, thickening and inflammation [on] the skin. The plaques are typically oval-shaped, of variable size and clearly distinct from adjacent normal skin.
As a result of the chronic, incurable nature of psoriasis, associated morbidity is significant. Patients in primary care and hospital settings have similar reductions in quality of life specifically in the functional, psychological and social dimensions. Symptoms specifically related to the skin (i.e., chronic itch, bleeding, scaling, nail involvement), problems related to treatments (mess, odor, inconvenience, time), arthritis, and the effect of living with a highly visible, disfiguring skin disease (difficulties with relationships, difficulties with securing employment, and poor self- esteem) all contribute to morbidity. About one in four patients experience major psychological distress, and the extent to which they feel socially stigmatized and excluded is significant.
Current available treatments for the disease are reasonably effective as short-term therapy. Extended disease control is, however, difficult to achieve as the safety profile of most therapeutic agents limit their long-term use.
Until now, the exact cause of psoriasis remains a mystery. But several family studies have provided compelling evidence of a genetic predisposition to psoriasis, although the inheritance pattern is still unclear. Other environmental factors such as climate changes, physical trauma, infections of the upper respiratory tract, drugs, and stress may also trigger its onset or development.
After a circumspect evaluation of the conflicting medical certifications of Drs. Alegre and Fugoso, the Court finds that serious doubts pervade in the former. While both doctors gave a brief description of psoriasis, it was only Dr. Fugoso who categorically stated a factor that triggered the activity of the respondent's disease - stress, drug or alcohol intake, etc. Dr. Alegre immediately concluded that it is not work-related on the basis merely of the absence of psoriasis in the schedule of compensable diseases in Sections 32 and 32-A of the POEA-SEC. Dr. Alegre faUed to consider the varied factors the respondent could have been exposed to while on board the vessel. At best, his certification was merely concerned with the examination of the respondent for purposes of diagnosis and treatment and not with the determination of his fitness to resume his work as a seafarer in stark contrast with the certification issued by Dr. Fugoso which categorically declared the respondent as "disabled." The certification of Dr. Alegre is, thus, inconclusive for purposes of determining the compensability of psoriasis under the POEA-SEC. Moreover, Dr. Alegre's specialization is General Surgery while Dr. Fugoso is a dermatologist, or one with specialized knowledge and expertise in skin conditions and diseases like psoriasis. Based on these observations, it is the Court's considered view that Dr. Fugoso's certification deserves greater weight.
It remains undisputed that the respondent used strong detergent, fabric conditioner, special soap and chemicals in performing his duties as a steward. Stress and climate changes likewise permeate his working environment as with that of any other seafarer. These factors, taken together with Dr. Fugoso's certification, confirm the existence of a reasonable connection between the nature of respondent's work and the onset of his psoriasis.
At any rate, even in the absence of an official finding by the company-designated physician or the respondent's own physician, he is deemed to have suffered permanent total disability pursuant to the following guidelines in Fil-Star Maritime Corporation v. Rosete, thus:Permanent disability is inability of a worker to perform his job for more than 120 days, regardless of whether or not he loses the use of any part of his body.It is undisputed that from the time the respondent was medically repatriated on October 7,2005 he was unable to work for more than 120 days. In fact, Dr. Alegre's certification was issued only after 259 days with the respondent needing further medical treatments thus rendering him unable to pursue his customary work. Despite the declaration in the medical reports that psoriasis is not contagious, no profit-minded employer will hire him considering the repulsive physical manifestation of the disease, its chronic nature, lack of long-term cure and the vulnerability of the patient to cardiovascular diseases and some cancers. Its inevitable impact [on] the respondent's chances of being hired and capacity to continue working as a seaman cannot be ignored. His permanent disability thus effectively became total in nature entitling him to permanent total disability benefits as correctly awarded by the LA and the CA.[32] (Emphasis supplied)
Total disability, on the other hand, means the disablement of an employee to earn wages in the same kind of work of similar nature that he was trained for, or accustomed to perform, or any kind of work which a person of his mentality and attainments could do.
A total disability does not require that the employee be completely disabled, or totally paralyzed. What is necessary is that the injury must be such that the employee cannot pursue his or her usual work and earn from it. A total disability is considered permanent if it lasts continuously for more than 120 days. x x x.