FIRST DIVISION

[G.R. No. 239390. June 3, 2019.]

BRIGHT MARITIME CORPORATION and/or NORBULK SHIPPING UK

LIMITED , petitioners, vs. JERRY J. RACELA , respondent.

DECISION

GESMUNDO , J : p

Before us is an appeal from the February 15, 2018 Decision 1 and the May 9,
2018 Resolution 2 of the Court of Appeals (CA) in CA-G.R. SP No. 148879 reversing and
setting aside the September 28, 2016 Decision 3 and October 27, 2016 Resolution 4 of
the National Labor Relations Commission (NLRC) Fifth Division. The CA reinstated the
Labor Arbiter's (LA) Decision, 5 dated April 19, 2016, which awarded total and
permanent disability benefits and attorney's fees to respondent.
Antecedents
On March 21, 2013, Jerry J. Racela (respondent) was hired by petitioner Bright
Maritime Corporation, a local manning agency, to work as tter on board the vessel
owned by its foreign principal, Norbulk Shipping UK Limited (petitioner). The
employment contract contained the following terms and conditions:

Duration of Contract : 8 months + 1 month upon mutual

agreement of both parties
Basic Monthly Salary : US$600.00
Hours of Work : 44 hours per week
Overtime : US$311.00 (OT 85 hours per
month) US$4.39 excess of OT
Rate
Vacation Leave Pay : US$194.00 per month
Point of Hire : Manila, Philippines
Supplementary Wage : US$595.00 per month 6

Respondent was also covered by a Collective Bargaining Agreement (CBA)

between Norbulk Manning Services Limited and Latvian National Seafarers Trade Union.
7

Prior to hiring, respondent was subjected to medical examination and was

declared "Fit for Sea Duty as Engine Rating." 8
Respondent left the Philippines on June 8, 2013, and boarded the vessel in
Singapore. Sometime in February 2014, respondent complained of chest pains and
di culty in breathing. On March 23, 2014, he was admitted at the Alisha Hospital in
Israel for pulmonary edema and was diagnosed with "severe aortic regurgitation and
aneurysm of the sinuses of valsalva-aortic root." He underwent open-heart surgery
(aortic valve replacement) on March 25, 2014 and was discharged and advised to
consult his personal cardiologist in the Philippines on April 13, 2014. He was, likewise,
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 prohibited from any physical exertion for six (6) months. On April 19, 2014, he was
repatriated for medical reasons. 9
Upon arrival in the Philippines, respondent was immediately con ned at the
Chinese General Hospital after being referred to the company-designated physician at
Alegre Medical Clinic for post-employment medical examination. 1 0 On April 22, 2014,
he was discharged and was advised to continue his medical therapy. 1 1
While on follow-up checkup with the company-designated physician, respondent
complained of pain over the surgical site on his chest and reported hearing a clicking
sound inside it. His condition was diagnosed as "aortic valve stenosis" and was referred
to a cardiologist. 1 2
When examined by a cardiologist on May 2, 2014, respondent was advised to
retrieve his angiogram results and to undergo repeat 2D Echocardiography in three to
four months. He was also directed to continue with his medications. 1 3 After
subsequent re-evaluations by the company-designated physician, 1 4 the latter rendered
a medical opinion on July 21, 2014, stating that since respondent's aortic valve
stenosis was pre-existing or hereditary, no disability grading was given pursuant to the
POEA-SEC Contract, and that maximum medical cure had already been reached in this
case. 1 5 Respondent followed up with the cardiology specialist who recommended the
conduct of coronary angiography, as the result of his 2D Echo showed dilated left
ventricle with severe hypokinesia. 1 6 In the medical report dated July 23, 2014, the
company-designated physician reiterated his assessment that no disability grade was
given to respondent because his condition was deemed not work-related. 1 7 CAIHTE

Respondent continued with his treatment under the company-designated

physician until August 27, 2014, when he was discharged from the hospital. He had
undergone coronary angiography on August 26, 2014, 1 8 the cost of which was still
shouldered by petitioners.
On September 25, 2014, respondent consulted a private physician, Dr. Efren R.
Vicaldo (Dr. Vicaldo) , who issued a medical certi cate stating that respondent was
suffering from valvular heart disease, severe aortic regurgitation, aneurysm of sinus
valsalva, S/P aortic valve replacement, normal coronary arteries and dilated left
ventricle with systolic dysfunction. He was then given an impediment grade of VI (50%)
and was declared unfit for sea duty. 1 9
On June 9, 2015, respondent led a disability complaint against petitioners. 2 0
He claimed that he was not informed of any assessment by the company-designated
physician as to his tness for sea duty. He alleged that he had told petitioners of the
ndings of his own private physician but petitioners rejected or avoided his repeated
requests for referral to a third doctor. Respondent sought full disability bene ts
(US$60,000.00), moral damages (Php1,000,000.00), exemplary damages
(P200,000.00) and attorney's fees (10% of total claims). 2 1

Petitioners countered that respondent was informed of the assessment made by

the company-designated physician on July 30, 2014, at a meeting with Gilbey Jane A.
Endaya and Jennifer M. Magsino, claims o cers of Pandiman Philippines, Inc.
(Pandiman) that were assigned to coordinate with the representative of petitioner
Norbulk. The causes and risk factors of his illness (aortic valve stenosis) having been
explained to him, respondent seemed to have understood that his ailment was not
work-related and that petitioners shall continue to pay for his medical expenses until
the 130th day or up to August 27, 2014, after which his treatment would be
discontinued. Respondent did not protest the assessment but only requested
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 petitioners to shoulder the cost of his coronary angiogram, which was granted. 2 2
About five (5) months later, petitioners received a letter dated January 5, 2015, 2 3
from respondent's counsel stating that since respondent was not informed of the
medical assessment by the company-designated physician, he obtained a second
opinion from his chosen doctor, Dr. Vicaldo. Said doctor declared him "un t to work as
seaman in any capacity" with an impediment grade of 6 (50% disability). Respondent
thus demanded payment of US$60,000.00 as permanent total disability bene t. After a
conciliation-mediation conference before the NLRC-SENA Unit failed to settle the
dispute, the proceeding was ordered closed and terminated. On April 13, 2015,
petitioners again received a letter from respondent's counsel requesting referral to a
third doctor for a final evaluation of respondent's disability. 2 4
Petitioners replied 2 5 to the counsel of respondent, refuting the allegation of
respondent that he was not informed of the medical assessment of the company-
designated physician, and also manifested their willingness to refer respondent to a
third doctor for a nal determination of whether his condition was work-related. On
June 1, 2015, respondent's counsel sent another letter denying petitioners' assertion
that respondent was duly informed of the company-designated physician's medical
assessment. 2 6 As per respondent's account, he was merely told that he still had to
undergo an angiogram and his medical treatment would stop after 120 days. 2 7
Petitioners further claimed that respondent's counsel even personally conferred
with their own counsel on the possible terms and conditions for the appointment of a
third doctor, during which the former promised to send an e-mail containing their
proposal. However, instead of such e-mail, petitioners received a summons from the
NLRC. Such actuations of respondent's counsel indicate his lack of genuine intention to
comply with the Third-Physician Rule under the POEA-SEC. 2 8
Ruling of the Labor Arbiter
In his Decision, 2 9 dated April 19, 2016, Labor Arbiter Thomas T. Que, Jr. (LA Que)
said that while respondent failed to seek the opinion of the third doctor, the stipulations
in the employment contract and CBA are merely permissive and not mandatory, hence
the use of the word "may." Moreover, with his disability still subsisting, respondent
acted within his rights in instituting the complaint against petitioners. 3 0
On the issue of whether respondent's heart ailment was work-related, LA Que
opined that their liability for compensation was impliedly admitted by petitioners when
they provided him with medical treatment and paid his sickness allowance. Such
continued medical treatment and payment of sickness allowance was indicative of
petitioners' assessment that respondent's illness did, in fact, arise in the course of
and/or was aggravated by the conditions of his employment. 3 1
LA Que further ruled that respondent's cardiovascular disease should be deemed
accidental because not all tters end up with such condition. This entitles respondent
to the maximum amount provided in the CBA. The ndings of the company-designated
physician were not given credence for being ambiguous. Considering that there was no
de nite assessment of respondent's tness to work and his medical conditions
remained unresolved, LA Que concluded that he was already deemed totally and
permanently disabled. 3 2
The dispositive portion of the LA's decision reads:
WHEREFORE , premises considered, judgment is hereby rendered nding
Complainant entitled to his claim for total and permanent disability benefits and
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 attorney's fees in the respective amounts of US$95,949 and $9,594.90 and,
correspondingly, holding Respondents jointly and severally liable to pay the
same.
All other claims are dismissed for lack of merit. DETACa

SO ORDERED. 33

Ruling of the NLRC

Petitioners appealed to the NLRC, which reversed the LA's ruling in its September
28, 2016 Decision. The NLRC disagreed with the LA's nding that respondent's illness
was work-related considering that he failed to present substantial evidence that would
show the causal connection between his work as a tter and his heart disease. Citing
medical references, the NLRC noted that aortic valve stenosis could be caused by
genetics, aging, and childhood rheumatic disease and may be aggravated by lifestyle
choices. These causes being natural, the illness could not have been accidental. As to
Dr. Vicaldo's ndings, the NLRC pointed out that said physician did not perform any test
on respondent. His recommendation was merely based on the medical examinations
conducted by the company-designated physician. 3 4
The NLRC also disagreed with the LA's view that respondent's illness did not
arise from an accident as provided in the CBA. Aortic Valve Stenosis is caused by
natural causes and not accidental. Since respondent failed to prove that his heart
disease was work-related, such illness is not compensable under the POEA-SEC and
the CBA. 3 5
The NLRC thus decreed:
WHEREFORE , the appeal is hereby GRANTED . The Decision of the
Labor Arbiter Thomas T. Que, Jr. is REVERSED and SET ASIDE . Accordingly,
the complaint is DISMISSED for lack of merit.
SO ORDERED. 36

Respondent led a motion for reconsideration but the NLRC denied the same. 3 7
He then elevated the case to the CA in a petition for certiorari under Rule 65.
Ruling of the CA
In its decision, the CA reversed the NLRC, nding respondent's illness to be work-
related. The pertinent portions of the CA's discussion on respondent's entitlement to
disability are herein reproduced:
The records of this case are bereft of any showing as to how
petitioner's nature of work caused or contributed to the aggravation of
his illness. Nevertheless, We nd that (sic) his illness to be work-
related for two reasons. First, petitioner did not exhibit any sign that he
was sick when private respondents employed him . Verily, petitioner's
blood pressure during his PEME was at 130/80mmHg., which is considered to
be higher than what experts consider optimal for most adults. Private
respondents' company-designated physician opined in his certi cation that
"stress test and 2D Echo will detect aortic stenosis in the PEME. The ECG may
provide signs but not de nitive." Nevertheless, petitioner's results for his chest x-
ray and ECG all came out normal. As such, petitioner was declared t for sea
duty. Evidently, there were no signs that petitioner was suffering from Aortic
Valve Stenosis at the time private respondents employed him. He only showed
signs and symptoms of the said cardiac injury while he was performing his
work on board with private respondents' vessel. Pursuant to Section 32-A of the
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 POEA-SEC, We can therefore conclude that there is a causal relationship
between petitioner's illness and the work he performed.
Second, the Supreme Court took judicial notice in several cases
that seafarers are exposed to harsh conditions of the sea, long hours
of work and stress brought about by being away from their families .
Compounded to this, their bodies are further subjected to wear and tear as a
consequence of their work or labor. Aside from these, it has been held in several
cases that "cardiovascular disease, coronary artery disease, and other heart
ailments are work-related and, thus, compensable."
xxx xxx xxx
Private respondents are further mistaken in their argument that petitioner
is not entitled to receive his disability compensation. It is clear from the records
of this case that private respondents' company-designated physician neither
gave petitioner a disability rating nor a categorical pronouncement that he is t
to work or is permanently disabled, whether total or permanent. Nevertheless,
petitioner's independent physician gave him an Impediment Grade of VI and
proclaimed him to be 'un t to resume work as seaman in any capacity.' In the
landmark case of Kestrel Shipping Co., Inc. v. Munar , it was held that injuries
with a disability grading from 2-14 under Section 32 of the POEA-SEC may be
deemed to be permanent and total if it incapacitates a seafarer from performing
his usual duties for a period of more than 120 or 240 days x x x.
xxx xxx xxx
Here, the company-designated physician refused to give
petitioner a disability rating on the premise that his illness is not
work-related . Still, it was explicitly stated in the company-designated
physician's certi cation that "maximum medical care has already been reached
in this case as the patient already underwent Aortic Valve Replacement."
Conspicuously, private respondents' company-designated physician,
himself, recommended petitioner to undergo Coronary Angiography because he
had dilated left ventricle with severe hypokinesia. After undergoing coronary
angiography, the following were found:
xxx xxx xxx
The coronary angiography showed insigni cant coronary artery
vessels. It also showed an avanabus oitpin of the right coronary
artery from the left coronary cell.
xxx xxx xxx
Observably, private respondents' company-designated physician
offered no explanation as with regard to petitioner's condition after
undergoing coronary angiography . Moreover, the progress report that was
issued by private respondents' company-designated physician appears to be
misleading. The abovequoted progress report stated that petitioner had an
"avanabus oitpin of the right coronary artery from the left coronary cell." It
appears after delving into medical literature that there is no such thing as
"avanabus oitpin of the right coronary artery from the left coronary cell." To
dispel any confusion, private respondents could have presented a
copy of the results of the coronary angiography, itself, but did not . Due
to such failure of the private respondents, there arises a presumption that
such evidence, if presented, would be prejudicial to it . aDSIHc

Assuming that private respondent's company-designated physician

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 made a typographical error. The said progress report could be interpreted to
mean that petitioner had an "anomalous origin of the right coronary artery from
the left coronary sinus." Studies have shown that anomalies of this kind rarely
happens. It was then found that this kind of anomaly may lead to sudden death
or myocardial ischemia without exhibiting any symptoms. Nevertheless, this
anomaly can be surgically treated. It was not clear, however, from the records of
this case if petitioner was treated for such anomaly. Neither was there any
showing that petitioner was able to work again as a tter without putting his life
in peril.
Thus, We nd that the NLRC committed grave abuse of discretion
amounting to lack or excess of jurisdiction in deleting the labor arbiter's award
of total and permanent disability compensation of US$60,000.00
(US$50,000.00 x 120%), in accordance with Section 32 of the 2010 POEA-SEC.
3 8 (emphases supplied; citations omitted)

The dispositive portion of the CA Decision reads:

WHEREFORE , premises considered, the petition is GRANTED . The
Decision dated September 20, 2016 and Resolution dated October 27, 2016,
both issued by the National Labor Relations Commission in NLRC LAC No. 05-
000379-16 are hereby REVERSED . The Decision of the Labor Arbiter dated 19
April 2016 is hereby AFFIRMED and REINSTATED .
SO ORDERED. 39

Petitioners' motion for reconsideration was likewise denied by the May 9, 2018
CA Resolution.
ISSUE
The main issue to be resolved in this case is whether or not respondent is
entitled to disability compensation under the POEA-SEC and/or the CBA.
Petitioners' Arguments
Petitioners assail the CA's nding that respondent's aortic valve stenosis is
work-related.
Considering that respondent failed to establish the causal relationship between
his illness and the nature of his work duties, petitioners argue that the CA clearly erred
in holding that he was entitled to permanent and total disability compensation. The
mere fact that respondent was declared t for sea duty prior to hiring does not prove
that he acquired his disease by reason of his employment. It was thus possible that he
was already suffering from a heart ailment but due to the limitations of the Pre-
Employment Medical Examination (PEME), the examining doctor failed to detect the
same. Petitioners stress that although ECG can provide signs of aortic valve stenosis,
the same is not de nitive according to the company-designated physician. The tests
that can properly diagnose said disease is Stress Test and 2D Echo, none of which
were conducted during the PEME. As to respondent's pre-hypertensive blood pressure
reading, it could only mean that his heart was not in perfect shape; and yet the PEME
result posted no hindrance to respondent's employment at sea or was insu cient
indication for the examining doctor to require him to undergo further tests. There is
certainly no basis for the CA to infer work-connection simply because respondent
passed the PEME. 4 0
Petitioners deplore the CA's factual ndings based only on presumptions and
absent the quantum of evidence required in labor cases — which is an erroneous
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 application of the law on compensation proceedings. In citing previous cases decided
by the Court where it was pronounced that cardiovascular disease, coronary artery
disease, and other heart ailments are work-related and compensable, the CA failed to
consider that the grant of bene ts in those cases were based on satisfaction of the
conditions set forth in Section 32-A (11) of the POEA-SEC. 4 1 It is imperative for
respondent to show by substantial evidence the nature of his work and the strain
appurtenant thereto that may have resulted in his condition. Notably, despite the CA's
recognition that the records of this case were bereft of any showing of such work
connection or work aggravation, it still held petitioners liable for the payment of
disability bene ts to respondent. Indeed, the speculations of the CA should not be
allowed to prevail over the express declaration of the company-designated physician
that respondent's illness is not work-related. 4 2
On the non-referral to a third doctor, petitioners maintain that it was the counsel
of respondent who breached the rule by the precipitate ling of the complaint while
they were still conferring on how to comply with the mandatory procedure. Even
assuming that said rule can be set aside in the interest of substantial justice, there is
still no valid basis for the award of disability bene ts because Dr. Vicaldo's
pronouncement of work-relation/aggravation is unsubstantiated. Said doctor issued a
medical certi cate to respondent after a one-time consultation without conducting
diagnostic or con rmatory tests. Petitioners cite previous instances when the Court
has warned the labor tribunals to take extreme caution in relying on the assessment of
Dr. Vicaldo. The CA should have done what the NLRC did when it refused to give
credence to the unfounded medical certificate of Dr. Vicaldo. 4 3 ETHIDa

In their Reply to respondent's Comment, petitioners contend that the principle of

work-aggravation cannot be appreciated in respondent's favor because he failed to
prove that his work as tter and/or the working conditions on board the vessel
aggravated his ailment. Petitioners cite respondent's record of hours of rest which was
attached to their position paper submitted before the Labor Arbiter. Said document
showed that the average time respondent worked was only 10 hours a day between
7:00 a.m. and 6:00 p.m., with one-hour break at 12 noon; and that he had su cient 14
hours of rest each day from July to March 2014. 4 4
Respondent's Arguments
In his Comment, respondent asserts that the CA correctly reinstated the LA's
award which is in accord with the POEA-SEC, as interpreted by the Court in its recent
decisions. Having been cleared as t to work in his PEME, it is clear that respondent
only suffered the illness while on board the vessel, for which he was medically
repatriated. The company-designated physician did not categorically state that
respondent's illness is work-aggravated; hence, the ndings of Dr. Vicaldo that his
condition is work-aggravated should prevail. 4 5
Respondent argues that since petitioners did not respond to his request for
referral to a third doctor, he is then deemed totally and permanently disabled in
contemplation of law, as held in several cases. Further, as held in Eyana v. Philippine
Transmarine Carriers, Inc., et al. , 4 6 if the injuries with a disability grading from 2 to 14
(partial and permanent) would incapacitate a person for more than 120 or 240 days,
depending on the need for further medical treatment, then the patient is deemed totally
and permanently disabled. 4 7 Similarly, in this case, respondent is entitled to total and
permanent disability bene ts, having been given a grade 6 disability rating by Dr.
Vicaldo. 4 8
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 In his Rejoinder to Petitioners' Reply, respondent insists that the CA correctly
held that his heart disease, though pre-existing or congenital, was work-aggravated. He
also points out that the nal report of the company-designated physician was issued to
Ms. Endaya and not to respondent. As to the meeting conducted by representatives of
the manning agency, respondent said that, not being doctors, their statements are
hearsay, and such does not sufficiently comply with the employer's obligation to issue a
de nite assessment of his illness and tness to work made by the company-
designated physician. 4 9
THE COURT'S RULING
The petition is meritorious.
Whether or not respondent's illness is compensable is essentially a factual issue.
50 Issues of facts may not be raised under Rule 45 of the Rules of Court because this
Court is not a trier of facts. It is not to re-examine and assess the evidence on record,
whether testimonial or documentary. 5 1 Among the recognized exceptions 5 2 to said
rule, as in the present case, is where the factual ndings of the Labor Arbiter and the
Court of Appeals are inconsistent with that of the NLRC.
While the LA and the CA found respondent's cardiovascular disease as work-
related and hence compensable, the NLRC declared that such ailment is neither work-
related nor a result of an accident.
The entitlement of overseas seafarers to disability bene ts is a matter governed,
not only by medical ndings, but also by law and contract. 5 3 The pertinent statutory
provisions are Articles 191 to 193 under Chapter VI (Disability Bene ts) of the Labor
Code, in relation to Rule X of the Rules and Regulations Implementing Book IV of the
Labor Code. The relevant contracts pertain to the POEA-SEC, as provided under
Department Order No. 4, series of 2000 of the Department of Labor and Employment
(DOLE), and the parties' CBA. 5 4
Since respondent was hired in 2013, it is the 2010 POEA-SEC (Amended
Standard Terms and Conditions Governing the Overseas Employment of Filipino
Seafarers On-Board Ocean-Going Ships) under Philippine Overseas Employment
Authority (POEA) Memorandum Circular No. 010-10 which is applicable in this case.
Section 20 (A) thereof governs the procedure for compensation and bene ts for a
work-related injury or illness suffered by a seafarer on board seagoing vessels during
the term of his employment contract, to wit:
SECTION 20. Compensation and Benefits. —
A. 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:
1. The employer shall continue to pay the seafarer his wages during
the time he is on board the ship.
2. If the injury or illness requires medical and/or dental treatment in a
foreign port, the employer shall be liable for the full cost of such medical,
serious dental, surgical and hospital treatment as well as board and lodging
until the seafarer is declared t to work or to be repatriated. However, if after
repatriation, the seafarer still requires medical attention arising from said injury
or illness, he shall be so provided at cost to the employer until such time he is
declared t or the degree of his disability has been established by the company-
designated physician.
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 3. In addition to the above obligation of the employer to provide
medical attention, the seafarer shall also receive sickness allowance from his
employer in an amount equivalent to his basic wage computed from the time he
signed off until he is declared t to work or the degree of disability has been
assessed by the company-designated physician. The period within which the
seafarer shall be entitled to his sickness allowance shall not exceed 120 days.
Payment of the sickness allowance shall be made on a regular basis, but not
less than once a month. cSEDTC

The seafarer shall be entitled to reimbursement of the cost of medicines

prescribed by the company-designated physician. In case treatment of the
seafarer is on an out-patient basis as determined by the company-designated
physician, the company shall approve the appropriate mode of transportation
and accommodation. The reasonable cost of actual traveling expenses and/or
accommodation shall be paid subject to liquidation and submission of o cial
receipts and/or proof of expenses.
For this purpose, the seafarer shall submit himself to a post-employment
medical examination by a company-designated physician within three working
days upon his return except when he is physically incapacitated to do so, in
which case, a written notice to the agency within the same period is deemed as
compliance. In the course of the treatment, the seafarer shall also report
regularly to the company-designated physician speci cally on the dates as
prescribed by the company-designated physician and agreed to by the seafarer.
Failure of the seafarer to comply with the mandatory reporting requirement shall
result in his forfeiture of the right to claim the above benefits.
If a doctor appointed by the seafarer disagrees with the assessment, a
third doctor may be agreed jointly between the Employer and the seafarer. The
third doctor's decision shall be final and binding on both parties.
4. Those illnesses not listed in Section 32 of this Contract are
disputably presumed as work-related.
5. In case a seafarer is disembarked from the ship for medical
reasons, the employer shall bear the full cost of repatriation in the event the
seafarer is declared (1) t for repatriation, or (2) t to work but the employer is
unable to nd employment for the seafarer on board his former ship or another
ship of the employer.
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 bene ts enumerated
in Section 32 of his Contract . Computation of his bene ts 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.
The disability shall be based solely on the disability gradings
provided under Section 32 of this Contract, and shall not be measured
or determined by the number of days a seafarer is under treatment or
the number of days in which sickness allowance is paid.
7. It is understood and agreed that the bene ts mentioned above
shall be separate and distinct from, and will be in addition to whatever bene ts
which the seafarer is entitled to under Philippine laws such as from the Social
Security System, Overseas Workers Welfare Administration, Employees'
Compensation Commission, Philippine Health Insurance Corporation and Home
Development Mutual Fund (Pag-IBIG Fund).
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 xxx xxx xxx
F. When requested, the seafarer shall be furnished a copy of all
pertinent medical reports or any records at no cost to the seafarer.
xxx xxx xxx (emphases supplied)
Pursuant to the foregoing, two (2) elements must concur for an injury or illness
to be compensable: first, that the injury or illness must be work-related; and second,
that the work-related injury or illness must have existed during the term of the
seafarer's employment contract. 5 5
To be entitled to compensation and bene ts under the governing POEA-SEC, it is
not su cient 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. 5 6
The POEA-SEC de nes a "work-related illness" as any sickness as a result of an
occupational disease listed under Section 32-A with the satisfaction of conditions
provided therein. Cardiovascular diseases, such as respondent's aortic valve stenosis,
is expressly included among those occupational diseases, which entitles the seafarer
to compensation for the resulting disability if any of the specified conditions are met.
SECTION 32-A. Occupational Diseases. —
For an occupational disease and the resulting disability or death to be
compensable, all of the following conditions must be satisfied :
xxx xxx xxx
1. The seafarer's work must involve the risks described herein;
2. The disease was contracted as a result of the seafarer'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; and
4. There was no notorious negligence on the part of the seafarer.
The following diseases are considered as occupational when
contracted under working conditions involving the risks described
herein : SDAaTC

xxx xxx xxx (emphases supplied)

During the term of his contract and while in the performance of his duties on
board petitioners' vessel, respondent undeniably suffered from severe aortic
regurgitation or valvular insu ciency (leaking of blood back into the left ventricle due
to improperly functioning aortic valve lea ets) 5 7 for which he was hospitalized and
underwent open-heart surgery (aortic valve replacement). Upon repatriation, his
condition was diagnosed by the company-designated physician as aortic valve
stenosis.
"In aortic valve stenosis, the aortic valve between the lower left heart chamber
(left ventricle) and the main artery that delivers blood from the heart to the body (aorta)
is narrowed (stenosis). When the aortic valve is narrowed, the left ventricle has to work
harder to pump a su cient amount of blood into the aorta and onward to the rest of
[the] body. This can cause the left ventricle to thicken and enlarge. Eventually the extra
work of the heart can weaken the left ventricle and [the] heart overall, and it can
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 ultimately lead to heart failure and other problems." 5 8 In adults, three conditions are
known to cause aortic stenosis: 1) Progressive wear and tear of a bicuspid valve
present since birth (congenital); 2) Wear and tear of the aortic valve in the elderly; and
3) Scarring of the aortic valve due to rheumatic fever as a child or young adult. 5 9 In
most elderly adults, aortic stenosis is caused by a buildup of calcium (a mineral found
in the blood) on the valve lea ets. Over time, this causes the lea ets to become stiff,
reducing their ability to fully open and close. 6 0 Respondent was just 49 years old when
he manifested symptoms of the disease after eight months of working on board
petitioners' vessel.
Treatment of aortic valve stenosis depends on the severity of the condition,
which may require surgery to repair or replace the valve. Left untreated, aortic valve
stenosis can lead to serious heart problems. 6 1 The doctor may recommend to limit the
patient's strenuous activity to avoid overworking the heart. 6 2 Aortic valve stenosis,
once it occurs, is irreversible. Medications may be prescribed to manage the
symptoms or reduce the burden on the heart. 6 3 In this case, respondent immediately
underwent open-heart surgery for valve replacement, continued medications, and
regular checkup within 130 days after his repatriation, with coronary angiogram as the
last procedure performed by the company-designated physicians.
Based on the foregoing, it may be concluded that respondent's heart disease has
rendered him un t for sea duty. The company designated-physician, however, refused
to issue a disability grading for the reason that such illness is not work-related.
On July 21, 2014, the 93rd day from respondent's signing-off and medical
repatriation, the company-designated physician, Dr. Natalio G. Alegre II, issued the
following medical assessment:
1. Aortic Valve Stenosis is the narrowing of the valve that conducts blood
from the heart to the aorta and to the circulatory system. The etiologies of aortic
valve stenosis are a deformed heart (bicuspid) [which] is hereditary or genetic in
origin, and childhood infection of Rheumatic Fever.
2. The risk factors are previous infection of Rheumatic Fever, an inherited
deformed heart and age.
3. Stress test and 2D Echo will detect aortic stenosis in the PEME. The ECG
may provide signs but not definitive.
4. Maximum medical care has already been reached in this case as the
patient already underwent Aortic Valve Replacement.
5. As the condition is pre-existing or hereditary, based on the POEA
Contract, no disability is given . 6 4 (emphasis supplied)
I n Fil-Pride Shipping Company, Inc., et al. v. Balasta , 6 5 the Court ruled that the
company-designated physician must arrive at a de nite assessment of the seafarer's
tness to work or permanent disability within a period of 120 or 240 days, pursuant to
Article 192 (c) (1) of the Labor Code and Rule X, Section 2 of the Amended Rules on
Employee's Compensation (AREC). If he fails to do so and the seafarer's medical
condition remains unresolved, the latter shall be deemed totally and permanently
disabled. Thus, even if it was shown that given the seafarer's delicate post-operative
condition, a de nitive assessment by the company-designated physician would have
been unnecessary as, for all intents and purposes, the seafarer was already un t for sea
duty. Still, with the said doctor's failure to issue a de nite assessment of the seafarer's
condition on the last day of the statutory 240-day period, the seafarer was deemed
totally and permanently disabled pursuant to Article 192 (c) (1) of the Labor Code and
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 Rule X, Section 2 of the AREC.
However, it must be pointed out that in the aforecited case, respondent
su ciently alleged the causal connection between his work duties/functions and his
heart disease, viz.: acEHCD

Just the same, in several cases, cardiovascular disease, coronary artery

disease, as well as other heart ailments were held to be compensable. Likewise,
petitioners failed to refute respondent's allegations in his Position Paper that in
the performance of his duties as Able Seaman, he inhaled, was
exposed to, and came into direct contact with various injurious and
harmful chemicals , dust, fumes/emissions, and other irritant agents; that he
performed strenuous tasks such as lifting, pulling, pushing and/or moving
equipment and materials on board the ship; that he was constantly exposed
to varying temperatures of extreme hot and cold as the ship crossed
ocean boundaries; that he was exposed as well to harsh weather conditions;
that in most instances, he was required to perform overtime work ; and that
the work of an Able Seaman is both physically and mentally stressful .
It does not require much imagination to realize or conclude that these tasks
could very well cause the illness that respondent, then already 47 years old,
suffered from six months into his employment contract with petitioners. x x x 6 6
(emphases supplied)
Subsequently, in Gamboa v. Maunlad Trans, Inc., et al. , 6 7 the Court reiterated
case law stating that without a valid nal and de nitive assessment from the company-
designated physician within the 120/240-day period, the law already steps in to
consider petitioner's disability as total and permanent. Thus, a temporary total
disability becomes total and permanent by operation of law. 6 8 Since the company-
designated physician therein failed to arrive at a nal and de nitive assessment of
petitioner seafarer's disability within the prescribed period, the law deems the same to
be total and permanent, which is classified as Grade 1 under the POEA-SEC.
Again, it bears stressing that in the aforecited case, the conditions set forth in
Section 32-A (21) of the 2010 POEA-SEC for degenerative changes in the spine
(osteoarthritis), which is listed as an occupational disease, were satisfied. Thus:
Moreover, degenerative changes of the spine, also known as
osteoarthritis, is a listed occupational disease under Sub-Item Number 21 of
Section 32-A of the 2010 POEA-SEC if the occupation involves any of the
following:
a. Joint strain from carrying heavy loads, or unduly heavy physical
labor, as among laborers and mechanics;
b. Minor or major injuries to the joint;
c. Excessive use or constant strenuous usage of a particular joint, as
among sportsmen, particularly those who have engaged in the more active
sports activities;
d. Extreme temperature changes (humidity, heat and cold exposures)
and;
e. Faulty work posture or use of vibratory tools[.]
Here, petitioner, as Bosun of respondents' cargo vessel that
transported logs, undeniably performed tasks that clearly involved
unduly heavy physical labor and joint strain. Hence, the NLRC cannot
be faulted in nding petitioner's back problem to be work-related .
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 (emphases supplied)
Clearly, the mere fact that a seafarer's disability exceeded 120 days, by itself, is
not a ground to entitle him to full disability bene ts. Such should be read in relation to
the provisions of the POEA Standard Employment Contract which, among others,
provide that an illness should be work-related. Without a nding that an illness is work-
related, any discussion on the period of disability is moot. 6 9
Cardiovascular disease is listed in Sec. 32-A as an occupational disease.
However, for cardiovascular disease to constitute as an occupational disease for
which the seafarer may claim compensation, it is incumbent upon the seafarer to show
that he developed the same under any of the following conditions identi ed in Section
32-A (11): 7 0
a. If the heart disease was known to have been present during employment,
there must be proof that an acute exacerbation was clearly precipitated by
an unusual strain by reasons of the nature of his work;
b. The strain of work that brings about an acute attack must be su cient
severity and must be followed within 24 hours by the clinical signs of a
cardiac insult to constitute causal relationship;
c. If a person who was apparently asymptomatic before being subjected 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;
d. If a person is a known hypertensive or diabetic, he should show
compliance with prescribed maintenance medications and doctor-
recommended lifestyle changes. The employer shall provide a workplace
conducive for such compliance in accordance with Section 1(A) paragraph
5; SDHTEC

e. In a patient not known to have hypertension or diabetes, as indicated in his

last PEME. 7 1
Respondent's aortic valve stenosis cannot be considered to have developed
under any of the rst three instances precisely because of his failure to show that the
nature of his work as tter involved "unusual strain" as to bring about an acute attack or
acute exacerbation of his heart disease that he supposedly contracted in the course of
employment. Even the CA conceded at the outset that there is absolutely no showing in
the records "as to how [respondent's] nature of work caused or contributed to the
aggravation of his illness."
As to the last two instances, there is no evidence that respondent has
hypertension or diabetes; neither is there any allegation or proof that he was taking
prescribed maintenance medicines or observing doctor-recommended lifestyle
changes. While his blood pressure reading of 130/80mmHG is considered pre-
hypertensive, there is no indication in his PEME that he was suffering from high blood
pressure. 7 2 The medical reports issued by the company-designated physicians also
failed to disclose that respondent suffered from either of these conditions.
Neither can respondent rely on the fact that he passed the PEME prior to his
engagement. Thus, we underscored in Loadstar International Shipping, Inc. v. Yamson,
et al.: 7 3
x x x The " t to work" declaration in the PEME cannot be a conclusive
proof to show that he was free from any ailment prior to his deployment. In this
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 regard, it is also true that the pre-existence of an illness does not irrevocably bar
compensability because disability laws still grant the same provided the
seafarer's working conditions bear causal connection with his illness. These
rules, however, cannot be asserted perfunctorily by the claimant as it is
incumbent upon him to prove, by substantial evidence, as to how and why the
nature of his work and working conditions contributed to and/or aggravated his
illness. 7 4 x x x
Indeed, respondent was unable to present substantial evidence to show that his
work conditions caused, or at the least increased the risk of contracting his illness.
Neither was he able to prove that his illness was pre-existing and that it was aggravated
by the nature of his employment. 7 5
Despite the dearth of evidence of work-relation or work-aggravation, the CA
proceeded to take judicial notice that in several cases seafarers are exposed to harsh
conditions of the sea, long hours of work and stress brought about by being away from
their families, compounded by the wear and tear caused to their bodies by their work or
labor. Additionally, the CA faulted petitioners for not presenting a copy of the results of
respondent's coronary angiography, which it said gave rise to the presumption that
such evidence if presented would be prejudicial to petitioners. On the assumption that
the company-designated physician made a typographical error in the medical report,
dated August 28, 2014, 7 6 stating that the result of the coronary angiography showed
an "avanabus oitpin of the right coronary artery from the left coronary cell," the CA
interpreted this to mean an anomalous origin of "the right coronary artery from the left
coronary sinus." Since such anomaly rarely happens, though it can be surgically treated,
the CA again faulted petitioners for not treating the same and for failing to show that
respondent was able to work again as a tter without endangering his life. Incidentally,
respondent was able to obtain a copy of the report on coronary angiography which was
attached to the petition for certiorari led before the CA. The cardiologist's conclusion
stated: "Insigni cant coronary artery disease" with the recommendation to "continue
medical therapy" and "aggressive secondary prevention."
The CA's reasoning based on generalized statements and presumptions does
not suffice to prove entitlement to disability compensation. As we held in the aforecited
case of Loadstar International Shipping, Inc. v. Yamson, et al.: 7 7
While it is true that probability and not ultimate degree of certainty is the
test of proof in compensation proceedings, it cannot be gainsaid, however, that
award of compensation and disability bene ts cannot rest on
speculations, presumptions and conjectures . In addition, the Court agrees
with the nding of the NLRC that "[c]omplainant [Ernesto] failed to
demonstrate that he was subjected to any unusual and extraordinary
physical or mental strain or event that may have triggered his stroke. 7 8
(emphases supplied/citation omitted)
In labor cases, as in other administrative proceedings, substantial evidence , or
such relevant evidence as a reasonable mind might accept as su cient to support a
conclusion, is required. The oft-repeated rule is that whoever claims entitlement to
bene ts provided by law should establish his right thereto by substantial evidence. 7 9
Substantial evidence is more than a mere scintilla. The evidence must be real and
substantial, and not merely apparent. 8 0 It has been ruled, time and again, that self-
serving and unsubstantiated declarations are insu cient to establish a case before
quasi-judicial bodies where the quantum of evidence required to establish a fact is
substantial evidence. 8 1
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 I n Scanmar Maritime Services, Inc., et al. v. De Leon , 8 2 the Court held that
seafarers claiming disability bene ts are burdened to prove the positive proposition
that there is a reasonable causal connection between their ailment and the work for
which they have been contracted. Logically, the labor courts must determine their
actual work, the nature of their ailment, and other factors that may lead to the
conclusion that they contracted a work-related injury. 8 3 Thus:
x x x this Court observes that all the tribunals below relied on the mere
fact of the 22-year employment of De Leon as the causative factor that
triggered his radiculopathy. They did not even specify his duties as a
seafarer throughout his employment .
At most, respondent merely alleged that in his last stint as a Third Mate,
he was a watchstander. His job entailed that he was responsible to the captain
for keeping the ship, its crew, and its cargo safe for eight hours a day. Still, he
did not particularize the laborious conditions of his work that would
cause his injury .
The CA mentioned that De Leon was consistently engaged in stressful
physical labor throughout his 22 years of employment. But it did not de ne
these purported stressful physical activities, nor did it point to any
piece of evidence detailing his work . AScHCD

xxx xxx xxx

In effect, De Leon failed to show before the labor tribunals his
functions as a seafarer, as well as the nature of his ailment. Absent
these premises, none of the courts can rightfully deduce any
reasonable causal connection between his ailment and the work for
which he was contracted . 8 4 (emphases supplied)
Consequently, although considered as an occupational disease, respondent's
heart ailment did not satisfy the conditions under Section 32-A (11) 2010 POEA-SEC to
be considered occupational. 8 5 His aortic valve stenosis not being work-related, the
same is held/deemed not compensable.
As we reiterated in the recent case of Esposo v. Epsilo Maritime Services, Inc.: 8 6
Hence, although cardiovascular diseases are listed as occupational
diseases, still, to be compensable under the POEA-SEC, all of the four (4) general
conditions for occupational diseases under Section 32, plus any one (1) of
the conditions listed under Section 32-A for cardiovascular diseases ,
must nonetheless be proven to have obtained and/or be obtaining. Moreover,
the same must be work-related and must have existed during the term of the
seafarer's employment.
In the present case, Esposo failed to substantially prove his claim that his
illness was work-related or that it was existing during the time of his
employment with Epsilon. He failed to show that his illness was known to have
been present during his employment or that the nature of his work brought an
acute exacerbation thereof as required under Section 32-A(11)(a). 8 7 (boldface
in the original)
As a nal note, while the Court adheres to the principle of liberality in favor of the
seafarer in construing the POEA-SEC, it cannot allow claims for compensation based
on surmises. Liberal construction is not a license to disregard the evidence on record
or to misapply our laws. 8 8
WHEREFORE , the petition is GRANTED . The February 15, 2018 Decision and
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 May 9, 2018 Resolution of the Court of Appeals in CA-G.R. SP No. 148879 are
REVERSED and SET ASIDE . The September 20, 2016 Decision and October 27, 2016
Resolution of the National Labor Relations Commission (Fifth Division) are hereby
REINSTATED .
SO ORDERED.
Bersamin, C.J., Del Castillo and Jardeleza, JJ., concur.
Carandang, * J., is on wellness leave.

Footnotes

* On Wellness Leave.
1. Rollo, pp. 53-67; penned by Associate Justice Jhosep Y. Lopez with Associate Justices Japar
B. Dimaampao and Manuel M. Barrios, concurring.

2. Id. at 69-70.
3. CA rollo, pp. 37-55; penned by Commissioner Mercedes R. Posada-Lacap with Presiding
Commissioner Grace E. Maniquiz-Tan and Commissioner Dolores M. Peralta-Beley,
concurring.

4. Id. at 57-60.
5. Id. at 266-291; penned by Labor Arbiter Thomas T. Que, Jr.

6. Rollo, pp. 54 and 124.

7. Id. at 125-139.

8. Id. at 149.

9. Id. at 55.
10. Id. at 154-155.

11. Id. at 156.

12. Id. at 157.

13. Id. at 158.

14. Id. at 159-163.

15. Id. at 164.

16. Id. at 165-166.

17. CA rollo, p. 184.

18. Id. at 68-71.

19. Id. at 72-73.

20. Rollo, p. 123.

21. CA rollo, pp. 81-91.

22. Rollo, pp. 168-169.

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 23. CA rollo, pp. 195-196.

24. Id. at 200-202.

25. Id. at 205-206.

26. Letter dated May 27, 2015, id. at 208-210.

27. Id.
28. Id. at 211-212.

29. Supra note 5.

30. Id. at 279-285.

31. Id. at 285-286.

32. Id. at 287-290.

33. Id. at 291.

34. Id. at 48-53.

35. Id. at 53-54.

36. Id. at 54.

37. Id. at 57-60.

38. Rollo, pp. 62-65.

39. Id. at 67.

40. Id. at 20-24.

41. Id. at 26.

42. Id. at 26-32.

43. Id. at 32-35.

44. Id. at 538-540; CA rollo, pp. 213-221.

45. Rollo, pp. 506-512.

46. 752 Phil. 232 (2015), citing Kestrel Shipping Co., Inc., et al. v. Munar, 702 Phil. 717, 730-731
(2013).

47. Id. at 243-244.

48. Rollo, pp. 518-523.

49. Id. at 552-556.

50. De Leon v. Maunlad Trans, Inc., et al., 805 Phil. 531, 539 (2017).

51. C.F. Sharp Crew Management, Inc., et al. v. Legal Heirs of the Late Godofredo Repiso, 780
Phil. 645, 665 (2016), citing Litonjua, Jr. v. Eternit Corporation, 523 Phil. 588, 605 (2006).

52. 1) When the conclusion is a finding grounded entirely on speculations, surmises, or

conjectures; (2) when the inference made is manifestly mistaken, absurd, or impossible;
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 (3) when there is grave abuse of discretion; (4) when the judgment is based on a
misapprehension of facts; (5) when the findings of fact are conflicting ; (6) when
the Court of Appeals, in making its findings, went beyond the issues of the case and the
same is contrary to the admissions of both appellant and appellee; (7) when the findings
of the Court of Appeals are contrary to those of the trial court; (8) when the findings of
fact are conclusions without citation of specific evidence on which they are based; (9)
when the Court of Appeals manifestly overlooked certain relevant facts not disputed by
the parties, which, if properly considered, would justify a different conclusion; and (10)
when the findings of fact of the Court of Appeals are premised on the absence of
evidence and are contradicted by the evidence on record. (Litonjua, Jr. v. Eternit
Corporation, supra)
53. Austria v. Crystal Shipping, Inc., et al., 781 Phil. 674, 681 (2016).
54. Id. at 681-682.

55. Bautista v. Elburg Shipmanagement Philippines, Inc., et al., 767 Phil. 488, 497 (2015), citing
Magsaysay Maritime Services, et al. v. Laurel, 707 Phil. 210, 221 (2013); Nisda v. Sea
Serve Maritime Agency, et al., 611 Phil. 291, 316 (2009).
56. Loadstar International Shipping, Inc. v. Yamson, et al., G.R. No. 228470, April 23, 2018,
citing Doehle-Philman Manning Agency, Inc., et al. v. Haro, 784 Phil. 840, 850 (2016);
Austria v. Crystal Shipping, Inc., et al., supra note 53, at 682 (2016).
57. <https://www.healthline/com/health/aortic-stenosis/causes> (visited May 5, 2019).
58. <https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-
20353139> (visited May 5, 2019).

59. Aortic Valve Stenosis Symptoms, Treatment, Types & Surgery by Daniel Lee Kulick, MD,
FACC, FSCAI (Medical Author) and William C. Shiel, Jr., MD, FACP, FACR (Medical Editor),
Medically Reviewed on 11/13/2017, accessed at
<https:www.medicinenet.com/aortic_stenosis/article.htm> (visited May 5, 2019).

60. <https://newheartvalve.com/uk/understand-your-heart/what-is-aortic-stenosis/> (visited

May 5, 2019).
61. <https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-
20353139> (visited May 5, 2019).

62. <https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/symptoms-causes/syc-
20353139> (visited May 5, 2019).
63. <https://www.healthline.com/health/aortic-senosis> (visited May 5, 2019).

64. CA rollo, p. 181.

65. 728 Phil. 297 (2014).

66. Id. at 311-312.

67. G.R. No. 232905, August 20, 2018.

68. Id., citing Talaroc v. Arpaphil Shipping Corporation, G.R. No. 223731, August 30, 2017, 838
SCRA 402, 416; Tamin v. Magsaysay Maritime Corporation, et al., 794 Phil. 286, 301
(2016).

69. See C.F. Sharp Crew Management, Inc. v. Rocha, et al., 809 Phil. 180, 199 (2017); see also
Monana v. MEC Global Shipmanagement and Manning Corporation, et al., 746 Phil. 736,
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 756 (2014).

70. See Bautista v. Elburg Shipmanagement Philippines, Inc., et al., supra note 55, at 498; see
also Dizon v. Naess Shipping Philippines, Inc., 786 Phil. 90, 102-103 (2016).

71. Standard Terms and Conditions Governing the Overseas Employment of Filipino Seafarers
On-Board Ocean-Going Ships.

72. Rollo, p. 149.

73. Supra note 56.

74. Id.
75. Id.

76. CA rollo, p. 190.

77. Supra note 56.

78. Id.

79. Esposo v. Epsilon Maritime Services, Inc., G.R. No. 218167, November 7, 2018, citing
Jebsens Maritime, Inc. and/or Alliance Marine Services, Ltd. v. Undag, 678 Phil. 938, 946-
947 (2011).

80. Id., citing Panganiban v. Tara Trading Shipmanagement, Inc., 647 Phil. 675, 688 (2010).

81. Interorient Maritime Enterprises, Inc. v. Creer III, 743 Phil. 164, 184 (2014), citing Coastal
Safeway Marine Services, Inc. v. Esguerra, 671 Phil. 56, 67 (2011).
82. 804 Phil. 279 (2017).

83. Id. at 288; see also Teekay Shipping Phils., Inc. v. Jarin, 737 Phil. 564, 573 (2014).
84. Id. at 289-290.

85. See C.F. Sharp Crew Management, Inc., et al. v. Alivio, 789 Phil. 564, 573 (2016).

86. Supra note 79.

87. Id.

88. Philman Marine Agency, Inc., et al. v. Cabanban, 715 Phil. 454, 483 (2013); citations
omitted.

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