Did the respondent Court of Appeals err in holding that the nature of the private respondent's work increased the risk of contracting ureterolithiasis, thereby entitling her to compensation under P.D. No. 626, as amended?  This issue confronts us in this petition for the review of the decision of the Court of Appeals of 7 August 1995 in CA-G.R. SP No. 34223.^[1]

The antecedent facts are summarized in the challenged decision as follows:

Lilia Arreola [private respondent herein] was employed as a Chemical Laboratory Technician in the National Bureau of Investigation on March 23, 1972.

Thereafter, Arreola was promoted as Senior Chemical Technician, Chemical Engineer, and finally as Engineer II.

As Engineer II, Arreola performs the following duties:

1.  Makes researches on and designs equipment needed to facilitate conclusive analysis by Forensic Chemist;

2.  Computes cost of proposed equipment based on designs made;

3.  Performs instrumental analysis of drugs, insecticides, volatile poisons, fuels and inorganic compounds, using gas (GS) and liquid (LC) chromatograph, UV, VIS and IR Spectrophotometers;

4.  Incharge (sic) of the supervision, maintenance and repair of modern chemical laboratory equipment installed in the Bureau;

5.  Computes cost of analysis performed;

6.  Attends to field cases and takes paraffin casts at the morgue and in the office;

7.  Renders holiday and night duties once a week and help the chemist in the examinations on incoming cases during the tour of duty;

8.  Assists the supervisor and chemist of the unit in conducting researches on some special cases;

9.  May assist NBI Agents in field work re investigation of industrial companies engaged in nefarious activities;

10. Performs other duties assigned to me (her) by (sic) supervisor from time to time. (Annex "B" of the instant Petition).

Sometime in May, 1993, Arreola suffered pains at her left flank accompanied by nausea, vomiting, and low moderate fever.  Her medical examination revealed the presence of stone deposits at her left urethra.

On May 18, 1993, Arreola underwent Ureterolithiasis (L) S/P Ureterolithomy (L) operation, followed by regular check-ups and medication for one month.  She spent P16,019.00 for her hospital bills, doctor's fees, x-ray, laboratory analysis, and medicine.

On June 16, 1993, Arreola filed with the GSIS an application for compensation benefit under PD No. 626, as amended.

On July 17, 1993, the GSIS denied her claim on the grounds that her ailment "Ureterolithiasis left" is a non-occupational disease; and that she failed to show that her position as Engineer II of the NBI has increased the risk of contracting the sickness.

Upon the denial of Arreola's request for reconsideration with the GSIS, she interposed an appeal to the Employees' Compensation Commission, docketed as ECC Case No. 6494.

On December 2, 1993, the ECC rendered a decision, the pertinent portions of which read:

"After a study of the records of the case, he failed to find proof that appellant's ailment, Ureterolithiasis left, Ureterolithomy, left, was brought about by her duties as Engineer II at the National Bureau of Investigation.  Where the ailment is not the direct or customary result of the employment and the herein appellant failed to show proof that the risk of contracting the disease was increased by her work and working conditions, the claim for compensation cannot be sustained.  This is the clear implication of Section I(B) of Rule III of the Rules Implementing PD 626, as amended, which explicitly provides that "for the sickness and the resulting disability or death to be compensable, the sickness must be the result of an occupational disease listed under the rules with conditions set therein satisfied, otherwise, proof must be shown that the risk of contracting it is increased by the working conditions.

x x x
Based on the foregoing discussions, the case therefore, is not meritorious for compensation benefits under the Employees Compensation Law (PD 6262 (sic), as amended).

FOR ALL THE FOREGOING, the decision appealed from is hereby AFFIRMED and the instant case is Dismissed for lack of merit.

SO ORDERED."^[2]

We also note that the Employees' Compensation Commission (ECC) made the following observations:

Moreover, medical findings show that Ureterolithiasis is the presence of renal stones in the ureter.  The ureter conveys urine from the renal pelvis to the bladder.  When stones in the renal pappillae or within the urinary     collecting system break loose, they enter the ureter or occlude the ureteropelvic causing obstruction and pain.

Urinary stones usually arise because of the breakdown of a delicate balance.  The kidneys must conserve water, but they must also excrete materials that have low solubility.  These two opposing requirements must be balanced against one another during adaptation to a particular combination of diet and activity.  (Reference: Harrison's Principles of Internal Medicine, 11th Edition, pp. 1211-1212).^[3]

Undaunted by the two adverse judgments, Arreola then filed a petition for review with the Court of Appeals.  She insisted that she was entitled to compensation under P.D. No. 626, as amended, since she was able to prove that the exigency and nature of her work as Engineer II of the National Bureau of Investigation (NBI) greatly increased the risk of contracting the ailment.

In their Comments to the above petition, herein petitioners (respondents below) Government Service Insurance System (GSIS) and ECC reiterated their stand that Arreola's disease was not included in the list of occupational diseases and the risk of contracting it had not been proved to have been increased by the nature of the petitioner's work.^[4]

In its decision of 7 August 1995,^[5] the Court of Appeals sustained the position of Arreola, reversed the appealed decision of the ECC, and ordered the GSIS to pay Arreola "the amount due her under P.D. 626, as amended."^[6] In support of its disposition, the appellate court stated:

The nature of the work of petitioner Arreola as Engineer II in the National Bureau of Investigation deals with research; instrumental analysis of drugs, insecticides, volatile poisons, fuels, and inorganic compound; attendance to field cases; taking of paraffin casts at morgue and in the office; and assisting NBI agents in field work in the matters of investigation of industrial corporations engaged in nefarious activities.

It is, therefore, safe to conclude that the exingency (sic) of petitioner's assigned tasks was such that she had to forego urination in order not to interrupt the flow of concentration.  In addition, tension, stress, and pressure must have aggravated her physical condition.

The Supreme Court in Narazo vs. Employees' Compensation Commission^[7] held that "x x x [i]t may be added that teachers have a tendency to sit for hours on end, and to put off or postpone emptying their bladders when it interferes with their teaching hours or preparation of lesson plans.  From human experience, prolonged sitting down and putting off urination result in stagnation of the urine.  This encourages the growth of bacteria in the urine, and affects the delicate balance between bacterial multiplication rates and the host defense mechanisms. Delayed excretion may permit the retention and survival of micro-organisms posing factors to pyelonephritis and uremia.  Thus, while We may concede that these illnesses are not directly caused by the nature of the duties of a teacher, the risk of contracting the same is certainly aggravated by their working habits necessitated by demands of job efficiency."

Similarly, considering the nature of the work of herein petitioner, the same could have increased the risk of contracting the disease.  We thus find her entitled to receive compensation benefits under PD No. 626, as amended.^[8]

In addition, the Court of Appeals commented that the ECC failed to appreciate the petitioner's more than twenty years of devoted public service, which earned her successive promotions to greater responsibilities and the fact that she had been performing the strenuous and demanding task of Chemical Engineer.  It also quoted Santos vs. Employees' Compensation Commission,^[9] which reiterates that claims falling under the Employee's Compensation Act should be liberally resolved to fulfill its essence as a social legislation designed to afford relief to the working man and woman in our society.^[10]

The petitioners forthwith appealed to us from the decision of the Court of Appeals by way of this petition for review under Rule 45 of the Rules of Court.  They contend that the appellate court's determination that Arreola's work increased the risk of her contracting ureterolithiasis is "pure speculation."  The petitioners pointedly state that there is no need to apply Article 4 of the Labor Code on the liberal interpretation of social legislation when the provisions of such are clear.

In her Comment, Arreola posits that while it is true that ureterolithiasis is not a listed occupational disease, yet under the "increased risk" theory, she has sufficiently proved that her claim for compensation is meritorious.  Moreover, she satisfactorily established that the nature of her work for the past twenty years, as former Chemical Lab Technician and Chemical Engineer, and currently as Engineer II, made her miss important health habits such as regularly drinking water and urinating.  She then chides the petitioners for making her claim for compensation a circuitous and painful path.

After a further evaluation of the case and assessment of the arguments of the parties, we rule for the private respondent and affirm the challenged decision of the Court of Appeals.

P.D. No. 626 (27 December 1974) further amended Title II of Book IV on the ECC and State Insurance Fund of the Labor Code of the Philippines (P.D. No. 442, as amended).  This law abandoned the presumption of compensability and the theory of aggravation under the Workmen's Compensation Act.^[11] For the sickness and resulting disability or death to be compensable, the claimant must prove that: (a) the sickness must be the result of an occupational disease listed under Annex "A" of the Rules on Employees' Compensation, or (b) the risk of contracting the disease was increased by the claimant's working conditions.^[12] This means that if the claimant's illness or disease is not included in the said Annex "A," then he is entitled to compensation only if he can prove that the risk of contracting the illness or disease was increased by his working conditions.^[13]

Despite the abandonment of the presumption of compensability established by the old law, the present law has not ceased to be an employees' compensation law or a social legislation; hence, the liberality of the law in favor of the working man and woman still prevails, and the official agency charged by law to implement the constitutional guarantee of social justice should adopt a liberal attitude in favor of the employee in deciding claims for compensability,^[14] especially in light of the compassionate policy towards labor which the 1987 Constitution vivifies and enhances.^[15] Elsewise stated, a humanitarian impulse, dictated by no less than the Constitution itself under the social justice policy, calls for a liberal and sympathetic approach to legitimate appeals of disabled public servants;^[16] or that all doubts to the right to compensation must be resolved in favor of the employee or laborer.  Verily, the policy is to extend the applicability of the law on employees' compensation to as many employees who can avail of the benefits thereunder.^[17]

The private respondent concedes that her ailment, ureterolithiasis, is not included in Annex "A" of the Rules on Employees' Compensation.  Nevertheless, she asserts that she was able to prove that the risk of contracting it was increased by the exigency and nature of her work.  Her burden of evidence did not require the presentation of proof beyond reasonable doubt nor a preponderance of evidence.  It was enough that she adduced substantial evidence.  In cases filed before administrative or quasi-judicial bodies, like the ECC, a fact is deemed established if it is supported by substantial evidence or that amount of relevant evidence which a reasonable mind might accept as adequate to justify a conclusion.^[18] It was then enough if the private respondent was able to show that the nature of her work or her working conditions increased the risk of her contracting ureterolithiasis.  Certainly, it was not necessary for her to breach the parameters of substantial evidence and to cross the difficult area of preponderance of evidence.  We agree with the Court of Appeals that the private respondent successfully discharged her burden of evidence and convincingly showed that, indeed, the nature of her work or her working conditions increased the risk of contracting ureterolithiasis.

According to the ECC in its impugned decision, ureterolithiasis is the presence of renal stones in the ureter and urinary stones usually arise because of the breakdown of a delicate balance.  Quoting Harrison's Principles of Internal Medicine, 11th edition, it added: "The kidneys must conserve water, but they must excrete materials that have low solubility.  These two opposing requirements must be balanced against one another during adaptation to a particular combination of diet and activity."^[19]

In the 13th Edition of Harrison's Principles of Internal Medicine, vol. 2 (International Edition, 1994), page 1330, we find the following entries:

PATHOGENESIS OF STONES

Urinary stones usually arise because of the breakdown of a delicate balance.  The kidneys must conserve water, but they also must excrete materials that have a low solubility.  These two opposing requirements must be balanced during adaptation to diet, climate, and activity.  The problem is mitigated to some extent by the fact that urine contains substances that inhibit crystallization of calcium salts and others that bind calcium in soluble complexes. These protective mechanisms are less than perfect.  When the urine becomes supersaturated with insoluble materials because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone.  (Stress supplied)

Clearly then, diet, climate, and activity are important considerations in achieving the delicate balance.  Note, however, that climate was excluded from the quotation made by the ECC.

The following are factors which contribute to the development of stones:

Geographic factors contribute to the development of stones.  In developing countries, children -- especially prepubescent boys -- are prone to bladder calculi.  In industrialized countries, most calculi are seen in adults as renal or ureteral stones.  Areas of high humidity and elevated temperatures appear to be contributing factors, and the incidence of symptomatic ureteral stones is greatest during hot summer months.

Diet and fluid intake may be important factors in the development of urinary stones.  Excess intake of calcium, oxalate, and purines can increase the incidence of stones in predisposed individuals.  Additionally, water or other fluid intake is important in preventing urolithiasis.  Persons in sedentary occupations have a higher incidence of stones than manual laborers.

Genetic factors may contribute to urinary stone formation.  Cystinuria is an autosomal recessive disorder. Homozygous individuals have markedly increased excretion of cystine and frequently have numerous recurrent episodes of urinary stones despite attempts to optimize medical treatment.  Renal tubular acidosis appears to be transmitted as a hereditary trait, and urolithiasis occurs in up to 75% of patients affected with this disorder.^[20] (Emphasis supplied)

It is thus medically established that the environment (included in geographic factor), water or other fluid intake and the nature of the occupation -- sedentary or otherwise -- are important factors in the development or inhibition of urinary stones or ureterolithiasis in general.  Certainly, too, the regularity of urination plays an important role since withholding urine for sometime may disturb the balance.  It is not denied that the private respondent's work exposed her to drugs, insecticides, volatile poisons, fuels and inorganic compounds, and chemical laboratory equipment.  Moreover, she attended to field cases and rendered holiday and night duties once a week and helped the chemists in the examinations of incoming cases.  Neither have the petitioners refuted the claim of the private respondent that she missed some important health habits such as regularly drinking enough water and urination.  As to the latter, the Court of Appeals concluded that "the exigency of [Arreola's] assigned tasks was such that she had to forego urination in order not to interrupt the flow of concentration."

All told then, the Court of Appeals committed no reversible error in its challenged decision.  It is apropos at this juncture to reiterate what we said in Vicente vs. Employees' Compensation Commission:^[21]

The court takes this occasion to stress once more its abiding concern for the welfare of government workers, especially the humble rank and file, whose patience, industry, and dedication to duty have often gone unheralded, but who, in spite of very little recognition, plod on dutifully to perform their appointed tasks.  It is for this reason that the sympathy of the law on social security is toward its beneficiaries, and the law, by its own terms, requires a construction of utmost liberality in their favor.  It is likewise for this reason that the Court disposes of this case and ends a workingman's struggle for his just dues.

The private respondent, however, is entitled to only twelve thousand six hundred and nineteen pesos (P12,619.00), and not P16,619.00, as the records are bereft of any substantiation representing her expenses for X-ray (P1,600.00), laboratory analysis (P300.00), and medicines (P1,500.00).

IN VIEW WHEREOF, the decision of the Court of Appeals in CA-G.R. SP No. 34223 is hereby AFFIRMED, and the Government Service Insurance System is hereby ordered to pay private respondent Ms. Lilia B. Arreola the sum of P12,619.00 as compensation. No pronouncement as to costs.

SO ORDERED.

Narvasa, C.J., (Chairman), Melo, Francisco, and Panganiban, JJ., concur.

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^[1] Rollo, 33-42.  Per Sandoval-Gutierrez, J., with Cui and Vasquez, JJ., concurring.

^[2] Rollo, 33-37.

^[3] Rollo, CA-G.R. SP No. 34223, 28-31.

^[4] Id., 53, 69-70.

^[5] Supra note 1.

^[6] Rollo, 42.

^[7] G.R. No. 80157, 6 February 1990, 181 SCRA 874, 877.

^[8] Rollo, 39-40.

^[9] 221 SCRA 182, 188 [1993].

^[10] Rollo, 40-41.

^[11] Naval vs. Employees' Compensation Commission, 199 SCRA 388, 392-393 [1991].

^[12] Section 167(1), Labor Code of the Philippines; Section 1, Amended Rules on Employees' Compensation; Quizon vs. Employees' Compensation Commission, 203 SCRA 426, 433 [1991]; GSIS vs. Court of Appeals, 250 SCRA 491, 496 [1995].

^[13] GSIS vs. Court of Appeals, supra note 12.

^[14] Nitura vs. Employees' Compensation Commission, 201 SCRA 278, 282-283 [1991].

^[15] Aris (Phils.), Inc. vs. NLRC, 200 SCRA 246, 254 [1991].

^[16] Diopenes vs. GSIS, 205 SCRA 331, 336 [1992].

^[17] Lazo vs. Employees' Compensation Commission, 186 SCRA 569, 575 [1990]; Nitura vs. Employees' Compensation Commission, supra note 14; Santos vs. Employees' Compensation Commission, supra note 9.

^[18] Section 5, Rule 133, Rules of Court.  See also GSIS vs. Court of Appeals, supra note 12, on substantial evidence; Nemaria vs. Employees' Compensation Commission, 155 SCRA 166, 171 [1987]; Narazo vs. Employees' Compensation Commission, 181 SCRA 874, 877 [1990].

^[19] Underscoring supplied for emphasis.

^[20] Laurence M. Tierney, et al., Current Medical Diagnosis and Treatment, 33rd Ed. [1994], 747.

^[21] 193 SCRA 190, 197 [1991].