This is a petition for review on certiorari of the decision dated October 1, 1981 rendered by the respondent Employees' Compensation Commission in ECC Case No. 1801, entitled "Expedita Librea, Appellant, versus Government Service Insurance System (Ministry of Education and Culture), Respondent", dismissing the claim of petitioner for death benefits under P.D. No. 626, as amended.

Petitioner is the widow of Eufronio Librea who served as a public school teacher at the Division of Public Schools in Lipa City since July 1, 1948 until his death on July 28, 1980, after thirty-two (32) years of public service. From an ordinary classroom teacher, Eufronio Librea successfully earned promotions to Assistant Principal in 1959; Principal I in July, 1970; District Guidance Coordinator; and finally, Division Physical Education Supervisor on November 14, 1974, his last post before his death.^[1]

Sometime in 1978, Eufronio Librea began to complain of a gradual loss of appetite, enlargement of the abdomen and severe anemia, often prompting him to go on sick leave. On July 2, 1980, he had to be admitted and confined at the Jimenez Memorial Hospital in Lipa City, where his ailment was diagnosed as cirrhosis of the liver in its terminal stage. He died of that ailment on July 28, 1980.

Dr. Jesus Inciong, the attending physician, affirmatively certified that the illness may have been directly caused by the nature of the duties of the deceased.^[2]

Subsequently, petitioner filed a claim for death compensation benefits with the Government Service Insurance System (GSIS). The claim was disapproved on October 27, 1980, based on the evaluation that the ailment which caused the death is not work-connected.

On November 28, 1980, petitioner sent a letter requesting for a reconsideration of the denial, attesting that the nature of her late husband's work as a teacher and later as a supervisor was very strenuous physically and mentally because being a physical education supervisor, he made it a point to inspect regularly all districts in his assigned Division including those in the remote barrios to attend to the physical education needs of the schools; that in the process, he had to contend himself with adverse weather conditions, extra-ordinary mental and physical fatigue due to the inaccessibility of some of these places and the scarcity of transportation facilities; and finally, that most of the time he was subjected to irregular meals and unhygienic eating habits due to lack of facilities; that his activities were not confined to the Division as he had to organize and participate in regional and national sports meet which required hectic schedules -- which factors weakened his state of health and rendered him susceptible to a fatal disease. The GSIS, however, did not have a change of heart and still denied the claim stressing that the cited conditions of work are not causally connected to the illness.

Petitioner sought a review of the denial before the respondent Commission which affirmed the decision of the GSIS and dismissed the case. Hence, this petition.

The issue to be resolved is whether the death of Eufronio Librea due to cirrhosis of the liver is compensable. Specifically, whether the work and nature of his duties increased the risk of contracting the fatal disease.

The etiology of cirrhosis of the liver is explained by the GSIS Medical Services as follows:

"Portal cirrhosis or cirrhosis of the liver occurs chiefly in males in late middle life. Malnutrition is believed to be a predisposing factor if not primary etiologic factor, and may account for its prevalence among alcoholics. This is a chronic disease characterized by increased connective tissue that spreads from the portal spaces, distorting liver architecture and impairing liver functions."^[3]

The denial of the claim by the GSIS is based on its conclusion that there was no work-connection between the disease and the duties performed by Eufronio Librea. Thus:

"x x x The conditions mentioned will not cause liver cirrhosis. Irregularity of meal intake per se, will not cause liver cirrhosis. Malnutrition as a predisposing, or a primary etiology of cirrhosis is caused by diet deficient in protein and specifically in choline and not as a result of meal irregularity (Merck Manual, p. 1076 and Cecil's Textbook of Medicine, p. 881). The possibility that nutritional deficiency might play an important role was proposed on the basis of frequent association of cirrhosis with alcoholism and nutritional deficiency and of the favorable therapeutic response of patients with cirrhosis to highly nutritious diet."^[4]

In affirming the denial, respondent Employees' Compensation Commission reasoned as follows:

"Viewed in the light of the foregoing medical principles, we cannot reverse the respondent GSIS's decision inasmuch as the genesis of the said ailment is not causally-related to the decedent's work and working conditions as physical education supervisor of the Ministry of Education and Culture. The decedent's duties such as training of athletes and reaching barrio schools in Lipa City, although admittedly abound with stress and strain, are too farfetched to have caused the development of liver cirrhosis. Similarly, irregular intake of meals contrary to the belief of appellant, is not an accepted medical pre-disposing cause to the development of liver cirrhosis."^[5]

Petitioner, however, assails the denial of the claim as arbitrary and contrary to the liberal spirit of the law on employees compensation, contending that:

"Respondent Commission's denial of the claim for compensation on the ground that the cause of death of Eufronio Librea is not work-connected, is arbitrary and not in accord with prevailing jurisprudence. The Commission completely ignored the nature and conditions of employment of the decedent which could have predisposed him to contract the fatal ailment. It is not disputed that the late Eufronio Librea started in the government service some thirty-two (32) years ago free from any physical or mental illness. It was only during the period of his employment that the symptoms of his illness manifested which could logically be traceable to his employment. It is likewise undisputed that decedent's employment exposed him to tremendous physical and mental stress from the time he started as an ordinary teacher up to the time of his death. During the few years that he was a physical education supervisor, the late Eufronio Librea experienced untold sufferings in the course of his inspections of barrio schools to attend to the physical education activities of the schools. More often than not, he was malnourished because he was forced by circumstances to eat whatever available food there was. This nutritional deficiency might have been the culprit in the development of his liver ailment. Again, in time of athletic meets, he had to prepare the teams for sports competition which undoubtedly involved physical and emotional strain as well as exposure to adverse weather conditions. All these employment factors might have conspired to weaken the body resistance of the decedent and made him susceptible to cirrhosis of the liver. At this point, it is to be reiterated that in the decision itself, it recognized malnutrition to be a predisposing factor if not a primary etiology factor in the development of cirrhosis of the liver. Certainly, it need not be emphasized that the late Eufronio Librea was subjected to this risk which is very common to his calling as a teacher. x x x "^[6]

We rule for the petitioner.

While the contention of petitioner that the death is compensable since the fatal illness of her husband was contracted only after his long years of service appears to be premised on the old rule of presumed compensability under the prior compensation act, we find merit in the contention that the duties and functions of the late Eufronio Librea as a teacher and later as a district supervisor for thirty-two years may have rendered him susceptible to contracting the fatal illness.

The rule under the applicable law^[7] is that in order for the employee to be entitled to sickness or death benefits, the sickness or death resulting therefrom must be, or must have resulted from either (a) any illness definitely accepted as an occupation disease listed by the Commission; or (b) any illness caused by employment subject to proof that the risk of contracting the same is increased by working conditions.^[8] To establish compensability under the second rule, known as the theory of increased risk, it must be shown that an illness or the fatal disease is caused by employment and the risk of contracting the same is increased by working conditions.^[9]

In the case at bar, the fatal disease suffered by the late Eufronio Librea is cirrhosis of the liver. Since it is not listed as an occupational disease, the claimant must show that the risk of contracting the same is increased by the work or working conditions of the deceased. According to the GSIS, the disease is common and occurs chiefly in males in late middle life. Malnutrition is believed to be a predisposing factor if not a primary etiologic factor. Respondent ECC explains that malnutrition as a predisposing, or a primary factor in liver cirrhosis is caused by diet deficient in protein and specifically in choline. It is therefore clear that diet deficiency is an etiologic factor of cirrhosis of the liver.

The duties of the late Eufronio Librea as a teacher and later as a physical education supervisor is admittedly fraught with mental and physical strain as he had to supervise remote barrio schools in far-flung areas in the district where he was assigned in the course of which he experienced missing meals, if not hunger, and insufficient food. His wife attests to this. She even went further and admitted that her husband was malnourished as a result of the multifarious activities entailed in his work. With these premises, to our mind there is sufficient basis for the inference that he must have suffered nutritional deficiency, particularly protein deficiency, which is a predisposing if not a primary factor in the development of cirrhosis of the liver. Indeed, even the attending physician is of the opinion that the fatal illness must have been directly caused by the nature of the duties of the deceased.

Petitioner emphasized that during the last few years that her husband was a physical education supervisor, Eufronio Librea experienced untold sufferings in the course of his inspections of barrio schools to attend to the physical education activities of the schools and that he was malnourished because of scarcity of food in the places he travelled to. In addition, her husband had to organize and prepare his Division for the national sports meet. All these may have indeed weakened the state of health of Eufronio Librea and rendered him susceptible to malnutrition and consequently to contracting cirrhosis of the liver. It cannot be denied that there are times when one is so engrossed in his duties to the point of overlooking the most basic of needs such as nutritious food.

It is not fair to speculate as the counsel for the GSIS seems to insinuate^[10] that the decedent's cirrhosis of the liver may have been contracted due to alcoholism. There is nothing in the record to support this speculation, and in the absence of any finding to the contrary, the late Eufronio Librea must be presumed not prone to taking alcoholic liquor.^[11] On the other hand, there is the consistent affirmation by the wife of the deceased to the effect that in the course of performing the physically and mentally demanding work of her deceased husband, the latter suffered food deficiency and malnutrition. It appears therefore that only malnutrition could have caused the illness of the deceased, and in view of the uncontroverted claim of the wife of Librea that her husband suffered malnourishment in the latter stage of his thirty-two years of devoted public service, it would be unfair to deny compensability.

It is of common knowledge that our public school teachers are among the lowly-paid public servants. Thus, it is not farfetched to state that some teachers, especially those with families to support, have very little to spare for their own personal food. Indeed, given our depressed economic realities, malnutrition is not confined to children but even to adults and more so to family breadwinners. In the case at bar, the wife of the late teacher admitted that her husband suffered nutritional deficiency.

Considering the foregoing facts, it cannot be denied that there is sufficient evidence to substantiate the claim that the work of Eufronio Librea increased the risk of contracting the fatal disease. This opinion is shared by the attending physician who examined Librea at the hospital and who affirmatively certified that the nature of Eufronio Librea's duties caused the development of cirrhosis of the liver. As we have already ruled, a physician's report is the best evidence of work-connection of workmen's ailments and can be the basis for an award even if the physician was not presented as a witness.^[12] The reason for the rule is that the attending physician is in the best position to judge possible causal relation between the illness and the work performed, and normally, he would not make a false certification for the sake of a lowly teacher.^[13] The conclusion of the medical division of respondent Commission that there is no proof of direct causal connection is not conclusive upon us. We have ruled that findings of doctors and chief medical officer of the GSIS and ECC who are not experts are not binding on the Supreme Court.^[14]

Respondent Commission should have appreciated Eufronio Librea's more than thirty years of devoted public service, which earned him the successive promotions to greater responsibilities, performing the strenuous and demanding task of a public school teacher. What the Court said in one case bears reiterating:

". . . As the agents charged by the law to implement the social justice guarantee secured by both the 1935 and 1973 Constitutions, respondents should adopt a more liberal attitude in deciding claims for compensation especially where there is some basis in the facts in inferring a work-connection. This should not be confused with the presumption of compensability and the theory of aggravation under the Workmen's Compensation Act. While these doctrines may have been abandoned under the new Labor Code (the constitutionality of such abrogation may still be challenged), it is significant that the liberality of the law, in general, still subsists."^[15]

WHEREFORE, the appealed decision of respondent ECC is hereby set aside and the Government Service Insurance System is ordered to pay petitioner the sums of Twelve Thousand Pesos (P12,000.00) as death benefits, One Thousand Pesos (P1,000.00) as funeral expenses and One Thousand and Two Hundred Pesos (P1,200.00) as attorney's fees.

SO ORDERED.

Bidin, Davide, Jr., and Romero, JJ., concur.
Gutierrez, Jr., J., see dissenting opinion.

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^[1] p. 1, ECC Decision; p. 17, Rollo.

^[2] Annex "A", Reply; p. 71, Rollo.

^[3] p. 1, ECC Decision; Annex A, Petition; p. 17, Rollo.

^[4] p. 3, Memorandum of the Solicitor General; p. 83, Rollo.

^[5] p. 3, ECC Decision; p. 19, Rollo.

^[6] pp. 4-5, Memorandum for Petitioner; pp. 96-97, Rollo.

^[7] Art. 167 (I) Presidential Decree No. 626, as amended, and Section 1(b) of the amended Rules on Employees' Compensation.

^[8] Dabatian v. GSIS, G.R. No. 47294, April 8, 1987; 149 SCRA 123.

^[9] Casumpang v. ECC, G.R. No. 48664, May 20, 1987; 150 SCRA 21.

^[10] p. 6, Memorandum of the GSIS; p. 121, Rollo.

^[11] Mercado v. WCC, 72 SCRA 265.

^[12] Lavilla v. Secretary of Labor, 122 SCRA 657.

^[13] Marte v. ECC, 96 SCRA 884.

^[14] Medina v. ECC, 128 SCRA 349.

^[15] Cristobal v. ECC, 103 SCRA 330 at pp. 336-337.

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