HYPERTENSIVE CARDIOVASCULAR DISEASES ARE GENERALLY HELD BY JURISPRUDENCE AS PERMANENT AND TOTAL DISABILITY

Hypertensive cardiovascular diseases are jurisprudentially held permanent total disability granting compensation to seafarers, who suffered therefrom and were under the treatment of or issued fit-to-work certifications by company-designated doctors beyond 120 or 240 days from their repatriation.

Constancio Caderao vs. Senator Crewing (Manila), Inc., et al./Senator Crewing (Manila), Inc., et al. vs. Constancio Caderao

G.R. No. 224532/G.R. No. 224565, June 21, 2017

Facts:

Senator Crewing (Manila), Inc. (SCMI) is a local manning agency. Aquanaut is among SCMI’s foreign principals.

Balatero was initially engaged by SCMI et al. as an able-bodied seaman. He had worked his way up to become 2nd Officer and had boarded 18 of SCMI et al.’s ships.

Balatero experienced chest pains, with palpitations and shortness of breath. He was taken to Odense University Hospital (Odense) in Denmark, diagnosed to have an elevated blood pressure, prescribed anti-hypertensive medicines, and discharged thereafter. Balatero again suffered from similar symptoms and was again brought to Odense, where he was advised to continue with the earlier prescribed anti-hypertensive medicines, and be repatriated for further medical evaluation.

Balatero disembarked from the ship and arrived in Manila on January 5, 2014. The day after, he reported to SCMI’s office for post-medical examination and was referred to Metropolitan Medical Center under the care of company-designated physician, Dr. Richard Olalia (Dr. Olalia). In the Medical Report, Dr. Olalia found Balatero to be suffering from “Uncontrolled Hypertension; Unstable Angina; To Consider Coronary Artery Disease [CAD]; Dyslipidemia,” the etiologies of which were multi-factorial but not work-related.

Balatero was later referred to Cardinal Santos Medical Center where he underwent Coronary Angiogram and Aortogram, which revealed that he had “Severe [CAD] of the [Left Anterior Descending], D2 and [Right Posterior Descending Artery]; and Moderate [CAD] LCx.”

Balatero underwent Percutaneous Transluminal Coronary Angioplasty (2 stents of the Mid Left Anterior Descending and Ostio Proximal Right Posterior Descending Artery). In Balatero’s subsequent medical check ups, Dr. Garrido prescribed maintenance medicines, which totalled five. He was subsequently declared fit to work, but with medical maintenance for the rest of his life.

Unconvinced about his fitness to resume sea duties, Balatero consulted Dr. Li-Ann Lara-Orencia (Dr. Lara-Orencia), an occupational doctor. As indicated in the Medical Certificate, Dr. Lara-Orencia found Balatero to be suffering from “Hypertensive Cardiovascular Disease,” which was ”precipitated by the stressful nature of his work.” Further, under Item No. 1 l(c) of the Philippine Overseas Employment Agency’s (POEA) Standard Employment Contract (SEC) for Seafarers, CAD is a compensable illness. Under Item No. 13, Uncontrolled Hypertension, arising from exposure to extreme physical and psychological stress at work, is an occupational illness. Dr. Lara-Orencia then concluded that Balatero cannot return to his employment as 3rd Officer due to the latter’s on and off chest pains, “easy fatigability” and continuous intake of five maintenance medicines.

Balatero demanded permanent total disability benefits, which SCMI et al. denied on the ground that after treatment and rehabilitation, the company-designated doctor had assessed Balatero with a disability of Grade 7 (Moderate Residuals of Disorders) under the POEA SEC.

Balatero filed before the NLRC a complaint for permanent total disability compensation, sickness allowance, damages and attorney’s fees.

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LA Ruling:

The LA rendered a decision ordering SCMI et al. to pay [Balatero] the amount of US$60,000.00 representing Balatero’s total and permanent disability benefits under the POEA Contract and attorney’s fees of 10% of the said amount.

Citing Wallem Maritime Services, Inc., et al. vs. NLRC, et al., the LA declared that the assessments of both the company-designated physicians and those consulted by the seafarers on their own accord are not conclusive, thus, need evaluation on their inherent merits.

Moreover, assuming arguendo that Balatero was already afflicted with cardiovascular disease prior to his employment with SCMI et al., his exposure to stressful working conditions and a diet of unhealthy, fatty and salty foods while on board the ship had likely triggered, contributed to the development of, or aggravated his condition. The LA also noted SCMI et al.’s inconsistent stances in initially declaring that Balatero’s illnesses were not work-related, and eventually determining that he had a Disability Grade of 7 under the POEA SEC.

SCMI et al. appealed to the NLRC.

NLRC Ruling:

The NLRC dismissed the appeal.

The NLRC again considered Balatero’s length of service rendered aboard 18 of the SCMI et al.’ ships, and the stressful and unhealthy conditions thereat, which contributed to or aggravated the development of Balatero’s Hypertensive Cardiovascular Disease.

Further, despite the continuous intake of prescription medicines, there was no assurance given by the company-designated physicians that Balatero would be able to fully recover from his condition and perform his work like he did before. The NLRC also agreed with the LA that since Balatero was forced to litigate to protect his rights, he is entitled to 10% of the award as attorney’s fees.

The NLRC denied SCMI et al.’ motion for reconsideration (MR).

SCMI et al. elevated the case to the CA via petition for certiorari.

CA Ruling:

Pending the resolution of their petition for certiorari filed before the CA, SCMI et al. conditionally paid Balatero the amount of US$66,000.00, with the provision that in case of a reversal of the NLRC’s judgment by the CA or this Court, the sum shall be returned.

The CA rendered a Decision partially granting the petition by denying Balatero’ s claims for permanent total disability compensation and attorney’s fees, and ordering SCMI and Aquanaut to solidarily pay him the amount of US$20,900.00 corresponding to Grade 7 Disability Rating benefits.

The CA ratiocinated that Section 20 (A) (3) of the 2010 POEA-SEC provides that if a doctor appointed by the seafarer disagrees with the assessment of the company-designated doctor, a third doctor may be agreed jointly between the employer and the seafarer, and the third doctor’s decision shall be final and binding on both parties. Consequently, this referral to a third doctor has been held by the High Court to be a mandatory procedure as a consequence of the provision that it is the company-designated doctor whose assessment should prevail.

The CA denied the respective MRs separately filed by Balatero and SCMI et al.

Issue/s:

Whether or not hypertensive cardiovascular diseases result in seafarer’s permanent and total disability

SC Ruling:

The SC partially grants Balatero ‘s petition, and denies that of the SCMI et al..

The Court examined the pleadings filed by SCMI et al. and notes that nowhere did they categorically state the date when the company-designated doctor had issued Balatero’s final disability rating. Further, SCMI et al. did not attach or completely quote the medical report of the company-designated doctor.

Viewed in the foregoing context, it can be concluded that as of June 3, 2014, which was more than 120 days from Balatero’ s repatriation, no final disability rating was yet issued by SCMI et al., sans proof too that the latter sought for an extension to further determine the seafarer’s fitness to work. Dr. Olalia’s Medical Report, dated January 8, 2014, which negated the work-relatedness of Balatero’s medical condition, was issued merely in the interim considering that tests and procedures were still to be performed. The said report cannot be considered as the final disability rating issued by the company-designated doctor.

In Balatero’s case, the company-designated doctor had made a final Grade 7 Disability Rating beyond 120 days from repatriation. In legal contemplation, such partial disability was by then already deemed permanent. As a result thereof, the issue of non-referral to a third doctor is rendered inconsequential.

In Dalusong, the SC held that in case no third doctor is appointed by the parties, the labor tribunal and the courts shall assess the inherent merits of the divergent findings of the company-designated doctor and the seafarer’s chosen physician.

The Court notes too that as pointed out by Balatero, Department of Health (DOH) Administrative Order (A.O.) No. 2007-0025 recommends non-issuance of fit-to-work certifications to seafarers “with acute or chronic cardiovascular condition limiting physical activity, requiring more than two (2) maintenance oral medicines and close monitoring, or causing significant disability,” specifically those (1) suffering from CAD, (2) has undergone Coronary Angioplasty within six months, with history of Uncontrolled Diabetes Mellitus, Hypertension and Dyslipidemia, and (3) Hypertension requiring three or more drugs, among others.

Balatero falls within the foregoing category. The SC held further that jurisprudence is replete with doctrines granting permanent total disability compensation to seafarers, who suffered from either cardiovascular diseases or hypertension, and were under the treatment of or issued fit-to-work certifications by company-designated doctors beyond 120 or 240 days from their repatriation.

The SC reinstated the LA and NLRC’ s ruling granting Balatero permanent total disability compensation, and set aside the CA’s disquisition that only benefits pertaining to Grade 7 Disability Rating should be awarded on the basis of the following: (1) Dr. Lara-Orencia’s ample explanation on how she had arrived at a permanent total disability assessment; (2) the recommendations of DOH A.O. No. 2007-0025 on the issuance of fit-to-work certificates; and (3) jurisprudence granting permanent total disability compensation to seafarers suffering from hypertensive cardiovascular diseases, who were either under the treatment of, or issued fit-to-work certifications by company-designated doctors beyond 120 or 240 days from their repatriation.