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.

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 a 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:

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:

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

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

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.

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 sport 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.

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:

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.