Tuberculosis among seafarers

Seafarers by nature of their work are exposed to a variety of occupational hazards making exposure to biological agents and the concomitant risk of communicable diseases extremely  high.

Because of their nature of work, seafarers are bound to visit many ports in different parts of the world and are thus exposed to various pandemic and epidemic diseases such as tuberculosis.

In Inter-Orient Maritime  vs. Creer (G.R. No. 181921 September 17, 2014) , the Supreme Court pointed out that pulmonary tuberculosis is airborne and easily transmissible by infected patients. The risk of being infected, or acquiring, the tuberculosis infection is mainly determined by exogenous factors. 

The probability of contact with a case of tuberculosis, the intimacy and duration of that contact, the degree of infectiousness of the case, and the shared environment of the contact are all important determinants of transmission.

On the other hand, the risk of developing the disease after being infected is largely dependent on endogenous factors. The tuberculosis bacteria may lie dormant in the infected person’s immune system for years before it becomes reactivated, or he may ultimately develop the disease within the first year or two after infection, depending on the innate susceptibility to disease of the person and level of immunity.

In ruling for the compensability of tuberculosis, the Supreme Court held in the case of BARKO vs. Alcayno (G.R. No. 188190               April 21, 2014) that  a certification declaring the seafarer  as fit to work contrary to a prior finding of tuberculosis can be considered as a ploy to circumvent the law intended to defeat the seafarer’s  right to be compensated for a disability which the law considers as permanent and total.

The Supreme Court  explained that tuberculosis is a contagious infection caused by the airborne bacterium Mycobacterium tuberculosis. It is usually transmitted by inhaling air contaminated by the bacterium. Active tuberculosis usually begins in the lungs (pulmonary tuberculosis). Tuberculosis that affects other part of the body (extrapulmonary tuberculosis) usually comes from pulmonary tuberculosis that has spread through the blood. Tuberculosis adenitis is a form of tuberculosis which affects the lymph nodes. 

The court noted that under the  POEA contract, "Pulmonary Tuberculosis" shall be considered as an occupational disease in "any occupation involving constant exposure to harmful substances in the working environment in the form of gases, fumes, vapors and dust."

The seafarer’s daily tasks as an able bodied seaman were to paint and chip rust on deck or superstructure of ship and to give directions to crew engaged in cleaning wheelhouse and quarterdeck, which constantly exposed him to different types of hazardous chemicals, such as paints, thinners, and other forms of cleaning agents and harmful substances, that may have invariably contributed to the aggravation of his illness.

The Supreme Court noted the suspicious  gesture of the company in having a medical certification declaring him as "fit to work" despite apparent clear knowledge that he has been subjected to a long period of medical treatment.

For a sick  seafarer to be entitled to medical benefits under the  POEA Contract,  it is not sufficient to simply 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 .

TB bacteria most commonly grow in the lungs, and can cause symptoms such as a bad cough that lasts three  weeks or longer, pain in the chest and coughing up blood or sputum (mucus from deep inside the lungs). Other symptoms of TB disease may include weakness or fatigue, weight loss, no appetite, chills, fever, and sweating at night.

Since one of the requirement for an illness to be compensable is that the seafarer suffered said illness during the effectivity of the POEA contract, it is imperative that his condition or symptoms  must be documented while he is on board the vessel.

Otherwise, his claim for disability benefits might be denied due to failure to prove that said illness occurred while his contract is still in force.

(Atty. Gorecho heads the seafarers’ division of the  Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786)

Stroke and seafarer's stress

A seafarer who suffered stroke on board the vessel must be compensated due to work-related stress.

 In the case of  Magsaysay Mitsui OSK Marine, Inc, v. Bengson (G.R. No. 198528, October 13, 2014⁾  disregarded the employer’s   claim that the seafarer’s hypertensive cardio-vascular disease is not compensable on the sole basis of its company-designated physician’s declaration that such illness is not work-related.

The Supreme Court ruled that the seafarer’s  illness, which has likewise been diagnosed as intracerebral hemorrhage or hemorrhagic stroke, is a serious condition, and could be deadly.

The Supreme Court noted  that the  seafarer has been working for the company since 1988 and has been serving as Third Mate for twelve (12) years.  

Having worked for the principal  since 1988 under employment contracts that were continuously renewed, it can be said that the seafarer  spent much of his productive years with the principal; his years of service certainly took a toll on his body, and he could not have contracted his illness elsewhere except while working for the principal. 

As Third Mate, he was saddled with heavy responsibilities relative to navigation of the vessel, ship safety and management of emergencies. 

The seafarer  was subjected to physical and mental stress and strain: as Third Mate, he is the ship’s fourth in command, and he is the ship’s safety officer; these responsibilities have been heavy burdens on his shoulders all these years, and certainly contributed to the development of his illness. 

Besides, it is already recognized that any kind of work or labor produces stress and strain normally resulting in wear and tear of the human body.

An overseas worker, having to ward off homesickness by reason of being physically separated from his family for the entire duration of his contract, bears a great degree of emotional strain while making an effort to perform his work well.

The strain is even greater in the case of a seafarer who is constantly subjected to the perils of the sea while at work abroad and away from his family.c

The Court has ruled that the list of illnesses/diseases in Section 32-A of the  POEA Standard Employment Contract (SEC) does not preclude other illnesses/diseases not so listed from being compensable. The POEA contract  cannot be presumed to contain all the possible injuries that render a seafarer unfit for further sea duties.   And equally significant, it is not the injury which is compensated, but rather it is the incapacity to work resulting in the impairment of one’s earning capacity.

An employee’s disability becomes permanent and total when so declared by the company-designated physician, or, in case of absence of such a declaration either of fitness or permanent total disability, upon the lapse of the 120 or 240-day treatment period while the employee’s disability continues and he is unable to engage in gainful employment during such period, and the company-designated physician fails to arrive at a definite assessment of the employee’s fitness or disability.

In many cases decided in the past, the Supreme  Court has held that cardiovascular disease, coronary artery disease, and other heart-related  ailments (including stroke)  are compensable. 

Thus, in Fil-Pride Shipping Co., Inc. v. Balasta, (G.R. No. 193047, March 3, 2014) severe 3-vessel coronary artery disease which the seaman contracted while serving as Able Seaman was considered an occupational disease.  In Villanueva, Sr. v. Baliwag Navigation, Inc., (702 SCRA 311).  it was held that the 2000 POEA-SEC considers heart disease as an occupational disease. 

 In Jebsens Maritime, Inc. v. Undag (662 SCRA 670) the Court held that hypertensive cardiovascular disease may be a compensable illness, upon proof.  In Oriental Shipmgt. Co., Inc. v. Bastol ( 622 SCRA 352) and Heirs of the late Aniban v. NLRC (347 Phil. 46)  it was held that myocardial infarction as a disease or cause of death is compensable, such being occupational.  Iloreta v. Philippine Transmarine Carriers, Inc (607 SCRA 796)  held that hypertensive cardiovascular disease/coronary artery disease and chronic stable angina are compensable.  

Micronesia Resources v. Cantomayor (552 Phil. 130)  stated that a finding of coronary artery disease entitles the claimant – a seaman Third Officer – to disability compensation.  In Remigio v .NLRC (521 Phil. 330) the Court held that the claimant – a musician on board an ocean-going vessel – was entitled to recover for suffering from coronary artery disease.  In Sepulveda v. ECC, (174 Phil. 242) it was declared that the employee’s illness, myocardial infarction, was directly brought about by his employment as schoolteacher or was a result of the nature of such employment.

 (Atty. Gorecho heads the seafarers’ division of the  Sapalo Velez Bundang Bulilan  law offices. For comments, email info@sapalovelez.com, or call 09175025808 or 09088665786)

Leukemia as an occupational illness

For a disability claim to prosper, a seafarer suffering from luekemia  only needs to show that his work and contracted illness have a reasonable linkage that must lead a rational mind to conclude that the seafarer's  occupation may have contributed or aggravated the disease.

Seafarers are exposed to occupational risk factors, as well as environmental risk factors, as part of their normal everyday activities since they spend a large part of their lives at sea. Most seafarers live and work under extremely hazardous conditions that can cause serious short-term and long-term damage to their health. In some cases, they are exposed to conditions that can even be fatal.

The seafarer is required to prove that: (1) he suffered an illness; (2) he suffered this illness during the term of his employment contract; (3) he complied with the procedures prescribed under Section 20-B; (4) his illness is one of the enumerated occupational disease or that his illness or injury is otherwise work-related; and (5) he complied with the four conditions enumerated under Section 32-A for an occupational disease or a disputably-presumed work-related disease to be compensable.   

Under POEA Contract,  “acute myeloid leukemia” and chronic lymphocytic leukemia. are  listed as  occupational diseases  if these are  secondary to prolonged benzene exposure.  Benzene is a widely used chemical and is mainly used as a "starting material in making other chemicals, including plastics, lubricants, rubbers, dyes, detergents, drugs, and pesticides."

Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system.  The cancerous cells in the bone marrow spill out into the bloodstream. 

In granting the full permanent disability benefits, the Court noted in the recent case of Grieg Philippines vs. Michael John Gonzalez (July 26, 2017, G.R. No. 228296) that  the  functions as an Ordinary Seaman aboard the vessel ,  among others,  included removing rust accumulations and refinishing affected areas of the ship with chemicals and paint to retard the oxidation process. This meant that he was frequently exposed to harmful chemicals and cleaning aids which may have contained benzene. Furthermore, the vessel  transported chemicals, which could have also contributed to the seafarer's leukemia.

The company miserably failed to dispute the medical finding that the seafarer's leukemia is not hereditary, as his tests reveal no apparent chromosome abnormality. This undeniable circumstance,  plus the fact that he was declared fit for sea duty prior to boarding the vessel for two (2) consecutive employment contracts with the same company, all the more bolster the conclusion that the conditions set forth in Section 32-A regarding the work-relatedness of his leukemia are present in this case.

Settled is the rule that for illness to be compensable, it is not necessary that the nature of the employment be the sole and only reason for the illness suffered by the seafarer. It is sufficient that there is a reasonable linkage between the disease suffered by the employee and his work to lead a rational mind to conclude that his work may have contributed to the establishment or, at the very least, aggravation of any pre-existing condition he might have had.

Most court cases arise due to the fact that the only types of cancer on the occupational illnesses list are (a)  cancer of the epithelial lining of the bladder (papilloma of the bladder), (b) cancer, epithellomatous or ulceration of the skin or of the corneal surface of the eye due to tar, pitch, bitumen, mineral oil or paraffin, or compound product. (c) Acute myeloid leukemia and (d) chronic lymphocytic leukemia.  In reality, many seafarers suffer from other type of cancers like that affects the lungs, kidney, liver, pancreas, nasopharyngeal and many more that  are  not one of the occupational diseases listed in the POEA Contract. An illness not otherwise listed in Section 32-A is disputably presumed work-related.This presumption works in favor of a seafarer, because it then becomes incumbent upon the employer  to dispute or overturn this presumption

Pneumonia as an occupational illness

 To be entitled to compensation and benefits, it is not sufficient to simply establish that the seafarer's pneumonia   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 .

It is   a well-known fact that seafaring is one of the most hazardous occupations, in regards to personal health and safety concerns of seafarers. 

Apart from accidents, seafarers are prone to certain serious diseases and health hazards due to the nature of onboard work, change in climatic conditions, type of cargo carried, working hours, materials being handled, epidemic and endemic diseases, personal habits etc. Because of their nature of work, seafarers are bound to visit many ports in different parts of the world and are thus exposed to various pandemic and epidemic diseases. 

      Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses, or fungi. Pneumonia causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. 

Pneumonia can be classified according to the organism that caused the infection (Bacterial, Viral, Mycoplasma and Fungal);  where it was acquired (hospital, community) or  how it is acquired (aspiration or ventilator-associated).

The seafarer  is required to prove that: (1) he suffered an illness; (2) he suffered this illness during the term of his employment contract; (3) he complied with the procedures prescribed under Section 20-B; (4) his illness is one of the enumerated occupational disease or that his illness or injury is otherwise work-related.  

A seafarer suffering from any of the  infections   would still have to satisfy four (4) conditions before his or her disease may be compensable: (a) the seafarer's work must involve the risks describe therein; (b)  the disease was contracted as a result of the seafarer's exposure to the described risks;  (c). the disease was contracted within a period of exposure and under such factors necessary to contract it; and (c) there was no notorious negligence on the part of the seafarer.

Since one of the requirement for an illness to be compensable is that the seafarer suffered said illness during the effectivity of the POEA contract, it is imperative that his condition or symptoms  must be documented while he is on board the vessel, such as Pneumonia symptoms can be mild to life-threatening. The most common symptoms of pneumonia can include: coughing that may produce phlegm (mucus); fever, sweating, and chills; shortness of breath and chest pain.    Otherwise, his claim for disability benefits might be denied due to failure to prove that said illness occurred while his contract is still in force.

 The Supreme Court ruled in a case the claimants   failed to adduce substantial evidence showing that the pneumonia, which the seafarer contracted, was caused by tetanus as a result of the burn injury.  There was no medical report which would even show that tetanus was the cause as to why the seafarer suffered pneumonia that eventually caused the death. Crew and Ship Management vs. Soria  G.R. No. 175491; December 10, 2012

The Supreme Court likewise ruled that the causes of  the seafarer's  death, as shown by his death certificate, indicate that pneumonia was simply the final illness that immediately brought about his  death. The long road to pneumonia started from an underlying cause AIDS that rendered him susceptible to the antecedent cause of tuberculosis, and to pneumonia as the immediate cause of death.  No evidence on record shows that seafarer's  working conditions on board as a First Engineer caused the pneumonia that brought on his death two years after he had disembarked from his vessel. (Escarcha vs. Leonis, July 5, 2010,  Gr. No. 182740)