THIRD DIVISION

[G.R. No. 208314. August 23, 2017.]

MANANSALA petitioner, vs. MARLOW NAVIGATION

ANTONIO B. MANANSALA,
PHILS., INC./MARLOW NAVIGATION CO. LTD./CYPRUS, AND/OR
MORALES respondents.
EILEEN MORALES,

DECISION

LEONEN J :
LEONEN, p

As laypersons, seafarers cannot be expected to make completely accurate

accounts of their state of health. Unaware of the nuances of medical conditions, they
may, in good faith, make statements that turn out to be false. These honest mistakes
do not negate compensability for disability arising from pre-existing illnesses shown to
be aggravated by their working conditions. However, when a seafarer's proper
knowledge of pre-existing conditions and intent to deceive an employer are
established, compensability is negated. HTcADC

This resolves a Petition for Review on Certiorari 1 under Rule 45 of the 1997
Rules of Civil Procedure praying that the assailed April 10, 2013 Decision 2 and July 18,
2013 Resolution 3 of the Court of Appeals in CA-G.R. SP No. 124546 be reversed and
set aside.
The assailed Court of Appeals Decision a rmed the National Labor Relations
Commission's December 13, 2011 Decision 4 and February 28, 2012 Resolution, 5
which, in turn, a rmed the Labor Arbiter's April 20, 2011 Decision. 6 The Labor Arbiter
dismissed Antonio B. Manansala's (Manansala) Complaint for payment of total and
permanent disability bene ts. The assailed Court of Appeals Resolution denied
Manansala's Motion for Reconsideration. 7
On April 8, 2010, Manansala's services were engaged by Marlow Navigation
Phils., Inc., for and on behalf of its principal, Marlow Navigation Co. Ltd./Cyprus, for him
to serve as a "fitter" on board the vessel M/V Seaboxer. 8
Before boarding the vessel, Manansala underwent a Pre-Employment Medical
Examination (PEME) on March 23, 2010 9 at the EL ROI Medical Clinic and Diagnostic
Center, Inc. 1 0 In his examination, Manansala was required to disclose information
regarding all existing and prior medical conditions. The examination speci cally
required information on 29 illnesses and/or conditions, among which were
hypertension and diabetes. Manansala's examination certi cate indicates that he
denied having hypertension and diabetes, speci cally answering "NO" when asked
about hypertension and diabetes mellitus. Following his examination, Manansala was
declared fit for sea duty and was deployed. 1 1
On May 30, 2010, while on board the M/V Seaboxer, Manansala suffered a stroke,
12 "experienc[ing] moderate headache at the vertex associated with dizziness and
blurring of vision and right[-]sided weakness." 1 3 He was, then, admitted to the ADK
Hospital in the Maldives 1 4 where a brain CT scan conducted on him showed that he
was suffering from an "[a]cute infarct at the left MCA territory." 1 5 Because of this,
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 Manansala was repatriated on June 8, 2010. 1 6
Manansala was con ned at the De Los Santos Medical Center from June 10,
2010 to June 23, 2010, 1 7 under the primary care of company-designated physician, Dr.
Teresita Barrairo (Dr. Barrairo). 1 8 While under Dr. Barrairo's care, he "repeatedly denied
that he ha[d] any past history of diabetes and hypertension." 1 9
On September 7, 2010, 2 0 Dr. Barrairo issued to Manansala an interim Grade 10
disability rating. 2 1 She issued a nal Grade 10 Disability assessment on September 30,
2010. 2 2
On October 21, 2010, Manansala led a Complaint against the respondents for
total and permanent disability bene ts, as well as damages and attorney's fees. 2 3
When the mandatory conferences failed, the parties were ordered to le their
respective position papers and responsive pleadings. 2 4
Two (2) months after he led his Complaint, on December 20, 2010, Manansala's
own doctor, Dr. Amado San Luis (Dr. San Luis), issued a medical opinion stating that
Manansala must be considered permanently disabled:
Medical Opinion
xxx xxx xxx
4. Patient should be permanently disabled (sic) because of
the inherent risk of his work as a seaman that will predispose him
to repeated stroke or other cardiovascular attacks. Because of the
presence of diabetes, hypertension, hyperlipidemia and stroke, he
is considered a high risk of (sic) developing another stroke. 2 5
The same opinion indicated that Manansala admitted to having had a long history
of hypertension and diabetes. He even admitted to taking Enalapril and Metformin as
maintenance medications. 2 6
On April 20, 2011, the Labor Arbiter rendered a Decision nding that Manansala
was suffering from pre-existing, rather than work-related, ailments. Therefore, he was
not entitled to disability benefits. 2 7
On December 13, 2011, the National Labor Relations Commission rendered a
Decision a rming that of the Labor Arbiter. 2 8 In a Resolution dated February 28, 2012,
the National Labor Relations Commission denied Manansala's Motion for
Reconsideration. 2 9
Manansala led a Petition for Certiorari before the Court of Appeals. In its
assailed April 10, 2013 Decision, the Court of Appeals sustained the decision of the
National Labor Relations Commission. 3 0 In its assailed July 18, 2013 Resolution, 3 1 the
Court of Appeals denied Manansala's Motion for Reconsideration. aScITE

Hence, Manansala led the present Petition. He now asserts that he properly
disclosed his pre-existing illnesses during his medical examination and that his stroke
was work-related. 3 2
For resolution is the sole issue of whether or not petitioner Antonio B. Manansala
is entitled to total and permanent disability bene ts occasioned by work-related
illnesses.
He is not.

I
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 Filipinos hired as seafarers are contractual employees whose employment is
governed by their respective contracts with their employers: "[t]heir employment is
governed by the contracts they sign every time they are rehired and their employment is
terminated when the contract expires." 3 3
Seafarers must be registered with the Philippine Overseas Employment
Administration (POEA). 3 4 The POEA Standard Employment Contract (POEA-SEC) must
be executed by seafarers and their employers "as a condition sine qua non prior to the
deployment for overseas work" 3 5 and is "deemed incorporated in [seafarer]
employment contract[s]." 3 6
The POEA-SEC 3 7 requires the employer to compensate a seafarer for work-
related illnesses. 3 8 It defines "work-related illness" as follows:
Definition of Terms:
xxx xxx xxx
12. Work-Related Illness — any sickness resulting to disability or death
as a result of an occupational disease listed under Section 32-A of
this Contract with the conditions set therein satisfied. 3 9
The bene ts that the employer must pay "when the seafarer suffers work-related
injury or illness during the term of his contract" 4 0 are outlined in Section 20 (B) of the
POEA-SEC. 4 1
The compensation to be given to a seafarer depends on the severity of the
disability suffered. Section 32 of the POEA-SEC provides a schedule of disabilities and
their corresponding impediment grades. 4 2 The grades range from 1 to 14, with 1 being
the most severe and entailing the highest amount of compensation. 4 3

II

Section 32-A of the POEA-SEC provides a non-exhaustive list 4 4 of diseases

considered as occupational. The mere occurrence of a listed illness does not
automatically engender compensability. The rst paragraph of Section 32-A requires
the satisfaction of all of its listed general conditions "[f]or an occupational disease and
the resulting disability or death to be compensable":
Section 32-A. OCCUPATIONAL DISEASES
For an occupational disease and the resulting disability or death to be
compensable, all of the following conditions must be satisfied:
(1) The seafarer's work must involve the risks described herein;
(2) The disease was contracted as a result of the seafarer's exposure
to the described risks;
(3) The disease was contracted within a period of exposure and under
such other factors necessary to contract it;
(4) There was no notorious negligence on the part of the seafarer.
To enable compensation, an occupational disease and ensuing death or disability
must, thus, be "work-related"; 4 5 that is to say that there must be a "reasonable linkage
between the disease suffered by the employee and his work." 4 6
Common sense dictates that an illness could not possibly have been "contracted
as a result of the seafarer's exposure to the described risks" 4 7 if it has been existing
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 before the seafarer's services are engaged. Still, pre-existing illnesses may be
aggravated by the seafarer's working conditions. To the extent that any such
aggravation is brought about by the work of the seafarer, compensability ensues:
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 su cient 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. 4 8
(Emphasis supplied).
Consistent with the basic standard in labor cases and other administrative
proceedings, the linkage between the disease or its aggravation and the working
conditions of a seafarer must be proven by substantial evidence. In Jebsens Maritime
v. Undag: 4 9
In labor cases as in other administrative proceedings, substantial
evidence or such relevant evidence as a reasonable mind might accept as
su cient to support a conclusion is required. The oft-repeated rule is that
whoever claims entitlement to the bene ts provided by law should establish his
or her right thereto by substantial evidence. Substantial evidence is more than a
mere scintilla. The evidence must be real and substantial, and not merely
apparent; for the duty to prove work-causation or work-aggravation imposed by
law is real and not merely apparent. 5 0 (Emphasis supplied, citations omitted)
Compensability is not limited to Section 32-A's listed occupational diseases. For
as long as seafarers are able to show by substantial evidence that they suffered
disabilities occasioned by a disease contracted on account of or aggravated by
working conditions, compensation is availing: HEITAD

Of course, the law recognizes that under certain circumstances, certain

diseases not otherwise considered as an occupational disease under the POEA-
SEC may nevertheless have been caused or aggravated by the seafarer's
working conditions. In these situations, the law recognizes the inherent paucity
of the list and the di culty, if not the outright improbability, of accounting for
all the known and unknown diseases that may be associated with, caused or
aggravated by such working conditions.
Hence, the POEA-SEC provides for a disputable presumption of work-
relatedness for non-POEA-SEC-listed occupational disease and the resulting
illness or injury which he may have suffered during the term of his employment
contract.
This disputable presumption is made in the law to signify that the non-
inclusion in the list of compensable diseases/illnesses does not translate to an
absolute exclusion from disability bene ts. In other words, the disputable
presumption does not signify an automatic grant of compensation and/or
bene ts claim; the seafarer must still prove his entitlement to disability bene ts
by substantial evidence of his illness' work-relatedness. 5 1

III

The POEA-SEC bars the compensability of disability arising from a pre-existing

illness when attended by an employee's fraudulent misrepresentation. Section 20 (E) of
the POEA-SEC states:
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 E. A seafarer who knowingly conceals and does not disclose past medical
condition, disability and history in the pre-employment medical
examination constitutes fraudulent misrepresentation and shall disqualify
him from any compensation and bene ts. This may also be a valid ground
for termination of employment and imposition of the appropriate
administrative and legal sanctions.
The POEA-SEC's terminology is carefully calibrated: it does not merely speak of
incorrectness or falsity, or of incompleteness or inexactness. Rather, to negate
compensability, it requires fraudulent misrepresentation.
To speak of fraudulent misrepresentation is not only to say that a person failed
to disclose the truth but that he or she deliberately concealed it for a malicious
purpose. To amount to fraudulent misrepresentation, falsity must be coupled with
intent to deceive and to profit from that deception.
Consequently, reasonable leeway may be extended for inability to make
complete and fastidiously accurate accounts when this inability arises from venial
human limitation and frailty. This is a normal tendency for laypersons — such as
seafarers — rendering accounts of their own medical conditions.

IV

Prospective seafarers undergo a pre-employment medical examination (PEME)

to determine if they are t to work. Republic Act No. 8042, as amended, otherwise
known as the Migrant Workers and Overseas Filipinos Act of 1995, tasks the
Department of Health to regulate the operations of clinics conducting PEMEs for
migrant workers. 5 2
Department of Health Administrative Order No. 2007-0025, which was in effect
when petitioner took his PEME, articulated guidelines on PEMEs for seafarers. 5 3 It
identified minimum test requirements, summarized as follows: 5 4

PEME "C"
PEME "B"
Serving
PEME "A" Serving
Seafarers
TEST New Seafarers
(40 years
Candidates (below 40
old and
years old)
above)

Audiometry ✓ ✓ ✓

Blood Uric Acid X X ✓

Chest X-ray ✓ ✓ ✓

Color Perception ✓ ✓ ✓
Test

Complete Blood ✓ ✓ ✓
Count and Blood
Typing

Complete Physical ✓ ✓ ✓
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 Examination and
Medical History

Dental Examination ✓ ✓ ✓

ECG ✓ X ✓

Fasting Blood X X ✓
Sugar

Hepatitis B ✓ ✓ ✓
Screening

HIV OPTIONAL

Psychometric ✓ ✓ ✓
examinations

Routine Stool ✓ ✓ ✓

Routine Urinalysis ✓ ✓ ✓

RPR ✓ ✓ ✓

Total cholesterol X X ✓

Triglyceride X X ✓

Visual Acuity ✓ ✓ ✓

As to their source, there are two categories of information obtained in PEMEs.

First is information obtained from and colored by the prospective seafarer's opinion,
i.e., information on medical history gained from probing questions asked to
prospective seafarers and answered by them to the best of their knowledge. Second is
information generated by procedures conducted by health professionals. From these, a
determination is made on whether a prospective seafarer is t, un t, or temporarily
unfit for sea duty: 5 5 ATICcS

C. On the Assessment of PEME Results

1. PEME recommendations shall be given as follows:
a.) Fit for Sea Duty — The seafarer is assessed as able to
perform safely the duties of his position aboard a ship in the
absence of medical care, without danger to his health or to
the safety of the vessel, crew and passengers.
b.) Unfit for Sea Duty — The seafarer is assessed to be not t
for sea duty.
c.) Temporarily Un t for Sea Duty — The seafarer is
assessed to be temporarily un t for sea duty when, at the
time of PEME, the result shows an abnormal nding, a
suspected medical or surgical condition, or a disclosed
signi cant past medical history which needs further
investigation and reevaluation. The examinee shall be given
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 thirty (30) days to undergo further assessment in accordance
with the established referral system of the accredited medical
clinic. Within the said period, the seafarer may either be
medically upgraded to tness or downgraded to un tness
inde nitely based on the results of the follow-up evaluation.
5 6 (Emphasis in the original)

Between the prospective seafarer and an examining physician, the latter is in a

better position to assess tness for the rigors of sea duty. Apart from one's literal
body, a prospective seafarer's only other contribution to a medical examination is a set
of responses to questions. A seafarer's personal health assessment is borne by his or
her amateur opinion, or otherwise unre ned understanding of nuanced medical
conditions. In contrast, the procedures attendant to a PEME are conducted and
supervised by professionals with scienti c and technical capabilities. Their
examinations generate veri able empirical data, which are then evaluated by a
physician.
A PEME is not expected to be an in-depth examination of a seafarer's health. 5 7
Still, it must ful ll its purpose of ascertaining a prospective seafarer's capacity for
safely performing tasks at sea. Thus, if it concludes that a seafarer, even one with an
existing medical condition, is "fit for sea duty," it must, on its face, be taken to mean that
the seafarer is well in a position to engage in employment aboard a sea vessel "without
danger to his health." 5 8
A recommendation stating that a seafarer is " t for sea duty" when standardized
procedures would readily reveal that he or she is not can only mean that medical
examiners failed to diligently screen a seafarer. The persons responsible for the
examination are then bound by their negligence. Ultimately, it is more appropriate that
the examining physician, a trained professional, and not the seafarer, who is a
layperson, be faulted for discounting the presence of diseases even after subjecting the
seafarer to a series of procedures.
For its part, a recruiting employer is expected to know the physical demands of a
seafarer's engagement. It is then equally expected to peruse the results of PEMEs to
ensure that, health-wise, its recruits are up to par. An employer who admits a
physician's " t to work" determination binds itself to that conclusion and its necessary
consequences. This includes compensating the seafarer for the aggravation of
negligently or deliberately overlooked conditions.

Essential hypertension is among the occupational diseases enumerated in

Section 32-A of the POEA-SEC. Section 32-A, paragraph 2 (20) of the POEA-SEC reads:
20. Essential Hypertension
Hypertension classi ed as primary or essential is considered compensable if it
causes impairment of function of body organs like kidneys, heart, eyes and
brain, resulting in permanent disability; Provided , that the following documents
substantiate it: (a) chest x-ray report, (b) ECG report, (c) blood chemistry report,
(d) funduscopy report, and (e) C-T scan." (Emphasis supplied)
Primary or essential hypertension is the most common form of hypertension. 5 9
It is a "consequence of an interaction between environmental and genetic factors." 6 0
Hypertension doubles the risk of cardio-vascular diseases, 6 1 the most common cause
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 of death in hypertensive patients. 6 2 Hypertensive patients are also susceptible to
having a stroke. 6 3
The following degrees of severity have been associated with identifying
hypertension: 6 4 TIADCc

Severity SBP, mmHg DBP, mmHg

Normal <120 and <80

Prehypertension 120-139 or 80-89

Stage 1 hypertension 140-159 or 90-99

Stage 2 hypertension ³160 or ³100

Literature on hypertension concedes a degree of ambiguity and acknowledges

variance in its effects and incidents:
High blood pressure is a trait as opposed to a speci c disease and
represents a quantitative rather than a qualitative deviation from the norm. Any
definition of hypertension is therefore, arbitrary.
xxx xxx xxx
The cardiovascular risks associated with a given blood pressure are
dependent upon the combination of risk factors in the speci c individual. These
include age, gender, weight, physical inactivity, smoking, family history, serum
cholesterol, diabetes mellitus and pre-existing vascular disease. Effective
management of hypertension therefore requires a holistic approach that is
based on the identi cation of those at highest cardiovascular risk and the
adoption of multifactorial interventions, targeting not only blood pressure but all
modifiable cardiovascular risk factors.
In light of these observations[,] a practical de nition of hypertension is
'the level of blood pressure at which the bene ts of treatment outweigh the
costs and hazards.' 6 5
Consistent with this, "most [hypertensive] patients remain asymptomatic"; 6 6 and
frequently, patients only discover that they are hypertensive because of a routine
examination or because complications have arisen. 6 7
The POEA-SEC's treatment of essential hypertension recognizes its gradations.
To enable compensation, the mere occurrence of hypertension, even as it is work-
related and concurs with the four basic requisites of the rst paragraph of Section 32-
A, does not su ce. The POEA-SEC requires an element of gravity. It speaks of essential
hypertension only as an overture to the "impairment of function of body organs like
kidneys, heart, eyes and brain." This impairment must then be of such severity as to be
"resulting in permanent disability." 6 8 Section 32-A, paragraph 2 (20), thus, requires
three successive occurrences: rst, the contracting of essential hypertension; second,
organ impairment arising from essential hypertension; and third, permanent disability
arising from that impairment.
In keeping with the requisite gravity occasioning essential hypertension, the mere
averment of essential hypertension and its incidents do not su ce. In addition to the
substantive requirements of essential hypertension's being the cause of organ
impairment leading to permanent disability, the POEA-SEC identi es documentary
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 requirements for considering a claim under Section 32-A, paragraph 2 (20). As is
evident from the use of the conjunctive word "and," this enumeration is inclusive and
cumulative, rather than alternative. Accordingly, all documentary requirements must be
submitted and satis ed; otherwise, a claim for bene ts should not be entertained.
These prerequisites are: rst, a chest x-ray report; second, an electrocardiogram (ECG)
report; third, a blood chemistry report; fourth, a funduscopy report; and fifth, a C-T Scan.
The POEA-SEC also includes cardio-vascular diseases in its list of occupational
diseases. They are compensable if, in addition to the requirements of the rst
paragraph of Section 32-A, any of the conditions listed in Section 32-A, paragraph 2
(11) are attendant:
11. Cardio-Vascular Diseases. Any of the following conditions must be met:
a. If the heart disease was known to have been present during
employment, there must be proof that an acute exacerbation was
clearly precipitated by the unusual strain by reasons of the nature of
his work.
b. The strain of work that brings about an acute attack must be
su cient severity and must be followed within 24 hours by the
clinical signs of a cardiac insult to constitute causal relationship.
c. If a person who was apparently asymptomatic before being
subjected to strain at work showed signs and symptoms of cardiac
injury during the performance of his work and such symptoms and
signs persisted, it is reasonable to claim a causal relationship.
AIDSTE

Diabetes is not among Section 32-A's listed occupational diseases. As with

hypertension, it is a complex medical condition typi ed by gradations. Blood sugar
levels classify as normal, pre-diabetes, or diabetes depending on the glucose level of a
patient. 6 9

Normal Pre-diabetes Diabetes

Mellitus

FPG <5.6 mmol/L 5.6-6.9 mmol/L ³7.0 mmol/L

2-h PG <7.8 mmol/L 7.8-11.0 ³11.1 mmol/L

mmol/L

HbA1C <5.6% 5.7-6.4% ³6.5%

Diabetes "is a clinical syndrome characterised by hyperclycaemia due to absolute

or relative de ciency of insulin." 7 0 It can cause several symptoms depending on its
type, Type 1 or Type 2. 7 1 Patients with Type 1 diabetes show more prominent
symptoms, while patients with Type 2 diabetes are mostly asymptomatic. 7 2 However,
the symptoms between these two types may overlap. Other symptoms may even be
inexplicit such as fatigue. 7 3 Diabetes can lead to several complications, among which
is suffering a stroke. 7 4
Hypertension and diabetes are hardly elementary conditions that a icted
laypersons could handily grasp. Even the POEA-SEC's appreciation of essential
hypertension proceeds from an understanding that hypertension per se does not
equate to disability warranting cessation of work and entailing compensation. Rather, it
concedes that hypertension is identified by degrees of severity.
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 Hypertension and diabetes can be di cult to recognize because of gradations
whose demarcations are not readily perceptible and because they can be
asymptomatic. This is especially true in their mild stages. Even in relatively advanced
stages, their symptoms may be generic that they are as easily mistaken to be indicating
other conditions. 7 5
The greater possibility, then, is that a seafarer's self-assessment of personal
medical conditions will fail to capture nuances that can make the difference between
tness and un tness for work. As laypersons, they do not have the requisite medical
knowledge to properly characterize their illnesses. Even if they are aware of their own
medical conditions, they may, in their non-professional opinion but still in good faith, be
convinced that their conditions are not so severe and that they can manage to perform
work aboard a vessel. Seafarers cannot be held to account under an inordinate
standard. The POEA-SEC takes exception to fraudulent misrepresentation, not to
honest mistakes.

VI

This Court nds petitioner to have knowingly and fraudulently misrepresented

himself as not a icted with hypertension or diabetes. He did not merely make
inaccuracies in good faith but engaged in serial dishonesty. Thus, this Court a rms the
Decision of the Court of Appeals.
During his PEME, petitioner was recorded to have "categorically answered 'No'
when asked whether he has ever suffered from or has been told to have hypertension
and diabetes." 7 6 After repatriation and while being treated by Dr. Barrairo, the
company-designated physician, he again "denied that he ha[d] any past history of
diabetes and hypertension." 7 7
However, in the medical opinion and evaluation prepared by his own physician, Dr.
San Luis, petitioner was indicated to not only have admitted that "he ha[d] a past history
of hypertension and diabetes," 7 8 but even that he was "regularly taking Enalapril and
Metformin respectively to treat the said illnesses." 7 9
Forced into a corner by his own con icting declarations, petitioner attempted to
extricate himself by disavowing the declarations he made in his PEME and claiming that
it was the examining physician who failed to accurately re ect his responses on his
examination certificate. 8 0
Petitioner's assertion is an admission that he fully knew of his conditions at the
moment he was examined, rendering it pointless for this Court to consider whether he
was merely confused at the time of his examination. Additionally, his assertion burdens
him with the task of proving his claims. As he was duty-bound to truthfully answer
questions during his examination, petitioner must show that despite his knowledge, he
did not willfully or deceptively withhold information. Likewise, his imputation of the
examining physician's liability despite the examination certi cate's indication that his
responses were duly recorded is an a rmative defense or an alternative version of
events that becomes his burden to prove.
Petitioner failed to discharge his burden. On the contrary, the con uence of
circumstances belies his claims.
Petitioner adequately understood the signi cance of the declarations attributed
to him in his examination certi cate. Petitioner's engagement aboard the M/V Seaboxer
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 was not his rst stint as a seafarer. He had been a seafarer since 1994, 8 1 although he
worked for respondents, on and off, only since 2007. 8 2 His prolonged seafaring
experience must have familiarized him with the conduct of PEMEs and the need for him
to give truthful answers. He explicitly declared, too, that he was "aware of the contents
of Section 20.E [on misrepresentation] in the POEA [Standard Employment Contract]."
8 3 Certainly, his awareness of Section 20 (E) must have impressed upon him not only
the potential complications of what he claims to be a false declaration foisted on him
by the examining physician but also the urgency of rectifying that error. Instead, he
remained silent and did nothing. Petitioner's concession by omission militates against
him. AaCTcI

This Court has nothing to rely on but petitioner's bare recollection. This does not
satisfy. He should have actively endeavored to demonstrate that the false declarations
in his examination certi cate were anomalous, stray errors. As a seafarer since 1994,
he must have completed several other medical examinations. His good faith could have
been substantiated by prior acts in analogous situations. He could have presented
copies of the certi cates for his previous medical examinations, but he did not. These
would have shown that while the responses he offered about his conditions in prior
instances had been properly recorded, the examining physician during his March 23,
2010 examination failed to render an accurate account.
It is, of course, possible that prior to his most recent medical examination on
March 23, 2010, petitioner had not been diagnosed with hypertension or diabetes. This
would make it impossible for him to present evidence of countervailing prior
declarations. However, even conceding this, petitioner's good faith is belied by other
circumstances attending this case.
Petitioner's good faith could have been demonstrated by his subsequent acts.
Knowing full well that a false declaration was made on his examination certi cate,
petitioner should, at the very least, not have compounded it. Instead of this, however, he
maintained before Dr. Barrairo upon repatriation that he had no history of either
hypertension or diabetes. It was only before his personally chosen physician did
petitioner admit to not only a history of diabetes and hypertension but even to the
maintenance medications he had been taking to address those illnesses.
A measure of good faith can be appreciated on the part of a seafarer who is
unable to grasp the nuances of his or her medical condition. This Court is unable to
appreciate this good faith here. Petitioner knew that his illnesses were of such severity
that he needed to take maintenance medicine. Despite this, he consistently maintained
that he had no history of hypertension or diabetes. Finally confronted with his own
discrepant statements, he denied accountability by shifting the blame to a person who
was beyond the reach of the proceedings he had initiated.
We are not a trier of facts and only questions of law may be brought before this
Court in Rule 45 petitions. Faced with nothing more than petitioner's self-serving,
unsubstantiated backtracking on his own inconsistencies, we see no need to deviate
from the uniform ndings of the Labor Arbiter, the National Labor Relations
Commission and the Court of Appeals. Petitioner's disavowals were not statements
made in good faith but were part of a serial utterance of lies.

VII

It works no less in petitioner's favor that he failed to observe the procedure

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 outlined by the POEA-SEC concerning disputed disability assessments by company-
designated physicians. Section 20 (B) (3) of the POEA-SEC requires referral to a third
physician in the event of diverging ndings by a company-designated physician and a
seafarer's personally chosen physician:
SECTION 20. COMPENSATION AND BENEFITS
xxx xxx xxx
B. COMPENSATION AND BENEFITS FOR INJURY OR ILLNESS
The liabilities of the employer when the seafarer suffers
work-related injury or illness during the term of his contract are as
follows:
xxx xxx xxx
3. Upon sign-off from the vessel for medical treatment, the seafarer is
entitled to sickness allowance equivalent to his basic wage until he
is declared t to work or the degree of permanent disability has
been assessed by the company-designated physician but in no case
shall this period exceed one hundred twenty (120) days.
For this purpose, the seafarer shall submit himself to a post-employment
medical examination by a company-designated physician within
three working days upon his return except when he is physically
incapacitated to do so, in which case, a written notice to the agency
within the same period is deemed as compliance. Failure of the
seafarer to comply with the mandatory reporting requirement shall
result in his forfeiture of the right to claim the above benefits.
If a doctor appointed by the seafarer disagrees with the
assessment, a third doctor may be agreed jointly between the
Employer and the seafarer. The third doctor's decision shall be
final and binding on both parties. (Emphasis supplied)
INC Shipmanagement, Inc. v. Rosales 8 4 explained the signi cance of this referral
and emphasized that it is "mandatory":
This referral to a third doctor has been held by this Court to be a
mandatory procedure as a consequence of the provision that it is the company-
designated doctor whose assessment should prevail. In other words, the
company can insist on its disability rating even against a contrary opinion by
another doctor, unless the seafarer expresses his disagreement by asking for
the referral to a third doctor who shall make his or her determination and whose
decision is nal and binding on the parties. We have followed this rule in a
string of cases, among them, Philippine Hammonia, Ayungo v. Beamko
Shipmanagement Corp., Santiago v. Pacbasin Shipmanagement, Inc., Andrada
v. Agemar Manning Agency , and Masangkay v. Trans-Global Maritime Agency,
Inc. Thus, at this point, the matter of referral pursuant to the provision of the
POEA-SEC is a settled ruling. 8 5 (Citations omitted)
Petitioner made no effort to comply with the required referral. He did not even
consult a personally chosen physician before ling his Complaint. Upon repatriation, the
company-designated physician, Dr. Barrairo, assessed petitioner and twice rendered
Grade 10 disability assessments in September 2010. 8 6 Disagreeing with these
assessments, petitioner would proceed to le his Complaint on October 21, 2010. 8 7 In
need of support for his Complaint, only two months after would petitioner pick a
personal physician, Dr. San Luis, to seek another opinion. Only on December 20, 2010
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 would Dr. San Luis declare that petitioner "should be permanently disabled (sic)." 8 8
Beyond this, there is no indication that petitioner did more to ascertain his proper
disability grade.
Petitioner's non-compliance constrains us to not lend credibility to his personal
physician's assessment. In any event, the record demonstrates why this assessment
deserves no credence as against that of the company-designated physician. He was
under the care and supervision of Dr. Barrairo throughout the more than four months
that intervened between his repatriation and the ling of his Complaint. 8 9 For a period,
he was kept under Dr. Barrairo's close observation as he was con ned at the De Los
Santos Medical Center from June 10, 2010 to June 23, 2010. 9 0 Dr. Barrairo's
prolonged care and observation of him yielded two disability assessments: rst, an
interim assessment on September 7, 2010; and another, a veri ed assessment on
September 30, 2010. 9 1 In contrast, petitioner's personal physician examined him on
only one occasion and only under such circumstances that petitioner needed backing
for his Complaint. 9 2 EcTCAD

Jurisprudence holds that, in analogous cases, company-designated physicians'

assessments are to be upheld. 9 3 This could have entitled petitioner to Grade 10
disability bene ts. However, his failure to observe Section 20 (B) (3)'s requirements is
not all that there is to this case. We cite his non-referral to a third physician, not as a
mitigating circumstance, but to emphasize how multi-layered exigencies militate
against him. We have explained at length how petitioner engaged in fraudulent
misrepresentation, deceptively concealing his pre-existing hypertension and diabetes.
This, in itself, is fatal to his cause. In keeping with Section 20 (E) of the POEA-SEC,
petitioner is, thus, disqualified from receiving any compensation.
WHEREFORE , the Petition for Review on Certiorari is DENIED.
DENIED The assailed April
10, 2013 Decision and July 18, 2013 Resolution of the Court of Appeals in CA-G.R. SP
No. 124546 are AFFIRMED.
AFFIRMED
SO ORDERED.
Velasco, Jr., Bersamin, Martires and Gesmundo, JJ., concur.
Footnotes

1. Rollo, pp. 3-19.

2. Id. at 20-30. The Decision was penned by Associate Justice Priscilla J. Baltazar-Padilla and
concurred in by Associate Justices Rosalinda Asuncion-Vicente and Agnes Reyes-Carpio
of the Eighth Division, Court of Appeals, Manila.
3. Id. at 31-32. The Resolution was penned by Associate Justice Priscilla J. Baltazar-Padilla and
concurred in by Associate Justices Rosalinda Asuncion-Vicente and Agnes Reyes-Carpio
of the Eighth Division, Court of Appeals, Manila.
4. No copy annexed to the Petition or to any of the pleadings submitted.

5. No copy annexed to the Petition or to any of the pleadings submitted.

6. No copy annexed to the Petition or to any of the pleadings submitted.

7. Id. at 33-44.
8. Id. at 20-21.

9. Id. at 111, Memorandum for the Respondents.

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 10. Id. at 21.

11. Id.
12. Id.

13. Id. at 94, Memorandum for the Petitioner.

14. Id. at 111, Memorandum for the Respondent.

15. Id. at 94.

16. Id. at 21.

17. Id.
18. Id. at 111.

19. Id. at 26.

20. Id. at 21.

21. Id. at 111.

22. Id. at 112, Memorandum for the Respondents.
23. Id. at 22.

24. Id. at 95, Memorandum for the Petitioner.

25. Id. at 22.

26. Id. at 26.

27. Id. at 22.

28. Id.
29. Id. at 22-23.

30. Id. at 96, Memorandum for the Petitioner.

31. Id.

32. Id. at 97-98, Memorandum for the Petitioner.

33. Millares v. National Labor Relations Commission, 434 Phil. 524, 538 (2002) [Per J.
Kapunan, Special First Division].

34. LABOR CODE, art. 20.

35. Vergara v. Hammonia Maritime Services, Inc., 588 Phil. 895, 909 (2008) [Per J. Brion,
Second Division].
36. Jebsen Maritime, Inc. v. Ravena, 743 Phil. 371, 385 (2014) [Per J. Brion, Second Division].

37. POEA Memorandum Circular No. 09-2000.

38. POEA Memorandum Circular No. 09-2000, sec. 20 (B).

39. POEA Memorandum Circular No. 09-2000, Definition of Terms.

40. POEA Memorandum Circular No. 09-2000, sec. 20 (B).
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 41. Section 20. COMPENSATION AND BENEFITS

xxx xxx xxx

  B. COMPENSATION AND BENEFITS FOR INJURY OR ILLNESS

    The liabilities of the employer when the seafarer suffers work-related injury or illness
during the term of his contract are as follows:
   1. The employer shall continue to pay the seafarer his wages during the time he is
on board the vessel;
   2. If the injury or illness requires medical and/or dental treatment in a foreign port,
the employer shall be liable for the full cost of such medical, serious dental, surgical and
hospital treatment as well as board and lodging until the seafarer is declared t to work
or to be repatriated.

   However, if after repatriation, the seafarer still requires medical attention arising
from said injury or illness, he shall be so provided at cost to the employer until such time
he is declared t or the degree of his disability has been established by the company-
designated physician.
   3. Upon sign-off from the vessel for medical treatment, the seafarer is entitled to
sickness allowance equivalent to his basic wage until he is declared t to work or the
degree of permanent disability has been assessed by the company-designated physician
but in no case shall this period exceed one hundred twenty (120) days.

   For this purpose, the seafarer shall submit himself to a post-employment medical
examination by a company-designated physician within three working days upon his
return except when he is physically incapacitated to do so, in which case, a written notice
to the agency within the same period is deemed as compliance. Failure of the seafarer to
comply with the mandatory reporting requirement shall result in his forfeiture of the right
to claim the above benefits.

   If a doctor appointed by the seafarer disagrees with the assessment, a third doctor
may be agreed jointly between the Employer and the seafarer. The third doctor's decision
shall be final and binding on both parties.

   4. Those illnesses not listed in Section 32 of this Contract are disputably presumed
as work related.
   5. Upon sign-off of the seafarer from the vessel for medical treatment, the employer
shall bear the full cost of repatriation in the event the seafarer is declared (1) t for
repatriation or (2) t to work but the employer is unable to nd employment for the
seafarer on board his former vessel or another vessel for the employer despite earnest
efforts.
   6. In case of permanent total or partial disability of the seafarer caused by either
injury or illness the seafarer shall be compensated in accordance with the schedule of
bene ts enumerated in Section 32 of this Contract. Computation of his bene ts arising
from an illness or disease shall be governed by the rates and the rules of compensation
applicable at the time the illness or disease was contracted.

42. POEA Memorandum Circular No. 09-2000, sec. 32 provides:

  Section 32. SCHEDULE OF DISABILITY OR IMPEDIMENT FOR INJURIES SUFFERED AND
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 DISEASES INCLUDING OCCUPATIONAL DISEASES OR ILLNESS CONTRACTED.

xxx xxx xxx

SCHEDULE OF DISABILITY ALLOWANCES

Impediment Grade Impediment
1 US$50,000 x 120.00%
2 - x 88.81%
3 - x 78.36%
4 - x 68.66%
5 - x 58.96%
6 - x 50.00%
7 - x 41.80%
8 - x 33.59%
9 - x 26.12%
10 - x 20.15%
11 - x 14.93%
12 - x 10.45%
13 - x 6.72%
14 - x 3.74%
43. Philippine Overseas Employment Administration Standard Employment Contract (2000),
sec. 32.
44. Occupational Diseases:

  1. Cancer of the epithelial lining of the bladder (Papillomar of the bladder)
  2. Cancer, epitheliomatous or ulceration of the skin or of the corneal surface of the eye
due to tar, pitch, bitumen, mineral oil or para n, or compound product or residue of
these substances.
  3. Deafness

  4. Decompression sickness

   (a) Caissons disease

   (b) Aeroembolism
  5. Dermatitis due to irritants and sensitizers

  6. Infection (Brucellosis)

    7. Ionizing radiation disease, in ammation, ulceration or malignant disease of skin or
subcutaneous tissues of the bones or leukemia, or anemia of the aplastic type due to X-
rays, ionizing particle, radium or radioactive substances.

  8. Poisoning and its sequelae caused by:

   (a) Ammonia

   (b) Arsenic or its toxic compound

   (c) Benzene or its toxic homologues, nitro and aminotoxic derivatives of benzene or
its homologue

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    (d) Beryllium or its toxic compounds

   (e) Brass, zinc or nickel

   (f) Carbon dioxide

   (g) Carbon bisulfide

   (h) Carbon monoxide

   (i) Chlorine
   (j) Chrome of its toxic compounds

   (k) Dinitrophenol or its homologue

   (l) Halogen derivatives of hydrocarbon of the aliphatic series

   (m) Lead or its toxic compounds

   (n) Manganese or its toxic compounds

   (o) Mercury or its toxic compounds

   (p) Nitrous fumes

   (q) Phosgene
   (r) Phosphorous or its toxic compounds

   (s) Sulfur dioxide

  9. Diseases Caused by abnormalities in temperature and humidity

   (a) Heat stroke/cramps/exhaustion

   (b) Chilblain/frostbite/freezing

   (c) Immersion foot/general hypothermia

  10. Vascular disturbance in the upper extremities due to continuous vibration from
pneumatic tools or power drills, riveting machines or hammers.
  11. Cardio-Vascular Diseases

xxx xxx xxx

  12. Cerebro-Vascular Accidents

xxx xxx xxx

45. Magsaysay Maritime Services v. Laurel, 707 Phil. 210, 221 (2013) [Per J. Mendoza, Third
Division].
46. Dayo v. Status Maritime Corporation, 751 Phil. 778, 789 (2015) [Per J. Leonen, Second
Division].

47. POEA Memorandum Circular No. 09-2000, sec. 32-A.

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 48. Magsaysay Maritime Services v. Laurel , 707 Phil. 210, 225 (2013) [Per J. Mendoza, Third
Division].
49. 678 Phil. 938 (2011) [Per J. Mendoza, Third Division].

50. Id. at 946-947.

5 1 . Jebsen Maritime, Inc. v. Ravena , 743 Phil. 371, 387-388 (2014) [Per J. Brion, Second
Division].
52. Rep. Act No. 8042, as amended by Republic Act No. 10022, sec. 23 (c) provides:

  Section 23. Role of Government Agencies. — The following government agencies shall
perform the following to promote the welfare and protect the rights of migrant workers
and, as far as applicable, all overseas Filipinos:

xxx xxx xxx

   (c) Department of Health. — The Department of Health (DOH) shall regulate the
activities and operations of all clinics which conduct medical, physical, optical, dental,
psychological and other similar examinations, hereinafter referred to as health
examinations, on Filipino migrant workers as requirement for their overseas
employment. Pursuant to this, the DOH shall ensure that:
   (c.1) The fees for the health examinations are regulated, regularly monitored and
duly published to ensure that the said fees are reasonable and not exorbitant;
   (c.2) The Filipino migrant worker shall only be required to undergo health
examinations when there is reasonable certainty that he or she will be hired and
deployed to the jobsite and only those health examinations which are absolutely
necessary for the type of job applied for or those speci cally required by the foreign
employer shall be conducted;
   (c.3) No group or groups of medical clinics shall have a monopoly of exclusively
conducting health examinations on migrant workers for certain receiving countries;

   (c.4) Every Filipino migrant worker shall have the freedom to choose any of the
DOH-accredited or DOH-operated clinics that will conduct his/her health examinations
and that his or her rights as a patient are respected. The decking practice, which requires
an overseas Filipino worker to go rst to an o ce for registration and then farmed out to
a medical clinic located elsewhere, shall not be allowed;

   (c.5) Within a period of three (3) years from the effectivity of this Act, all DOH
regional and/or provincial hospitals shall establish and operate clinics that can serve the
health examination requirements of Filipino migrant workers to provide them easy
access to such clinics all over the country and lessen their transportation and lodging
expenses; and
   (c.6) All DOH-accredited medical clinics, including the DOH-operated clinics,
conducting health examinations for Filipino migrant workers shall observe the same
standard operating procedures and shall comply with internationally-accepted standards
in their operations to conform with the requirements of receiving countries or of foreign
employers/principals.

    Any foreign employer who does not honor the results of valid health examinations
conducted by a DOH-accredited or DOH-operated clinic shall be temporarily disquali ed
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 from participating in the overseas employment program, pursuant to POEA rules and
regulations.

    In case an overseas Filipino worker is found to be not medically t upon his/her

immediate arrival in the country of destination, the medical clinic that conducted the
health examination/s of such overseas Filipino worker shall pay for his or her
repatriation back to the Philippines and the cost of deployment of such worker.
  Any DOH-accredited clinic which violates any provision of this section shall, in addition
to any other liability it may have incurred, suffer the penalty of revocation of its DOH
accreditation.
  Any government o cial or employee who violates any provision of this subsection shall
be removed or dismissed from service with disquali cation to hold any appointive public
o ce for ve (5) years. Such penalty is without prejudice to any other liability which he
or she may have incurred under existing laws, rules or regulations.

53. DOH Admin. Order No. 2007-0025, VI provides:

  VI. SPECIFIC GUIDELINES

xxx xxx xxx

  B. On PEME
  1. The PEME shall be administered on the following: Seafarers, including cadets,
trainees, regular employees of local shipping lines, contractual employees of foreign-
owned shipping companies, and pre-licensure examinees.
  2. The PEME to be conducted shall, among others, undertake and consider the following
procedures and criteria, accordingly:

   a.) Past medical history of the examinee shall be taken. When necessary, previous
medical records of each seafarer candidate/serving seafarer shall be reviewed.

   b.) The current Joint National Committee Recommendation on Prevention,

Detection, Evaluation and Treatment of High Blood Pressure shall be used for reference.
Minimum PEME test requirements for seafarers shall follow the Minimum PEME Test
Requirements posted at the DOH website www.doh.gov.ph
   c.) Distant and near vision, including color perception test (Ishihara Plates), shall
form part of the initial and periodic PEME requirements. Test for primary colors shall be
considered in case of defective Ishihara result. It shall not impair the seafarer's
capability to work provided it is cleared by an accredited eye specialist or low vision
specialist. Results of visual acuity shall be expressed in both decimal and Snellen's
notation provided in the format of the PEME Fitness Certi cation for Seafarers posted at
the DOH website www.doh.gov.ph

   d.) Audiometric exam shall form part of the initial and regular PEME requirements.
Hearing acuity shall be measured from 500 Hz to 8000 Hz.
   e.) Full clinical notes and results of the laboratory, x-ray, ECG, and other
examinations shall be kept along with the form describing the examinee's previous
medical history duly signed by the examinee as stated in the Instructions to Accredited
Medical Clinics posted at the DOH website www.doh.gov.ph

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    f.) Physical Capabilities required for entry-level seafarers shall be based on
shipboard task, function, event or condition as mentioned under Job Requirements and
Fitness Standards posted at the DOH website www.doh.gov.ph
   g.) In case of crew members of ships in coastal trade, offshore supply vessels,
tugboats and barges, the international tness standard and health requirement of these
guidelines may be modi ed by national maritime authorities, and restricted service
health certi cates may be issued to the crew members. Nevertheless, the safety of the
vessel at sea must be maintained, seafarers' duties must be performed safely, and their
health must be safeguarded.
54. DOH Admin. Order No. 2007-0025, VI (B) (2) (b).

55. DOH Admin. Order No. 2007-0025, VI (C).

56. DOH Administrative Order No. 2007-0025, VI (C).

57. Estate of Ortega v. Court of Appeals , 576 Phil. 601, 620 (2008) [Per J. Tinga, Second
Division].

58. DOH Administrative Order No. 2007-0025, VI (C).

59. MCGRAW-HILL EDUCATION, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 1616 (19th
ed.).

60. Id.
61. Id.

62. Id.
63. Id.

64. Id.
6 5 . P. BLOOMFIELD, A. BRADBURY, N.R. GRUBB & D.E. NEWBY, Cardiovascular Disease,
DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 551 (20th ed.).
66. Id.

67. Id.
68. POEA Memorandum Circular No. 09-2000, sec. 32-A (20).

69. MCGRAW-HILL EDUCATION, HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 2399 (19th

ed.).

70. B.M. FRIER & M. FISHER, Diabetes Mellitus, DAVIDSON'S PRINCIPLES AND PRACTICE OF
MEDICINE 808 (20th ed.).
71. Id. at 818.

72. Id.
73. Id.

74. Id. at 829 lists the complications of diabetes, as follows:

  A. Microvascular/neuropathic

  1. Retinopathy, Cataract

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    - Impaired vision

  2. Nephropathy
   - Renal failure

  3. Peripheral neuropathy

   - Sensory loss

   - Motor weakness
  4. Autonomic neuropathy

   - Postural hypotension
   - Gastrointestinal problems (gastroparesis; altered bowel habit)

  5. Foot disease

   - Ulceration

   - Arthropathy
  B. Macrovascular

  1. Coronary circulation

   - Myocardial ischaemia/infarction

  2. Cerebral circulation

   - Transient ischaemic attack
   - Stroke

  3. Peripheral circulation

   - Claudication

   - Ischaemia
75. Symptoms of Hyperglycaemia may include nocturia, change in weight, blurring of vision,
nausea, headache, mood change, irritability, and apathy see B.M. FRIER & M. FISHER,
Diabetes Mellitus, DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 818 (20th
ed.); Hypertension may also have nonspeci c symptoms such as "dizziness,
palpitations, easy fatigability, and impotence" see MCGRAW-HILL EDUCATION,
HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 1621 (19th ed.).
76. Rollo, p. 26.

77. Id.
78. Id.

79. Id.

80. Id.
81. Id. at 97.

82. Id. at 93-94.

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 83. Id. at 27.

84. INC Shipmanagement, Inc. v. Rosales, 744 Phil. 774 (2014) [Per J. Brion, Second Division].
85. Id. at 787.

86. Rollo, p. 21.

87. Id. at 22.

88. Id.
89. Id. at 21.

90. Id.

91. Id.

92. Id. at 22.

9 3 . As in Santiago v. Pacbasin Ship Management , 686 Phil. 255, 268-269 (2012) [Per J.
Mendoza, Third Division]:

  At any rate, said nding ought not to be given more weight than the disability grading
given by the company-designated doctor. The POEA Standard Employment Contract
clearly provides that when a seafarer sustains a work-related illness or injury while on
board the vessel, his tness or un tness for work shall be determined by the company-
designated physician. However, if the doctor appointed by the seafarer makes a nding
contrary to that of the assessment of the company-designated physician, the opinion of
a third doctor may be agreed jointly between the employer and the seafarer as the
decision nal and binding on both of them. In this case, Santiago did not avail of this
procedure. There was no agreement on a third doctor who shall examine him anew and
whose nding shall be nal and binding. Thus, this Court is left without choice but to
uphold the certi cation made by Dr. Lim with respect to Santiago's disability. (Citation
omitted)

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