5/19/2021 E-Library - Information At Your Fingertips: Printer Friendly preservative foods that are not easily digested.[33] He also explained that his duties as third engineer exposed him to hazardous chemicals, smoke emissions, combustion in the engine room, which could have weakened his immune system and increased his susceptibility to infectious virus or bacteria.[34] John Hopkins Medicine states that various infections such as virus, bacteria, or parasites in the digestive tract could lead to the inflammation of the appendix.[35] Clearly, there is risk of contracting the illness by Macahilas's working condition. Aside from the disputable presumption of work-relatedness of appendicitis, Macahilas was able to establish the causal connection between his work and his illness. We have held that "it is enough that the work has contributed, even in a small degree, to the development of the disease[illness] since strict proof of causation is not required. Only reasonable proof of work-connection and not direct causal relation is required to establish compensability."[36] The explanations of Macahilas, coupled with his undisputed claims on limited food options on board the vessel and that his work was strenuous and entailed exposure to hazardous chemicals, reasonably establish the work-relatedness of his illness. Anent the diagnosis for fistula and hernia, We find the same to be work-related. The CT-scan results of Macahilas's abdomen area showed that said conditions were located at the surgical/incisional site.[37] Fistula is defined as "an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Fistulas are usually the result of an injury or surgery."[38] Incisional hernia, on the other hand, "occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes. Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision."[39] Thus, the subsequent conditions of Macahilas clearly resulted from the surgery for appendicitis in a hospital in Mexico, where he was brought by his employer. As to how much benefits should be paid to Macahilas, We find BSM liable for US$60,000.00 representing permanent and total disability benefits for failure of the company-designated physician to issue a final and definitive assessment within the 120/240-day mandated period.[40] A final, conclusive and definite assessment must clearly state whether the seafarer is fit to work or the exact disability rating, or whether such illness is work-related, and without any further condition or treatment.[41] It should no longer require any further action on the part of the company-designated physician and it is issued by the company-designated physician after he or she has exhausted all possible treatment options within the periods allowed by law.[42] In view of the foregoing, We cannot consider as valid and final an assessment merely stating that the illness of a seafarer is not work-related. Even with said assessment, the company-designated physician is bound to timely issue a fit to work assessment or disability grading. Here, the fitness assessment was issued 419 days after Macahilas's repatriation. Facts also show that Macahilas's illness was assessed as not work-related on the same day of his medical repatriation on January 17, 2014. Records[43] show that Macahilas must still undergo further examination of his condition. He was even under the care of the company-designated physician thereafter and was subjected to a https://elibrary.judiciary.gov.ph/thebookshelf/showdocsfriendly/1/66559 5/10