6/14/2021 E-Library - Information At Your Fingertips: Printer Friendly b. the strain of work that brings about an acute attack must be sufficient 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 so 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 d. if a person is known hypertensive or diabetic, he should show compliance with prescribed maintenance medication and doctor- recommended lifestyle changes. The employer has provided a workplace conducive for such compliance in accordance with Section 1(A), paragraph 5. e. in a patient not known to have hypertension or diabetes, as indicated on his last PEME (Emphasis supplied) It is undisputed that the highlighted conditions above have been met because Alfredo was immediately brought by the employer to a hospital in Africa, where he underwent bypass surgery. We are unconvinced by MMMI's claim that Alfredo's illness is not work-related. The company anchors its position on the "not work related" assessment of the companydesignated physician and the fact that Alfredo suffers from a pre-existing coronary hypertension. While Alfredo has a pre­existing illness, such does not prove that his working condition did not aggravate the illness. It is settled that when it is shown that the seafarer's work may have contributed to the establishment or, at the very least, aggravation of any pre-existing disease, the condition/illness suffered by the seafarer shall be compensable.[57] Here, Alfredo's tasks as Messman required physical labor. He explained that he performed a wide variety of responsibilities from cleaning in the vessel to lifting heavy loads as a porter. His work definitely produced stress and strain normally resulting in the wear and tear of the body.[58] As his coronary hypertension was declared by the company-designated physicians as "cleared"[59] in the PEME, it is highly probable that the strain of Alfredo's work aggravated his pre-existing condition that caused his heart attack episodes on board the vessel. We have held that "only reasonable proof of work-connection and not direct causal relation is required to establish compensability."[60] Aside from the fact that Alfredo's condition is listed as an occupational disease, the undisputed fact that his pre-existing condition is controlled prior to deployment, but he later suffered episodes of heart attack on board the vessel, reasonably establish the work-relatedness of his illness. Moreover, We cannot uphold the "not work related assessment" issued by the companydesignated physician because it is not a final assessment. 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.[61] It should no longer require any further action on the part of https://elibrary.judiciary.gov.ph/thebookshelf/showdocsfriendly/1/66856 6/12