Eric Berube v. New England Truck Tire Centers, Inc.

Insurance Company


Date Decided

November 30, 2023

Panel Members

David Hirtle

Lindsey Sands

Christine Smith


Legal Causation Pre-Existing Injury Medical Evidence Partial Incapacity Legal Causation Medical Evidence Partial Incapacity Pre-Existing Injury


combined effects

File Size

183 KB


Summary from the Troubh Heisler Attorneys

Eric Berube v. New England Truck Tire Centers, Inc., - In a case involving aggravation of a preexisting condition, the Appellate Division addresses how the required initial finding of a work injury under sec. 201(4), before addressing work aggravation, can be analyzed under the “combined effects” prism set forth in Bryant v. Masters Machine Co., 444 A.2d 329 (1982), and how an award of incapacity benefits can be sustained in the absence of a medical opinion authored by a qualified medical expert. In Berube v. New England Truck Tire Centers, Inc. WCB No. 23-19 Berube claimed a 2/9/21 injury from lifting heavy tires, resulting in aggravation of a preexisting hemorrhoid condition. He went unsuccessful surgery and was unable to return to his job. The only causation opinion was authored by a Nurse Practitioner. There were no medical opinions addressing the ability to work. But, Berube testified to the nature of his symptoms and the physical limitations caused by his condition.

The ALJ granted Berube’s petitions for award and for payment of medical expenses, awarding a closed end period of total incapacity benefits followed by ongoing partial based on an imputed earning capacity of $560 per week. Motions for Further Findings of Fact were denied.

On appeal the employer argued that application of sec. 201(4) in the first instance required the ALJ find that a work related injury occurred, before analyzing whether that injury significantly aggravated a preexisting condition. It argued that the ALJ made no such finding. The Appellate Division held that while the ALJ failed to make an express finding that a work injury occurred, it was apparent from the ALJ’s analysis that the Judge applied the “combined effects” principles of Bryant to establish both medical and legal causation. This satisfies the requirement of finding a work injury occurred. Specifically, medical causation was found based on Berube’s testimony and the reports of the Nurse Practitioner that the heavy lifting caused an increase in hemorrhoid symptoms and the disability that followed. In a combined effects case legal causation can be established where the employee brings some element of personal risk due to the preexisting condition but the employment contributes a substantial element of risk that offsets the personal risk. There was competent evidence for both these conclusions.

Rejecting the employer’s argument that a nurse practitioner’s opinion is not qualified to support a medical causation opinion, the panel offered that the ALJ was free to choose among medical opinions and that this objection goes to the weight and not the admissibility of the medical opinion.

The employer also argued the ALJ erred by awarding incapacity benefits in the absence of a qualified medical opinion addressing work ability. Citing the 1923 Law Court decision in Michaud’s Case, 122 Me. 276, which held that an award of incapacity benefits can be supported even in the absence of medical evidence, Berube’s testimony along with the medical records showing unsuccessful surgery and post-surgical complications and the need for ongoing treatment provided competent evidence to support the ALJ’s conclusion.

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