“Di: Zahabi suspected that the work environment might have triggered | the worker's  mige re

Clinical
Opinion, BE Pang, March 20, 2026 ie

Having recorded that the treating ENT specialist identified the work environment as the trigger for the acute escalation,
the Opinion does not apply that finding. Instead, it pivots to the audiological measurement that the average noise level
(57.6 dBA) was “not considered hazardous to hearing,” and concludes on that basis that the worker's “pre-existing and
non-occupational conditions”, rather than the incident, are the main driving factor.

Why this matters: the Thin Skull Rule

Under settled workers' compensation principle, a pre-existing vulnerability does not defeat a claim where a workplace
event triggers, aggravates, or.accelerates that vulnerability into a disabling condition — the employer, and the
compensation system, take the worker as they find them. A noise level being “not hazardous to hearing” in an
audiological sense does not answer the separate question of whether that same noise, in this worker, triggered a
migraine and tension cascade severe enough to cause his first-ever emergency migraine presentation. Ms. Pang's own
quoted record already answers that second question: the treating ENT specialist said it did. An audiofogist's assessment
of hearing-hazard levels is not a basis to overrule that specialist's causal impression, and the Opinion does not identify
any medical basis on which it does so.

7. The Prescription Record: A Stable Baseline, Disrupted at the Moment of Exposure

The worker's prescription claims history, obtained from his extended health benefits provider, was not before Ms. Pang
and is not addressed in the Opinion. It is directly relevant to the Opinion's conclusion that. the worker's presentation is
driven by “pre-existing” factors.

For the approximately seventeen months before January 12, 2026 (August 2024 to November 2025), the worker's
prescription record consists of exactly two medications: sumatriptan, an acute migraine medication, filled at consistent
roughly three-month intervals (August-2024, November 2024, February 2025, May 2025, August 2025, November
2025), and bilastine, an allergy medication, filled monthly without interruption. No other medication appears in this
seventeen-month record.

On January 31, 2026 —~ within days of the OMCI exposure and the onset of ear pain on January 23, 2026 — an
emergency department physician prescribed sumatriptan, prednisone, and pantoprazole as part of treating the worker's
acute presentation, corresponding to the same Royal Columbian Hospital attendance described in Section 6, above.
This was not a routine refill: it was an emergency prescription, approximately eleven weeks after the worker's previous
sumatriptan fill — at the edge of, not outside, his established three-month patlern, but issued in an emergency
department rather than through routine care,

Following that attendance, the prescription record changes materially. Sumatriptan fills accelerate to four-to-five-week
intervals (February 25, April 1, and April 28, 2026). More significantly, four medications appear in the worker's record
for the first time in the entire seventeen-month period, beginning in February and March 2026, and have continued
monthly since: quetiapine (first filled February 5, 2026), and trazodone, sertraline, and risperidone (each first filled
March 4-5, 2026). None of these four medications appears anywhere in the worker's prescription history before the
exposure period.

The worker submits this is the relevant evidentiary record: a stable, two-medication baseline for at least seventeen
months, followed by emergency-room initiation of acute migraine treatment within days of a documented occupational
exposure, followed by an entirely new regimen of psychiatric medications sustained without interruption for over four
months. This medication history, its timing, and its composition are not addressed anywhere in the Opinion. The
worker notes this regimen was assembled reactively across multiple emergency department visits rather than through
coordinated psychiatric care, and that he has since been referred to the Mental Health Unit at Royal Columbian
Hospital, with a virtual psychiatric consultation scheduled for July 13, 2026 to review and coordinate it.

Sourve: Preseription claims history, extended health benefits provider, August 202-4-present,
ip 7 DUS fi

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