MEDICAL EVIDENCE REBUTTAL

Response to the WorkSafeBC Clinical Opinion of March 20, 2026, and the TELUS Health Submission of
August 14, 2026
WorkSafeBC Claim #42647461 — Review #R0360901 — Mark Holand
Clinical Opinian under reviews Flora Pang, MSc. RAUD, Aud{C), Audiologist Advisor, dated 2026-03-20 (Form 68B86}
Prepared for submission to the WorkSafeBC Review Division

( pdated with the July 16, 2026 consultation report of Dr. Arman Abdalkhani, MD, FRCSC. Van City Ear, Nose & Throat,
received following the initial draft of this rebuttal.

}. Executive Summary

The worker's position, from the first written record of this hazard onward, has never been that the noise in the
OMC! Control Training Room was loud enough to cause conventional noise-induced hearing loss. The worker
said so. himself, in writing, on January 22, 2026 — before any medical assessment, before the emergency room
visit, and before this claim existed. Both the Clinical Opinion of March 20, 2026 and the TELUS Health
submission of August 14, 2026 nonetheless build their entire analysis around testing. and rejecting,
mechanisms the worker never claimed — acoustic trauma and acoustic shock — while never engaging with the
mechanism the worker's own treating specialists have identified: a tensor tympani muscular response and

temporomandibular joint (TMJ) dysfunction, arising from sustained exposure acting on a documented autistic
sensory processing profile.

Specialist medical evidence obtained since March 20, 2026 — from an otolaryngologist, a neurology and pain
specialist, an independent audiology clinic, and the worker's own prescription claims history — directly
contradicts each factual basis on which the Opinions conclusion rests. In summary:

e Never the claim: the worker's own contemporaneous safety report states plainly that the noise was below
the threshold requiring hearing protection — the claim was never acoustic trauma, and disproving
acoustic trauma disproves nothing.

¢ Wrong mechanism tested throughout: both the Opinion and the TELUS Health submission test only
acoustic trauma and acoustic shock, mechanisms no treating specialist has proposed, while never
assessing the tensor tympani, TMJ, and autonomic mechanism the worker's own specialists identified.

© Managed baseline, disrupted by exposure: the worker's migraine condition was under active, dacumented
management before January 2026 and was destabilized, not revealed, by the workplace exposure.

e Ignored objective audiological findings: independent testing found a 20-30 dB asymmetry and confirmed
hyperacusis, neither of which is addressed in the Opinion or the TELUS Health submission,

* Sclective use of its own central exhibit: the Opinion quotes the January 30, 2026 ER record's note that the

noisy environment likely triggered the worker's migraine, then uses that same trigger as a reason to deny
the claim rather than apply it.

¢ No engagement with the medication timeline: a seventeen-month, two-medication prescription record

changed materially within days of the exposure and has not returned to baseline; neither submission
mentions it.

® Sensory profile treated backwards: the worker's autistic sensory processing profile is used as evidence the
condition is pre-existing and therefore irrelevant, when it is in fact the reason this specific,
moderate-level, sustained. exposure was clinically significant for this specific worker.

¢ The Opinion's own causal theory is now contradicted by the clinical course: as of July 16, 2026, the
worker's migraines have resolved with self-management while the ear pain has not — directly refuting the
claim that migraines are “the main driving factor” of the worker's ongoing complaints.

« A third independent specialist confirms the same non-audiological mechanism: Dr. Abdalkhani, ENT,
examining the worker independently of Dr. Samad, likewise finds “likely muscular or neurological” ear
pain with a “possible TMJ component,” and no otologic pathology.

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