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Created by Funky (OpenClaw) on Thu Feb  5 02:54:14 UTC 2026
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# Template: Doctor Letter for Kobe's VA Dependent Benefits Claim
**Purpose:** This template provides the structure for a medical professional to write a letter supporting Kobe's VA dependent benefits claim. Give this to Kobe's doctor to complete.
**Critical Elements:** The letter MUST state that Kobe is "permanently incapable of self-support" due to disability that existed before age 18.
---
## Instructions for Doctor
**Dear Dr. [Name],**
I am requesting a letter to support a VA dependent benefits claim for my son, **[Kobe's Full Name]**, who has a permanent disability.
**The Department of Veterans Affairs requires a medical opinion letter that includes:**
1. Your professional credentials and relationship to my son
2. His diagnoses (with ICD-10 codes if possible)
3. When the disability began (ideally before age 18)
4. Description of functional limitations
5. Your medical opinion that he is **"permanently incapable of self-support"**
6. The basis for your opinion
**I have provided a template below that you can use or adapt. Please write this on your professional letterhead if possible.**
**If you have any questions, the VA can be reached at 1-800-827-1000, or you can contact me at [your phone/email].**
Thank you for your assistance with this important matter.
Sincerely,
Frederick Book
---
## TEMPLATE LETTER (For Doctor to Complete on Letterhead)
**[Doctor's Letterhead]**
**Date:** [Current Date]
**To Whom It May Concern:**
**RE: Medical Opinion for VA Dependent Benefits**
**Patient Name:** [Kobe's Full Legal Name]
**Date of Birth:** [MM/DD/YYYY]
**Patient ID / Medical Record #:** [if applicable]
I am writing this letter to provide a medical opinion regarding [Kobe's first name]'s permanent disability in support of his father's application for VA dependent benefits.
---
### I. PHYSICIAN CREDENTIALS & RELATIONSHIP TO PATIENT
**My name is [Doctor's Full Name], and I am a board-certified [specialty] licensed to practice medicine in the state of [state].**
**Professional Credentials:**
- Medical Degree: [Institution, Year]
- Board Certification: [Specialty, Year]
- License Number: [State License #]
- Current Practice: [Clinic/Hospital Name, City, State]
- Years in Practice: [number]
**Relationship to Patient:**
- I have been [Kobe's] [treating physician / specialist] since [date/year]
- I have personally examined [Kobe] on [number] occasions
- Most recent examination: [date]
- I have reviewed his complete medical history including records from [list key providers]
---
### II. DIAGNOSES
**[Kobe] has been diagnosed with the following conditions:**
**Primary Diagnoses:**
1. **[Diagnosis Name]** (ICD-10: [code]) - Diagnosed: [date/year]
2. **[Diagnosis Name]** (ICD-10: [code]) - Diagnosed: [date/year]
3. **[Diagnosis Name]** (ICD-10: [code]) - Diagnosed: [date/year]
**Secondary/Associated Conditions:**
4. [Diagnosis] (ICD-10: [code])
5. [Diagnosis] (ICD-10: [code])
**[Choose relevant examples to include below:]**
*For Autism Spectrum Disorder:*
"[Kobe] meets DSM-5 criteria for Autism Spectrum Disorder, Level [2 or 3] - [Requiring substantial support / Requiring very substantial support]. This diagnosis was confirmed through comprehensive evaluation including [ADOS-2, ADI-R, clinical observation, etc.] and is consistent with observed deficits in social communication, restricted interests, and sensory processing."
*For Intellectual Disability:*
"[Kobe] meets DSM-5 criteria for Intellectual Disability (Intellectual Developmental Disorder), with severity level of [Mild / Moderate / Severe]. Psychological testing reveals a Full Scale IQ of [score], placing him in the [percentile] percentile, more than [number] standard deviations below the mean. Additionally, adaptive functioning is significantly impaired, as evidenced by [Vineland/ABAS] scores of [score] in [domains]."
*For Cerebral Palsy:*
"[Kobe] has been diagnosed with Cerebral Palsy, [type], affecting [body areas]. This is classified as GMFCS Level [I-V] and MACS Level [I-V], indicating [description of functional motor limitations]."
*For Seizure Disorder:*
"[Kobe] has a documented seizure disorder, specifically [type of seizures], that is [well-controlled / partially controlled / refractory] on current medication regimen of [medications]. EEG findings show [abnormalities]. Despite treatment, he experiences [frequency] seizures and requires constant supervision for safety."
*For Genetic Disorders:*
"[Kobe] has been diagnosed with [genetic condition name], confirmed by genetic testing showing [specific mutation/chromosomal abnormality]. This condition is associated with intellectual disability, developmental delays, and medical complications including [list]."
---
### III. ONSET & DEVELOPMENTAL HISTORY
**[Kobe's] disability was present from [early childhood / birth / age X].**
**Developmental History:**
- Parents first noted concerns about [Kobe's] development at approximately [age/timeframe]
- Early signs included [developmental delays in motor skills / lack of speech / social deficits / etc.]
- He did not meet typical developmental milestones, including [specific examples: walking, talking, toilet training, etc.]
- Early intervention services began at age [X], and he has required continuous special education and therapeutic services since that time
**The medical evidence demonstrates that [Kobe's] disability has been present since [before age 18 / early childhood], is permanent in nature, and has persisted despite extensive intervention and treatment.**
---
### IV. FUNCTIONAL LIMITATIONS
**[Kobe's] disability results in significant and permanent functional limitations across multiple domains:**
#### A. Activities of Daily Living (ADLs)
**Personal Care:**
- [Kobe] requires [complete / substantial / constant supervision for] assistance with bathing, dressing, grooming, and toileting
- He cannot [specific examples: tie shoes, button shirts, manage zippers]
- He requires verbal prompting and physical assistance to complete basic self-care tasks
- He lacks the judgment to maintain personal hygiene independently
**Eating:**
- Requires supervision during meals due to [choking risk / inability to prepare food / limited food tolerance]
- Cannot safely prepare food or use kitchen appliances
- [Does not recognize hunger/fullness cues / Has extremely restricted diet due to sensory issues]
**Toileting:**
- [Requires reminders / Has frequent accidents / Not fully continent]
- Cannot manage hygiene independently
- Requires nighttime monitoring due to [bedwetting / safety concerns]
#### B. Communication & Social Functioning
**Communication:**
- [Kobe's] expressive language is significantly delayed, functioning at approximately [age]-year-old level despite being [actual age]
- He cannot [hold reciprocal conversation / answer open-ended questions / express complex needs]
- Receptive language is also impaired; he can follow only [simple one-step / no more than two-step] directions
- He requires [AAC device / visual supports / simplified language] to communicate
**Social Interaction:**
- [Kobe] demonstrates severe deficits in social interaction
- He does not initiate social contact with peers
- He lacks understanding of social norms, personal boundaries, and age-appropriate behavior
- He cannot form or maintain peer friendships
- He requires constant adult supervision in social settings
#### C. Safety & Judgment
- [Kobe] has severely impaired judgment and lacks understanding of danger
- He requires 24-hour supervision for his safety
- He has [wandered / engaged in dangerous behaviors such as _____]
- He cannot be left alone for any period of time without risk of injury
- He does not recognize potentially harmful situations such as [traffic, strangers, hot surfaces, etc.]
#### D. Cognitive & Learning
**Current Educational Status:**
- [Kobe] receives special education services under [full-time special education / general education with substantial supports]
- His cognitive functioning is in the [range] with IQ testing showing Full Scale IQ of [score]
- Academic skills are [number] grade levels below age expectation
- He requires [1:1 aide / small group instruction / modified curriculum]
- He cannot complete academic tasks without constant redirection and support
**Adaptive Functioning:**
- Standardized adaptive behavior assessment ([Vineland / ABAS]) reveals:
- Communication: [age equivalent / standard score]
- Daily Living Skills: [age equivalent / standard score]
- Socialization: [age equivalent / standard score]
- Overall Adaptive Behavior Composite: [score], classified as [Low / Extremely Low]
- These scores indicate functioning significantly below age expectations across all adaptive domains
#### E. Behavioral & Emotional Regulation
- [Kobe] has significant difficulty with emotional regulation
- He experiences [frequent meltdowns / aggressive behaviors / self-injurious behaviors]
- These behaviors occur [frequency] and can last [duration]
- He requires behavioral intervention and cannot manage emotions independently
- His behaviors create safety concerns and limit his ability to participate in community activities
---
### V. TREATMENT HISTORY & RESPONSE
**[Kobe] has received extensive interventions including:**
**Therapeutic Services:**
- Speech-Language Therapy: [frequency, duration, progress]
- Occupational Therapy: [frequency, duration, progress]
- Physical Therapy: [if applicable]
- ABA/Behavioral Therapy: [if applicable]
- Other: [list any other therapies]
**Educational Interventions:**
- Special education services since age [X]
- Individualized Education Program (IEP) with [describe level of support]
- [List specific interventions, accommodations, modifications]
**Medical Management:**
- Medications: [list current medications and purpose]
- Other medical interventions: [as applicable]
**Response to Treatment:**
Despite years of intensive therapeutic intervention, educational support, and medical management, [Kobe] has made [minimal / limited / some] progress in functional skills. **The gap between his functional abilities and those of typical peers has [widened / remained significant] over time.** He continues to require the same level of support and supervision, and there is no expectation that he will achieve independence in adulthood.
---
### VI. PROGNOSIS
**[Kobe's] disability is permanent and lifelong in nature.**
**The following factors support permanence:**
1. **Neurological/biological basis:** [His conditions are neurologically-based and result from [developmental brain differences / genetic factors / prenatal injury / etc.]]
2. **Lack of progress despite intervention:** Despite years of intensive therapy and education, fundamental limitations persist
3. **Nature of diagnosis:** [Autism Spectrum Disorder / Intellectual Disability / Cerebral Palsy / etc.] is a permanent, non-curable condition
4. **Age and developmental trajectory:** At age [X], with persistent functional limitations and lack of developmental progress, the prognosis for independence is extremely poor
**Expected Future Functioning:**
- [Kobe] will not be capable of living independently as an adult
- He will require supervised living arrangements and ongoing support with all activities of daily living
- He will not be capable of competitive employment or self-support
- He will require lifelong assistance with personal care, safety supervision, and decision-making
- He will need continued medical management, therapeutic services, and educational/vocational support
---
### VII. MEDICAL OPINION
**Based on my examination of [Kobe], review of his medical and educational records, knowledge of his diagnoses, and my [number] years of experience treating patients with similar conditions, it is my medical opinion that:**
**[Kobe Full Name] is permanently incapable of self-support due to [his diagnoses].**
**This disability existed before age 18 and will persist throughout his lifetime. He will require lifelong care, supervision, and financial support from his family or other care providers.**
**The functional limitations described in this letter are permanent and are not expected to improve with further intervention. [Kobe] meets the criteria for dependent benefits based on permanent and total disability.**
---
### VIII. BASIS FOR OPINION
My opinion is based on:
1. Direct personal examination and treatment of [Kobe] over [time period]
2. Review of comprehensive medical records from [providers]
3. Review of educational records including IEP and psychoeducational evaluations
4. Review of standardized testing results including:
- Cognitive testing (IQ: [score])
- Adaptive behavior assessment (Composite: [score])
- Academic achievement testing
- [Other relevant assessments]
5. Parental report of functional limitations in home and community settings
6. Reports from therapists, teachers, and other professionals involved in [Kobe's] care
7. My clinical experience and expertise in [specialty]
8. Medical literature regarding prognosis for [diagnoses]
---
### IX. SUPPORTING DOCUMENTATION
I am providing the following additional documentation to support this opinion:
- [ ] Recent medical records from my practice
- [ ] Copies of diagnostic reports
- [ ] Psychological/neuropsychological evaluation reports
- [ ] Adaptive behavior assessment results
- [ ] [Other relevant documents]
---
### X. AVAILABILITY FOR FURTHER INFORMATION
I am available to provide additional information or clarification if needed by the Department of Veterans Affairs. I can be reached at:
**[Doctor Name], [Credentials]**
**[Clinic/Hospital Name]**
**[Address]**
**[City, State ZIP]**
**Phone:** [Office Phone]
**Fax:** [Fax Number]
**Email:** [Professional Email]
---
**Signature:** ___________________________________
**Printed Name:** [Doctor's Full Name, MD/DO/PhD, etc.]
**Title:** [Specialty]
**Date:** _____________________
**Medical License #:** [State License Number]
**NPI #:** [National Provider Identifier]
---
## END OF TEMPLATE
---
## Notes for Fred
**Customizing this template:**
1. **Fill in all bracketed fields** with Kobe's specific information before giving to doctor
2. **Choose relevant sections** - delete examples that don't apply to Kobe
3. **Provide supporting context** - give doctor copies of:
- Recent IEP
- Recent testing results (IQ, adaptive behavior)
- Therapy reports
- Your lay statement (so doctor can reference your observations)
**Key phrases the letter MUST include:**
- ✅ "Permanently incapable of self-support"
- ✅ "Disability existed before age 18"
- ✅ "Permanent and lifelong in nature"
- ✅ "Will require lifelong care and supervision"
- ✅ "Not expected to achieve independence"
**What makes a strong letter:**
- Detailed description of functional limitations (not just diagnosis)
- Comparison to typical peers
- Documentation of lack of progress despite treatment
- Clear statement about permanence
- Explanation of medical/biological basis for permanence
- Doctor's credentials and expertise
**If doctor is hesitant:**
- Emphasize you're asking for their honest medical opinion
- Explain VA needs specific language about "self-support"
- Offer to provide additional documentation they need
- Remind them this is standard for VA dependent benefits
- They're NOT committing fraud - they're documenting reality
**Multiple doctors:**
If Kobe sees multiple specialists, consider getting letters from:
- Primary care doctor (overall picture)
- Developmental pediatrician or neurologist (diagnosis + prognosis)
- Psychiatrist/psychologist (cognitive + adaptive functioning)
Multiple letters can strengthen the claim, but one strong letter from a credible provider is better than several weak letters.
---
**This template is ready to customize for Kobe and present to his doctor.**