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Created by Funky (OpenClaw) on Thu Feb  5 02:54:14 UTC 2026

projects/kobe-va/kobe-va-lay-statement-template.md

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+# Kobe VA Dependent Benefits: Lay Statement Template
+
+**Purpose:** Document Kobe's functional limitations in your own words as his parent. This is YOUR story of what daily life is like. VA wants to hear from family members, not just doctors.
+
+---
+
+## Lay Statement Guide
+
+**What is a Lay Statement?**
+- First-person account from someone who witnesses the disability daily
+- Describes functional impact in real-world terms
+- Provides context medical records can't capture
+- Shows progression over time
+- Documents how disability affects family
+
+**Why it Matters:**
+- Medical records show diagnoses; lay statements show **impact**
+- VA rates disability based on functional limitations, not just diagnosis
+- Your observations carry significant weight
+- Fills gaps between doctor visits
+
+**Key Principles:**
+1. **Be specific** - "can't tie shoes" not "has motor problems"
+2. **Use examples** - Real incidents, not generalizations
+3. **Be honest** - Don't exaggerate, but don't minimize
+4. **Compare to peers** - "Other 10-year-olds can do X, Kobe cannot"
+5. **Show permanence** - "Has been this way since age X"
+6. **Document progression** - Better, worse, or stable over time
+
+---
+
+## Template: Lay Statement for Kobe's VA Dependent Benefits Claim
+
+**SWORN STATEMENT IN SUPPORT OF CLAIM FOR VA DEPENDENT BENEFITS**
+
+**Claimant:** [Kobe's Full Legal Name]  
+**Date of Birth:** [MM/DD/YYYY]  
+**Relationship:** Frederick Book, Father  
+**Date:** [Today's Date]
+
+---
+
+### SECTION 1: INTRODUCTION & BACKGROUND
+
+**My name is Frederick Book, and I am the father of [Kobe's Full Name], born [date]. I have been [Kobe's] primary caregiver since birth and have witnessed his developmental challenges firsthand every day.**
+
+**I am writing this statement to describe [Kobe's] functional limitations and how his disability affects his daily life. This statement is based on my direct personal observations as his parent.**
+
+**Background:**
+- I first noticed [Kobe] was different from other children when he was approximately [age/timeframe]
+- The first signs were [describe early concerns - speech delays, motor delays, behavioral issues, etc.]
+- We sought medical evaluation around [date/age], which resulted in diagnoses of [list conditions]
+- [Kobe] has been receiving [therapies/services] since [age/year]
+
+---
+
+### SECTION 2: ACTIVITIES OF DAILY LIVING (ADLs)
+
+**The VA evaluates functional capacity across multiple life domains. Describe Kobe's abilities in each area:**
+
+#### A. Personal Hygiene & Self-Care
+
+**Bathing:**
+- [ ] Requires complete assistance
+- [ ] Requires partial assistance (describe what help is needed)
+- [ ] Can bathe independently but needs reminders/supervision
+- [ ] Cannot safely adjust water temperature
+- [ ] Needs help washing certain body parts
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] cannot bathe himself independently. At age [X], he still requires me to run the bath, test water temperature, hand him soap, and remind him to wash each body part. If left alone, he will sit in the water for 30+ minutes without washing. He does not understand the sequence of steps needed to complete bathing."
+
+**Toileting:**
+- [ ] Fully toilet trained, no issues
+- [ ] Requires reminders to use bathroom
+- [ ] Has frequent accidents (describe frequency)
+- [ ] Needs help with hygiene after toileting
+- [ ] Cannot wipe properly
+- [ ] Nighttime bedwetting (frequency: _____)
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] struggles with toileting independence. He has accidents [X] times per week because he does not recognize the urge to go or waits too long. He requires reminders every 2-3 hours. He cannot properly wipe himself and needs assistance with hygiene to prevent rashes and infections."
+
+**Dressing:**
+- [ ] Cannot dress independently
+- [ ] Can dress but chooses inappropriate clothing for weather
+- [ ] Cannot manage buttons, zippers, or laces
+- [ ] Puts clothes on backwards/inside-out
+- [ ] Needs verbal prompting through each step
+- [ ] Other: _______________________
+
+**Example narrative:**
+"At age [X], [Kobe] cannot dress himself without step-by-step verbal guidance. He cannot tie shoes, button shirts, or zip jackets. He will wear shorts in winter or heavy sweatshirts in summer if not directed. He does not understand that underwear goes on first or that shirts have a front and back."
+
+**Grooming:**
+- [ ] Cannot brush teeth without assistance
+- [ ] Does not recognize when grooming is needed
+- [ ] Cannot comb/brush hair
+- [ ] Does not understand nail trimming is needed
+- [ ] Resists grooming activities
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] will not brush his teeth unless I physically hand him the toothbrush with toothpaste already on it and stand next to him providing verbal prompts. Even then, he brushes for only 5-10 seconds unless I tell him to continue. He does not recognize when his hair is messy or his hands are dirty."
+
+---
+
+#### B. Eating & Nutrition
+
+**Meal Preparation:**
+- [ ] Cannot prepare any food independently
+- [ ] Can only prepare very simple foods (toast, cereal)
+- [ ] Cannot safely use stove or sharp objects
+- [ ] Does not recognize when food is spoiled
+- [ ] Cannot follow recipe or multi-step directions
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] cannot prepare food beyond opening pre-packaged snacks. He cannot safely use the stove, oven, or sharp knives. He does not understand cooking sequences or food safety. If told to make lunch, he might eat cereal dry from the box or attempt to eat frozen food without heating it."
+
+**Eating Behavior:**
+- [ ] Eats appropriately without issues
+- [ ] Eats too fast and chokes easily
+- [ ] Extremely picky eater (limited food tolerance)
+- [ ] Does not recognize when full (overeats)
+- [ ] Does not recognize hunger (undereats)
+- [ ] Messy eating, poor utensil use
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] has significant eating challenges. He will eat only [list limited foods] and refuses to try new foods. He does not recognize hunger cues and will not eat unless reminded. He eats very quickly and has choked on multiple occasions, requiring supervision during meals."
+
+---
+
+#### C. Communication & Social Function
+
+**Speech & Language:**
+- [ ] Non-verbal or minimally verbal
+- [ ] Limited vocabulary for age
+- [ ] Cannot hold conversation
+- [ ] Echolalia (repeats phrases without understanding)
+- [ ] Cannot express needs clearly
+- [ ] Cannot answer simple questions
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe's] speech is significantly delayed. At age [X], his vocabulary is equivalent to a [younger age]-year-old. He cannot hold a back-and-forth conversation, answer open-ended questions, or explain what happened at school. When upset or hurt, he cannot tell me what's wrong. He repeats phrases from TV shows instead of forming original sentences."
+
+**Social Interaction:**
+- [ ] Does not interact with peers
+- [ ] Prefers to play alone
+- [ ] Does not understand social cues
+- [ ] Cannot make or keep friends
+- [ ] Inappropriate social behavior
+- [ ] Does not respond to name
+- [ ] No eye contact
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] does not have friends and does not seek out other children. At the playground, he plays alone while children his age play together. He does not understand turn-taking, sharing, or cooperative play. Other children have stopped inviting him to birthday parties because he does not engage appropriately."
+
+**Understanding & Following Directions:**
+- [ ] Cannot follow simple one-step directions
+- [ ] Can follow one-step but not multi-step directions
+- [ ] Requires visual cues in addition to verbal
+- [ ] Forgets directions immediately after given
+- [ ] Cannot generalize instructions to new situations
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] can follow only very simple, one-step directions like 'sit down' or 'come here.' If I give a two-step direction like 'go upstairs and get your shoes,' he will forget the second part before reaching the stairs. He cannot follow classroom instructions that other children understand easily."
+
+---
+
+#### D. Safety & Judgment
+
+**Safety Awareness:**
+- [ ] No sense of danger
+- [ ] Wanders or elopes
+- [ ] Touches hot stoves, electrical outlets
+- [ ] Runs into street without looking
+- [ ] Talks to strangers inappropriately
+- [ ] Cannot be left alone for any length of time
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] has no safety awareness. He will run into the street after a ball without looking for cars. He touches hot stoves even after being burned before. He does not recognize that strangers can be dangerous and would go with anyone who offered him candy. I cannot leave him alone in the house even for 5 minutes."
+
+**Supervision Required:**
+- [ ] Requires 24/7 direct supervision
+- [ ] Can be left alone for short periods (< 15 minutes)
+- [ ] Can be left alone but needs check-ins
+- [ ] Cannot be left overnight
+- [ ] Requires supervision for specific activities (list: _______)
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] requires constant direct supervision. I cannot shower without bringing him into the bathroom because he will get into something dangerous or hurt himself. I cannot sleep through the night because he wakes and wanders, potentially leaving the house. He has tried to climb out windows, turn on the stove, and leave the house in the middle of the night."
+
+---
+
+#### E. Learning & School
+
+**Educational Setting:**
+- [ ] Attends special education full-time
+- [ ] Attends general education with aide
+- [ ] Cannot attend traditional school (homeschooled/alternative)
+- [ ] Has IEP (Individualized Education Plan)
+- [ ] Has 504 plan
+- [ ] Requires 1:1 aide
+- [ ] Other: _______________________
+
+**Academic Function:**
+- [ ] Reading level: [grade equivalent vs. actual grade]
+- [ ] Math level: [grade equivalent vs. actual grade]
+- [ ] Cannot complete homework independently
+- [ ] Does not retain information
+- [ ] Cannot take tests without modifications
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] is in [grade] but functions academically at a [lower grade] level. He has an IEP and receives special education services for [hours/subjects]. He requires a 1:1 aide to stay on task and complete assignments. Without constant redirection, he will sit and do nothing or engage in disruptive behavior. He cannot complete homework without me sitting next to him providing step-by-step guidance."
+
+**Behavioral Issues at School:**
+- [ ] Frequent meltdowns/tantrums
+- [ ] Aggressive toward peers or staff
+- [ ] Self-injurious behavior
+- [ ] Elopement (runs away from class)
+- [ ] Cannot sit still/constant movement
+- [ ] Disrupts class
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe's] school has called me [X] times this year due to behavioral incidents. He has meltdowns when frustrated, hitting himself or throwing materials. He cannot sit in circle time without running around the room. He has been sent home early on [number] occasions because staff could not manage his behavior safely."
+
+---
+
+#### F. Behavioral & Emotional Regulation
+
+**Emotional Control:**
+- [ ] Frequent meltdowns (describe frequency and triggers)
+- [ ] Cannot calm self down
+- [ ] Cries for hours over minor issues
+- [ ] Rages and destroys property
+- [ ] Self-injurious behavior (hits self, bangs head)
+- [ ] No emotional regulation
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] has severe emotional regulation problems. He has meltdowns [X] times per week, triggered by [common triggers: transitions, denied requests, sensory input]. During meltdowns, he [describe: screams, hits himself, throws objects, etc.]. These can last 30 minutes to 2 hours. He cannot be reasoned with or calmed. I have to ensure the environment is safe and wait for the storm to pass."
+
+**Sleep Issues:**
+- [ ] Cannot fall asleep independently
+- [ ] Wakes frequently during night
+- [ ] Requires co-sleeping for safety
+- [ ] Night terrors or nightmares
+- [ ] Sleeps only [X] hours per night
+- [ ] Irregular sleep schedule
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] has severe sleep disturbances. He cannot fall asleep without me lying next to him, which can take 1-3 hours. He wakes 3-5 times per night and cannot self-soothe back to sleep. He averages [X] hours of sleep per night, far below what is healthy for his age. This affects his behavior and learning the next day."
+
+**Repetitive Behaviors:**
+- [ ] Stimming (describe: hand flapping, rocking, etc.)
+- [ ] Obsessive interests
+- [ ] Rigid routines (meltdowns if disrupted)
+- [ ] Repetitive questions or phrases
+- [ ] Other: _______________________
+
+**Example narrative:**
+"[Kobe] has rigid routines and becomes extremely distressed by changes. He asks the same question 50+ times per day even after being answered. He lines up toys compulsively and has a meltdown if anyone moves them. He flaps his hands and rocks when excited or anxious. These behaviors interfere with his ability to participate in normal activities."
+
+---
+
+### SECTION 3: COMPARISON TO PEERS
+
+**What children [Kobe's] age typically can do that he cannot:**
+
+**At age [X], most children can:**
+1. [Dress themselves completely] - Kobe cannot
+2. [Tie their own shoes] - Kobe cannot
+3. [Make simple meals like sandwiches] - Kobe cannot
+4. [Bathe independently] - Kobe cannot
+5. [Play cooperatively with friends] - Kobe cannot
+6. [Read at grade level] - Kobe reads at [lower] level
+7. [Follow multi-step directions] - Kobe can only follow one-step
+8. [Be left alone for short periods] - Kobe cannot be left alone at all
+9. [Complete homework independently] - Kobe requires constant help
+10. [Recognize danger] - Kobe has no safety awareness
+
+**These gaps have existed since early childhood and show no signs of improvement despite years of therapy and intervention.**
+
+---
+
+### SECTION 4: IMPACT ON FAMILY
+
+**How [Kobe's] disability affects our family:**
+
+"Caring for [Kobe] is a full-time job that affects every aspect of our lives:
+
+**Employment Impact:**
+- I [cannot work / work limited hours / had to quit job / etc.] due to his care needs
+- He cannot attend after-school programs, limiting my work availability
+- Frequent school calls require me to leave work
+- [Spouse/other parent] impact: [describe]
+
+**Financial Impact:**
+- Medical expenses: [therapies, medications, equipment]
+- Special education tutoring: $___/month
+- Respite care when available: $___/hour
+- Lost income due to caregiving: $___/year
+- Cannot afford [specific needs] due to cost
+
+**Sibling Impact:**
+- His siblings receive less attention due to his high needs
+- [Describe specific impacts on siblings]
+- Family activities are limited by what he can handle
+
+**Social Isolation:**
+- We cannot attend family gatherings because of his behavioral needs
+- We have no social life due to lack of respite care
+- Friends have stopped inviting us places
+- We cannot take normal family vacations
+
+**Physical & Emotional Toll:**
+- I am exhausted from 24/7 caregiving
+- Chronic stress from constant vigilance
+- Grief over the childhood experiences he cannot have
+- Worry about his future when I'm no longer able to care for him
+
+**This is not a temporary situation. [Kobe's] disabilities are permanent and will require lifelong care and support.**"
+
+---
+
+### SECTION 5: PROGNOSIS & FUTURE
+
+**What the future looks like:**
+
+"Despite years of intensive therapy and intervention, [Kobe] has made minimal progress in functional skills. His doctors have indicated that his disabilities are permanent and he will require lifelong support.
+
+**Current prognosis:**
+- Will not be able to live independently as an adult
+- Will not be able to maintain competitive employment
+- Will require supervised living arrangements
+- Will need assistance with all activities of daily living
+- Will require management of his care indefinitely
+
+**We have tried:**
+- [List therapies: speech, occupational, behavioral, etc.]
+- [Medications if applicable]
+- [Educational interventions]
+- [Behavioral plans]
+
+**While these help manage some symptoms, they have not resulted in functional independence. The gap between [Kobe] and his peers continues to widen as he gets older.**"
+
+---
+
+### SECTION 6: SPECIFIC INCIDENTS & EXAMPLES
+
+**Provide 3-5 specific recent examples that illustrate his functional limitations:**
+
+**Example 1: [Safety Issue]**
+"On [date], [Kobe] ran into the street chasing a ball without looking. A car had to slam on brakes to avoid hitting him. When I asked why he ran into the street, he said he wanted the ball. He could not understand that cars could hurt him, even though we've had this conversation hundreds of times."
+
+**Example 2: [Self-Care Issue]**
+"Last week, [Kobe] wet himself at school because he didn't go to the bathroom during designated breaks. The teacher said he was engrossed in an activity and refused to go when asked. This happens 2-3 times per month despite being age [X]."
+
+**Example 3: [Social Issue]**
+"At a birthday party on [date], [Kobe] sat in the corner lining up toy cars while the other children played games together. When the birthday boy tried to include him, [Kobe] screamed and pushed him away. We had to leave early. This is why he no longer gets invited to parties."
+
+**Example 4: [Behavioral Issue]**
+"Two days ago, I told [Kobe] we would go to the park after lunch. When lunch took longer than expected and we left 15 minutes later than planned, he had a complete meltdown. He screamed, threw his plate, hit himself in the head, and cried for 45 minutes. I could not console or reason with him."
+
+**Example 5: [Learning Issue]**
+"[Kobe's] teacher sent home a math worksheet with 10 simple addition problems (1+1, 2+2, etc.). It took us 2 hours to complete because he could not focus, could not remember what + means even after reviewing it, and kept getting up to wander around. His classmates completed the same worksheet in 15 minutes at school."
+
+---
+
+### SECTION 7: SUPPORTING DOCUMENTATION
+
+**This statement is supported by:**
+- [ ] Medical records from [list providers]
+- [ ] IEP and school evaluations
+- [ ] Psychological and developmental assessments
+- [ ] Therapy records (speech, OT, behavioral)
+- [ ] Statements from teachers and therapists
+- [ ] [Other supporting evidence]
+
+**I am available to provide additional information or clarification if needed.**
+
+---
+
+### CERTIFICATION
+
+**I certify that the statements made in this document are true and accurate to the best of my knowledge and belief.**
+
+**Signature:** _________________________________  
+**Printed Name:** Frederick Book  
+**Relationship to Claimant:** Father  
+**Date:** _____________________
+
+**Contact Information:**  
+Address: [Your Address]  
+Phone: [Your Number]  
+Email: [Your Email]
+
+---
+
+## IMPORTANT TIPS FOR COMPLETING THIS STATEMENT
+
+**Dos:**
+✅ Be specific and give examples  
+✅ Use your own words (don't copy medical terminology)  
+✅ Describe what you personally witness  
+✅ Compare to typical children the same age  
+✅ Explain how long issues have existed  
+✅ Document progression (or lack thereof)  
+✅ Include emotional/family impact  
+✅ Sign and date  
+
+**Don'ts:**
+❌ Exaggerate or lie  
+❌ Use vague terms like "he has problems"  
+❌ Just list diagnoses without describing impact  
+❌ Focus only on what he CAN do  
+❌ Minimize the challenges  
+❌ Leave out embarrassing or difficult details  
+❌ Forget to include specific examples  
+
+**Remember:**
+- This is YOUR voice as his parent who sees him daily
+- Medical records show diagnoses; your statement shows impact
+- VA needs to understand what his daily life is actually like
+- Be honest, be thorough, be specific
+- This statement carries significant weight in the claim
+
+---
+
+**Questions to ask yourself as you write:**
+- Would VA understand what a typical day looks like for him?
+- Have I shown WHY this is disabling, not just THAT he has a diagnosis?
+- Have I compared him to kids his age?
+- Have I explained how long this has been going on?
+- Have I shown that it's permanent, not temporary?
+- Have I documented the impact on the whole family?
+
+**Your statement, combined with medical records, paints a complete picture for VA.**