# Kobe VA Dependent Benefits: Complete Documentation Checklist

**Purpose:** Master checklist for gathering all documentation needed for VA dependent benefits claim. Use this to track progress and ensure nothing is missed.

**Claim Goal:** Establish that Kobe has a permanent disability that existed before age 18, rendering him incapable of self-support.

---

## CLAIM TIMELINE TRACKER

| Milestone | Target Date | Actual Date | Status |
|-----------|-------------|-------------|--------|
| Records requests sent | ___/___/___ | ___/___/___ | [ ] |
| Doctor appointment scheduled | ___/___/___ | ___/___/___ | [ ] |
| All medical records received | ___/___/___ | ___/___/___ | [ ] |
| Lay statement completed | ___/___/___ | ___/___/___ | [ ] |
| Doctor letter obtained | ___/___/___ | ___/___/___ | [ ] |
| Complete package compiled | ___/___/___ | ___/___/___ | [ ] |
| VA Form 21-686c completed | ___/___/___ | ___/___/___ | [ ] |
| Claim submitted to VA | ___/___/___ | ___/___/___ | [ ] |
| VA acknowledgment received | ___/___/___ | ___/___/___ | [ ] |
| C&P exam scheduled (if needed) | ___/___/___ | ___/___/___ | [ ] |
| Decision received | ___/___/___ | ___/___/___ | [ ] |

---

## SECTION 1: VA FORMS & OFFICIAL DOCUMENTS

### Required Forms

**Primary Form:**
- [ ] **VA Form 21-686c** - Declaration of Status of Dependents
  - Available: https://www.va.gov/find-forms/about-form-21-686c/
  - Can file online via eBenefits or VA.gov
  - Or mail paper form to regional office
  - **Key sections for disabled child:**
    - Part III, Section B: Information about helpless child
    - Must answer questions about child's disability
    - Requires doctor signature in certain cases

**Additional Forms (may be needed):**
- [ ] **VA Form 21-4138** - Statement in Support of Claim
  - Use this to submit lay statement if needed
  - Can also be used for additional explanatory information
  
- [ ] **VA Form 21-0788** - Authorization to Disclose Information
  - Allows VA to request medical records directly
  - Fill out for each medical provider
  
- [ ] **VA Form 21-4142** - Authorization for Release of Information
  - Another authorization form for medical records
  - Use if providers require specific VA form

**Identity Documents:**
- [ ] Kobe's birth certificate (certified copy)
- [ ] Kobe's Social Security card (copy)
- [ ] Your DD-214 (if not already in VA file)
- [ ] Proof of your VA disability rating (award letter)

**Status:**
- Forms obtained: [ ]
- Forms completed: [ ]
- Forms ready to submit: [ ]

---

## SECTION 2: MEDICAL RECORDS

**Purpose:** Establish medical history, diagnoses, and permanence of disability

### A. Primary Care Records

**Pediatrician/Family Doctor:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Address/Contact: _______________________
  - [ ] Request sent: ___/___/___
  - [ ] Records received: ___/___/___
  - [ ] **Date range:** [Start] to [End]
  
**What to request:**
- [ ] Complete medical history
- [ ] Well-child visit notes
- [ ] Growth and developmental screening results
- [ ] Referral letters to specialists
- [ ] Immunization records
- [ ] Any developmental delay documentation

**Additional Primary Care Providers:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Records sent: ___/___/___ | Received: ___/___/___
  
### B. Specialist Records

**Developmental Pediatrician:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Developmental assessments
    - [ ] Diagnosis documentation
    - [ ] Functional assessments
    - [ ] Treatment recommendations

**Neurologist (if applicable):**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Neurological exam results
    - [ ] Brain imaging (MRI, CT, EEG)
    - [ ] Seizure documentation
    - [ ] Medication management notes

**Psychiatrist/Psychologist:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Psychological evaluation reports
    - [ ] IQ testing results
    - [ ] Adaptive behavior assessments (Vineland, ABAS)
    - [ ] Diagnostic assessments (ADOS for autism, etc.)
    - [ ] Cognitive functioning reports

**Geneticist (if applicable):**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Genetic testing results
    - [ ] Chromosomal analysis
    - [ ] Syndrome diagnosis documentation

### C. Therapy Records

**Speech-Language Pathologist:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Initial evaluation
    - [ ] Progress notes
    - [ ] Standardized test results (CELF, PPVT, etc.)
    - [ ] Current functional level

**Occupational Therapist:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Sensory processing evaluations
    - [ ] Fine motor assessments
    - [ ] Self-care skills evaluations
    - [ ] ADL functioning reports

**Physical Therapist (if applicable):**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Gross motor assessments
    - [ ] Mobility evaluations
    - [ ] Equipment needs documentation

**Behavioral/ABA Therapist:**
- [ ] **Provider:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  - [ ] **Key documents:**
    - [ ] Functional behavior assessments
    - [ ] Behavior intervention plans
    - [ ] Progress data
    - [ ] Adaptive skill assessments

### D. Hospital/Emergency Records

- [ ] **Facility:** [Hospital Name] ________________
  - [ ] **Dates of service:** _____________________
  - [ ] **Reason:** (birth records, ER visits, admissions)
  - [ ] Request sent: ___/___/___ | Received: ___/___/___

**What to request:**
- [ ] Birth records (especially if complications)
- [ ] Newborn screening results
- [ ] ER visit records (head injuries, seizures, etc.)
- [ ] Inpatient admission records
- [ ] Surgical records (if any)

**Additional facilities:**
- [ ] **Facility:** _____________ | Sent: ___/___ | Received: ___/___
- [ ] **Facility:** _____________ | Sent: ___/___ | Received: ___/___

---

## SECTION 3: EDUCATIONAL RECORDS

**Purpose:** Document educational impact and need for special services

### A. School Records

**Current School:**
- [ ] **School:** [Name] ________________________
  - [ ] **Contact:** [Special Ed Coordinator] ____________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___

**What to request:**
- [ ] **Current IEP (Individualized Education Program)**
  - [ ] Present levels of performance
  - [ ] Goals and objectives
  - [ ] Services provided (hours/type)
  - [ ] Accommodations and modifications
  - [ ] Most recent progress reports
  
- [ ] **All previous IEPs** (every year)
  - Shows progression and long-term needs
  
- [ ] **Initial evaluation for special education**
  - Documents when disability was first identified by school
  - Often includes comprehensive testing
  
- [ ] **All re-evaluations** (typically every 3 years)
  - [ ] Psychoeducational evaluation
  - [ ] Academic achievement testing
  - [ ] Cognitive/IQ testing
  - [ ] Adaptive behavior assessment
  - [ ] Functional behavior assessment
  
- [ ] **Report cards** (all years)
  - Shows academic functioning
  
- [ ] **Progress reports** (IEP goal progress)
  
- [ ] **504 Plan** (if applicable, before IEP)
  
- [ ] **Discipline records**
  - Behavioral incident reports
  - Suspensions or removals from class
  
- [ ] **Attendance records**
  - May show pattern of school avoidance or medical absences

**Previous Schools:**
- [ ] **School:** _____________ | Sent: ___/___ | Received: ___/___
- [ ] **School:** _____________ | Sent: ___/___ | Received: ___/___

### B. Early Intervention Records

**Birth to Age 3:**
- [ ] **Program:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  
**What to request:**
- [ ] Initial IFSP (Individualized Family Service Plan)
- [ ] All IFSP updates
- [ ] Evaluation reports
- [ ] Service provider notes
- [ ] Developmental assessments
- [ ] Transition plan to preschool

**Age 3-5 (Preschool):**
- [ ] **Program:** [Name] ________________________
  - [ ] Request sent: ___/___/___ | Received: ___/___/___
  
**What to request:**
- [ ] Preschool IEP
- [ ] Developmental assessments
- [ ] Readiness evaluations

---

## SECTION 4: DIAGNOSTIC ASSESSMENTS

**Purpose:** Formal testing that documents disability severity

### Key Assessments to Obtain

**Intellectual/Cognitive:**
- [ ] **IQ Testing** (WISC, WAIS, Stanford-Binet, etc.)
  - [ ] Test name: ___________________
  - [ ] Date administered: ___/___/___
  - [ ] Full Scale IQ: _____
  - [ ] Verbal IQ: _____
  - [ ] Performance IQ: _____
  - [ ] Where obtained: _________________
  - [ ] Copy in file: [ ]

**Adaptive Functioning:**
- [ ] **Vineland Adaptive Behavior Scales**
  - [ ] Date: ___/___/___ | Score: _____ | Copy: [ ]
- [ ] **ABAS (Adaptive Behavior Assessment System)**
  - [ ] Date: ___/___/___ | Score: _____ | Copy: [ ]
- [ ] **Other:** ___________________
  - [ ] Date: ___/___/___ | Score: _____ | Copy: [ ]

**Academic Achievement:**
- [ ] **WIAT (Wechsler Individual Achievement Test)**
  - [ ] Date: ___/___/___ | Reading: ___ | Math: ___ | Copy: [ ]
- [ ] **Woodcock-Johnson**
  - [ ] Date: ___/___/___ | Scores: _________ | Copy: [ ]
- [ ] **Other:** ___________________

**Autism Screening (if applicable):**
- [ ] **ADOS-2** (Autism Diagnostic Observation Schedule)
  - [ ] Date: ___/___/___ | Result: _________ | Copy: [ ]
- [ ] **ADI-R** (Autism Diagnostic Interview-Revised)
  - [ ] Date: ___/___/___ | Result: _________ | Copy: [ ]
- [ ] **M-CHAT** (Modified Checklist for Autism in Toddlers)
  - [ ] Date: ___/___/___ | Result: _________ | Copy: [ ]

**Speech/Language:**
- [ ] **CELF** (Clinical Evaluation of Language Fundamentals)
  - [ ] Date: ___/___/___ | Scores: _________ | Copy: [ ]
- [ ] **PPVT** (Peabody Picture Vocabulary Test)
  - [ ] Date: ___/___/___ | Score: _____ | Copy: [ ]

**Other Relevant Testing:**
- [ ] **Test:** ___________ | Date: ___/___ | Result: _____ | Copy: [ ]
- [ ] **Test:** ___________ | Date: ___/___ | Result: _____ | Copy: [ ]

---

## SECTION 5: STATEMENTS & LETTERS

### A. Medical Opinion Letter (CRITICAL)

**Doctor to complete letter stating:**
- [ ] **Provider:** [Name of doctor] ________________________
  - [ ] Specialty: _____________________
  - [ ] **Letter requested:** ___/___/___
  - [ ] **Letter received:** ___/___/___

**Letter must include:**
- [ ] Child's diagnoses (with ICD codes)
- [ ] When disability began (preferably before age 18)
- [ ] Nature and severity of disability
- [ ] Functional limitations in clear terms
- [ ] Prognosis (permanent vs. temporary)
- [ ] Opinion: Child is "permanently incapable of self-support"
- [ ] Medical basis for opinion
- [ ] Doctor's credentials and relationship to child

**Use the template:** `kobe-va-doctor-letter-template.md`

### B. Parent Lay Statement

- [ ] **Lay statement completed:** ___/___/___
- [ ] **Reviewed and revised:** ___/___/___
- [ ] **Signed and dated:** ___/___/___

**Use the template:** `kobe-va-lay-statement-template.md`

**Key elements included:**
- [ ] Specific examples of functional limitations
- [ ] Comparison to typical children same age
- [ ] Daily care requirements described
- [ ] Safety concerns documented
- [ ] Educational impact explained
- [ ] Social functioning described
- [ ] Family impact included
- [ ] Permanence emphasized

### C. Third-Party Statements (OPTIONAL BUT HELPFUL)

**Teacher/School Staff:**
- [ ] **Name:** _____________ | **Role:** _____________
  - [ ] Statement requested: ___/___/___
  - [ ] Statement received: ___/___/___

**Therapist:**
- [ ] **Name:** _____________ | **Type:** _____________
  - [ ] Statement requested: ___/___/___
  - [ ] Statement received: ___/___/___

**Other Family Members:**
- [ ] **Name:** _____________ | **Relationship:** _____________
  - [ ] Statement completed: ___/___/___

**What they should address:**
- Their relationship to child and how long they've known him
- Specific observations of limitations
- How child compares to others they work with
- Prognosis based on their professional judgment

---

## SECTION 6: FINANCIAL DOCUMENTATION

**Purpose:** May be needed to show child is not self-supporting

- [ ] **Proof child lives with you:**
  - [ ] Lease/mortgage showing child's name or your address
  - [ ] School enrollment showing your address
  - [ ] Medical records showing your address
  
- [ ] **Proof you provide financial support:**
  - [ ] Bank statements showing expenses for child
  - [ ] Medical bills in child's name
  - [ ] Receipts for therapy, equipment, medications
  
- [ ] **Proof child has no income:**
  - [ ] Statement that child receives no SSI/SSDI
  - [ ] Or copy of SSI award letter (doesn't disqualify from VA benefits)
  - [ ] Documentation child is not employed

---

## SECTION 7: SUPPORTING EVIDENCE COMPILATION

### Evidence Categories

**A. Diagnosis Evidence**
- [ ] Organized by condition (autism, intellectual disability, etc.)
- [ ] Earliest documentation first
- [ ] Shows progression over time
- [ ] Includes formal diagnostic reports

**B. Functional Limitation Evidence**
- [ ] ADL assessments
- [ ] Adaptive behavior testing
- [ ] School functional assessments
- [ ] Therapy progress notes showing limitations
- [ ] IEP present levels of performance

**C. Permanence Evidence**
- [ ] Early childhood diagnoses
- [ ] Lack of progress despite intervention
- [ ] Doctor statements about prognosis
- [ ] Progressive worsening (if applicable)
- [ ] Genetic diagnoses (if applicable)

**D. Timeline Documentation**
- [ ] Create a chronological timeline showing:
  - When first concerns arose
  - When diagnoses were made
  - What interventions were tried
  - Current status
- [ ] Emphasizes: "This started before age 18 and is permanent"

---

## SECTION 8: ORGANIZATION & SUBMISSION

### A. Document Organization

**Create binder or digital folders with:**

1. **Section 1: Forms**
   - [ ] VA Form 21-686c (completed)
   - [ ] VA Form 21-4138 (if using for lay statement)
   - [ ] Other VA forms

2. **Section 2: Identity Documents**
   - [ ] Birth certificate
   - [ ] Social Security card
   - [ ] Your VA documents

3. **Section 3: Medical Opinion Letter**
   - [ ] Doctor's letter (THE MOST IMPORTANT DOCUMENT)

4. **Section 4: Parent Lay Statement**
   - [ ] Your detailed statement

5. **Section 5: Medical Records**
   - [ ] Organized by provider
   - [ ] Chronological within each provider
   - [ ] Tab dividers between providers

6. **Section 6: Educational Records**
   - [ ] Most recent IEP first
   - [ ] Then previous IEPs in reverse chronological order
   - [ ] Evaluation reports

7. **Section 7: Testing & Assessments**
   - [ ] Psychological evaluations
   - [ ] IQ testing
   - [ ] Adaptive behavior assessments
   - [ ] Academic testing

8. **Section 8: Third-Party Statements**
   - [ ] Teacher statements
   - [ ] Therapist statements
   - [ ] Other supporting letters

9. **Section 9: Timeline & Summary**
   - [ ] Create one-page timeline of key dates
   - [ ] Brief summary of evidence

### B. Document Preparation

- [ ] **Make copies:**
  - [ ] Keep original documents
  - [ ] Submit copies to VA (unless they require originals)
  - [ ] Keep second set of copies for your records
  
- [ ] **Organize chronologically:**
  - [ ] Oldest documents first or most recent first (be consistent)
  
- [ ] **Label everything:**
  - [ ] Write child's name and DOB on every page
  - [ ] Number pages if submitting large packet
  
- [ ] **Create index:**
  - [ ] List of all documents being submitted
  - [ ] Where each can be found (page numbers)

### C. Submission Methods

**Option 1: Online** (fastest)
- [ ] Via VA.gov or eBenefits
- [ ] Upload documents as PDFs
- [ ] Receive immediate confirmation
- [ ] Can track status online

**Option 2: Mail**
- [ ] Send to VA Regional Office
- [ ] Use certified mail, return receipt requested
- [ ] Keep proof of mailing
- [ ] Allow 7-10 business days for processing

**Option 3: In Person**
- [ ] Regional office or VA medical center
- [ ] Get stamped copy as proof of filing
- [ ] Can ask questions in person

**Submission details:**
- [ ] **Method chosen:** _______________
- [ ] **Date submitted:** ___/___/___
- [ ] **Confirmation received:** ___/___/___
- [ ] **Claim number assigned:** _______________

---

## SECTION 9: POST-SUBMISSION TRACKING

### A. Initial Processing

- [ ] **VA acknowledgment received:** ___/___/___
- [ ] **Claim number:** _______________
- [ ] **Assigned Regional Office:** _______________
- [ ] **Expected decision timeframe:** _______________

### B. Development (if VA requests more info)

- [ ] **Request for additional evidence:** ___/___/___
  - [ ] What they want: _____________________
  - [ ] Deadline: ___/___/___
  - [ ] Submitted: ___/___/___

- [ ] **C&P Exam scheduled** (Compensation & Pension exam)
  - [ ] Date: ___/___/___ | Time: _____ | Location: _________
  - [ ] Type: (In-person / Telehealth / Records review)
  - [ ] Examiner: _____________________
  - [ ] Exam completed: ___/___/___
  - [ ] **Bring to exam:**
    - [ ] Photo ID
    - [ ] List of current medications
    - [ ] Summary of functional limitations
    - [ ] Any recent medical records not yet submitted

### C. Decision

- [ ] **Decision letter received:** ___/___/___
- [ ] **Decision:** (Approved / Denied / Deferred)
- [ ] **Effective date:** ___/___/___
- [ ] **Monthly benefit amount:** $_________

**If Approved:**
- [ ] First payment received: ___/___/___
- [ ] Set up direct deposit if not already done
- [ ] Understand reporting requirements (child's status changes)

**If Denied:**
- [ ] Read denial letter carefully
- [ ] Note reasons for denial
- [ ] Deadline to appeal: ___/___/___ (1 year from decision)
- [ ] Decide: (Gather more evidence / File appeal / Request HLR / Supplemental claim)

---

## SECTION 10: COMMON PITFALLS & HOW TO AVOID THEM

### ❌ Missing Critical Evidence

**Problem:** "I didn't know I needed that"  
**Solution:** This checklist! Submit everything, let VA decide what's relevant

### ❌ Vague Statements

**Problem:** "He has problems with daily living"  
**Solution:** "He cannot dress himself, requires assistance bathing, and cannot prepare any food"

### ❌ No Doctor Letter

**Problem:** Submitted only medical records, no clear opinion  
**Solution:** Get explicit letter stating "permanently incapable of self-support"

### ❌ Missing Permanence

**Problem:** Didn't emphasize disability is lifelong  
**Solution:** Include prognosis, show early onset, document lack of progress

### ❌ No Comparison to Peers

**Problem:** Didn't show how child differs from typical children  
**Solution:** Include adaptive behavior testing, educational evaluations

### ❌ Too Much Medical Jargon

**Problem:** Submitted only doctor notes full of terminology  
**Solution:** Include parent lay statement in plain English

### ❌ Gaps in Timeline

**Problem:** Missing years of records  
**Solution:** Create timeline explaining gaps, submit statement if records unavailable

### ❌ Insufficient Functional Evidence

**Problem:** Proves diagnosis but not impact  
**Solution:** Focus on what child CANNOT do, need for supervision, ADL limitations

---

## SECTION 11: QUICK REFERENCE

### Absolute Must-Haves (Cannot file without these)

1. ✅ **VA Form 21-686c** (Declaration of Status of Dependents)
2. ✅ **Birth certificate** (proves age and relationship)
3. ✅ **Medical evidence of disability** (diagnosis + functional impact)

### Extremely Important (Claim likely fails without these)

4. ✅ **Doctor letter with clear opinion** (permanently incapable of self-support)
5. ✅ **Proof disability began before age 18**
6. ✅ **Evidence of functional limitations** (IEP, adaptive behavior testing, therapy notes)

### Very Helpful (Strengthens claim significantly)

7. ✅ **Parent lay statement** (your detailed observations)
8. ✅ **IEP and school records** (educational impact)
9. ✅ **Adaptive behavior assessment** (Vineland, ABAS showing scores)
10. ✅ **Early childhood records** (shows permanence)

### Nice to Have (Additional support)

11. ✅ Third-party statements (teachers, therapists)
12. ✅ Photos or videos showing functional limitations
13. ✅ Financial documentation of care costs

---

## SECTION 12: KEY CONTACT INFORMATION

**VA Resources:**
- **VA Benefits Hotline:** 1-800-827-1000
- **eBenefits:** https://www.ebenefits.va.gov/
- **VA.gov:** https://www.va.gov/
- **MyHealtheVet:** https://www.myhealth.va.gov/

**Your VA Information:**
- **Regional Office:** _______________
- **File Number / VA Claim Number:** _______________
- **eBenefits Username:** _______________

**Your VSO (Veterans Service Organization):**
- **Organization:** (DAV, VFW, American Legion, etc.) _______________
- **VSO Name:** _______________
- **Phone:** _______________
- **Email:** _______________

**Key Medical Providers:**
- **Primary Doctor:** _____________ | Phone: _____________
- **Specialist:** _____________ | Phone: _____________
- **Therapist:** _____________ | Phone: _____________

**Key School Contacts:**
- **Special Ed Coordinator:** _____________ | Phone: _____________
- **IEP Case Manager:** _____________ | Phone: _____________

---

## SECTION 13: NOTES & REMINDERS

**Document any issues, questions, or important information here:**

**___/___/___** - 
_________________________________________________________________
_________________________________________________________________

**___/___/___** - 
_________________________________________________________________
_________________________________________________________________

**___/___/___** - 
_________________________________________________________________
_________________________________________________________________

---

## FINAL CHECKLIST BEFORE SUBMISSION

**Review this right before you mail/upload:**

- [ ] VA Form 21-686c completed and signed
- [ ] All required identity documents included
- [ ] Doctor letter explicitly states "permanently incapable of self-support"
- [ ] Parent lay statement is detailed and specific
- [ ] Medical records show diagnoses with dates
- [ ] Evidence shows disability existed before age 18
- [ ] Functional limitations are well-documented
- [ ] IEP or educational evaluations included
- [ ] All documents have child's name and DOB on them
- [ ] Made copies of everything for my records
- [ ] Know where I'm submitting (online/mail/in person)
- [ ] Have tracking method (certified mail or upload confirmation)
- [ ] Wrote down confirmation/claim number

**You've got this, Fred. One step at a time.** 💪

---

**Document Status:**
- Started: ___/___/___
- Last updated: ___/___/___
- Submitted to VA: ___/___/___