obsidian-vault/projects/kobe-va/kobe-va-documentation-checklist.md

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: //___