obsidian-vault/projects/kobe-va/kobe-va-doctor-letter-template.md

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.

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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

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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.

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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]

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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]."

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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.

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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

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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.

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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

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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.

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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]

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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]

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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]

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Signature: ___________________________________
Printed Name: [Doctor's Full Name, MD/DO/PhD, etc.]
Title: [Specialty]
Date: _____________________

Medical License #: [State License Number]
NPI #: [National Provider Identifier]

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END OF TEMPLATE

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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.

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This template is ready to customize for Kobe and present to his doctor.