Sample Disability Letter Template printable pdf download

SAMPLE Disability Letter

Date

From (your address, or address of anyone who is helping you)

Re: Adhesion Related Disease (ARD)

To: (Benefits office)

Department of Veterans Affairs

Re: Disability – Jane Doe

I am the Outreach Patient Advocate for the International Adhesion Society and have been assisting

Jane with her medical and physical needs since she started to suffer disabling symptoms in 1991!

I have responded to these updates previously and I understand the necessity of such updates. I will

tell you this regarding your Veteran, Jane Doe and any future changes in her health situation. Jane

will probably die before she is able to secure any type of medical intervention that will save her life,

even at this stage. There is no known procedure that can abort the debilitating physical

deterioration that Jane is experiencing!

I invite you to forward these questionnaires to me as timely as necessary for you reviews of the

disability claims of veterans…but I also want you to take a good look at these pictures of Jane.

Veteran of the United States of America, and know that this is one veteran who is most deserved of

our countries financial and medical support!

My observations of Jane’s symptoms/condition:

Jane was seeking medical intervention from a wide variety of medical care providers for urinary

bladder pain and incontinency. She had non specific abdominal/pelvic pain which did not respond

to treatment by any of the physicians she sought treatment from. Dates of medical visits are far to

numerous to track as Jane was presenting to medical appointments with doctors, to medical

centers for diagnostic testing and treatment attempts as well as surgical intervention. All this was

unproductive in offering her any relief from her abdominal/pelvic pain, urinary incontinency, gastro -

esophageal reflux disease, nausea, vomiting and fatigue.

Specific months, days and years are all one as for Jane, her life is in constant need of medical

intervention, her symptoms only increase in severity as time and lack of medical intervention, goes

on for her. It is almost ludicrous for you to be requesting information such as this, when all it would

take is to look at Jane’s photos and ask yourself who would or could employ her?

Her symptoms of chronic abdominal/pelvis pain increase over time, little effective relief has been

found for that symptom, her nausea and GERD increased due to medications prescribed for her

pain and her associated symptoms of urinary bladder and intestinal difficulties became worse as

she then started fecal incontinence following a surgery and that is now irreversible! Jane lives with

these symptoms with no site of effective medical intervention in site for her.

Sample Disability Letter Template