Medical Sufficiency Letters
"What is a Medical Sufficiency Statement/Letter and how do I get one for my dependant?"
Simply put, a statement, or letter, of medical sufficiency addresses the medical status of an individual. These letters, or statements, must be updated on a regular basis by the individual's Primary Care Physician. This letter is then submitted as proof of a dependant's "Medical Sufficiency" when applying for an incapacitation status, a Favorable Dependency Determination, ID cards and other benefits and services.
Medical Sufficiency Statement
A letter of Medical Sufficiency is a formal statement written in narrative form by an individual's designated Primary Care Physician (PCP) regarding that individual's current medical condition. The PCM may be an assigned physician at a Military Treatment Facility (MTF) for those on TriCare Prime, or with access to an active duty MTF, or an assigned civilian Primary Care Physician (PCP).
This letter should contain the following information:
- Individual's name, birth date and age
- current diagnosis
- Date of onset of the disability (example: at birth, age 6 months, post accident which occurred 03/15/1999 etc.)
- the individual's current physical and cognitive status
- functional level (list what the individual CANNOT do or needs assistance doing)
- current treatments
- mobility status, if applicable (ambulatory with walker/crutch/cane, uses a manual or power wheelchair, etc.)
- prognosis for recovery
- prognosis for ability to support self in the future
- any other statements regarding the individual's current medical status which may be deemed helpful and necessary
A letter written by a physician from a Military Treatment Facility (MTF) should be submitted on the approved DoD form as dictated by each branch of service. These forms should be readily available to medical staff at each treatment facility.
A civilian physician's letter should be written on official letterhead and contain full contact information to include address and phone numbers of both the physician and the medical facility, if appropriate.
Four Most Common Mistakes
- Failure to allow enough time for your PCM to dictate and print a letter. Depending on the facility or office this process can take up to 3 weeks or longer.
- Failure to submit a complete letter. Make sure all the detail you need is included the first time around.
- Failure to include the date the document was written.
- Lack of signature. Be sure the letter has been properly signed by the individual who originated it.
Letters of Medical Sufficiency are a vital part of the application process for Dependency Determinations, ID cards and other benefit programs. Failure to submit a complete letter can derail your entire application process. By submitting a current and accurate letter you'll be able to speed the process and obtain the services you need.
One Last Tip: If a specialized letter or set of forms is required for a specific action, KEEP THE ORIGINALS! You'll most likely need them later.