Dear__________:

This is to provide medical support for the disability application of Mr./Ms. ___________ who has Huntington's Disease.

Mr./Ms. ___________ was seen in our clinic for the first time on (date) and diagnosed as affected with Huntington's Disease (HD). Symptoms began in (year). We have followed Mr./Ms. ___________ since then and are confident of the diagnosis based upon clinical observations and his/her positive family history of an affected parent and affected (paternal/maternal) relatives. CT/MRI findings include __________.

Huntington's disease is an inherited neurodegenerative disorder that is gradually progressive, ending in death from infection or general debilitation an average of 16 years after onset.

There are 3 characteristic clinical features: (1) loss of ability to control bodily movements; (2) loss of ability to think and act quickly, to learn new material and to remember; and (3) apathy and severe depression, often resulting in suicidal behavior. Patients also exhibit poor social judgment and may be irritable and aggressive.

When last examined on (date), Mr./Ms. ___________ had abnormal eye movements, slow/ dysarthric speech, poorly coordinated finger-thumb tapping, and rapid alternating movements, a wide-based gait with poor heel to toe walking, choreiform movements, brisk deep tendon reflexes, flexor planters and clonus. He/she is at high risk for falling. The sensory examination, Romberg and cranial nerves are not affected in Huntington's disease.

Mr./Ms. ___________ is slow and inaccurate with calculations, has poor recent memory, and at home cannot remember to carry out routine tasks such as ___________. His/her employer reports ___________. For these reasons, he/she has been told that he/she cannot work there any longer. The patient last worked on (date fired). (# job failures óshow that this is different from his/her pre-morbid work history).

We do not routinely administer IQ tests to people with Huntington's disease for purposes of disability assessment. Although they decline, the IQ remains above 70 and does not adequately reflect the person's inability to work. This is because the person can perform some tasks when continually prompted, as is the case with IQ testing. However, people with Huntington's disease cannot perform even a simple sequence of tasks unprompted as would be the case at even a low level job. (Results of relevant neuropsychology tests here.)

Vocational Rehabilitation is not helpful to people with HD. Their ability to learn new tasks is poor. They are slow and disorganized. Their poor motor coordination prevents their safe employment in manual labor.

Mr./Ms. ___________ has suffered from depression associated with Huntington's disease since (date). He/she is apathetic and irritable. These symptoms also interfere with his/her ability to work.

In summary, this (age)-year old man/woman was well until (year) when Huntington's disease began. He/she has been unable to work since (date) because of (list reasons). We hope you will grant disability to this fatally ill individual. If you wish further information, please call ___________.

Disclaimer:The indications and dosages of this material have either been recommended in the medical literature or conform to the practices of physicians expert in the care of people with Huntington's disease. The indications do not necessarily have specific approval forth Food and Drug Administration (FDA) for the indications and dosages for which they are recommended. The package insert for each drug should be consulted for uses and dosage approved by the FDA. Because standards for dosage change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs. Statements and opinions expressed in this book are not necessarily those of the Huntington's disease Society of America, Inc. nor does HDSA promote, endorse, or recommend any treatment or therapy mentioned herein. The lay reader should consult a physician or other appropriate health care professional concerning any advice, treatment or therapy set forth in this book.