It is a determination that the paperwork submitted did not establish it.

Which means that a new submission, with the missing document in it, is a new request, with its own decision and its own fresh appeal rights, and the old letter has no power over it at all.

The missing document was a mobility-specific functional assessment by a qualified therapist.

Debra Ngwenya is a qualified therapist.

Debra Ngwenya had been seeing Maya Lin every three weeks for four years.

Debra Ngwenya had never been asked for that document, because nobody had ever told her it was missing, because the denial letter had gone to the family and not to her and the family had read one page of it.