For instance, many universities in the United States require medical documentation of a diagnosis to receive accommodations, and that that medical documentation have been obtained within a certain number of years before the students start at the university (anywhere from 4-7), for students with limb differences, or disabilities where their functional limitations won't have substantially changed since birth, it may be just another bureaucratic hoop to have to jump through, and cause them to incure additional costs related to obtaining medical documentation.