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I don't think that's the totality of the evidence (at least I hope it's not). I'm happy to be corrected, but I think that's all we've seen and seems to be more of an open letter.
I'm not even sure it's real, is declaring "NB has made a career of perpetuating her age facade" really within the remit of a family doctor?
You're asking good questions about N's medical diagnosis, but it's not something I know anything about, so for the time being, going solely by the pics I'm more inclined to believe N.
It seems to have been written in 2016, could it be related to the Mans family's attempt to reverse the court decision to change N's age to 22?