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It is a fairytale that the VPOTUS could start 25th-A proceedings an his/her own with a living, breathing POTUS still in that office.

I'm thinking the VP could start the ball rolling...might be political suicide to do it. Better have someone else to do it and bring the VP in.

25-A Section 4 doesn't say anything about a medical determination must be made to trigger 25A

Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

And in the section after that, it says that the president can rebut

https://en.m.wikipedia.org/wiki/Twenty-fifth_Amendment_to_the_United_States_Constitution

“Thereafter, when the President transmits to the President pro tempore of the Senate and the Speaker of the House of Representatives his written declaration that no inability exists, he shall resume the powers and duties of his office
“

—unless—

unless the Vice President and a majority of either the principal officers of the executive department[note 2][7] or of such other body as Congress may by law provide, transmit within four days to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office. “

And Congress decides if the president is unfit; it takes 2/3rds of House and 2/3rds of Senate, and the VP continues as acting President. If one, the President resumes office:

Thereupon Congress shall decide the issue, assembling within forty-eight hours for that purpose if not in session. If the Congress, within twenty-one days after receipt of the latter written declaration, or, if Congress is not in session, within twenty-one days after Congress is required to assemble, determines by two-thirds vote of both Houses that the President is unable to discharge the powers and duties of his office, the Vice President shall continue to discharge the same as Acting President; otherwise, the President shall resume the powers and duties of his office.
“