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Use this form to submit a statement to support a claim. For more information you can contact us through Ask VA: https://ask.va.gov/, or call us toll-free at 1-800-827-1000 (TTY:711). VA forms are available at www.va.gov/vaforms. After completing the form, mail to:
Use VA Form 21-4138 to provide additional information to support your claim. Downloadable PDF. Download VA Form 21-4138 (PDF) Related forms and instructions. VA Form 21-10210. Form name: Lay/Witness Statement. Use VA Form 21-10210 to submit a formal statement to support your VA claim—or the claim of another Veteran or eligible family member.
Use this form to submit a statement to support a claim. For more information you can contact us through Ask VA: https://ask.va.gov/, or call us toll-free at 800-827-1000 (TTY:711). VA forms are available at www.va.gov/vaforms.
The following statement is made in connection with a claim for benefits in the case of the above-named veteran: VA FORM 21-4138, JAN 2015.
Supporting forms for VA claims. When you file a claim for some VA benefits, you’ll need to submit additional forms to support your claim. Use this page to find the forms you need.
If you’re a service member filing a disability compensation claim through the Benefits Delivery at Discharge (BDD) program, you must submit a Separation Health Assessment - Part A Self-Assessment form.
VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits.
VA Form 21-4138, the “Statement in Support of Claim,” is used by veterans or their loved ones to provide additional information or statements supporting their claims for benefits from the U.S. Department of Veterans Affairs (VA).
Friends, family, or coworkers can use VA Form 21-4138 to support the veteran’s claim and verify the physical or social limitations the veteran experiences due to their disability.
VA Form 21-4138, commonly referred to as the “Statement in Support of Claim,” is a crucial document that veterans and their affiliates use during the claims process. This form serves as a conduit for providing essential information that corroborates a veteran’s claim for VA benefits.