VA Form 21-4138 or 21-10210: which form to use for a statement

What VA Form 21-4138 is for

VA.gov describes the Statement in Support of Claim in one line: use it to share more information as instructed by another VA form or process. The examples on its form page include more detail about your family situation or finances for pension, Dependency and Indemnity Compensation or accrued benefits claims, a reimbursement you received after filing a medical expense report, and more detail about claimed disabilities or other issues that cannot fit on the original claim form. The instruction printed on the form itself is shorter still: use this form to submit a statement to support a claim.

The form is two pages. Section I collects the veteran's or beneficiary's identification: name, Social Security number, VA file number if there is one, date of birth, service number if applicable, phone, email and mailing address. Section II, Remarks, is an open box for your statement, and it continues on page two under a header that repeats your Social Security number. Section III is a declaration that the statements are true and correct to the best of your knowledge and belief, followed by your signature, which the form marks as required, and the date.

The current PDF carries the revision date July 2024 in its footer and notes that it supersedes the June 2021 version. The form's burden notice estimates that it takes about 15 minutes to complete.

What VA Form 21-10210 is for

VA.gov says to use the Lay/Witness Statement to submit a formal statement to support your VA claim, or the claim of another Veteran or eligible family member, and notes that people also call it a buddy statement. The instructions on the PDF make the two uses explicit: the form is for a statement from a veteran or claimant, or from someone writing on their behalf.

It is longer than 21-4138 because it has room for a witness. Section I identifies the veteran. Section II identifies the claimant and is completed only if the claimant is not the veteran. Section III is the statement itself, item 17, with the instruction to describe what you yourself know or have observed about the facts or circumstances relevant to the claim, and a note asking you to indicate the claimed issue you are addressing. Section IV records the witness's name, phone, email and relationship to the veteran, with boxes for served with, family or friend, coworker or supervisor, and other. Section V is the certification and a required signature.

One detail trips people up: at the time of writing, the VA.gov page for this form lists a revision date of June 2021, while the downloadable PDF is marked July 2024 and says it supersedes the June 2021 version. Download a fresh copy from VA.gov rather than reusing one saved years ago.

Which one fits your situation

A spouse, friend, coworker or someone you served with is writing about what they saw. VA Form 21-10210 is the natural fit, because it has a section for the witness's contact details and their relationship to you. The form says each witness needs a separate copy.

You are writing about your own symptoms. VA.gov's evidence page lists three ways to provide lay evidence, for you or anyone else: a statement on a blank piece of paper, VA Form 21-10210, or VA Form 21-4138. The 21-10210 instructions include a veteran writing on their own behalf, and 21-4138 is the general form VA points to for details that do not fit on the claim form. Either way, the content is your account of the facts.

A VA letter or another form told you to use a specific form. Follow that instruction. Sharing information as instructed by another VA form or process is exactly how VA.gov describes 21-4138.

The statement is about an in-service traumatic event behind PTSD or another mental health condition. VA.gov's evidence page says claims for those conditions also need VA Form 21-0781, the Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s). A 21-4138 or 21-10210 does not replace it.

How to fill in and send either form

Both forms say you may complete them online or by hand, and that handwritten forms should be printed in ink, neatly, one letter per box. Both carry the same penalty statement: the law provides severe penalties, including fine or imprisonment, for knowingly submitting a false statement or evidence of a material fact. Read what you wrote before you sign.

The printed instructions on both PDFs say to mail the completed form to Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. Each form's VA.gov page also links to an online tool that lets you submit the statement without sending the paper form.

Timing is flexible. VA.gov's page on what happens after you file says you can submit evidence at any time, but that evidence arriving after the evidence-gathering step sends the claim back to that step for review. The page on filing a claim says you have up to a year from the date VA receives your claim to turn in evidence.

Common mistakes with both forms

Putting two witnesses on one 21-10210. The form's note says to use a separate form for each statement, including an additional statement of your own.

Leaving out the claimed issue. The 21-10210 statement section asks you to indicate the claimed issue you are addressing. A statement that never says which condition it concerns is harder to match to your claim.

An unsigned form. The signature line is marked required on both forms, and a statement typed on a computer still has to be signed.

Emailing the form to the address in the fine print. Both forms print a VA Reports Clearance Officer email address in their burden notice and say directly not to send the completed form there. Use the mailing address or the online tool instead.

Writing it all at the end. Months of symptoms are hard to reconstruct from memory in one sitting. Some veterans keep a dated log as things happen; ClaimLog, for example, lays the entries in such a log out as a statement following the layout of VA Form 21-4138 and adds a blank 21-10210 with a note for a witness. You still read every sentence, sign by hand and send it yourself.

This guide is general information about VA forms, not legal or medical advice. Forms and instructions change, so check the form page on VA.gov before you send anything. For help with your claim, VA's Office of General Counsel accredits Veterans Service Organization representatives, attorneys and claims agents.

Frequently asked questions