VA Form 21-10210: How to Fill Out a Lay or Witness Statement

VA Form 21-10210, the Lay/Witness Statement, is VA's form for a formal statement supporting a claim. You can use it to write about your own claim, or a witness such as a spouse, friend, coworker or fellow service member can use it to describe what they saw. People often call it a buddy statement.

The current PDF is the July 2024 edition, which replaced the June 2021 version, although VA's form page still lists June 2021 as the revision date. It has three pages, five sections and items numbered 1 to 22. Each statement needs its own form. The walkthrough below follows the form in order.

Who completes which section

The form says to complete Section II "ONLY IF the claimant is NOT the veteran," for example a family member filing a claim based on the veteran's service. It says to complete Sections IV and V when the statement is "from someone else writing on your behalf." The signature in item 22A is marked required for every statement.

Before you start

Download the form from VA's Form 21-10210 page. Check the bottom left of page 1 for "JUL 2024." You can fill in the PDF on a computer or by hand; by hand, VA asks for ink, neat printing, one letter per box and filled-in circles.

A witness needs some of the veteran's details. VA's online version says that to support someone else's claim you will need their date of birth, Social Security number, VA file number if available, and contact information. If you are the veteran, you can fill in Section I yourself before handing the form to the witness, so they do not need to ask for your Social Security number.

Section I: veteran's identification (items 1 to 8)

• Item 1: the veteran's name (first, middle initial, last).
• Item 2: Social Security number. On the fillable PDF it repeats automatically at the top of pages 2 and 3.
• Item 3: VA file number, if there is one.
• Item 4: date of birth.
• Item 5: VA insurance file number, if applicable.
• Item 6: current mailing address, if applicable.
• Item 7: telephone number, with a separate line for an international number.
• Item 8: email address, and a box to check if the veteran agrees to receive electronic correspondence from VA about the claim.

Section II: claimant's identification (items 9 to 16)

Complete this only if the claimant is not the veteran. The items mirror Section I for the claimant: name (9), Social Security number (10), VA file number (11), date of birth (12), VA insurance file number (13), mailing address (14), telephone (15), and email with the electronic-correspondence box (16). A veteran writing about their own claim, or a witness supporting a veteran's own claim, leaves this section blank.

Section III: the statement (item 17)

The statement box starts on page 2 and continues on page 3. The form gives two instructions. First, "Please indicate the claimed issue that you are addressing." Second, item 17 asks the writer to "Describe what you yourself know or have observed about the facts or circumstances relevant to this claim before VA."

A clear statement usually runs in this order:

1. The issue: "This statement concerns [veteran's name]'s claim for [condition]."
2. The writer's relationship and how they know: how long, and in what setting.
3. What the writer saw or experienced: specific events or changes.
4. When and how often: dates, ranges or frequency, honestly approximate where needed.
5. One concrete example.
6. What the writer does not know, such as the diagnosis or cause.

Attribute anything the veteran said: "She told me the pain increased," not "I know the pain increased." Keep approximate dates approximate and say how the writer remembers them. Leave out diagnostic terms the writer does not personally understand. In one Board case, a veteran's own specific testimony about flare-ups supported a higher ankle rating when the exam could not capture them.

Section IV: witness contact information (items 18 to 21)

Complete this when someone other than the veteran or claimant wrote the statement.

• Item 18: the witness's name.
• Item 19: relationship to the veteran or claimant; check all that apply: served with, family or friend, coworker or supervisor, or other (with a short description).
• Item 20: telephone number.
• Item 21: email address.

Section V: certification and signature (items 22A and 22B)

The writer certifies: "I have completed this statement and that its information is true and correct to the best of my knowledge and belief." Item 22A is the veteran, claimant or witness signature, marked required. Item 22B is the date signed. The form warns that knowingly submitting a false statement can bring fines or imprisonment. The form has no notary section.

A completed fictional example (witness-authored)

Fictional example. Sam Okafor is writing to support a friend's claim for asthma. Every detail is invented.

Item 17 statement:

This statement concerns Terrence Hale's claim for asthma.

I have known Terrence since 2017. We have played in the same Saturday pickup basketball game at the Anytown community center almost every week since 2021.

Through 2022, Terrence played full games with the rest of us. Starting in the spring of 2023, I saw him stop after five or ten minutes of play, bend over with his hands on his knees, and use an inhaler from his bag. By late 2024 this happened most Saturdays. On March 15, 2025, he left in the middle of a game, and I found him sitting in his car with the windows down about twenty minutes later. He told me he could not catch his breath. He stopped coming to the game in the fall of 2025.

I do not know his diagnosis or what caused his breathing problems. I am describing what I saw at the games.

Adding to or correcting a statement later

The form's rule is one statement per form: "If you would like to submit an additional statement on your own behalf or if you have more than one witness writing on your behalf, use a separate form (VA Form 21-10210) for each statement." So an addendum is a new 21-10210. Start its statement with a line such as "This adds to my statement dated [date] about [issue]," then give only the new or corrected facts. Each witness uses a separate form, and so does each additional statement from the veteran.

How to submit it

• With your application: the form's instructions say to submit it with your application if you are providing statements to support your claim.
• Online: sign in to VA.gov with an identity-verified Login.gov or ID.me account and use VA's online Lay/Witness Statement, linked from the Form 21-10210 page.
• Upload to a pending claim: VA's claim status tool accepts evidence for a pending disability claim for up to one year after VA receives the claim; for a decision review or appeal, VA points to QuickSubmit (VA upload page).
• By mail: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444, as printed on the form.

Keep a copy of the signed form and any confirmation. For more complete letter examples by relationship, see the VA buddy letter examples; for a statement about your own experience, see the VA personal statement examples.

Drafting help, and what it is not

Claim Raven's buddy letter builder helps a witness draft the statement and downloads a plain letter without an account. A plain letter is not the official 21-10210; the writer still copies the statement into the form or submits it as a signed plain-paper statement, and nothing is filed with VA. A signed-in veteran can send and track invitations with Standard or Plus. Claim Raven sells these tools and has a commercial interest in them.

VA Form 21-10210 questions

Sources and scope

Checked September 23, 2026: VA Form 21-10210 page (which lists a June 2021 revision date) and the downloaded PDF (VA Form 21-10210, JUL 2024, supersedes JUN 2021; OMB 2900-0881); VA's online Lay/Witness Statement introduction page (sign-in with an identity-verified account; one statement per form; information needed to support someone else's claim); VA evidence requirements; VA evidence upload page. The example is fictional. Follow the instructions on the current form.