VA Form 21-4138: How to Fill It Out

VA Form 21-4138: How to Fill Out a Statement in Support of Claim

Claim Raven Team · September 21, 2026 · 3 min read

Use VA Form 21-4138 to add information requested by another VA form or process. Follow this field-by-field checklist and keep the statement focused.

Use VA Form 21-4138 when another VA form or process asks for more information, or when relevant details about a claimed disability do not fit on the original form. The current official page also offers an online submission option.

Start with VA's current Form 21-4138 page. The page lists a July 2024 revision date. Do not download a copy from an unknown document site when VA provides the current form directly.

Decide whether 21-4138 is the right form

VA gives examples such as adding disability details that do not fit on the original claim form or providing information requested by another benefits process. For a formal statement written by another person to support your claim, VA identifies Form 21-10210 as the Lay/Witness Statement form.

The form number is not the substance. First decide what fact the statement needs to add.

Compare lay statement versus buddy statement when deciding whose account the statement needs.

Prepare the statement before filling the form

Draft the content in plain text. Use this sequence:

Identify the claim, condition, or request the statement concerns.
State the purpose in one sentence.
Describe the facts in date order.
Separate what you experienced from what a record or another person says.
Point to supporting documents by date and name.
State uncertainty honestly.
Remove unrelated history.

Fictional example

I submit this statement to explain the onset and current effects of my claimed right shoulder condition. During a field exercise in September 2012, I fell from a vehicle and landed on my right shoulder. I went to the unit clinic the next morning. The September 2012 clinic note is included with my claim. I have had periods of pain with overhead movement since then, although I did not seek treatment every time. My March 2026 orthopedic note documents the current diagnosis and limited motion. I do not remember the exact day of the field exercise.

This example identifies the issue, event, record, symptom history, current record, and uncertain date. It does not supply a medical opinion.

Complete and review the form

Use the identity and claim information exactly as VA requests. Keep attachments clearly labeled. If you continue the statement on another page, repeat enough identifying information to keep the pages together and follow the current form instructions.

Before signing, check:

The condition or issue is named consistently.
Dates match the records or are labeled approximate.
The statement does not claim that VA received an attachment you have not submitted.
Medical conclusions are left to qualified medical evidence.
Every attachment referenced is actually included or identified for VA to obtain.
The certification and signature reflect the final version.

Submit through an official channel

The current VA Form 21-4138 page offers the PDF and an online statement option. Use the instructions provided with the form or the authorized online process. Keep a copy of the completed statement and confirmation available to you. Claim Raven does not file the form for you.

Draft the narrative before moving it to the form

If you need help organizing your own account, Claim Raven's free personal statement builder guides the timeline, symptoms, and daily-impact questions. It supports editing and PDF, Word, or text downloads without an account. You still review, sign, and submit through the channel you choose.

See VA personal statement examples for three fictional structures.

Sources and scope

Reviewed September 20, 2026: VA Form 21-4138; VA Form 21-10210; VA evidence requirements; Claim Raven personal statement builder product page. Always follow the instructions on the current official form.

Check it yourself

Does your statement cover what a rater looks for?

Paste your draft. This checks whether the statement covers the elements a rater looks for. It does not judge your writing and it does not send the text anywhere.

What this checks and why

Written in your own voice. A lay statement is your account. Raters give weight to what you personally experienced and observed, in your words.
Says when and where it started. The rater is looking for the link between service and the condition. A statement that never places the start of symptoms in time or place cannot help with that.
Describes current symptoms. Ratings are assigned on current symptoms, not on the diagnosis label. The rater needs to picture what a bad day looks like.
Says how often and how long. Most rating criteria turn on frequency and duration. Constant versus weekly versus monthly can be the difference between rating levels.
Shows the effect on work and daily life. Functional impact is what separates a rating from a diagnosis. What can you no longer do, or do only with help?
Gives at least one specific example. One concrete incident is worth more than a paragraph of general description. It shows the rater a real day.
Mentions treatment or why there was none. Raters look for treatment history. If you did not seek care, saying why (no access, stigma, told to tough it out) answers the question before it is asked.
Leaves medical conclusions to a clinician. A lay statement is strongest describing what you experienced. Stating a medical cause in your own voice adds nothing and can read as advocacy.

Build the statement in the free tool

The free builder walks through each element above and lets you download the result without an account.