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

Use VA Form 21-4138, Statement in Support of Claim, when VA or another VA form or process asks you for more information, or when details about a claimed disability do not fit on the original claim form. If you want to submit a formal statement supporting your own claim, or a witness wants to support yours, VA points to Form 21-10210 instead.

The current PDF is the July 2024 edition, which replaced the June 2021 version. It is two pages with three sections and ten numbered items: your identification (items 1 to 8), a Remarks section for the statement, and a signed declaration (items 9 and 10). The walkthrough below follows the form in order.

21-4138 or 21-10210?

The first four rows are the examples VA lists on its 21-4138 page, and that page links to 21-10210 for a formal statement. VA also accepts a signed statement written on plain paper (VA evidence page). If a VA letter names a specific form, use the one it names.

Before you start

Download the form from VA's Form 21-4138 page rather than a third-party site. The edition date is printed at the bottom left of page 1: "JUL 2024." You can complete the PDF on a computer or by hand. If you write by hand, VA asks for ink, neat printing and one letter per box.

To use VA's online version instead, you sign in to VA.gov with an identity-verified Login.gov or ID.me account. VA's online tool says it may suggest a different form before you continue, depending on what you want to send.

Have these ready: the veteran's Social Security number, VA file number if there is one, date of birth, service number if applicable, and the VA letter or form you are responding to.

Section I: identification (items 1 to 8)

• Item 1, veteran or beneficiary's name. First name, middle initial, last name. The form labels this item "Veteran/Beneficiary's Name," while items 2, 4 and 5 ask for the veteran's details.
• Item 2, veteran's Social Security number. This number also fills in automatically at the top of page 2 on the fillable PDF, so the two pages stay matched.
• Item 3, VA file number. Only if you have one.
• Item 4, veteran's date of birth. Month, day, year.
• Item 5, veteran's service number. Only if applicable.
• Item 6, telephone number. Include the area code. There is a separate line for an international number.
• Item 7, email address. Optional.
• Item 8, mailing address. Street, apartment or unit, city, state or province, country and ZIP or postal code.

Section II: Remarks

This is where the statement goes. The heading reads: "The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary." The Remarks box continues on page 2 under "Section II: Remarks (Continued)."

Write it in this order:

1. What you are responding to. Name the VA letter and its date, or the form whose space ran out. For example: "This statement adds details about the conditions I listed on my VA Form 21-526EZ dated June 30, 2026."
2. One topic at a time. Use a numbered paragraph for each condition or question.
3. Facts in date order. Say what happened, when, and where the record of it is.
4. Where the evidence is. Name each attached document by date and title, or the provider VA should contact.
5. What you are unsure of. Say it plainly instead of guessing.

The form gives no rule for extra pages. If the Remarks will not fit, a practical approach is to attach a page with the veteran's name and file number or Social Security number at the top, write "continued on attached page" at the end of the Remarks, and sign and date the attachment. VA's online version asks you to use a new form for each separate statement.

Section III: declaration (items 9 and 10)

• Item 9, signature. Required. By signing, you certify "that the statements on this form are true and correct to the best of my knowledge and belief." The form warns that knowingly submitting false statements can bring fines or imprisonment.
• Item 10, date signed. Month, day, year.

The signature line is for the veteran or beneficiary. If someone else needs to sign for you, VA has a separate alternate-signer form, VA Form 21-0972; ask VA or an accredited representative whether it applies to your situation.

A completed fictional example

Fictional example. Dana Whitfield filed a claim on VA Form 21-526EZ and ran out of room to explain two conditions. The entries below are invented, including the Social Security number and phone number.

Remarks (Section II):

This statement adds details about two conditions I listed on my VA Form 21-526EZ dated June 30, 2026. They did not fit in the space on that form.

1. Right wrist condition. In May 2013, at Fort Example, a tailgate latch failed during vehicle maintenance and the tailgate struck my right wrist. I was seen at the troop medical clinic the same day. The service treatment note dated May 21, 2013 is attached. Since 2023 I have been treated at Example Hand Clinic, and I am submitting VA Form 21-4142 so VA can request those records.

2. Heel pain in both feet (plantar fasciitis). The pain began during a road-march training cycle in the spring of 2014. I went to sick call twice that year; I believe the visits were in April and June, but I do not remember the exact dates. A podiatrist at Example Foot Care has treated me since 2022, and that practice is also listed on my VA Form 21-4142.

Attached: service treatment note dated May 21, 2013 (1 page).

The Remarks answer the gap the claim form left: what each condition is, when it started, and where the records are. The medical questions are left to the records and to any examination VA orders.

How to submit it

• Online: sign in to VA.gov with an identity-verified account and use VA's online statement form, linked from the Form 21-4138 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 an appeal, VA points to its QuickSubmit tool (VA upload page).
• By mail: the form lists Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
• In response to a VA letter: if the letter gives its own return instructions, follow them.

Uploading evidence to VA explains which upload route fits each claim lane.

Keep a copy of the signed form and any confirmation.

Check it before you sign

• The condition or issue is named the same way everywhere.
• Dates match the records, or are labeled approximate.
• Every attachment you mention is actually attached, or is identified for VA to request.
• Medical conclusions come from medical records, not from the statement.
• The signature and date reflect the final version.

Draft the remarks first

Writing the Remarks as plain text first makes the form easier to fill in. Claim Raven's free personal statement builder guides the timeline, symptoms and daily-impact questions and downloads PDF, Word or text without an account. It does not fill in or submit the VA form. Claim Raven sells claim tools and has a commercial interest in this one. For a longer statement about your own experience, see the VA personal statement examples; if your statement is really a formal lay statement, the VA Form 21-10210 walkthrough covers that form field by field.

VA Form 21-4138 questions

Sources and scope

Checked September 23, 2026: VA Form 21-4138 page (form revision date July 2024) and the downloaded PDF (VA Form 21-4138, JUL 2024, supersedes JUN 2021; OMB 2900-0075); VA's online 21-4138 introduction page (sign-in with an identity-verified account); VA Form 21-10210 page; VA supporting forms page (Form 21-0972); VA evidence requirements; VA evidence upload page. The example is fictional. Always follow the instructions on the current form and in any VA letter you received.