VA Form 21-10210: Lay/Witness Statement

What VA Form 21-10210 is for

Use this form for a formal statement that supports a claim. You can write about your own claim, or a witness such as a spouse, friend, coworker or fellow service member can describe what they saw. Each statement needs its own form.

Want help finding the words first? The buddy letter builder walks a witness through guided questions. Its download is a plain letter, not the 21-10210, so you would still copy the statement into this form. Draft a witness statement first.

What you fill in by hand

The filler never asks for your Social Security number, VA file number, date of birth or signature. You write those in by hand. Leave these boxes for yourself:

• Items 2 and 10: Social Security numbers (also at the top of pages 2 and 3)
• Items 3 and 11: VA file numbers
• Items 4 and 12: dates of birth
• Items 5 and 13: VA insurance file numbers
• Items 7, 15 and 20: international phone numbers
• Items 22A and 22B: signature and date signed

Where to send it

• With your application: the form says to send statements with your application when you have them.
• Pending disability claim: upload it through VA's claim status tool on VA.gov. It accepts evidence for up to one year after VA receives the claim.
• Decision review or appeal: VA points to its QuickSubmit upload tool.
• By mail: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
• One statement per form. Each witness, and each extra statement from the veteran, uses a separate 21-10210.
• Keep a copy of the signed form and any confirmation.

Claim Raven does not submit forms to VA. You review the filled PDF, sign and date it, and send it to VA yourself. Claim Raven is independent and is not affiliated with VA.

Official form and guide

• VA's page for Form 21-10210 on VA.gov
• How to fill out VA Form 21-10210

This filler uses the July 2024 edition of the form.