VA Form 21-4138: Statement in Support of Claim

What VA Form 21-4138 is for

VA uses this form when a VA letter or another VA form asks you for more information, or when details about a claimed disability do not fit on your claim form.

Writing a formal statement about your own condition, or asking a witness to write one? VA points to Form 21-10210 for that. Use the free 21-10210 statement builder.

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:

• Item 2: Social Security number (both pages)
• Item 3: VA file number
• Item 4: date of birth
• Item 5: service number
• Items 9 and 10: signature and date

Where to send it

• 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.
• Answering a VA letter: if the letter gives its own return instructions, follow them.
• Keep a copy of everything you send.

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 21-4138 on VA.gov
• How to fill out VA Form 21-4138

This filler uses the July 2024 edition of the form.