Fillable Form VA 21-4138

What is a VA Form 21-4138?

VA Form 21-4138, officially the Statement in Support of Claim, is a document used by veterans to support a claim for benefits. The Department of Veterans Affairs will use this information in this form to determine if the claim is legitimate and should be approved.

Additional information may be required for specific personal circumstances.

VA Form 21-4138 may be used also for the following purposes:

• To request an update on VA Claim status.
• To submit stories and information that supports one of the 4 Pillars of a VA Claim (Eligibility, Service-connection, Impairment Ratings, and Effective Dates.)
• To submit complaints about the VA Claims process.
• To disagree with a statement in a VA Ratings Decision or Statement of the Case.
• To update the VA on a change in dependency status.

How to fill out VA Form 21 4138?

VA Form 21-4138 consists of two pages of fillable boxes. You will need around 15 minutes to review the instructions, find the information, and complete this form. It contains the following sections:

• Veteran/Beneficiary’s Identification Information
• Remarks
• Declaration of Intent

Section I - Veteran/Beneficiary’s Identification Information

Item Number 1
Provide your full name.

Item Number 2
Provide your social security number (SSN)

Item Number 3
Provide your VA file number if you have one.

Item Number 4
Provide your date of birth.

Item Number 5
Provide your veteran’s service number if you have one.

Item Number 6
Provide your telephone number including the area code.

Item Number 7
Provide your email address.

Item Number 8
Provide your mailing address. Fill out the number and street, apartment or unit number, City, State, ZIP Code, and Country on the fields provided.

Section II - Remarks

Enter the information here that you would like the VA to know in support of your claim. If you need more pages, attach a separate sheet. You may also attach any supporting papers or documents if needed.

In cases that you can’t remember details, this section may be filled by friends, family members, spouses, friends, co-workers, or neighbors.

Section III - Declaration of Intent

Item Number 9
Provide your signature.

Item Number 10
Provide the date you signed and completed the form.

Submission

VA form 21-4138 may be filed online, by mail, or fax along with other forms.

If you will submit through the mail, send the form to:

U.S. Department of Veterans Affairs
Debt Management Center
P.O. Box 11930
St. Paul, MN 55111

If you will submit via fax, send the form to the number 1-612-970-5798.

Tips:

• Identify the scope of your statement in Section II. You may write about all claims that you have pending before the VA on one form or choose to write about just one claim on each form.
• Write a draft of your statement before entering it on the form.
• If you have written a statement on this claim before, make sure that this new statement is filling in any gaps in the previous statement. Provide as much detail as possible.
• Keep your statement factual. It should not contradict any other statements you have made in the past. If any statement or evidence of a material fact is false, you might face severe penalties which include fine or imprisonment, or both.
• If possible, keep your statement short. Keep it to one page filled with significant facts and details.
• If you have provided any incorrect information in the past, be sure to include it in the new statement and state it as a correction.
• Do not exaggerate or downplay when completing Section II of this form.
• You may also include “buddy statements”. Buddy statements are statements from friends, family members, spouses, friends, co-workers, or neighbors which provide lay evidence that can supplement medical and military records. The Buddy Statement can support the main statement by confirming the location or date of the event. In cases, when the veteran cannot remember the details of the event, the Buddy Statement can make the event more clearly.
• Provider of buddy statements must include full contact information, the full name of the veteran for whom the letter is being written, and the date.
• To legally certify the form, don’t forget to sign it. If filing online, you have the option to add your signature by drawing it with your finger or upload your signature from any internet-connected device.
• If you are unsure about dates, names, and other relevant information, include it in your statement but provide a disclaimer that you can’t completely remember it. By entering all related details, you are sharing a factual story.
• If you are writing for direct service connection, focus on the circumstances during service that resulted in your current injury, disability, or condition.
• If you are writing for an increased rating, write about how your current injury, disability, or condition has worsened over the years.
• If you have time, let someone read over your statement for checking for gaps or loopholes before submission to the VA.
• You may also ask an accredited Veteran's lawyer to help you identify the issues that you need to prove with your statement.
• Your SSN will be used by the VA to identify your claim file and ensure that your records are properly associated. If you refuse to provide your SSN, the VA will not deny your benefits. Providing your SSN account information is voluntary.
• Aside from VA Form 21-4138, you may access other VA forms online. If you want to file an application for compensation and/or pension, use VA form 21-526. If the VA recently denied your claim for disability benefits, then use VA form 21-4192. If you want to claim due to injury or damage, use VA form 95.