Fillable Form VA 21-4138

What is Form VA 21-4138?

Form VA 21-4138, Statement in Support of Claim, or also known as the VA Disability Claim, is used by veterans to establish proof for their claim of disability benefits from the Department of Veterans Affairs (VA).

How to fill out Form VA 21-4138?

To complete the Statement in Support of Claim, you must provide the following information:

Section 1. Veteran/Beneficiary’s Identification Information

Item 1. Veteran/Beneficiary’s Name

Enter your first name, middle initial, and last name.

Item 2. Veteran’s Social Security Number

Enter your Social Security Number (SSN).

Item 3. VA File Number

Enter your Veterans’ Affairs file number if you have one; otherwise, leave it blank.

Item 4. Veteran’s Date of Birth

Enter your date of birth using the format: Month-Day-Year.

Item 5. Veteran’s Service Number

Enter your Veteran’s Service Number (VSN) if you have one; otherwise, leave it blank.

Item 6. Telephone Number

Enter your correct telephone number including the area code. You may enter an international phone number if applicable.

Item 7. E-mail Address

Enter your e-mail address if you have one; otherwise, leave it blank.

Item 8. Mailing Address

Enter your correct mailing address. Include the street number, unit number, P.O. Box, city, state, ZIP code, and country.

Section 2. Remarks

Enter a statement for your claim of benefits. You must write any sort of evidence to support your disability claim. This may consist of information that wasn’t asked in the first section of Form VA 21-4138.

You may go into detail about what your disability is, how severe it is, how much it impacted your ability to work, or how it affected your social life. You may also include other service-related disabilities and other conditions you’ve obtained due to said disabilities.

On page 2 of Form VA 21-4138, enter your Social Security Number once again before filling out the second page of the Remarks section.

Section 3. Declaration of Intent

Affix your signature. Afterward, enter the current date using the format: Month-Day-Year. This will certify that the information you’ve stated in the previous sections is all correct and factual.

Providing false information on this form will lead to severe penalties which include fines or imprisonment.

What is the purpose of Form VA 21-4138?

If you are a veteran with a service-related disability, the Department of Veterans Affairs (VA) may give you tax-free benefits after assessing the information you’ve provided using this form.

Once the Department of Veterans Affairs (VA) approves your Statement in Support of Claim, you will be granted monthly benefits.

After granting you monthly disability benefits, the department will then assess your disability rating. This disability rating will help you qualify for a specific level of monthly disability benefits. If you are given a high rating, you will also be given high compensation.

How does the VA decide my disability rating?

The Department of Veterans Affairs will assess your disability rating through a number of factors including, but not limited to:

• Your disability’s symptom severity
• Your disability’s negative impact on your work ability
• Your disability’s negative impact on your social life
• Your disability’s negative impact on your day to day tasks
• Any secondary conditions that were obtained due to your service-related disability
• Other service-related disabilities you may have

Where to submit Form VA 21-4138?

After completely filling out the Statement in Support of Claim, you may submit it in person at your regional Veterans Affairs office. You may also submit the form through mail.

Send your Statement in Support of Claim to the address below:

Department of Veterans Affairs

Claims Intake Center

P.O. Box 4444

Janesville, WI 53547-4444

How long does it take for the VA to reach a decision?

It normally takes several months for the Department of Veterans Affairs (VA) to fully come to a decision regarding your disability benefits. According to the official website of VA, on average, you will be able to get their decision in 144.4 days.

What other documents do I need when filling out Form VA 21-4138?

To solidify your Statement in Support of Claim for disability benefits, you may submit the following documents including, but not limited to:

• Department of Veterans Affairs records related to your claimed illnesses
• Hospital records related to your claimed illnesses
• Doctor’s reports related to your claimed illnesses
• X-rays related to your claimed illnesses
• Medical test results related to your claimed illnesses
• Private medical records related to your claimed illnesses
• Supporting statements from your family, relatives, friends, clergy members, law enforcement personnel, and other people that have witnessed your claimed illnesses
• Form DD214 or your Certificate of Release or Discharge from Active Duty

These documents should show factual information about your claimed illnesses or how it’s gotten worse throughout time.

You may choose to collect these documents all by yourself or you may ask help from the Department of Veterans Affairs to collect them for you.

You are not required to submit these documents right away. You are allowed to save your form application and finish it once you are ready with your evidence. You are given 365 days from the date of your application to complete your Statement in Support of Claim and submit the needed documents.

What if this is my first time filling out a Statement in Support of Claim?

According to the official website of the Department of Veterans Affairs (VA), you are required to submit the following evidence during your first claim of disability benefits:

• A physical or mental disability proven by a medical professional
• An event, injury, or disease that occurred during your active-duty services
• A link between your physical or mental disability and said event, injury, or disease that occurred during your active-duty services

What happens if the VA denies my claim?

Having your Statement in Support of Claim denied is not uncommon. If ever this happens, you may provide more factual evidence to prove your claim and change the outcome of the department’s decision.