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VA Form 21-4138: Statement in Support of Claim

VA Form 21-4138 is the general purpose statement form for VA benefit claims. Veterans and other claimants use it to give VA information in their own words that does not fit on the claim form itself.

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What is VA Form 21-4138?

VA Form 21-4138, Statement in Support of Claim, is a two page form with a large free text block where a claimant can explain anything relevant to a pending or planned claim: how a disability began, details about family finances, corrections to earlier submissions, or answers to a VA request for more information. It works across benefit types, including disability compensation, pension, and Dependency and Indemnity Compensation.

The statement is signed under penalty of law, so it carries evidentiary weight. VA now prefers more specific forms for some uses, and the current edition, dated July 2024, notes that witness or "buddy" statements from someone other than the claimant belong on VA Form 21-10210 instead.

Who files VA Form 21-4138?

Veterans adding an explanation or details to a disability, pension, or other VA claim
Survivors and family members responding to a VA request for more information
Claimants correcting or updating something they reported earlier
Anyone whose supporting statement does not have a more specific VA form

How to fill out VA Form 21-4138

Fill in your name, Social Security number, VA file number, and contact information at the top.
Write your statement in the remarks block. Identify the claim it relates to and stick to facts, dates, and specifics.
Sign and date the certification. An unsigned statement cannot be accepted as evidence.
Download the completed PDF and keep a copy for your records.
Upload it to your claim through va.gov or QuickSubmit, or mail it to the VA Claims Intake Center address in the form instructions.

Quick fill VA Form 21-4138 on this page

Prefer to see the form itself while you type? Open VA Form 21-4138 in the editor to fill it on the actual pages, add a signature, and download.

These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to VA.

Page 1 25 fields

Read Instructions above. SECTION 1: VETERAN / BENEFICIARY'S IDENTIFICATION INFORMATION. Read Note above. 1. VETERAN / BENEFICIARY'S NAME

1. VETERAN / BENEFICIARY'S NAME. Middle Initial. 1 character max.

1. VETERAN / BENEFICIARY'S NAME. Last Name. 18 characters max.

2. VETERAN'S SOCIAL SECURITY NUMBER. Enter First Three Digits.

2. VETERAN'S SOCIAL SECURITY NUMBER. Enter Middle Two Digits.

2. VETERAN'S SOCIAL SECURITY NUMBER. Enter Last Four Digits.

3. V. A. FILE NUMBER (If applicable). Enter 9 digit file number.

4. VETERAN'S DATE OF BIRTH. Enter 2 digit Month.

4. VETERAN'S DATE OF BIRTH. Enter 2 digit day.

4. VETERAN'S DATE OF BIRTH. Enter 4 digit year.

5. Veteran's Service Number (If applicable). Enter 9 digits.

6. TELEPHONE NUMBER (Include Area Code). Enter three digits of Area Code.

6. TELEPHONE NUMBER (Include Area Code). Enter middle three digits.

6. TELEPHONE NUMBER (Include Area Code). Enter last four digits.

6. Enter International Phone Number (If applicable).

7. E-MAIL ADDRESS (Optional). Line 1 of 2. 20 characters max.

7. E-MAIL ADDRESS (Optional). Line 2 of 2. 20 characters max.

8. MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country). Number and Street. 30 characters max.

8. MAILING ADDRESS. Apartment or Unit Number. 5 characters max.

8. MAILING ADDRESS. City. 18 characters max.

8. MAILING ADDRESS. State or Province. 2 characters max.

8. MAILING ADDRESS. Country. 2 characters max.

8. MAILING ADDRESS. ZIP or Postal Code. First 5 digits.

8. MAILING ADDRESS. ZIP or Postal Code. Last 4 digits.

SECTION 2: REMARKS (The following statement is made in connection with a claim for benefits in the case of the above named veteran /

Page 2 4 fields

SECTION 2: REMARKS (Continued). The following statement is made in connection with a claim for benefits in the case of the above named

10. DATE SIGNED. Enter 2 digit Month.

10. DATE SIGNED. Enter 2 digit day.

10. DATE SIGNED. Enter 4 digit year.

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Frequently asked questions

What should I use VA Form 21-4138 for?

Use it when VA asks you for more information, or when you need to explain something about your claim in your own words and no specific form exists for it. For a first-time disability claim use VA Form 21-526EZ, and for statements from witnesses supporting your claim use VA Form 21-10210.

Can someone else write a buddy statement on this form?

VA prefers that lay and witness statements from people other than the claimant go on VA Form 21-10210. A statement on 21-4138 will still be considered, but using the dedicated form helps VA process it correctly.

Is there a limit to how much I can write?

The form has a fixed remarks block plus a continuation area on the second page. If you need more room, you can attach additional pages; put your name and file number on each one so they stay with your claim.

VA Form 21-4138: Statement in Support of Claim

What is VA Form 21-4138?

Who files VA Form 21-4138?

How to fill out VA Form 21-4138

Quick fill VA Form 21-4138 on this page

Frequently asked questions

Related forms

VA Form 21-10210: Lay/Witness Statement

VA Form 21-526EZ, Application for Disability Compensation

VA Form 20-0995: Decision Review Request: Supplemental Claim