Department of Veterans Affairs

Fill out VA Form 21-4138 online

Statement in Support of Claim

VA Form 21-4138 is a written statement that a veteran or beneficiary sends to VA to add information to a claim. VA says to use it when another VA form or process tells you to share more information, for example family or financial details for a pension, Dependency and Indemnity Compensation (DIC) or accrued benefits claim, or details about claimed disabilities that do not fit on the original claim form.

Fill out VA Form 21-4138 Blank form from the VA

The form opens in our PDF editor with its own fields ready to type into. You can fill it in without an account; downloading the filled PDF needs a free account. A free account gets 15 credits a day, enough for one form a day.

Edition: JUL 2024
Pages: 2
Fillable fields: 33
Checked against the VA: November 8, 2026

GuruPDF is not affiliated with the Department of Veterans Affairs. This page explains the form in plain words; it is not legal or tax advice. Always check the official instructions before you file.

Who uses VA Form 21-4138

Veterans who need to add details about claimed disabilities or other issues that do not fit on the original claim form
Claimants for pension, DIC or accrued benefits who need to share more details about their family situation or finances
People telling VA about a reimbursement they received after they sent a medical expense report
Anyone another VA form or process tells to send more information in support of a claim

Before you start

The veteran's Social Security number and date of birth
The VA file number and the veteran's service number, if they apply
A phone number, an email address (optional) and a mailing address
Any VA form or notice that asked you for more information
The facts, names and dates you want to explain, written out in order

How to fill out VA Form 21-4138

Section I, items 1 to 5: identification
Enter the name of the veteran or beneficiary (first, middle initial, last) in item 1. Item 2 asks for the veteran's Social Security number, item 3 for the VA file number (if applicable), item 4 for the veteran's date of birth and item 5 for the veteran's service number (if applicable). Do not write in the VA date stamp box at the top of the page.
Section I, items 6 to 8: contact details
Give a telephone number with area code in item 6, or fill in the international phone number field if it applies. Item 7, email address, is optional. In item 8, enter the mailing address: number and street, apartment or unit number, city, state or province, country and ZIP or postal code.
Section II: remarks
Write your statement in the remarks area. The form says the statement is made in connection with a claim for benefits for the veteran or beneficiary named in Section I. The remarks area continues on page 2.
Page 2 header
Enter the veteran's Social Security number in the box at the top of page 2.
Section III, items 9 and 10: declaration of intent
By signing, you certify that the statements on the form are true and correct to the best of your knowledge and belief. Item 9 is the signature of the veteran or beneficiary and is required. Enter the date you sign in item 10, in MM/DD/YYYY format.

After you fill it out

The completed form goes to VA. The form's instructions say to mail it to VA's Evidence Intake Center at the address printed at the top of page 1. VA also lets you submit the statement online on VA.gov instead of sending the paper form. For questions, the form points to Ask VA and VA's toll-free number.

Signing: Item 9, the signature of the veteran or beneficiary, is required, and item 10 is the date signed. The form says that if you complete it by hand you should print the information in ink, but it does not say whether a digital signature is accepted on a mailed copy, so follow VA's instructions or print the form and sign it by hand.

Watch out for

The form warns that the law provides severe penalties, including a fine, imprisonment or both, for knowingly submitting a false statement or false evidence of a material fact.
Do not send the completed form to the VA Reports Clearance Officer email address printed on page 2. That address is only for comments about the time it takes to fill in the form.
VA says that in many cases there are better ways to share information or requests than this form. Its list of supporting forms can help you see whether a more specific form fits.

Questions about VA Form 21-4138

How is this form different from VA Form 21-10210?

Form 21-4138 is for sharing more information as instructed by another VA form or process, and its signature line (item 9) is for the veteran or beneficiary. VA Form 21-10210, the Lay/Witness Statement, is for a formal statement to support your own VA claim or the claim of another Veteran or eligible family member. People also call it a buddy statement.

Do I have to use this form, or can I write a letter?

VA's page on evidence for a disability claim says lay evidence can be given as a statement written on a blank piece of paper, on VA Form 21-10210 or on VA Form 21-4138. VA also says it may tell you to use Form 21-4138 in certain cases.

Can I put more than one statement on one form?

VA's page for its online version of this form says that if you want to submit more than one statement, you need to use a new form for each statement.

Do I have to give a Social Security number?

The Privacy Act notice on page 2 says VA uses the Social Security number to identify the claim file and that giving it is voluntary. It also says that refusing to give it will not by itself lead to a denial of benefits.

How do I send the form to VA?

VA's supporting forms page says this form can be submitted online or by mail. The paper form gives a mailing address for VA's Evidence Intake Center, and VA.gov has its own online version of the statement.