Form 21-4138 is the Statement in Support of Claim that the U.S. Department of Veterans Affairs (VA), through the Veterans Benefits Administration, accepts when a veteran or beneficiary needs to add a written statement to a claim for benefits. It is the form VA points to when another VA form or process asks for more information, or when details do not fit on the original claim form. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form itself and the online alternative are published by VA.
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What is 21-4138?
Statement in Support of Claim (VA Form 21-4138) is the Department of Veterans Affairs (VA) form used to submit a written statement that supports a claim for benefits, with identification of the veteran or beneficiary, a remarks section and a signed declaration that the statement is true.
The form has three parts. Section I identifies the veteran or beneficiary (lines 1 to 8). Section II, Remarks, is the free-text space for the statement itself and continues on a second block. Section III, Declaration of Intent, holds the signature and date (lines 9 and 10). The revision printed on the form is JUL 2024, which supersedes the JUN 2021 edition. It is issued under OMB Control No. 2900-0075, which expires 07/31/2027.
VA's page for the form lists the areas it relates to: careers and employment, disability, education and training, health care, housing assistance, life insurance and pension. The form is a general-purpose statement, not a claim by itself.
VA Form 21-4138 differs from VA Form 21-10210, Lay/Witness Statement, which VA describes as the form for a formal statement supporting your claim or the claim of another Veteran or eligible family member, sometimes called a "buddy statement." VA also publishes VA Form 20-10207, Priority Processing Request, and VA Form 20-10206, Freedom of Information Act (FOIA) or Privacy Act (PA) Request, which serve different purposes.
Who needs to file 21-4138?
Veterans and beneficiaries who want to put information in writing in support of a claim use this form. VA's page gives examples of when it fits:
- You need to share more details about your family situation or finances for applications or claims related to pension, Dependency and Indemnity Compensation, or accrued benefits.
- You want to tell VA about reimbursement you received after you submitted a medical expense report.
- You need to share more details about claimed disabilities or other issues that cannot fit on the original claim form.
- Another VA form or process tells you to use VA Form 21-4138 to share more information.
The signature line (line 9) is labeled as the signature of the veteran or beneficiary and is marked required. The form does not describe any other signer or representative.
If you are writing a statement for another Veteran's or family member's claim as a witness, VA's page points to VA Form 21-10210, Lay/Witness Statement, instead.
When to file 21-4138
Use Form 21-4138 when another VA form or process instructs you to provide additional information, or when what you need to say does not fit on the original claim form. The form prints no due date of its own, so the timing follows the claim or VA request it supports. VA's page says the statement is made in connection with a claim for benefits, so have the claim in mind, and the VA file number if you have one, before you start. If a VA letter or form that asked for the statement sets a deadline, that deadline governs.
How to fill out 21-4138
Read the instructions and privacy notice
Before you start, read the Privacy Act and Respondent Burden notice on page 2. You may complete the form online or by hand; if by hand, print in ink, neatly, one letter per box.
Enter the veteran or beneficiary's name
Line 1: first name, middle initial and last name of the veteran or beneficiary.
Enter SSN, file number and birth date
Line 2: Social Security number in the format 999-99-9999. Line 3: VA file number, if applicable. Line 4: the veteran's date of birth as MM/DD/YYYY.
Add service number and contact details
Line 5: the veteran's service number, if applicable. Line 6: telephone number with area code, (999) 999-9999, or the international number if applicable. Line 7: e-mail address, which is optional.
Complete the mailing address
Line 8: number and street, apartment or unit number, city, state or province, country and ZIP code or postal code.
Write your statement in Section II
In Remarks, write the statement you are making in connection with the claim for benefits of the named veteran or beneficiary. Use the continuation block if you need more room.
Sign and date the declaration
Section III: sign on line 9, which is required, and enter the date on line 10 as MM/DD/YYYY. Signing certifies that the statements are true and correct to the best of your knowledge and belief.
Review and download the completed PDF
Check names, numbers and dates, then download or print the completed PDF from FillingPDF and send it through one of the channels described under How to submit.
How to submit 21-4138
You can submit a statement in support of claim by mail or through VA's online tool.
- By mail: after completing the form, mail it to Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
- Online: VA says you can submit your statement in support of claim online instead of filling out and sending the paper form, at https://www.va.gov/supporting-forms-for-claims/submit-statement-form-21-4138/.
- Questions: contact VA through Ask VA at https://ask.va.gov/ or call toll-free 800-827-1000 (TTY: 711). VA forms are available at www.va.gov/vaforms.
Do not send the completed form to the VA Reports Clearance Officer email address printed on page 2; that address is only for comments on the respondent burden estimate. FillingPDF lets you fill out and download the PDF; submission follows the VA channels above.
Common mistakes to avoid
- Submitting the form without the veteran or beneficiary's signature on line 9, which the form marks as required.
- Leaving off the date signed on line 10 or writing it in a format other than MM/DD/YYYY.
- Mailing the completed form to the VA Reports Clearance Officer email address on page 2, which is only for comments on the burden estimate.
- Printing by hand in pen that is not ink, or writing more than one character per box, when you fill out the paper form by hand.
- Omitting the VA file number on line 3 when you have one.
- Using this form for a lay or witness statement about another person's claim, when VA directs that to VA Form 21-10210.
- Using the superseded JUN 2021 edition instead of the current JUL 2024 revision.
- Writing a false statement: the form warns of fine or imprisonment, or both, for willfully submitting false evidence of a material fact.
Frequently asked questions
What is VA Form 21-4138 used for?
VA Form 21-4138, Statement in Support of Claim, is used to give VA a written statement that supports a claim. VA says to use it to share more information as instructed by another VA form or process, or to add details that cannot fit on the original claim form.
Can I fill out Form 21-4138 online?
Yes. You can fill out the PDF online on FillingPDF and download or print it; the form itself says it may be completed online or by hand. VA also offers its own online tool for submitting the statement. FillingPDF does not send the form to VA.
Where do I mail VA Form 21-4138?
Mail it to Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. For questions, use Ask VA at https://ask.va.gov/ or call 800-827-1000 (TTY: 711).
Do I have to sign the Statement in Support of Claim?
Yes. Line 9, the signature of the veteran or beneficiary, is marked required, and line 10 asks for the date signed as MM/DD/YYYY. By signing you certify the statements are true and correct to the best of your knowledge and belief.
Is my Social Security number required on Form 21-4138?
Giving your SSN is voluntary, according to the form's Privacy Act notice, and refusing to provide it by itself will not result in denial of benefits. VA uses the SSN to identify your claim file and match your records to it.
What is the difference between 21-4138 and 21-10210?
Form 21-4138 is a statement in support of your own claim. VA Form 21-10210, Lay/Witness Statement, is the form VA describes for a formal statement supporting your claim or the claim of another Veteran or eligible family member, often called a buddy statement.
How long does it take to complete VA Form 21-4138?
VA estimates an average of 15 minutes per respondent, per year, including time for reviewing instructions, gathering data and completing the form. Your time depends on the length of your remarks.
Is there a deadline to file a statement in support of claim?
The form prints no deadline of its own. You submit it in connection with a claim or when another VA form or process asks for more information, so any deadline comes from that claim or VA's request.
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