21-4138

Statement in Support of Claim (VA Form 21-4138)

Agency
VA
Revision
July 2024
Fillable fields
33
Pages
2
Official source
VA form page
Checked
October 20, 2026
Fill 21-4138 online
Page 1 of form 21-4138

VA Form 21-4138: Statement in Support of Claim

VA Form 21-4138 is the U.S. Department of Veterans Affairs Statement in Support of Claim. It gives a Veteran or beneficiary space for a written statement made in connection with a claim for VA benefits. VA's form page says to use it to share more information as instructed by another VA form or process.

VA's page gives examples: more details about a family situation or finances for pension, Dependency and Indemnity Compensation or accrued benefits, reimbursement received after a medical expense report, and details about claimed disabilities or other issues that can't fit on the original claim form.

The form is two pages. Section I identifies the Veteran or beneficiary, Section II holds the remarks and continues on page 2, and Section III is the certification and signature. VA's page says the statement can also be submitted online. You can fill out the PDF free in your browser on this page and download the result without an account.

Top of page 1 of VA Form 21-4138: Statement in Support of Claim, as printed by VA

What's on VA Form 21-4138

Items 1 to 5: identification

The Veteran's or beneficiary's name, the Veteran's Social Security number, the VA file number if there is one, the Veteran's date of birth and service number.

Items 6 to 8: contact details

Telephone number, with a place for an international number, an optional email address and a mailing address.

Section II: remarks

Open space for the statement, made in connection with a claim for benefits in the case of the Veteran or beneficiary named in Section I. It continues on page 2.

Section III: certification and signature

A certification that the statements are true and correct to the best of your knowledge and belief, the required signature in Item 9 and the date in Item 10.

Penalty and privacy notices

Page 2 states the penalty for willfully submitting a false statement, the Privacy Act information and a respondent burden of about 15 minutes.

How to file VA Form 21-4138

  1. 1

    Fill in Section I

    Enter the identification and contact details. If completed by hand, the form asks for ink, neat and legible printing and one letter per box.

  2. 2

    Write your statement

    Use the Section II remarks space on page 1 and its continuation on page 2.

  3. 3

    Sign and date it

    Sign Item 9, which the form marks as required, and enter the date in Item 10.

  4. 4

    Mail it or submit online

    Mail it to the Evidence Intake Center in Janesville, Wisconsin, or submit the statement online through VA's form page.

Why fill Form 21-4138 on indox

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Where to send it

By mail

Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.

Online

VA's form page says you can submit your statement in support of claim online instead of filling out and sending the paper form.

Questions

The form points to Ask VA at ask.va.gov and the toll-free number 800-827-1000 (TTY: 711).

Edition

The July 2024 edition supersedes the June 2021 edition. It carries OMB Control No. 2900-0075, which expires 07/31/2027.

Related forms

Who uses VA Form 21-4138?

  • Pension, DIC and accrued benefit claimants

    To share more details about a family situation or finances for applications or claims related to pension, Dependency and Indemnity Compensation or accrued benefits.

  • People who sent a medical expense report

    To tell VA about reimbursement received after a medical expense report was submitted.

  • Disability claimants

    To share more details about claimed disabilities or other issues in support of a claim that can't fit on the original claim form.

  • Anyone directed by another VA form

    VA's page says the form is used to share more information as instructed by another VA form or process.

  • Witnesses use a different form

    VA's page lists VA Form 21-10210, Lay/Witness Statement, for a formal statement supporting your claim or another Veteran's or family member's claim, sometimes called a buddy statement.

VA's form page gives these examples of when the form may be needed.

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Questions about Form 21-4138

What is VA Form 21-4138 used for?

VA's form page says to use it to share more information as instructed by another VA form or process, for example details about claimed disabilities that can't fit on the original claim form.

Can I submit VA Form 21-4138 online?

Yes. VA's form page says you can submit your statement in support of claim online instead of filling out and sending the paper form.

Is VA Form 21-4138 a buddy statement?

No. VA's page lists VA Form 21-10210, Lay/Witness Statement, as the form for a formal statement that people sometimes call a buddy statement.

Does the statement need a signature?

Yes. Item 9, the signature of the Veteran or beneficiary, is marked required, and Section III certifies that the statements are true and correct to the best of your knowledge and belief.

What if my statement does not fit on page 1?

The Section II remarks space continues on page 2 of the form.

Where do I mail VA Form 21-4138?

The form lists Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.