21-4138

Statement in Support of Claim

A general-purpose form for submitting statements, explanations, or information to support your VA claim.

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Used in these claim stages:

initial_claim supplemental_claim evidence_submission

Last updated by VA: January 1, 2024

How to Complete This Form

This versatile form is used to provide additional information or explanations to support your claim.

1. Fill in your personal information at the top
2. In the main section, write your statement clearly and specifically
3. Focus on facts, dates, and specific details
4. If describing an event, include who, what, when, where
5. Sign and date the form

This form can be used by you or by witnesses providing buddy statements.

Helpful Tips

- Be specific and detailed in your statements
- Include dates, locations, and names when possible
- Describe how your condition affects your daily life in concrete terms
- For buddy statements, have witnesses describe what they personally observed

Common Mistakes to Avoid

- Being too vague or general
- Not including specific examples
- Forgetting to sign and date
- Writing opinions instead of observations (for buddy statements)

Deadline Information

Submit with your claim or within any applicable appeal deadline.