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U.S. Department of Veterans Affairs (VBA) Edition VA Form 21-4138, JUL 2024 (OMB No. 2900-0075, expires 07/31/2027) 2 pages

VA Form 21-4138 — Statement in Support of Claim

VA's general-purpose form for telling VA more about your claim in your own words.

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VA Form 21-4138 · Statement in Support of Claim
The official U.S. Department of Veterans Affairs (VBA) form, edition VA Form 21-4138, JUL 2024 (OMB No. 2900-0075, expires 07/31/2027) — blank
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VA Form 21-4138 (2024) Statement in Support of Claim — page 1 of 2
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VA Form 21-4138 (2024) Statement in Support of Claim — page 2 of 2
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Fill This Form Online Blank PDF from U.S. Department of Veterans Affairs (VBA)

What is VA Form 21-4138?

VA Form 21-4138 is a written statement to the Department of Veterans Affairs in support of a claim for benefits. VA's form page says to use it when another VA form or process tells you to share more information: details about your family situation or finances for pension, Dependency and Indemnity Compensation or accrued benefits, a reimbursement you received after you submitted a medical expense report, or more about claimed disabilities or other issues that can't fit on the original claim form.

The form has three sections: the veteran's or beneficiary's identification information, a Remarks section for the statement itself (with a continuation on page 2), and a declaration that the statements are true and correct, signed and dated.

VergeHR pre-fills the name, date of birth and email from the person's employee record, prints your statement across the page 1 Remarks box and its page 2 continuation, and puts everything onto VA's own PDF (JUL 2024 edition). It saves the finished form in the person's folder in Files. You can sign it by hand or send it for eSignature in VergeHR, then mail it yourself; VergeHR never submits anything to VA.

Who fills it
The veteran or beneficiary the claim is about.
Pages
2: identification and remarks, then remarks continued and the signature.
Mail to
Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444 (printed on the form).
Online option
VA's form page says you can also submit a statement in support of claim online.
Edition
VA Form 21-4138, JUL 2024 (OMB No. 2900-0075, expires 07/31/2027)

Who needs to fill out VA Form 21-4138?

  • Veterans who need to add information to a disability compensation or pension claim.
  • Survivors and other beneficiaries giving VA more detail on family or financial circumstances for pension, DIC or accrued benefits.
  • Anyone a VA letter or another VA form has asked for a written statement.

When to Use VA Form 21-4138

  • When another VA form or process instructs you to share more information.
  • To explain your family situation or finances for pension, DIC or accrued benefits.
  • To tell VA about a reimbursement you received after submitting a medical expense report.
  • To describe claimed disabilities or other issues in more detail than the claim form allows.
  • For a statement from someone other than the claimant, VA's page points to VA Form 21-10210, the Lay/Witness Statement.

What You Need Before You Start

  • The veteran's name, Social Security number and date of birth, and the VA file number and service number if they apply.
  • A phone number, an email address (optional) and the current mailing address.
  • What you want to tell VA: which claim or request the statement is about, and the facts, dates and places that support it.

What’s On VA Form 21-4138

The 2024 edition has 2 pages. VergeHR asks for it in 3 parts, and it is signed by Veteran or beneficiary:

  1. Section I: Veteran/beneficiary's identification informationVeteran or beneficiary
  2. Section II: RemarksVeteran or beneficiary
  3. Section III: Declaration of intent and signatureVeteran or beneficiary

How to fill out VA Form 21-4138, step by step

1 Section I: Identification

Items 1 to 8: the veteran's or beneficiary's name, the veteran's Social Security number, VA file number, date of birth and service number, then phone, email and mailing address. The form asks for one letter per box when filled by hand; VergeHR prints them that way.

2 Section II: Remarks

Write your statement. The page 1 box continues on page 2 under 'Remarks (Continued)'. VergeHR splits a long statement across both for you and tells you if it won't fit.

3 Section III: Declaration and signature

The signer certifies the statements are true and correct to the best of their knowledge and belief, signs item 9 and dates item 10.

Common Mistakes to Avoid

  • Leaving out the Social Security number or VA file number, so VA can't match the statement to the claim.
  • Not saying which claim or VA request the statement supports.
  • Forgetting to sign item 9, which the form marks as required.
  • Using this form for a buddy or witness statement from someone else, when VA Form 21-10210 is meant for that.
  • Mailing it somewhere other than the Evidence Intake Center address printed on the form.

After You Fill It Out

Sign and date the form, by hand or through VergeHR's eSignature.

Mail it to the Evidence Intake Center address printed on the form, or use VA's online option instead.

Keep a copy. VergeHR files the finished PDF in the person's folder in Files with the rest of the claim paperwork.

Fill Out VA Form 21-4138 Online with VergeHR

  1. Pick the employee. Choose an employee and VergeHR fills in their name, date of birth, email and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 20 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real U.S. Department of Veterans Affairs (VBA) form, and let VergeHR do any worksheet arithmetic.
  4. Generate the official PDF. VergeHR prints your answers into the agency’s own PDF and files it with that employee’s documents. Sign it, or send it for e-signature.

VergeHR fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

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VA Form 21-4138: frequently asked questions

What is VA Form 21-4138 used for?

To give VA more information in support of a claim when another VA form or process asks for it, for example about family situation or finances, a reimbursement after a medical expense report, or more detail about claimed disabilities.

Can I submit VA Form 21-4138 online?

VA's form page says you can submit a statement in support of claim online instead of mailing the paper form. VergeHR prepares the paper form if you prefer to mail it.

Where do I mail VA Form 21-4138?

The form says to mail it to Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.

Can a friend or family member use this form to support my claim?

VA's page lists VA Form 21-10210, the Lay/Witness Statement, for a formal statement supporting your claim or someone else's, sometimes called a buddy statement.

What if my statement is longer than the form?

The Remarks box continues on page 2. If that's not enough, use another 21-4138 for the rest.

Do I have to give my Social Security number?

The Privacy Act notice says giving your SSN is voluntary and refusing won't by itself lead to a denial of benefits, but VA uses it to identify your claim file.

Official Sources

VergeHR is not affiliated with or endorsed by U.S. Department of Veterans Affairs (VBA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-01.

Fill Out VA Form 21-4138 Online