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VA Form 21-4138 Online

Use this online workflow when you need to add a written statement or clarification to a VA benefits claim. Complete the form, review the generated PDF, and continue to mailing.

Department of Veterans Affairs · 21-4138 · July 2024

Step 1 of 5

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Not affiliated with Department of Veterans Affairs.

USPS delivery with tracking options.

Certified Mail available.

What you need

Veteran or beneficiary identifying information
Current mailing address
A clear written statement supporting the claim
Signature and date
Signed form (wet signature required)
Supporting evidence (optional) (optional) — Attach records or documents that support the statement, such as medical records, correspondence, or lay statements.

How it works

Fill out the form
Add attachments
Preview the PDF
Mail it

Where it gets mailed

We prefill the recipient for you.

Department of Veterans Affairs Evidence Intake Center

P.O. Box 4444 Janesville, WI 53547-4444

Packet order

Cover sheet (auto-generated)
Completed form PDF
Attachments (in the order you upload)

Common mistakes

Leaving the remarks section too vague to help the claim reviewer.
Forgetting to sign and date page 2.
Using an outdated mailing address for the VA Evidence Intake Center.
Omitting claimant identification details that tie the statement to the VA file.

FAQs

When should I use VA Form 21-4138?

Use VA Form 21-4138 when you need to submit a written statement, clarification, or explanation in support of a VA benefits claim.

Do I need to sign VA Form 21-4138?

Yes. The form requires the veteran or beneficiary to sign and date the declaration section on page 2.

Can I attach supporting evidence with this form?

Yes. If your statement refers to medical records, correspondence, buddy statements, or other evidence, include those attachments with your mailing.

Sources

Last verified

Last Department of Veterans Affairs verification: March 27, 2026