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The process of applying for veterans' benefits can often seem complex and daunting, but the VBA VA 21 4138 form serves as a vital tool in simplifying this journey. Officially recognized as the Statement in Support of Claim form, it plays a crucial role for veterans and their families by offering a structured means to provide necessary information and personal statements regarding their claims. This document is instrumental in communicating with the Department of Veterans Affairs (VA), allowing individuals to elaborate on their situations, clarify any circumstances surrounding their service, and highlight specific needs or considerations. Its flexibility makes it applicable to a wide array of claims, ranging from compensation and pension benefits to health care and education services. By properly completing and submitting this form, veterans take a significant step towards accessing the benefits they've rightfully earned through their service, making it an essential component of the claims process.

Preview - VBA VA 21 4138 Form

OMB Control No. 2900-0075

Respondent Burden: 15 minutes

Expiration Date: 12/31/2020

VA DATE STAMP

(DO NOT WRITE IN THIS SPACE)

STATEMENT IN SUPPORT OF CLAIM

INSTRUCTIONS: Read the Privacy Act and Respondent Burden on Page 2 before completing the form. Complete as much of Section I as possible. The information requested will help process your claim for benefits. If you need any additional room, use the second page.

SECTION I: VETERAN/BENEFICIARY'S IDENTIFICATION INFORMATION

NOTE: You will either complete the form online or by hand. Please print the information request in ink, neatly, and legibly to help process the form.

1.VETERAN/BENEFICIARY'S NAME (First, Middle Initial, Last)

2. VETERAN'S SOCIAL SECURITY NUMBER

3. VA FILE NUMBER (If applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. VETERAN'S DATE OF BIRTH (MM/DD/YYYY)

Month

 

 

Day

 

 

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. VETERAN'S SERVICE NUMBER (If applicable)

6.TELEPHONE NUMBER (Include Area Code)

7. E-MAIL ADDRESS (Optional)

8.MAILING ADDRESS (Number and street or rural route, P.O. Box, City, State, ZIP Code and Country)

No. &

Street

Apt./Unit Number

State/Province

Country

City

ZIP Code/Postal Code

SECTION II: REMARKS

(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary.)

VA FORM

21-4138

EXISTING STOCKS OF VA FORM 21-4138, JAN 2015,

Page 1

DEC 2017

WILL BE USED.

 

VETERAN'S SOCIAL SECURITY NO.

SECTION II: REMARKS (Continued)

(The following statement is made in connection with a claim for benefits in the case of the above-named veteran/beneficiary.)

SECTION III: DECLARATION OF INTENT

I CERTIFY THAT the statements on this form are true and correct to the best of my knowledge and belief.

9.SIGNATURE (Sign in ink)

10.DATE SIGNED (MM/DD/YYYY)

PENALTY: The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it to be false.

PRIVACY ACT INFORMATION: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA Programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education, and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. VA uses your SSN to identify your claim file. Providing your SSN will help ensure that your records are properly associated with your claim file. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is subject to verification through computer matching programs with other agencies.

RESPONDENT BURDEN: We need this information to obtain evidence in support of your claim for benefits (38 U.S.C. 501(a) and (b)). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 15 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

VA FORM 21-4138, DEC 2017

Page 2

Form Data

Fact Name Description
Form Identification The form in question is known as the VBA VA 21-4138, or Statement in Support of Claim.
Purpose This form is used by veterans to support a claim for benefits, providing additional evidence or clarification regarding their claim.
Users Primarily utilized by veterans or claimants seeking benefits from the Veterans Benefits Administration (VBA).
Accessibility The form can be accessed and submitted electronically through the VA's eBenefits platform or obtained in paper format at VA offices.
Submittal Process Completed forms can be submitted online, by mail, or in person at a VA office.
Governing Laws While the form itself is federal, the specific benefits and claims process it supports are governed by United States Code Title 38 – Veterans’ Benefits.

Instructions on Utilizing VBA VA 21 4138

Once the VBA VA 21-4138 form is completed and submitted, it marks a crucial step in addressing a Veteran's request or concern. This documentation acts as a means for Veterans to provide a statement in support of their claim, ensuring their voices are heard and considered in a formal manner. It's important to fill it out accurately and comprehensively, as it can significantly impact the resolution of their claims or appeals.

  1. Start by entering the Veteran's full name in the designated space at the top of the form. Ensure accuracy to avoid any potential processing delays.
  2. Proceed to fill in the Veteran's Social Security Number. This critical piece of information assists in identifying the individual's case and linking the form to the right records.
  3. Include the claim number if it's available. While not always required, providing it can facilitate a faster review process by directly associating this statement with existing claims.
  4. In the section labeled "Statement," articulate the concerns or information that need addressing. Be clear and concise, but don't hesitate to provide all necessary details that can support the claim or appeal. Remember, this narrative could play a pivotal role in the outcome.
  5. After completing the statement, review the document thoroughly. Verify the accuracy of the personal information and the completeness of the statement provided. Any discrepancies or omissions might lead to unwarranted delays.
  6. Sign and date the form in the designated areas. These actions formally certify the document, affirming the veracity of the information and the legitimacy of the statement.
  7. Lastly, submit the form to the appropriate office as directed. Submission can often be made via mail or in person, depending on the instructions provided by the Veterans Affairs office or as outlined in accompanying materials.

After submission, the document will be reviewed as part of the larger process in addressing the Veteran's claim or appeal. The individual may be contacted for further information or to clarify details in the statement provided. It's advisable to keep a copy of the completed form for personal records and future reference. Timely and accurate submission of this form helps ensure that each Veteran's case is considered with the attention and thoroughness it deserves.

Obtain Answers on VBA VA 21 4138

  1. What is the VBA VA 21-4138 form used for?

    The VBA VA 21-4138 form, also known as the Statement in Support of Claim form, is used by veterans to provide additional evidence or to clarify information related to a claim for benefits with the Department of Veterans Affairs (VA). This form allows veterans to explain circumstances or provide details that can support their claim for disability benefits, pension, education benefits, and more.

  2. How can one obtain the VBA VA 21-4138 form?

    The form can be obtained in several ways. Veterans can:

    • Download it directly from the VA's official website.
    • Request a copy through the mail by contacting the VA.
    • Visit a local VA office and pick up a form in person.

    It's important to ensure that the latest version of the form is used to avoid any processing delays.

  3. Are there any specific instructions for completing the VBA VA 21-4138 form?

    Yes, when completing the form, veterans should:

    • Be as detailed as possible when describing the evidence or circumstances related to their claim.
    • Include any relevant dates, locations, and people involved.
    • Attach any additional documentation that supports their statement.
    • Sign and date the form before submitting it to the VA.

    Providing clear and concise information can help the VA process the claim more efficiently.

  4. Where should the completed VBA VA 21-4138 form be submitted?

    The completed form, along with any supporting documentation, should be mailed to the VA regional office that handles the veteran's claim. The address for the regional office can be found on the VA's official website or by contacting the VA directly. Alternatively, the form can be submitted in person at a local VA office. Some claims may also be submitted online through the eBenefits platform.

Common mistakes

Filling out the VBA VA 21-4138 form, also known as the Statement in Support of Claim, is a critical step for veterans seeking benefits. However, common mistakes can delay the processing of your claim or even impact its outcome. Here’s a list of seven common mistakes to avoid:

  1. Not being specific enough: Many people fail to provide detailed information regarding their claim. It’s important to include specific dates, events, and how these have affected you. Vague descriptions can lead to misunderstandings about your situation.

  2. Omitting relevant information: Leaving out key pieces of information can weaken your claim. Ensure you include all relevant medical conditions, events, and circumstances related to your claim.

  3. Failing to proofread: Simple mistakes such as typos, incorrect dates, or inaccurate information can lead to processing delays or requests for clarification. Always review your form before submission.

  4. Using the wrong form: The VA offers many forms for different types of claims. Using the wrong one could result in your claim being misdirected or not processed at all. Make sure the VBA VA 21-4138 is the correct form for your specific claim.

  5. Not signing the form: An unsigned form is incomplete to the VA and will not be processed. Ensure you sign and date the form where required.

  6. Forgetting to include supporting documents: The VA needs evidence to support your claim. Failing to attach medical records, service documents, or other supportive documentation can significantly delay the process.

  7. Lack of organization: Submitting a disorganized claim can make it difficult for the VA to review your case. Organize your evidence in a clear and logical manner to facilitate a smoother review process.

Avoiding these common mistakes can enhance the likelihood of a favorable outcome for your claim. Attention to detail and providing complete, accurate information is key when filling out the VBA VA 21-4138 form.

Documents used along the form

When dealing with the Veterans Affairs (VA) for compensation or pension claims, the VBA VA 21-4138 form, also known as the Statement in Support of Claim, is a commonly used document. It allows veterans to provide additional information that might help their case. However, this form is often not the only document used in the process. Several other forms and documents play crucial roles in supporting and strengthening a veteran's claim. Understanding these documents can significantly impact the outcome of a claim.

  • VBA VA 21-526EZ - Application for Disability Compensation and Related Compensation Benefits. This form is the starting point for veterans filing for disability benefits. It requires detailed information about their service and the disabilities they claim are connected to that service.
  • VBA VA 22-1995 - Request for Change of Program or Place of Training. Veterans or beneficiaries using the GI Bill might need this form to change their educational or training institution. It ensures their benefits are correctly applied to their new program or school.
  • DD Form 214 - Certificate of Release or Discharge from Active Duty. This document is critical for nearly all VA benefit claims. It provides verification of military service, including dates, type of discharge, and reasons for leaving the service. A veteran's eligibility for most VA benefits hinges on the information contained in this document.
  • VBA VA 21-8940 - Veteran’s Application for Increased Compensation Based on Unemployability. This form is essential for veterans seeking to obtain benefits at the 100% disability rate, under the Total Disability Individual Unemployability (TDIU) criteria, because they are unable to maintain employment due to service-connected disabilities.
  • Medical Records/Evidence - Though not a form, submitting medical evidence including doctor’s reports, hospital records, and other medical tests, directly supports the claim's basis. These records illustrate the severity of conditions claimed and establish a direct connection to military service.

While navigating the VA claims process can be daunting, understanding and accurately completing the necessary forms and documents can lead to a successful outcome. The above-listed forms are often used together with the VBA VA 21-4138 form to provide a comprehensive picture of a veteran’s claim for benefits. It’s always beneficial to seek guidance and ensure all submitted information is clear, accurate, and supportive of the claim.

Similar forms

  • VA Form 10-10EZ, Application for Health Benefits: This document is used by veterans to apply for health benefits through the Department of Veterans Affairs (VA), similar to how the VA Form 21-4138 is used for submitting statements in support of claims. Both forms serve as crucial means for veterans to initiate or support requests for VA benefits.

  • SSA-827, Authorization to Disclose Information to the Social Security Administration: Like the VA Form 21-4138, this form is an authorization document that allows the release of personal information, but in this case, to the Social Security Administration. Both forms facilitate the processing of benefits by allowing the relevant authorities access to necessary personal details.

  • VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits: This document shares similarities with VA Form 21-4138 as both are used by veterans to apply for benefits. However, Form 21-526EZ specifically pertains to disability compensation, whereas Form 21-4138 can support a wider range of veteran benefits claims by providing additional evidence or clarification.

  • VA Form 22-1995, Request for Change of Program or Place of Training: Used by veterans to request changes to their education benefits, this form, like the VA Form 21-4138, plays a role in modifying existing VA benefits. Both forms are vital tools for veterans seeking to adjust their benefits according to changing needs or circumstances.

  • IRS Form 4506-T, Request for Transcript of Tax Return: While primarily a tax document, IRS Form 4506-T is similar to the VA Form 21-4138 in that it allows individuals to request vital information be sent to a third party, in this case, tax return transcripts to lenders or other authorized entities. Both forms facilitate the presentation of personal information to support applications for benefits or services.

  • HUD-1 Settlement Statement: This form is used in real estate transactions to itemize services and fees charged to the borrower by the lender. Similar to VA Form 21-4138, which supports claims for benefits with detailed statements, the HUD-1 assists in the clear understanding of charges and payments during property transactions.

  • FAFSA (Free Application for Federal Student Aid): Although targeting a different audience, the FAFSA is similar to the VA Form 21-4138 in terms of its objective to secure financial aid. Both forms are fundamental in the process of applying for financial assistance, with the FAFSA focusing on educational support and the VA Form 21-4138 on veterans' benefits.

Dos and Don'ts

When filling out the VBA VA 21-4138 form, a Statement in Support of Claim for veterans seeking to present evidence or clarify information related to their benefits claims, attention to detail is paramount. This document serves as a direct communication line with the Department of Veterans Affairs, ensuring that the provided information is clear, concise, and relevant, which will assist in the expeditious and accurate processing of claims. Below are essential guidelines to follow and pitfalls to avoid in order to ensure the effectiveness of your submission.

Five Things You Should Do:

  1. Provide Complete Information: Ensure all fields are filled out accurately. Include your full name, Social Security number, and any claim numbers assigned to your case. Omitting this information could delay the processing of your form.
  2. Be Specific: When explaining the circumstances or providing evidence pertaining to your claim, offer detailed information. Dates, locations, and detailed descriptions of incidents or conditions that support your claim are invaluable.
  3. Stay Focused: Only include information that is relevant to your claim. While it may be tempting to include additional details, focus on the facts that directly affect your case.
  4. Proofread: Before submission, review your form for errors. Spelling mistakes or unclear handwriting can lead to misunderstandings or processing delays.
  5. Sign the Form: Your signature attests to the veracity of the information provided and is necessary for the form to be processed. Ensure you sign and date the form in the designated area.

Five Things You Shouldn't Do:

  1. Leave Sections Blank: If a section does not apply to you, write “N/A” (not applicable) instead of leaving it blank. This indicates to the reviewer that you did not mistakenly overlook the section.
  2. Use Jargon or Acronyms: Avoid using military slang, acronyms, or complex legal terminology that may not be universally understood by the VA staff processing your claim.
  3. Submit Unnecessary Information: Do not attach documents or add testimonials that are not directly relevant to your claim. This can distract from the critical elements of your case.
  4. Express Frustration or Anger: Keep the tone of your statement objective and professional. Emotional statements, while understandable, can detract from the clarity and effectiveness of your communication.
  5. Forget to Make Copies: Always keep a copy of the completed form and any supporting documents for your records before submission. This ensures you have a backup in case the original is lost or misplaced.

Misconceptions

The VBA VA 21-4138 form, also known as the Statement in Support of Claim, is a vital document used by veterans seeking to provide additional evidence or clarification for their claims with the Veterans Benefits Administration. Several misconceptions surround the usage and importance of this form, which can potentially hinder the efficacy and outcome of veterans' claims. Here, we aim to dispel some of these common misunderstandings.

  • Misconception 1: The form is only for initial claims. In reality, the VBA VA 21-4138 form can be used at any point in the claims process - whether at the initial filing, in response to a request for more information, or to support an appeal.
  • Misconception 2: More is always better. While it's important to provide thorough information, only relevant details that directly support the claim should be included. Excessive or irrelevant information can actually delay the review process.
  • Misconception 3: The form is optional and doesn't significantly impact the claims process. On the contrary, a well-prepared statement can substantively aid in clarifying the specifics of a claim, potentially leading to a more favorable outcome.
  • Misconception 4: Legal representation is required to complete the form. Veterans can fill out and submit this form on their own. However, consulting with a Veterans Service Officer (VSO) or legal advisor can help in preparing a more effective statement.
  • Misconception 5: The form can substitute for official medical records or evidence. Although the VBA VA 21-4138 is a critical component of the claims process, it is meant to supplement official records and evidence, not replace them.
  • Misconception 6: A claim will be approved faster if submitted without the VBA VA 21-4138 form. In reality, if additional evidence or clarification is necessary, not including this form might slow down the process, as the VA may have to request additional information.
  • Misconception 7: Filling out the form is complex and time-consuming. The form is designed to be straightforward, allowing veterans to explain their situation in their own words without the need for legal terminology or extensive documentation.
  • Misconception 8: Handwritten statements are less effective than typed ones. The VA reviews handwritten and typed statements equally. The key is clarity and relevance of the information provided, not the mode of submission.
  • Misconception 9: Electronic submission of the VBA VA 21-4138 is unavailable or not recommended. Electronic submissions through the VA's online portal are accepted and can expedite the processing of the claim.

Understanding these misconceptions and leveraging the VBA VA 21-4138 form effectively can greatly influence the outcome of a veteran's claim. Accurate, concise, and relevant information is the cornerstone of a strong support statement, helping to streamline the claims process and improve the odds of a favorable decision.

Key takeaways

The VBA VA 21-4138 form, often referred to as the Statement in Support of Claim, serves as a critical document for individuals seeking to provide additional evidence or clarification to support their claim with the Department of Veterans Affairs (VA). Here are five key takeaways to ensure its proper use and completion:

  • Understand the Purpose: This form is designed to allow veterans and claimants to provide narrative evidence that supports their claim for benefits. It can be used to elaborate on the details of an event related to service, explain the circumstances of a disability, or provide further clarification to previously submitted evidence.
  • Complete All Sections: Make sure to fill out each section of the form thoroughly. Provide your full name, Social Security number, and VA file number if available. Be as detailed as possible when describing the incident or facts supporting your claim. This detail aids the VA in understanding your situation better and in processing your claim more efficiently.
  • Be Clear and Concise: When detailing your account of events or explaining your disability, clarity, and conciseness are key. Avoid ambiguous language and keep your explanations straightforward. This assists VA representatives in accurately evaluating your claim.
  • Attach Supporting Documents: Although not always required, attaching relevant medical records, service documents, or other evidence that supports your statement can be very helpful. Ensure that these documents are well-organized and clearly referenced in your statement on the form.
  • Sign the Form: Your signature is required to validate the form. Signing the VBA VA 21-4138 form confirms that the information provided is true and accurate to the best of your knowledge. Unsigned forms may lead to delays in the processing of your claim.

By closely following these guidelines, claimants can effectively use the VBA VA 21-4138 form to support their claim, potentially expediting the review process and improving the chances of a favorable outcome.

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