Free VBA VA 21 4138 Form in PDF

Free VBA VA 21 4138 Form in PDF

The VBA VA 21 4138 form, also known as the Statement in Support of Claim, is a crucial document used by veterans to provide additional evidence or to clarify information concerning their benefits claims with the Department of Veterans Affairs (VA). This form plays a significant role in ensuring that veterans receive the support and benefits they deserve by allowing them to elaborate on their claim or to highlight specific areas that require further attention. For those looking to supplement their claims, understanding how to properly fill out and submit this form is key. Click here to learn more about filling out the VBA VA 21 4138 form.

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The VBA VA 21 4138 form serves as a vital piece of documentation in the lives of veterans seeking benefits and services from the Veterans Affairs (VA). This form, often seen as a bridge between veterans and the support they deserve, is used primarily to submit a statement in support of a claim. It provides a structured way for veterans to furnish additional information that may affect the decision on their claim, ranging from service-related injuries to personal hardships that impact their ability to work. The flexibility of the form allows for a wide array of information to be communicated, including but not limited to, new evidence, clarification of circumstances, or any changes in a veteran’s condition. As such, it plays a significant role in the VA's evaluation process, ensuring that all relevant details are considered. The importance of this form cannot be understated, as it often contributes to the successful resolution of claims, facilitating a smoother interaction with the VA and helping veterans to access the benefits they require efficiently.

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

Document Specs

Fact Description
Purpose of the Form The VBA VA 21-4138 form is utilized by veterans to provide supplemental statements to support claims for benefits, allowing them to furnish additional evidence and explanations regarding their case.
Who Uses It This form is specifically designed for use by veterans who are seeking to add further evidence or clarification to existing claims with the Department of Veterans Affairs.
What It Supports It supports a variety of claims, including but not limited to, compensation, pension, education benefits, and healthcare claims, serving as a versatile tool for veterans to communicate their needs.
Accessibility The form is accessible through the U.S. Department of Veterans Affairs website, making it easily obtainable for veterans nationwide.
Federal Regulation The usage and processing of the VBA VA 21-4138 form are governed by federal laws applicable to the Department of Veterans Affairs, ensuring consistent handling across all states.

Instructions on Writing VBA VA 21 4138

After gathering the necessary information and preparing to detail your circumstances, the next step is to fill out the VBA VA 21-4138 form. This form is a valuable tool for communicating details pertinent to your case. Clear and precise completion of this form supports the effective processing of your submission. Here are the steps required to successfully fill out the VBA VA 21-4138 form:

  1. Start by entering your full name, including first, middle, and last names, to ensure your form is attributed to the correct individual.
  2. Include your Social Security Number (SSN) next. This critical piece of information helps in verifying your identity and linking your form to your records.
  3. Provide your VA file number if it differs from your SSN. This number is essential for those who have a separate file number assigned to their case.
  4. Fill in your current address, complete with street name and number, city, state, and ZIP code. Accurate address information ensures any correspondence related to your case reaches you without delay.
  5. Enter your service number if applicable. This is especially relevant for individuals whose service predates the use of SSN or for those who served in certain capacities.
  6. Date the form to document when the information was provided, lending context to your submission.
  7. Detail the information pertinent to your case in the space provided. Be as clear and thorough as possible. This section is where you convey the specifics of your situation, needs, or requests.
  8. Sign the form. Your signature is crucial as it validates the form and authorizes action based on its contents.

Once you have completed these steps, review the form to ensure all information is correct and fully represented. Your careful attention to details and specifics can significantly affect the processing and outcome of your submission. Following submission, the relevant department will review your form and take the necessary steps based on the information you have provided.

Understanding VBA VA 21 4138

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, is primarily used by veterans to provide additional information or to clarify information related to a claim they have submitted to the Department of Veterans Affairs (VA). This form can serve as a critical piece of evidence for claims processing, allowing veterans to explain the specifics of their situation, the impact of their service-connected conditions on their lives, or any other details that might support their claim for benefits.

How can I submit the VBA VA 21-4138 form?

The form can be submitted in several ways to the VA. Veterans may choose to mail the completed form directly to the VA regional office that handles their claim. Alternatively, the form can be submitted in person at a local VA office. For those seeking convenience and faster processing, the VA also accepts submissions through their online platform, eBenefits, or through the VA's digital claim submission system, allowing veterans to easily upload and submit the form electronically along with any other supporting documents for their claim.

What information should be included on the VBA VA 21-4138 form?

When completing the VBA VA 21-4138 form, it is essential to provide detailed information that supports your claim. This includes your full name, Social Security number, and VA file number if applicable. Clearly state the purpose of your statement and then provide a thorough explanation of the evidence you are presenting or the information you are clarifying. It's crucial to be as specific as possible regarding dates, locations, and how your service has impacted your health and well-being. Finally, ensure that you sign and date the form before submission.

Can someone else fill out the VBA VA 21-4138 form on behalf of a veteran?

Yes, a third party, such as a family member, friend, or legal representative, can fill out the form on behalf of a veteran. However, it is important that the person completing the form on the veteran’s behalf clearly indicates their relationship to the veteran and provides their own contact information. The statement provided should still reflect the veteran's personal experience and account. The veteran's signature is required, unless under exceptional circumstances where the veteran is unable to sign, in which case, this should be clearly noted and explained on the form.

Is there a deadline for submitting the VBA VA 21-4138 form?

While there is no strict deadline for submitting the VBA VA 21-4138 form, it is advisable to submit it as soon as possible after filing your initial claim or when you have additional information that could impact the outcome of your claim. Timely submission is crucial as it can significantly influence the processing time and final decision of your claim. Keep in mind, however, that submitting this form does not extend any deadlines related to your claim, so be aware of and adhere to all applicable deadlines provided by the VA.

Common mistakes

Filling out the VBA VA 21-4138 form, known as the Statement in Support of Claim for veterans seeking benefits, is a crucial step in the process. However, mistakes can be easily made, complicating or delaying claims. One common error is not providing specific dates and details when describing events related to their claim. Precision helps the Veterans Affairs (VA) fully understand the circumstances and make an accurate assessment.

Another mistake often made is failing to sign the form. This oversight may seem minor, but it can invalidate the entire document, requiring the individual to resubmit their claim, thereby prolonging the process. Additionally, some individuals overlook the importance of including their VA file number. This crucial piece of information links the form to their existing file, ensuring the VA can easily connect the new information with the veteran's records.

Leaving sections blank is also a common error. Even if a question seems irrelevant or the answer is "none," it's essential to state this explicitly. Blank sections can lead to assumptions of oversight or incomplete information, potentially causing unnecessary delays in processing the claim.

Many veterans also miss the opportunity to attach supporting documents. Corroborating evidence, such as medical records or personal letters, can significantly strengthen a claim. By omitting these documents, veterans may inadvertently weaken their cases.

Another frequent misstep is failing to clarify how the claimed conditions are connected to military service. Explicitly stating this connection is crucial, as the VA needs to establish service connection to approve benefits. Without this clear linkage, the evaluation of the claim can become challenging.

Some individuals mistakenly believe that exaggeration or minimizing their issues will help their case. However, honesty is paramount when filling out the form. Misrepresentation can lead to skepticism about the claim's validity and ultimately harm the veteran's credibility and chances of approval.

Lastly, a significant number of veterans rely solely on the VBA VA 21-4138 form for their claim, neglecting to submit formal medical evidence. While personal statements are valuable, they are notably strengthened by medical documentation and expert opinions. Thus, not including medical evidence is a missed opportunity to substantiate the claim further.

Documents used along the form

When dealing with veterans' affairs, especially in the context of claims for benefits, a variety of forms and documents are usually involved. The VBA VA 21 4138 form, known as the Statement in Support of Claim, plays a crucial role in this process. It serves as a personal statement from the veteran or the interested party to support a claim for benefits. However, this form is often not the only document needed. Several other forms and documents typically accompany it to complete a claim, provide evidence, or meet specific criteria required by the Veterans Benefits Administration. Here's a brief overview of some commonly used forms and documents that are often submitted along with the VBA VA 21 4138 form.

  • DD Form 214 - This document is the Certificate of Release or Discharge from Active Duty. It's crucial for veterans as it officially documents the service member's release from military service and categorizes their discharge, affecting eligibility for benefits.
  • VA Form 21-526EZ - Titled the Application for Disability Compensation and Related Compensation Benefits, this form is used by veterans to initiate the claim process for service-connected disability benefits.
  • VA Form 21-22 - Known as the Appointment of Veterans Service Organization as Claimant's Representative, this form allows veterans to designate an organization to help them with their claims.
  • VA Form 21-2680 - The Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, is used to apply for additional benefits based on the need for aid and attendance or housebound status.
  • VA Form 21-0845 - Authorization to Disclose Personal Information to a Third Party. This form is used by veterans to give the VA permission to release personal information to a designated individual or organization.
  • Medical Records - Veterans are often required to submit medical records that document their injuries, conditions, or disabilities. These records provide crucial evidence to support their claims for benefits.
  • VA Form 10-10EZ - Application for Health Benefits, is the form veterans use to apply for health care services through the VA, which may be part of managing or treating conditions related to service.
  • VA Form 21-8940 - Titled Veterans Application for Increased Compensation Based on Unemployability, it is used by veterans to claim benefits based on the inability to maintain substantial employment due to service-connected conditions.
  • Buddy Statements - Also known as Lay Statements, these are written statements from fellow service members, family, or friends that can help corroborate the veteran’s claim, providing evidence of how the veteran's service-connected injuries or conditions affect their daily life.

Understanding the purpose and requirement for each of these forms and documents can be instrumental in successfully navigating the benefits claim process. While the VBA VA 21 4138 form allows a veteran to provide an account or explanation in support of their claim, the other documents serve as evidence, authorization, or applications for specific benefits. Together, they work to provide a comprehensive picture of the veteran's service and current needs, essential for the Veterans Benefits Administration to make informed decisions regarding benefit claims.

Similar forms

The VBA VA 21-4138 form, also known as the Statement in Support of Claim, is used by veterans to provide additional information that might support their claim for benefits. A similar document is the SSA-827, Authorization to Disclose Information to the Social Security Administration. Both forms are essential in the process of obtaining benefits, where the SSA-827 allows the SSA to obtain medical records and other information needed to make a decision on disability benefits. Like the VBA VA 21-4138, it plays a crucial role in supporting an individual's case for benefits.

Another related document is the VA Form 10-5345, Request for and Authorization to Release Health Information. This form, used within the Department of Veterans Affairs, enables the release of a veteran’s health information to specified individuals or organizations, similarly to how the VBA VA 21-4138 form supports a claim with additional information. However, the VA Form 10-5345 focuses specifically on health records, underlining the importance of medical information in supporting claims.

The Form I-134, Affidavit of Support, used in immigration proceedings, shares a common purpose with the VBA VA 21-4138 form in providing critical supporting documentation. The I-134 helps to demonstrate that visa applicants have adequate means of financial support and are not likely to rely on the U.S. government for assistance. Although it serves a different administrative function, the emphasis on supporting evidence as a foundation for a claim or application is a shared attribute.

The IRS Form 4506-T, Request for Transcript of Tax Return, also parallels the VBA VA 21-4138 in its function of supporting applications with official documents. This IRS form allows individuals to request past tax return information, often used to verify income and tax compliance. Like the 21-4138, the 4506-T supports various claims, including loan applications and government assistance claims, by providing authoritative documentation.

Similarly, the HUD-1 Settlement Statement, used in real estate transactions, serves a comparable purpose by detailing the financial transactions involved in property sales. While fundamentally different in content, both the HUD-1 and the VBA VA 21-4138 forms provide essential information that supports a primary process — purchasing a home and claiming benefits, respectively. Each document ensures parties have the detailed information needed to make informed decisions or support claims.

The DA Form 31, Request and Authority for Leave, from the Department of the Army, offers another example of documentation designed to support specific requests, similar to the VBA VA 21-4138. Servicemembers use DA Form 31 to request leave from duty, providing pertinent information to justify their absence. Both forms serve to present a case to the respective authority, aiming to secure approval by furnishing necessary and supporting details.

Dos and Don'ts

Filling out the VBA VA 21-4138 form, also known as the Statement in Support of Claim, requires careful attention to detail. This document is crucial for veterans seeking to establish the validity of their claim for benefits with the Department of Veterans Affairs (VA). Here are five dos and don'ts to guide you through the process.

Do:

  1. Provide Detailed Information: Clearly explain the evidence supporting your claim. Offer specific dates, locations, and any relevant names or events to paint a complete picture for the reviewer.
  2. Be Concise: While details are important, ensure your statements are to the point. Avoid unnecessary information that doesn't directly support your claim.
  3. Review for Accuracy: Double-check your statement for any spelling or grammatical errors, and confirm that all information is accurate and matches any documents you're referencing.
  4. Sign and Date the Form: Ensure you've signed and dated the form. An unsigned form might not be processed.
  5. Keep Copies: Always keep a copy of the completed form and any documents you submit for your personal records.

Don't:

  1. Leave Sections Blank: If a section does not apply to you, fill it with "N/A" for not applicable. Blank sections can cause delays in processing your claim.
  2. Use Unclear Handwriting: If you're filling out the form by hand, make sure your handwriting is legible. Consider typing your responses if handwriting might be an issue.
  3. Exaggerate or Fabricate Information: Stick to the facts. Exaggerating or including false information can severely impact the credibility of your claim.
  4. Forget to Provide Supporting Documentation: If you reference any documents, reports, or other forms of evidence, make sure to include copies with your submission.
  5. Submit Without Reviewing: Always review your entire submission package, including the form and any attachments, to ensure completeness and accuracy before sending it to the VA.

Misconceptions

When it comes to navigating the complexities of the Veterans Affairs (VA) system, the VBA VA 21-4138 form is a crucial document. This form, officially known as the Statement in Support of Claim, plays a pivotal role in the claims process for veterans seeking benefits. However, there are several common misconceptions surrounding this form that can lead to confusion or misunderstandings. Here, we'll address five of these misconceptions to provide clearer guidance.

  • Misconception #1: The form is too complicated to fill out without legal help. Many individuals believe that they need a lawyer's assistance to complete the VBA VA 21-4138 form due to its perceived complexity. While legal advice can be beneficial, especially in complex cases, the form is designed to be straightforward for veterans to fill out. It primarily requires a detailed statement regarding the claim, which the veteran can provide based on their personal experiences and knowledge.

  • Misconception #2: The form alone is sufficient for a successful claim. This misunderstanding may lead some veterans to assume that simply submitting the VBA VA 21-4138 form guarantees the approval of their benefits claim. However, while this form is important, it is one piece of the puzzle. The VA requires comprehensive evidence to support a claim, including medical records, service documents, and potentially other supporting documents, alongside the 21-4138 form.

  • Misconception #3: You can only submit the form once. A common myth is that veterans have only one opportunity to submit this form for a particular claim. In reality, veterans can submit additional Statements in Support of Claim if new evidence arises or if they need to provide further clarification to support their claim. The process is designed to be flexible, allowing veterans to strengthen their case as needed.

  • Misconception #4: The form's main purpose is for new claims. While it's true that the VBA VA 21-4138 form is often used to support new claims, its usefulness is not limited to this function. The form can also be instrumental in reopening previously denied claims, filing for an increase in disability ratings, or providing additional evidence for a pending claim. Its versatility makes it a valuable tool throughout the claims process.

  • Misconception #5: Filling out the form guarantees a quicker claims process. Some veterans may believe that thoroughly filling out and submitting this form will expedite the review of their claim. While providing clear, detailed information can help reduce delays caused by requests for further evidence, the VA's claims process involves multiple steps and reviews, and the time frame can vary widely based on the specifics of the case and current backlog. Submitting a well-prepared form is important, but it does not ensure a speedy resolution.

Understanding these misconceptions about the VBA VA 21-4138 form can empower veterans to navigate the claims process more effectively. Accurate information and clear communication are key to advocating for one's rights and accessing deserved benefits.

Key takeaways

The VBA VA 21-4138 form, also known as the Statement in Support of Claim, is a vital document for veterans seeking benefits from the Department of Veterans Affairs (VA). This form allows veterans to provide additional information or clarification about their claim, supporting their request for benefits. Here are key takeaways on filling out and using this form effectively.

  • Accuracy is crucial: When filling out the VA 21-4138 form, ensure all information provided is accurate and complete. Mistakes or omissions can delay the processing of your claim.
  • Personal Information: Start by filling out your personal information, including your full name, Social Security number, and VA file number, to help the VA identify your claim file quickly.
  • Provide Detailed Information: Use the form to provide detailed information about your claim. Include dates, locations, and specific details about the events related to your claim.
  • Be Specific: Avoid general statements. Specific details can strengthen your claim by giving the VA a clear understanding of your situation.
  • Supporting Evidence: While filling out the form, mention any evidence you are submitting alongside the form or have previously submitted. This could include medical records, service records, or witness statements.
  • Additional Sheets: If you need more space to provide your statement, you can attach additional sheets. Ensure each sheet includes your name and Social Security number at the top.
  • Signature Required: Do not forget to sign and date the form. An unsigned form may not be processed by the VA.
  • Consultation Helps: If you're unsure how to proceed, consulting a Veterans Service Officer (VSO) can be beneficial. They can offer guidance and help in filling out the form accurately.
  • Keep Copies: Always keep a copy of the filled-out form and any documents you submit for your records. This will help you in case there are any disputes or questions about your claim in the future.
  • Submission: Submit the completed form to the VA regional office handling your claim. You can find the mailing address on the VA's website or call their customer service for guidance.
  • Follow-up: After submitting your form, follow up with the VA if you do not receive a confirmation within a reasonable time frame. Keeping track of your claim's status is important.

By following these guidelines, veterans can ensure that their VBA VA 21-4138 form is filled out correctly, helping to streamline the benefits claim process with the Department of Veterans Affairs.

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