Personal Statements: Guide & Free Template

Which form?

Your own statement can go on VA Form 21-4138 (Statement in Support of Claim). VA also offers VA Form 21-10210 (Lay/Witness Statement), which a veteran can use to describe their own observations. Mental health claims based on stressors use VA Form 21-0781. Our template gives you the structure, and you can submit it as-is or transfer it to a VA form.

A structure that works

1. The claim: which condition(s) you're writing about
2. In service: what happened, when and where, and who saw it. Include treatment, profiles, and duties that caused wear and tear.
3. Since service: when symptoms continued or started, and treatment you've had
4. Today: frequency, severity, and duration of symptoms, flare-ups, and medications and side effects
5. Impact: work (missed days, accommodations, jobs lost), sleep, family, and daily activities
6. Certification, signature, and date

Tips

• One section per condition, short paragraphs, specific examples
• Match your words to what you'll tell the C&P examiner. Consistency builds credibility. See C&P exam prep.
• Describe your worst days and how often they happen, honestly
• Leave out legal arguments and medical conclusions. Stick to facts you know.