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Your statement, and your buddy's, in your own words.
VA must consider what you and the people who know you saw. Get the questions VA cares about and a template to finish yourself, and send a buddy a private link that walks them through VA Form 21-10210. Free, whether or not you buy anything from ServiceRecord.
Step 1
What is the statement about?
Step 2
Your personal statement
VA looks for specifics in your own words. Cover these:
- Where you were serving and what your job was.
- What happened, with an approximate date and place.
- What symptoms you noticed then, and whether you went to sick call or told anyone.
- How the symptoms continued after service, and when you first saw a doctor about them.
- How the condition affects your work, sleep, family life and daily activities now.
See the template
I am [Your name]. I served in the [branch] from [year] to [year].
VA decided my claim for [condition] in a decision dated [date on the decision letter]. I am sending this statement so VA can consider it.
[Describe what happened in service, when and where, and the symptoms you had then. Say if you went to sick call or told anyone.]
[Describe how the symptoms continued after service, and when you first saw a doctor about them.]
[Describe how it affects your work, sleep, family life and daily activities today.]
I certify that the statements above are true and correct to the best of my knowledge and belief.
[Signature] [Date]
Made on your device. Fill in the yellow blanks in your own words, then sign and date it.
Step 3
Ask a buddy for a statement
A spouse, family member, friend or someone you served with can describe what they saw. Send them a private link: it explains what a lay statement is, asks them what they saw themselves, and fills in VA Form 21-10210 for them to sign. They should cover:
- How the witness knows you, and for how long.
- What they personally saw or heard: the event, an injury, or your symptoms, with approximate dates and places.
- Changes they have noticed in you over time: how you were before, and how you are now.
- How it affects your daily life, work, sleep or family, from what they have seen.
- Only firsthand knowledge. Anything they learned from someone else should say so.
Make a private link
Share only what you're comfortable with. The link page shows your buddy what you enter below and the condition from step 1, nothing else. Leave out your Social Security and VA file numbers and medical details. The link has no personal information in it, works for 30 days, and you can turn it off any time. You send it yourself; we never email or text your buddy.
Add the condition in step 1 first.