Edit VA Form 21-10210 online free, or download the PDF
VA Buddy Statement (Lay/Witness Statement): Lay/Witness Statement
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VA Form 21-10210 in short
VA Form 21-10210 is a formal statement that supports a VA claim. A veteran, a claimant, or someone writing on their behalf, such as a fellow service member or family member, describes what they know or saw. VA says people also call it a buddy statement. VA offers an online version.
| Issued by | U.S. Department of Veterans Affairs (VA), Veterans Benefits Administration |
|---|---|
| Current version | Rev. July 2024 (checked 2026-10-25) |
| Who fills it in | The veteran or claimant, or a witness writing on their behalf. VA's form page says it can support your own claim or the claim of another veteran or eligible family member. |
| Who receives it | VA, at the Evidence Intake Center in Janesville, Wisconsin. |
| Where to send it | Online: VA's form page says you can submit your statement online instead of sending the paper form. By mail, the form says to send it to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. The form says to submit it with your application if you are providing statements to support your claim. |
| Deadline | The form has no deadline of its own. Follow any date in a VA letter or the deadline that applies to the claim it supports. |
| Official links | Official page · Official PDF |
What changed
The JUL 2024 edition supersedes the JUN 2021 edition, as printed on the form. VA did not publish a list of changes.
How to fill out VA Form 21-10210, line by line
| Section I, items 1 to 5 | Veteran's identification The veteran's name, Social Security number, VA file number, date of birth, and VA insurance file number if any. Dates use MM/DD/YYYY. |
| Section I, items 6 to 8 | Veteran's contact details Mailing address, phone number, and email. There is a box to agree to receive electronic correspondence from VA. |
| Section II, items 9 to 16 | Claimant's identification Complete only if the claimant is not the veteran, for example a surviving spouse. |
| Section III, item 17 | Statement Describe what you yourself know or observed about the facts relevant to the claim. Say which claimed issue you are addressing. It continues on page 3. |
| Section IV, items 18 to 21 | Witness contact information Complete if the statement is from someone else. Give the witness's name, relationship to the veteran or claimant (served with, family or friend, coworker or supervisor, or other), phone, and email. |
| Section V, items 22A and 22B | Signature and date The veteran, claimant, or witness signs and dates. The form marks the signature as required and certifies the information is true and correct to the best of the signer's knowledge. |
Common mistakes to avoid
- Putting more than one witness statement on one form. The form says to use a separate VA Form 21-10210 for each statement.
- Not saying which claimed issue the statement is about. The form asks you to indicate it.
- Writing about things the witness only heard secondhand. The form asks for what you yourself know or observed.
- Skipping Sections IV and V when the statement comes from a witness.
- Leaving the signature in item 22A blank. The form marks it as required.
- Leaving out the veteran's Social Security number or VA file number, which help VA match the statement to the claim.
Questions about VA Form 21-10210
Is VA Form 21-10210 a buddy statement?
Yes. VA's form page says people also call this statement a buddy statement.
Can I submit VA Form 21-10210 online?
Yes. VA's form page says you can submit your statement online instead of sending the paper form.
Where do I mail VA Form 21-10210?
The form says to mail it to Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.
Can several witnesses use one form?
No. The form says to use a separate VA Form 21-10210 for each statement if more than one witness is writing on your behalf.
What is the difference between VA Form 21-10210 and VA Form 21-4138?
VA Form 21-4138 is the veteran or beneficiary's own statement in support of claim. VA Form 21-10210 is a lay or witness statement and can come from someone else writing on the claimant's behalf.
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Sources
Checked against the official sources on 2026-10-25. PDF Editor Hub is not affiliated with the U.S. Department of Veterans Affairs or any government agency. This page is general information, not legal or tax advice.