VA Form 21-10210: Lay/Witness (Buddy) Statement

What is VA Form 21-10210?

VA Form 21-10210 is a formal written statement that supports a VA claim. It can come from the veteran or claimant, or from someone writing on their behalf, such as a fellow service member, family member, friend or coworker. VA's form page notes that people sometimes call it a 'buddy statement'.

The form asks for the veteran's identification, the claimant's if the claimant isn't the veteran, the statement itself, and, when the statement is from someone else, the witness's name, relationship and contact details. The note on the statement page asks you to say which claimed issue you're addressing and to describe what you yourself know or have observed about the facts or circumstances. Use a separate form for each statement and each witness.

FileIt pre-fills the veteran's name, date of birth and email from the vault, prints the statement across page 2 and its continuation on page 3, and fills VA's own PDF (JUL 2024 edition). It saves the finished form in the person's vault folder. The person making the statement signs it by hand or through FileIt's eSignature, and you mail it to VA yourself.

Who writes it: The veteran or claimant, or a witness writing on their behalf.
Who signs: The person making the statement (veteran, claimant or witness).
Pages: 3: identification, the statement, then witness details and signature.
Mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444 (printed on the form).
Edition: VA Form 21-10210, JUL 2024 (OMB No. 2900-0881, expires 07/31/2027)

Who needs to fill out VA Form 21-10210?

Fellow service members who saw an in-service event, injury or stressor and can describe it.
Spouses, family and friends who can describe how a condition affects the veteran day to day.
Coworkers and supervisors who saw the effects of a disability at work.
Veterans and claimants who want to submit their own formal statement.

When to use VA Form 21-10210

With a claim, when a statement from someone who knows the facts would support it, as the instructions describe.
When VA asks for more evidence of an event or of how a condition affects the veteran.
Once for each person: the form says to use a separate 21-10210 for each additional statement and each witness.

What you need before you start

The veteran's name, Social Security number and date of birth, and VA file or insurance file numbers if they apply.
If the claimant isn't the veteran, the claimant's details and mailing address.
The statement: the claimed issue it supports and what the writer personally knows or observed, with dates and places.
For a witness: their name, relationship to the veteran or claimant, phone and email.

What’s on VA Form 21-10210

The 2024 edition has 3 pages. FileIt asks for it in 5 parts, and it is signed by Person making the statement (veteran, claimant or witness):

Section I: Veteran's identification informationPerson making the statement (veteran, claimant or witness)
Section II: Claimant's identification informationPerson making the statement (veteran, claimant or witness)
Section III: StatementPerson making the statement (veteran, claimant or witness)
Section IV: Witness contact informationPerson making the statement (veteran, claimant or witness)
Section V: Certification of statement and signaturePerson making the statement (veteran, claimant or witness)

How to fill out VA Form 21-10210, step by step

1 Section I: Veteran's identification

Items 1 to 8: the veteran's name, SSN, VA file number, date of birth, VA insurance file number, mailing address (if applicable), phone and email.

2 Section II: Claimant's identification

Items 9 to 16, only if the claimant isn't the veteran, for example a surviving spouse.

3 Section III: Statement

Item 17: name the claimed issue and describe what you yourself know or have observed. It continues onto page 3.

4 Section IV: Witness contact information

Items 18 to 21, when the statement is from someone writing on the veteran's or claimant's behalf: their name, relationship (tick all that apply), phone and email.

5 Section V: Certification and signature

The person who made the statement certifies it's true and correct to the best of their knowledge and belief, signs 22A (required) and dates 22B.

Common mistakes to avoid

Not saying which claimed issue the statement supports.
Writing about things the witness heard second-hand rather than what they know or saw themselves.
Putting two witnesses on one form instead of one form each.
Leaving Sections IV and V incomplete when the statement is from a witness.
Forgetting the signature in 22A, which the form marks as required.

After you fill it out

Have the person who made the statement sign and date Section V, by hand or with FileIt's eSignature.

Mail it to the Evidence Intake Center address on the form, ideally with or soon after the claim it supports. VA's page also offers an online way to submit a statement.

Keep a copy. FileIt files it in the person's vault folder alongside the claim.

Fill out VA Form 21-10210 online with FileIt

Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 49 fields in all. Your answers save as you go.
Check the live preview. Watch your answers land on the real U.S. Department of Veterans Affairs (VBA) form, and let FileIt do any worksheet arithmetic.
Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault. Sign it, or send it for e-signature.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start VA Form 21-10210 now — it’s free

VA Form 21-10210: frequently asked questions

What is a buddy statement?

It's a formal statement from someone who knows about the facts of a veteran's claim. VA's form page says people sometimes call VA Form 21-10210 a buddy statement.

Who can write a VA Form 21-10210?

The veteran or claimant, or someone writing on their behalf. A witness completes Sections IV and V with their own contact details and signature.

Can one form cover two witnesses?

No. The form says to use a separate VA Form 21-10210 for each additional statement or each witness writing on your behalf.

What should the statement say?

The claimed issue you're addressing, and what the writer personally knows or has observed about the facts or circumstances relevant to the claim.

How is this different from VA Form 21-4138?

VA Form 21-4138 is the Statement in Support of Claim, used to share more information when another VA form or process instructs you to. VA Form 21-10210 is the lay or witness statement, and it has a section for a witness writing on someone's behalf.

Can I submit it online?

VA's form page says you can submit your statement online instead of sending the paper form. FileIt prepares the paper form if you'd rather mail it.

Official sources

Blank form (PDF), published by U.S. Department of Veterans Affairs (VBA): https://www.vba.va.gov/pubs/forms/VBA-21-10210-ARE.pdf
Official instructions and guidance: https://www.va.gov/find-forms/about-form-21-10210/
Edition shown on this page: VA Form 21-10210, JUL 2024 (OMB No. 2900-0881, expires 07/31/2027) (checked 2026-10-01).

FileIt is not affiliated with or endorsed by U.S. Department of Veterans Affairs (VBA) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-01.