Veteran Signing a Witness Statement as Part of Their ApplicationThe Department of Veterans Affairs may be entrusted with protecting the physical health and mental well-being of American heroes, but the process of obtaining benefits can be time-consuming and emotionally exhausting. Even with compelling evidence and a concrete service connection, health officials are sometimes reluctant to approve claims without a third-party perspective.

While the Department of Veterans Affairs prioritizes medical records in the adjudication of benefits claims, it actively reviews and assesses third-party testimony. VA Form 21-10210, Lay Witness Statement, provides a potent opportunity for servicepeople to reinforce their claim without having to schedule a doctor’s appointment.

Lay and Witness Statements

VA Form 21-10210, Lay Witness Statement, is a sworn declaration made in support of a Veteran’s claim for benefits. Unlike other Department of Veterans Affairs documents, VA Form 21-10210 is intended for use by laypeople acquainted with the petitioner.

A layperson or other witness could be any of the following:

  • Spouse
  • Relative
  • Friend
  • Co-worker
  • Another Veteran

While the Department of Veterans Affairs has few restrictions on who can complete and submit VA Form 21-10210 on a serviceperson’s behalf, the third section of this form—the statement—should be completed by a witness who is not a medical professional.

When to Use VA Form 21-10210

VA Form 21-10210, Lay Witness Statement, could be used to:

  • Describe and detail the service-related event that caused a Veteran’s injuries or disability
  • Support an initial claim for benefits
  • Reinforce an appeal for an adverse determination

While VA Form 21-10210 serves a wide range of purposes, it is often used as evidence for eligibility for individual unemployability benefits and increased disability ratings.

The Importance of VA Form 21-10210

The Department of Veterans Affairs is notorious for long waiting times and extensive backlogs. Although recent procedural changes have improved the agency’s efficiency, government health officials cannot always adjudicate a claim for benefits solely on the basis of a Veteran’s service records and health history. VA Form 21-10210 serves several purposes:

  • A sworn affidavit can be used as evidence demonstrative of how a service-related injury or disability has developed and impacted a Veteran’s physical and mental well-being.
  • VA Form 21-10210 could explain how a pre-existing injury has been exacerbated by military service.
  • The Department of Veterans Affairs can use the testimony included in a completed VA Form 21-10210 to establish a service connection or develop a more holistic understanding of a Veteran’s disability.

While VA Form 21-10210 does not require an in-depth medical understanding of a Veteran’s complaint, lay witnesses must still collect the information needed to effectively support a friend or relative’s claim for benefits.

Preparing to Fill Out VA Form 21-10210

Any layperson acquainted with a Veteran can fill out Section III – Statement on VA Form 21-10210. Under certain limited circumstances, a Veteran can submit a statement on their own behalf, in support of their own claim.

However, because VA Form 21-10210 can effectively make or break a claim for benefits, Veterans and their loved ones should exercise caution when working through this form. Before writing a statement, try to:

  • Review your condition. If you are filling out VA Form 21-10210 for yourself, proactively document the approximate cause of your injury and explain how your condition has deteriorated over time.
  • Explain relevant evidence. Although VA Form 21-10210 does not allow for the inclusion of medical evidence, Section III – Statement, permits lay witnesses to explain how an injury or disability has affected the claimant’s life.
  • Include examples. If the disability has impacted the Veteran’s ability to hold steady employment, play sports, or socialize, provide coherent examples.

Filling Out VA Form 21-10210

VA Form 21-10210, Lay Witness Statement, is comprised of the following five sections:

  1. Section I – Veteran’s Identification Information
  2. Section II – Claimant’s Identification Information
  3. Section III – Statement
  4. Section IV – Witness Contact Information
  5. Section V – Certification of Statement and Signature

While VA Form 10-10210 is a reasonably straightforward document, Veterans and their loved ones should pay close attention to detail and ensure that they do not omit any information. Any mistake, no matter how minor, could result in significant processing delays or requests for additional evidence.

Section I – Veteran’s Identification Information

The first section of VA Form 21-10210 relates to the Veteran. You should include the following information:

  • The Veteran’s first name, last name, and middle initial
  • The Veteran’s Social Security number
  • The Veteran’s VA file number, if any exists
  • The Veteran’s date of birth
  • The Veteran’s VA insurance file, if applicable
  • The Veteran’s current mailing address, which does not need to be the same as the Veteran’s current residential address
  • The Veteran’s phone number and email address

Section I – Veteran’s Identification Information assists the Department of Veterans Affairs in identifying the claimant, locating the Veteran’s service records, and reviewing their medical history.

Under most circumstances, the department can still process VA Form 21-10210 even if the first section is incomplete. However, critical elements—including the Veteran’s name, Social Security number, and date of birth—should never be omitted.

If you are filling out the Lay Witness Statement for a friend or family member, ask them for any missing information before returning the form.

Section II – Claimant’s Identification Information

Section II – Claimant’s Identification Information is identical in form and content to the first section. This section only needs to be completed if the person applying for benefits is not the Veteran.

Section III – Statement

The third section of VA Form 21-10210 is the lay or witness statement. The statement can be written by the Veteran, if they intend to swear to the truthfulness of their own claim, or by a third party acquainted with the Veteran’s disability. A witness statement could be broken down into three separate components:

  • An introduction. If the writer is not the Veteran, they should introduce themselves and provide their full name, contact information, and a brief description of their relationship to the Veteran. The introduction should reiterate the Veteran’s name and the duration of the relationship.
  • A description of the situation. After completing the introduction, explain how the Veteran’s injury or disability has impacted their life. This could include visible physical symptoms, such as a limp, or a description of apparent changes in mental health, lifestyle, or routine. Veterans who are writing on behalf of another Veteran could also try to corroborate their friend’s claims by sharing first-hand observations about the probable service-connected event that caused the disability.
  • A description of the Veteran’s current symptoms. The Department of Veterans Affairs needs to have a comprehensive understanding of how a Veteran’s symptoms have emerged or changed over time. If you regularly see the claimant, explain how their injury currently impacts their life. Your observations should be specific, to the point, and concise.

While some lay witnesses use the third section of VA Form 21-10210 to compliment the Veteran’s character or testify to their integrity, statements should be focused mainly on the claimant’s physical injuries and potential service-related connection.

Section IV – Witness Contact Information

If a person other than the Veteran has written the statement, they should provide the following information for Section IV – Witness Contact Information:

  • The witness’s first name, last name, and middle initial
  • The witness’s relationship with the claimant
  • The witness’s telephone number
  • The witness’s e-mail address

Section V – Certification and Signature

The final section of VA Form 21-10210, Certification and Signature, requires a signature and an affirmation that all of the information provided in the form is true and correct to the best of the signatory’s knowledge.

VA Form 21-10210 must be signed and dated by the Veteran, the claimant, or the witness. Signatures must be made in ink.