How to Fill Out VA Form 21-10210 (Lay Statement)

A VA lay statement (VA Form 21-10210, also called a lay witness statement or buddy statement) is a sworn statement from someone who knows the veteran, describing what they have seen firsthand. A spouse, relative, friend, co-worker, or fellow veteran can write one. The most useful statements give specific examples of how the disability affects the veteran's daily life, work, and relationships.

The 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, the VA is 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 lay testimony. A VA lay statement on Form 21-10210 gives veterans a way to strengthen a claim without having to schedule a doctor's appointment.

Lay and Witness Statements
When to Use VA Form 21-10210
The Importance of VA Form 21-10210
Preparing to Fill Out VA Form 21-10210
Filling Out VA Form 21-10210
VA Lay Statement Example
Was Your Claim Denied Even With Lay Evidence?
Frequently Asked Questions
Get Help With Your Lay Statement

Get Your Free Case Evaluation

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. Veterans and their families often call it a lay statement, witness statement, or buddy statement.

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 Veteran'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, the VA cannot always decide a claim based only on a Veteran's service records and health history. VA Form 21-10210 serves several purposes:

A sworn statement can be used as evidence of how a service-related injury or disability has developed and affected a Veteran's physical and mental well-being.
VA Form 21-10210 could explain how a pre-existing injury has been made worse 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 complete understanding of a Veteran's disability.

While VA Form 21-10210 does not require an in-depth medical understanding of a Veteran's condition, 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, the 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 make or break a claim for benefits, Veterans and their loved ones should take care 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, document the approximate cause of your injury and explain how your condition has worsened over time.
Explain relevant evidence. Although VA Form 21-10210 does not allow for the inclusion of medical evidence, Section III, the Statement, lets lay witnesses explain how an injury or disability has affected the claimant's life.
Include examples. If the disability has affected the Veteran's ability to hold steady employment, play sports, or socialize, give specific examples.

Filling Out VA Form 21-10210

VA Form 21-10210, Lay/Witness Statement, has the following five sections:

Section I: Veteran's Identification Information
Section II: Claimant's Identification Information
Section III: Statement
Section IV: Witness Contact Information
Section V: Certification of Statement and Signature

While VA Form 21-10210 is a fairly simple document, Veterans and their loved ones should pay close attention to detail and make sure they do not leave out 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, helps the Department of Veterans Affairs identify the claimant, locate the Veteran's service records, and review 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 who knows about the Veteran's disability. A witness statement can be broken down into three parts:

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 restate the Veteran's name and how long the writer has known them.
A description of the situation. After the introduction, explain how the Veteran's injury or disability has affected their life. This could include visible physical symptoms, such as a limp, or changes in mental health, lifestyle, or routine. Veterans writing on behalf of another Veteran can also back up their friend's claim by sharing first-hand observations about the service-connected event that likely caused the disability.
A description of the Veteran's current symptoms. The Department of Veterans Affairs needs a complete picture of how a Veteran's symptoms have emerged or changed over time. If you regularly see the claimant, explain how their condition affects their life now. 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 focus mainly on the Veteran's physical and mental symptoms and their possible connection to service.

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 email 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 signer's knowledge.

VA Form 21-10210 must be signed and dated by the Veteran, the claimant, or the witness. If you would rather not use the paper form, the VA also accepts lay statements online through VA.gov.

VA Lay Statement Example

Every lay statement should be written in the witness's own words and describe what they have personally seen. The example below shows the structure a strong statement follows: who the writer is, what changed, and specific examples. Replace the bracketed text with real details.

Sample: spouse writing in support of a PTSD claim

My name is [full name]. I have been married to [Veteran's name] since [year], and we have lived together the entire time. I knew him before he deployed to [location] in [year], and I have seen him every day since he came home.

Before his deployment, [Veteran's name] was social and easygoing. Since he returned, he rarely sleeps more than three or four hours a night. At least twice a week he wakes up shouting or drenched in sweat. He no longer goes to restaurants, church, or our children's games because crowds make him anxious and he needs to sit with his back to the wall.

He lost his job at [employer] in [year] after arguments with his supervisor, and he has not been able to keep a job for more than a few months since. Over the past year his symptoms have gotten worse. He checks the locks on our doors several times every night and becomes angry over small things, which he never did before his service.

I certify that the statements above are true and correct to the best of my knowledge.

Notice what the example does: it names the relationship and how long the writer has known the Veteran, compares life before and after service, and gives concrete, countable details (hours of sleep, how often nightmares happen, what the Veteran has stopped doing). It does not diagnose a condition or praise the Veteran's character. Those details are what give a lay statement weight.

Was Your Claim Denied Even With Lay Evidence?

If you are gathering witness statements, your claim may already be contested, or it may have been denied once. A denial does not always mean the VA rejected the lay evidence. Sometimes the VA overlooked it, gave it too little weight, or needed a medical opinion to go with it.

Which option comes next depends on the evidence. If you have a new lay statement or other new evidence, it goes with a Supplemental Claim. A Higher-Level Review does not accept new evidence, so it only makes sense when the evidence already in your file should have been enough. Choosing the wrong path can cost months, and an attorney can review your decision letter and tell you which one fits your case.

Frequently Asked Questions

What is VA Form 21-10210?

VA Form 21-10210, known as the Lay Witness Statement or buddy letter, is a sworn declaration made in support of a veteran's claim for VA disability benefits. Unlike other VA documents, it is intended for use by laypeople, not medical professionals, who are acquainted with the veteran. It can be submitted by a spouse, relative, friend, co-worker, or fellow veteran, and in some cases by the veteran themselves.

Who can submit a VA Form 21-10210 lay witness statement?

Almost anyone acquainted with the veteran can complete and submit VA Form 21-10210, including a spouse, relative, friend, co-worker, or fellow veteran. The statement section should be completed by someone who is not a medical professional. In limited circumstances, the veteran may also submit a statement on their own behalf in support of their own claim.

When should VA Form 21-10210 be used?

VA Form 21-10210 can be used to describe and detail the service-related event that caused a veteran's injuries or disability, support an initial claim for benefits, or reinforce an appeal after an adverse determination. It is particularly valuable as evidence for individual unemployability (TDIU) claims and requests for increased disability ratings.

What are the five sections of VA Form 21-10210?

VA Form 21-10210 has five sections: Section I covers the veteran's identifying information including name, Social Security number, date of birth, and contact details. Section II covers the claimant's identifying information and only needs to be completed if the claimant is not the veteran. Section III is the written statement itself, which should include an introduction, a description of how the disability has impacted the veteran's life, and a description of current symptoms. Section IV covers the witness's contact information. Section V is the certification and signature, which affirms that all information is true and correct. The statement can also be submitted online through VA.gov instead of on the paper form.

What should a lay witness statement include?

An effective lay witness statement in Section III should include an introduction identifying the writer and their relationship to the veteran, a description of how the veteran's injury or disability has affected their daily life including visible physical symptoms and changes in mental health or routine, and a description of the veteran's current symptoms and how they have changed over time. Statements should be specific and use concrete examples, such as describing tasks the veteran can no longer perform. They should focus on the disability's impact rather than general character praise.

Can a veteran submit a lay witness statement for their own claim?

Yes. Under certain limited circumstances, a veteran can submit VA Form 21-10210 on their own behalf in support of their own claim. If doing so, the veteran should proactively document the approximate cause of their injury, explain how the condition has deteriorated over time, and include specific examples of how the disability has impacted their ability to work, socialize, or perform daily activities.

What happens if VA Form 21-10210 is filled out incorrectly?

Any mistake on VA Form 21-10210, no matter how minor, could result in significant processing delays or requests for additional evidence. Critical elements in Section I, including the veteran's name, Social Security number, and date of birth, should never be omitted. Under most circumstances the VA can still process the form if Section I is incomplete, but it is strongly recommended to complete all sections accurately and in full.

Get Help With Your Lay Statement

A well-written lay statement can strengthen a claim, and a poorly completed form can slow it down. If your claim was denied or rated too low, the Law Office of Sean Kendall can review your file and help you build the evidence for your appeal. We represent Veterans nationwide on a contingency-fee basis, so you pay no attorney fee unless we win benefits for you. Call (877) 629-1712 toll-free or (303) 449-4773, or request a free case review.