VA Personal Statement Template (Form 21-4138)
Every claim has one personal statement (VA Form 21-4138). What makes it strong is whether it contains all four components. Check yours.
The template (fill every bracket)
1 — The issue and how it’s service-connected. Every day I struggle with [condition]. I believe it is [caused by / aggravated by my service-connected [primary]], because [event or link].
2 — The impact on me. Because of [condition], I experience [symptoms, how often]. It [the personal and emotional toll].
3 — Medications (if any). I take [medication(s)] from [provider]. Side effects include [list], which [how they affect you].
4 — Impact on work, family, social life, and employment. [Jobs lost or left, income lost; strained relationships, isolation; activities you can no longer do.]
I certify that the statements above are true and correct to the best of my knowledge and belief. Signature: ______ Date: __/__/____
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