Lay Statement Template
Use this form to provide a personal statement (or buddy/spouse statement) supporting a VA claim.
Guidance from fellow veterans, not legal advice. Keep a copy for your records.
1) Veteran Information
Full Name
Last 4 (or File #)
Date of Birth
Phone
Address
Email
2) Claim Information
VA File # (if known)
Date
Issue(s) this statement supports
3) Statement
In your own words, explain what happened, when it began, and how it affects daily life and function. Be specific and consistent with records.
- When it started and any service event/injury/exposure involved.
- Current symptoms and frequency (flare-ups, bad days vs good days).
- Impact on work, family, sleep, daily activities.
- Treatment history and medications, if any.
4) Certification & Signature
I certify this statement is true and correct to the best of my knowledge.
Printed Name
Signature
Date
Relationship (if not the veteran)
5) Attachments (optional)
List documents you’re submitting with this statement (e.g., medical notes, photos).
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