# Personal Statement (VA Form 21-4138)

Drafts your own factual personal statement for a VA disability claim, organized in the format of VA Form 21-4138. Use it when you need to put your own experience on paper in a clear, factual structure before reviewing the draft with your accredited VSO.

## Prompt

## Context
You are helping [VETERAN NAME], a veteran, draft a personal statement to support a VA disability claim. This statement is the veteran's own account, in their own words. It is not a medical opinion. It does not represent the veteran legally. It will be used as supporting evidence and reviewed with an accredited Veterans Service Officer (VSO) before any submission to the VA.

Condition or conditions the statement covers: [CONDITION OR CONDITIONS]
Service branch and dates of service: [BRANCH AND SERVICE DATES]
Military occupational specialty or role: [MOS OR ROLE]
The veteran's account in their own words: [YOUR ACCOUNT, describe when the condition started or the event occurred, where you were stationed or deployed, what you experienced, and how the condition affects you now in daily life and work]

## Task
Draft a personal statement organized into four numbered sections:
1. Introduction: who the veteran is and what condition this statement addresses.
2. In-service account: when and where the condition started or the relevant event occurred, as the veteran described it.
3. Current impact: how the condition affects daily life, work, sleep, or relationships, as the veteran described.
4. Connection: a plain statement, in the veteran's own words, that in their opinion the current condition is connected to the in-service experience described above.

End the statement with a note that this is the veteran's own statement and they will review it with an accredited VSO before submitting.

## Standards
- Write only what the veteran described in [YOUR ACCOUNT]. Do not add symptoms, diagnoses, dates, locations, or exposures the veteran did not mention.
- Do not invent events, medical facts, or any detail not provided.
- Do not use clinical terminology the veteran did not use. Write in plain language that sounds like the veteran.
- Do not exaggerate severity or functional impact beyond what the veteran stated.
- Do not state a medical nexus opinion. The connection section reflects the veteran's own belief, not a medical or legal conclusion.
- Do not predict a rating, guarantee an outcome, or suggest what to claim to maximize compensation.
- VA claim preparation and representation are regulated under 38 CFR. An accredited VSO, claims agent, or VA-accredited attorney can help at no cost for initial claims. Warn the veteran not to pay unaccredited preparers, sometimes called claim sharks, who charge illegal fees.
- This is not legal advice and not medical advice.
- If [YOUR ACCOUNT] is missing, vague, or too brief to draft a meaningful statement, ask the veteran for more detail before drafting.

## Variables

- VETERAN NAME
- CONDITION OR CONDITIONS
- BRANCH AND SERVICE DATES
- MOS OR ROLE
- YOUR ACCOUNT

## Input checklist

- [ ] Write your account in your own words before running this prompt. Describe when the condition started, what happened in service, and how it affects you now. The AI organizes what you provide; it does not invent your story.
- [ ] Have your service dates and branch ready so the statement is accurate to your record.
- [ ] Keep your Social Security number, VA file number, and claim number out of the prompt. Share only facts you are comfortable putting into an AI tool.
- [ ] Verify your in-service events and dates against your own records before running this prompt. Accuracy matters.
- [ ] Plan to take the draft to an accredited VSO before submitting anything to the VA. Representation for initial claims is free. Do not pay anyone who is not accredited to prepare your claim.
- [ ] Review the draft line by line. Correct anything that does not match your actual experience before taking it to your VSO.

## Verification checklist

- [ ] Read every sentence: does it reflect what you actually said, or did the AI add a symptom, date, location, or detail you did not provide?
- [ ] Confirm no clinical diagnosis appears that you did not name. Lay statements describe symptoms and functional impact, not diagnoses.
- [ ] Check the in-service account: are the events, dates, and locations accurate to your memory and your records?
- [ ] Confirm the connection section does not overreach into a medical nexus conclusion. It should state your own belief, not a medical opinion.
- [ ] Check that no rating prediction, outcome guarantee, or compensation-maximizing language appears anywhere in the draft.
- [ ] Do not submit this draft to the VA without first reviewing it with an accredited VSO, claims agent, or VA-accredited attorney.
- [ ] Do not pay anyone who is not VA-accredited to prepare or file your claim. Accredited VSO help for initial claims is free.

## Sample output

Sample output. Generated by AI from sample inputs:

Veteran: Marcus Hale. Condition: tinnitus (ringing in both ears). Branch: Army, 2010 to 2019. MOS: 88M (Motor Transport Operator). Account: I drove heavy trucks and convoy equipment for most of my nine years. Engine noise, exhaust, and weapons qualification were constant. We had hearing protection but we did not always use it during long convoys because you needed to hear radio traffic and the road. Since I got out in 2019 the ringing in my ears has never stopped. It is worse at night and I have trouble sleeping because of it. My wife says I have the TV up too loud. I never had ear problems before the Army.

Personal Statement of Marcus Hale
In Support of VA Disability Claim: Tinnitus

1. Introduction
I am Marcus Hale. I served in the United States Army as a Motor Transport Operator (88M) from 2010 to 2019. This statement describes the ringing in my ears that I believe is connected to my military service.

2. In-Service Account
During my nine years in the Army, my primary duty was driving heavy trucks and convoy equipment. I was regularly exposed to sustained engine noise, exhaust, and the sound of weapons fire during qualification. Hearing protection was issued and used at times, but during long convoys I and others would remove it to hear radio communications and road conditions. This was common practice in my unit. I had no ear problems before I enlisted.

3. Current Impact
Since separating in 2019, I have had a constant ringing in both ears that has not stopped. It is worse at night, which makes it difficult to fall asleep and stay asleep. My wife has noted that I keep the television at a higher volume than before. The ringing is present every day.

4. Connection
In my opinion, the constant ringing in my ears that I experience today is connected to years of noise exposure during my service as a Motor Transport Operator. I had no ear problems before I enlisted and they began during and continued after my service.

Note: This is my personal statement in my own words. I will review this draft carefully and take it to an accredited Veterans Service Officer before submitting it to the VA.

## Customization notes

Run this prompt once per condition. A focused, single-condition statement is clearer and easier for a reviewer to follow than a statement covering multiple conditions at once. If your condition involves mental health, toxic exposure, or military sexual trauma, note that in your account and let your accredited VSO advise on additional evidence types and presumptive conditions. For appeal situations, the same prompt works: describe the original in-service event and add what has changed or worsened since your last rating decision.

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From The VA & Benefits Navigator Library at vetslearn.com/libraries/va