Va form 21 4142-2025

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The document is a VA Form 21-4142, which serves as an authorization for veterans to disclose their medical records to the Department of Veterans Affairs (VA). It outlines the types of medical information that can be released, including treatment records related to various impairments. The form requires personal identification details from the veteran and specifies that it is voluntary but necessary for processing claims. It also includes privacy notices and instructions for completing the form.

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Click ‘Get Form’ to open VA Form 21-4142 in the editor.
In Section I, specify the records you authorize for release. Clearly indicate all medical records, including treatment details and any specific conditions.
Proceed to Section II and fill in your identification information. Ensure that your name, date of birth, and Social Security number are accurate for proper processing.
If applicable, complete Section III with the patient’s identification details if they differ from yours.
In Section IV, list all sources of records you wish to disclose. This may include hospitals, clinics, or other healthcare providers.
Finally, in Section V, provide your signature and date in Item 13 and ensure you understand the limitations of this authorization before submitting.

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Versions	Form popularity	Fillable & printable
2021	4 Satisfied (61 Votes)
2018	4.8 Satisfied (95 Votes)
2014	4 Satisfied (36 Votes)
2012	4 Satisfied (63 Votes)
2004	4.3 Satisfied (190 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the VA $3600 benefit?

VA disability pay or disability compensation is a tax-free monthly payment given to veterans with a service-related disability and an other than dishonorable discharge. Those veterans may qualify for a tax-free, monthly benefit ranging from $165 to over $3,600.

What VA claims are hardest to prove?

What is the Hardest VA Claim to Get? Mental Health Conditions (e.g., PTSD, Depression) Sleep Apnea. Tinnitus and Hearing Loss. Military Sexual Trauma (MST) Chronic Pain Without a Clear Diagnosis.

What is the most common 100% VA disability?

Tinnitus Tinnitus is by far the most common condition veterans receive disability benefits for. In 2024, 3,255,323 U.S. military veterans were receiving disability benefits for tinnitus. That number is more than 1 million higher than the next most common condition. That count is increasing rapidly.

Can I fill out VA Form 21-4138 online?

You may complete the form online or by hand.