VA Form 21-4170-2025

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When to use this form. Use VA Form 21-10210 to submit a formal statement to support your VA claimor the claim of another Veteran or eligible family member. People also sometimes call this statement a buddy statement.
What is VA form 21P 4171? VA Form 21P-4171 is used to gather information that is needed to determine veterans spouses eligibility for benefits based on a common law marital relationship. The latest form for Supporting Statement Regarding Marriage (VA Form 21P-4171) expires 2021-03-31 and can be found here.
Documents may be submitted by mail, in person at a VA regional office or electronically. However, VA recommends submitting correspondence electronically as this is the fastest method of receipt.
VA Form 21-4170 is used to gather information that is necessary to determine whether a valid common law marriage was established. The form is used by persons claiming to be common law widows/widowers of deceased veterans and by veterans and their claimed common law spouses.
An accredited attorney, claims agent, or Veterans Service Organization (VSO) representative can help you file a claim or request a decision review. Learn how to find and appoint one of these types of accredited representatives to help you.
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NOTE: Examiner must be a Medical Doctor (MD) or Doctor of Osteopathic (DO) medicine, physician assistant or advanced practice registered nurse.
Who is required to file va form 21p 4171? VA Form 21-4171 is a form used by veterans who are applying for disability benefits from the Department of Veterans Affairs (VA). It is completed by the veteran and must be signed and dated by the veteran or a representative of the veteran.
You may apply for Aid and Attendance or Housebound benefits by filling out, or have your doctor complete, VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) and mailing it to the Pension Management Center (PMC).

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