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Click ‘Get Form’ to open it in the editor.
In Part I, provide your personal information including your name, VA file number, and Social Security Number. Ensure all details are accurate for identification purposes.
Move to Part II and indicate if you would like to receive a telephone call from a representative. Select your preferred time slots for contact.
In Part III, list each specific issue of disagreement in the provided boxes. Clearly state the nature of your disagreement and check the appropriate area of disagreement.
Complete Item 11A by explaining why you believe the decision was incorrect. If necessary, attach additional pages for further clarification.
Finally, sign and date the form in Part IV to certify that all statements are true. Remember to keep a copy for your records before submission.
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VA Form 21-4138 can be completed online or printed and filled out by hand. Veterans may also ask for assistance with filling out the form, such as from an accredited veterans representative. First, you should provide identifying information in Section I, such as: Full name.
What is VA form 21 0958?
In order for us to begin processing your NOD, you must complete, sign, and return VA Form 21-0958, Notice of Disagreement, within one year of the date of the decision notice we sent you on the decision(s) you are intending to appeal, or within 60 days from the date of this notice, whichever is later.
What is the hardest VA claim to get?
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.
Is VA Form 21 4138 still valid?
SUPERSEDES VA FORM 21-4138, JUN 2021. Before completing this form, read the Privacy Act and Respondent Burden on page 2. Use this form to submit a statement to support a claim. For more information you can contact us through Ask VA: , or call us toll-free at 1-800-827-1000 (TTY:711).
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Notice of Disagreement (NOD) (U.S. Department of Veterans
Important: Effective March 24, 2015, VA will only accept issues listed on a timely VA Form 21-0958, Notice of Disagreement, if required, as part of the appeal
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