VAFORMS.NET – VA Form 21-4142 – Authorization to Disclose Information to the Department of Veterans Affairs (VA) – VA Form 21-4142 is an authorization that grants the VA permission to obtain personal information from non-VA sources, including medical records. Such personal information may include hospitalizations, outpatient, and psychotherapy records. This form can be used to file for disability compensation and an increase in benefits. You can also file a Supplemental Claim, which is basically the same as the original form but includes additional evidence that supports your claim.
Download VA Form 21-4142 – Authorization to Disclose Information to the Department of Veterans Affairs (VA)
| Form Number | VA Form 21-4142 – |
| Form Title | Authorization to Disclose Information to the Department of Veterans Affairs (VA) |
| Edition Date | June 2022 |
| File Size | 2 MB |
What is a VA Form 21-4142?
The purpose of VA Form 21-4142 is to collect personal information about disabled veterans. This information may include information about hospitalizations, outpatient care, or psychotherapy. It’s important to fill out the form correctly to avoid mistakes. In addition, it’s vital to write legibly, as a mistake can make it more difficult for the VA to verify the information.
VA Form 21-4142 is a document that the United States Department of Veterans Affairs must have on file before it can review your medical claim. You can download the form from the Veterans Affairs documentation website or pick one up from your local Veterans Affairs office. When filling out the form, make sure to fill out boxes 1 through 4 completely. Once you’ve signed the form, you can take the next step and submit it to the VA.
Before submitting the form, ensure you have all of your records with you. If you have private medical records, it’s helpful to send them along with the claim to reduce processing time. Once your claim has been processed, the VA will schedule an appointment with you for a Compensation and Pension (C&P) examination.
VA Form 21-4142 – Authorization to Disclose Information to the Department of Veterans Affairs (VA)
VA Form 21-4142 – Authorization to Disclose Information to the Department of Veterans Affairs (VA) is a legal document that is used to authorize the release of your medical information to Veterans Affairs. You must submit this form along with your claim to the VA. You can download the form from the Veterans Affairs documentation website or get a copy from your local VA office. Make sure to fill out boxes 1, 2, and 4.
Once you have filled out the form, the VA will ask for all your medical records. Be sure to include the names and phone numbers of all the medical facilities you’ve used to receive care. Also, make sure to list the date and condition of each visit. You’ll need to provide a signature and personal information. The VA will use this information to determine your eligibility for veterans’ benefits.
VA Form 21-4142 Example
