Supporting evidence for a disability compensation claim
Department of Veterans Affairs
Evidence Intake Center
PO Box 4444
Janesville, WI 53547-4444
VA Form 21-4142 — Authorize a private-records request
Authorize VA to request private medical information for the applicable claim or review. Do not use it as a substitute for the benefit application.
Use the current official form
Revision: August 2024.
Attach it to the applicable claim or review request; sending evidence alone does not necessarily initiate a review. Other benefit destinations are separate.
Submission instructions
In person
Disability compensation documents through the applicable claim or review channel.
A VA regional benefits office