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Veterans Benefits AdministrationM21-1, Part III - page 59 / 71

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February 25, 2005M21-1, Part III

Change 131

Appendix B

Exhibit B-3 - continued

a.  This person should have personal knowledge of your disabilities.  Each person should submit a

statement on the enclosed VA Form titled “Statement in Support of Claim” or a letter with the following statement above the signature:

I hereby certify that the information I have given is true to the best of my knowledge and belief.

b.  The person’s name and complete address must be clearly shown.  Identify the statement with your

name and VA file number.

c.  The statement should describe exactly what the person observed and mention specific dates and

places.

d.  A person on active duty at the time should include his or her service number and military unit.

WHAT YOU SHOULD DO NEXT

Please send this information to the address at the top of this letter as soon as you can, preferably within 60 days.  If you wish, you may visit our office with the evidence.  The sooner we receive what we need, the sooner we will be able to decide your claim.

If we don’t hear from you within one year from the date of this letter, we can only begin payment of benefits from the date we get your response.

IF YOU HAVE ANY QUESTIONS

If you have any questions about this letter or any VA benefits, call our toll-free Gulf Information Helpline at 1-800-PGW-VETS.

Sincerely yours,

[Signature Block of Veterans Service Center Manager]

Enclosure:  VA Form 21-4138

5-B-5

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