Fill out VA 21-4142 (Authorization to Disclose Information) online
VA Form 21-4142 authorizes the VA to request and obtain private medical records from non-VA healthcare providers on behalf of a veteran. This form gives the VA permission to retrieve treatment records, hospital records, and other medical documentation that may support a disability compensation claim or other VA benefits application.
How to fill out VA 21-4142 (Authorization to Disclose Information)
Enter veteran identification information
Provide your full name, Social Security number, VA file number (if known), date of birth, and contact information so the VA can associate the authorization with your claim.
Identify the healthcare provider
Enter the full name, address, phone number, and fax number of each non-VA healthcare provider whose records you want the VA to obtain. Be as specific as possible to avoid delays.
Specify the treatment details
For each provider, list the medical condition(s) treated and the approximate dates of treatment (start and end dates). This helps the VA request the correct records and speeds up processing.
Sign and submit
Sign and date the authorization. Submit it to the VA along with your disability claim or as supplemental evidence. The VA will contact the listed providers to obtain your medical records. Follow up if records are not received within 30-60 days.
About VA 21-4142 (Authorization to Disclose Information)
Who needs this form
Veterans who have received medical treatment from private (non-VA) healthcare providers and want the VA to obtain those records to support a disability claim. This is commonly submitted alongside VA Form 21-526EZ or during the evidence-gathering phase of a VA benefits claim.
Where to submit
Submit to the VA by mail to the Evidence Intake Center, by fax, online at va.gov, or through your Veterans Service Organization (VSO). The authorization is valid for 180 days from the date of signature.
Source and content freshness
- Reviewed: 2026-02-24
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not providing complete and accurate names and addresses for each healthcare provider
- Failing to specify the medical conditions treated and the approximate dates of treatment
- Letting the authorization expire before the VA has obtained all records (the form is valid for 180 days)
- Not submitting a separate authorization for each non-VA provider if required by VA processing
Frequently asked questions
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Why should I use VA 21-4142 instead of obtaining records myself?
While you can obtain and submit your own medical records, using VA Form 21-4142 allows the VA to request records directly from your providers, which can be faster and ensures the VA gets exactly the documentation it needs. It also shifts the burden of record retrieval from you to the VA. However, the authorization is only valid for 180 days, so submit it promptly. If you have copies of your records readily available, you may also submit them directly to speed up the process.
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