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Buddy and personal statement worksheet
Turn your own observations into a structured statement using VA Form 21-10210's format. This tool does not write your statement for you and does not evaluate what you write.
Notes outline
Statement Notes Worksheet
A plain outline of the topics VA Form 21-10210 asks about, to help you organize your own words. RatingScope is not VA and does not prepare or submit your statement.
Section I: Identification
Privacy Safeguard: RatingScope does not collect Social Security numbers, VA file numbers, or dates of birth. Those lines remain blank on your generated statement so you can complete them privately and securely offline.
Section II: Your notes
NOTES FOR YOUR OWN REFERENCE (not a VA form)
Space for your own words
SECTION I: VETERAN / BENEFICIARY IDENTIFICATION
1. Veteran Name: ______________________________
2. Date of Birth: [Fill offline after printing]
3. VA File / SSN: [Fill offline after printing]
4. Branch of Service: ______________________________
SECTION II: YOUR NOTES
1. In-Service Incurrence & Onset Timeline
(No details entered)
2. Current Symptom Severity & Worst-Day Incapacitation
(No details entered)
3. Occupational & Daily Living Impact
(No details entered)
This worksheet is not VA's form. Use VA's own form if you decide to submit a statement.
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