VA Form 21-4142Authorization to Disclose Information to the Department of Veterans Affairs
The HIPAA release that lets VA request your treatment records from private doctors and hospitals on your behalf.
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- The form is free from VA
- August 2024 edition
- You edit it, you sign it, you submit it
What VA Form 21-4142 is for.
VA Form 21-4142 is a signed authorization. It gives VA permission to contact the private providers you name — a civilian doctor, a hospital, a therapist — and request the records they hold about your treatment. Without it, VA can only see what it already has: your service treatment records and anything from VA's own medical centers.
It travels with a companion, VA Form 21-4142a (General Release for Medical Provider Information). The 4142 is the authorization; the 4142a is where you list each provider, their address, the dates you were treated and the conditions they treated. VA needs both, and the online version asks for the two together.
The authorization is good for 12 months from the date you sign it, unless you revoke it in writing first. It only covers the providers and dates you list — VA does not get a blanket key to your medical history.
- Official title
- Authorization to Disclose Information to the Department of Veterans Affairs
- Form number
- VA Form 21-4142
- Current edition
- August 2024
- Plain name
- Private records release
When VA Form 21-4142 is the right form — and when it isn’t.
This is the form you need if…
- You were treated for a claimed condition by a private provider and you don't have those records in hand.
- VA has sent you a letter asking you to submit a 21-4142 for a named provider.
- You are filing a Fully Developed Claim and would rather VA gather the private records than gather them yourself.
- A provider has closed, moved or is slow to release records to you directly, and a VA request may move faster.
Reach for a different form if…
- You already have complete copies of the private records — submit them directly with the claim instead. It's faster and you can read them first.
- The treatment was at a VA medical center or a military hospital. VA already has access to those records and the form doesn't apply.
- You want your own copy of your records. This form releases them to VA, not to you — request them from the provider or through the VA's own C-File process.
Still not sure which form your claim needs? An accredited VSO will help you file it for free, and VeteranAI works alongside them, never instead of them.
Filling out VA Form 21-4142, step by step.
What each part of the form is asking for, and what a rater does with the answer. Item numbers change between editions; the questions don’t.
Decide whether to gather the records yourself first
If a provider can hand you the records in a week, do that and skip the form — you get to read what's in them before VA does. Use the 4142 for the providers you can't get to.
Complete the veteran identification section
Name, Social Security number or VA file number, date of birth, and contact details. If the claimant is someone other than the veteran — a surviving spouse, for instance — there is a separate claimant section.
List every provider on the 21-4142a
One entry per provider: the practice or facility name, full mailing address, the dates of treatment (as close as you can — a month and year is fine), and the conditions treated there. Attach more pages if you have more providers than the form has room for.
Sign and date the authorization
The date you sign starts the 12-month clock. An unsigned or undated form is returned, and the request doesn't go out until it comes back.
Submit it with the claim, or in answer to VA's letter
Online through VA.gov, uploaded to your claim, or mailed to the Claims Intake Center. If VA asked for it in a development letter, sending it back promptly keeps the claim moving.
Where VA Form 21-4142 goes wrong.
- Mistake 1
Naming a provider without the dates or the condition
A request VA sends with no date range is easy for a records office to answer with nothing. Give the months, and say what you were treated for.
- Mistake 2
Expecting VA to chase the provider
VA sends the request and follows up, but it won't chase a provider indefinitely. If the records never arrive, VA rates the claim on what it has. Check with the provider yourself that they went out.
- Mistake 3
Letting the authorization expire mid-claim
Claims routinely take longer than a year. If VA has to make a second request after the 12 months, it needs a fresh form — and it will write to you asking for one.
- Mistake 4
Using it for records you could have submitted yourself
Every record VA has to request adds weeks to the claim. Submitting the copies you already hold is the faster path, and it lets you read what the evidence says first.
Know what VA already holds before you ask for more.
The 21-4142 exists to get records into your file. The C-File Analyzer reads the file you already have — every page of it — and tells you, in plain English, which conditions are documented and where the gaps are. So the form goes out for the records that matter, not for every doctor you've ever seen.
Self-help software for veterans filing their own claims. Not accredited, not a representative — you edit every line, you sign it, you submit it, and nobody takes a cut of your benefits.
Read my recordsSee the C-File Analyzer →VA Form 21-4142, answered
Question not here? team@veteranai.coVA Form 21-4142 is a signed release that authorizes VA to request your treatment records from private, non-VA providers — a civilian doctor, hospital or therapist — so the records can be added to your disability claim. It's paired with Form 21-4142a, where you list each provider, the dates of treatment and the conditions treated.
The authorization is good for 12 months from the date you sign it, unless you revoke it in writing sooner. If VA needs to request records after that, it will ask you for a new form.
The 21-4142 is the authorization — your signed permission for VA to obtain records. The 21-4142a (General Release for Medical Provider Information) is where you name each provider, give their address, the treatment dates and the conditions treated. VA needs both; the online version collects them together.
No. If you have complete copies of the private records, submit them directly with your claim. That's faster than waiting for VA to request them, and you get to read what the evidence says before it's rated. Use the 21-4142 for records you can't obtain yourself.
The 21-4142 is free. What goes on it is the work.
VeteranAI builds the content that goes on VA Form 21-4142 with you — in your words, edited by you, signed by you. Nobody takes a cut of your benefits.
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