src/applications/simple-forms/21-4138/config/constants.js
import React from 'react';
import { useSelector } from 'react-redux';
import { VA_FORM_IDS } from 'platform/forms/constants';
export const PrimaryActionLink = ({ href = '/', children, onClick = null }) => (
<div className="action-bar-arrow">
<div className="vads-u-background-color--primary vads-u-padding--1">
<a className="vads-c-action-link--white" href={href} onClick={onClick}>
{children}
</a>
</div>
</div>
);
const PrimaryActionLinkWithOnClick = ({ href = '/' }) => {
const { livingSituation, otherReasons, otherHousingRisks } = useSelector(
state => state.form.data,
);
const handlePriorityProcessingOnClick = e => {
e.preventDefault();
sessionStorage.setItem(
`dataTransfer-${VA_FORM_IDS.FORM_20_10207}`,
JSON.stringify({
data: { livingSituation, otherReasons, otherHousingRisks },
expiry: Date.now() + 300000, // 5 minutes
}),
);
window.location.href = href;
};
return (
<PrimaryActionLink href={href} onClick={handlePriorityProcessingOnClick}>
Start your request
</PrimaryActionLink>
);
};
export const TITLE = 'Submit a statement to support a claim';
export const SUBTITLE = 'Statement in Support of Claim (VA Form 21-4138)';
export const workInProgressContent = {
description:
'We’re rolling out Submit a Statement to Support a Claim (VA Form 21-4138) in stages. It’s not quite ready yet. Please check back again soon.',
redirectLink: '/',
redirectText: 'Return to VA home page',
};
export const STATEMENT_TYPES = Object.freeze({
BUDDY_STATEMENT: 'buddy-statement',
DECISION_REVIEW: 'decision-review',
PRIORITY_PROCESSING: 'priority-processing',
PERSONAL_RECORDS: 'personal-records',
NEW_EVIDENCE: 'new-evidence',
NOT_LISTED: 'not-listed',
});
export const STATEMENT_TYPE_LABELS = Object.freeze({
[STATEMENT_TYPES.BUDDY_STATEMENT]:
'I want to submit a formal statement to support my claim or someone else’s claim. This is also known as a “buddy statement.”',
[STATEMENT_TYPES.DECISION_REVIEW]:
'I want to request a decision review for my claim.',
[STATEMENT_TYPES.PRIORITY_PROCESSING]:
'I want to request that VA process my claim faster due to certain qualifying situations.',
[STATEMENT_TYPES.PERSONAL_RECORDS]: 'I want to request my personal records.',
[STATEMENT_TYPES.NEW_EVIDENCE]: 'I have new evidence to submit.',
[STATEMENT_TYPES.NOT_LISTED]:
"The type of statement I want to submit isn't listed here.",
});
export const DECISION_REVIEW_TYPES = Object.freeze({
NEW_EVIDENCE: 'new-evidence',
ERROR_MADE: 'error-made',
BVA_REQUEST: 'bva-request',
});
export const DECISION_REVIEW_TYPE_LABELS = Object.freeze({
[DECISION_REVIEW_TYPES.NEW_EVIDENCE]: 'I have new and relevant evidence.',
[DECISION_REVIEW_TYPES.ERROR_MADE]:
'I think there was an error with a decision on my case.',
[DECISION_REVIEW_TYPES.BVA_REQUEST]:
"I want the Board of Veteran's Appeals to review my case.",
});
export const DECISION_REVIEW_TYPE_DESCRIPTIONS = Object.freeze({
[DECISION_REVIEW_TYPES.ERROR_MADE]:
"Don't select this option if you have new evidence to submit.",
[DECISION_REVIEW_TYPES.BVA_REQUEST]:
'You can also submit new evidence with certain types of Board Appeals.',
});
export const LIVING_SITUATIONS = Object.freeze({
OVERNIGHT:
'I live or sleep overnight in a place that isn’t meant for regular sleeping. This includes a car, park, abandoned building, bus station, train station, airport, or camping ground.',
SHELTER:
'I live in a shelter (including a hotel or motel) that’s meant for temporary stays.',
FRIEND_OR_FAMILY:
'I’m staying with a friend or family member, because I can’t get my own home right now.',
LEAVING_SHELTER:
'In the next 30 days, I will have to leave a facility, like a homeless shelter.',
LOSING_HOME:
'In the next 30 days, I will lose my home. (Note: This could include a house, apartment, trailer, or other living space that you own, rent, or live in without paying rent. Or it could include a living space that you share with others. It could also include rooms in hotels or motels.)',
OTHER_RISK: 'I have another housing risk not listed here.',
NONE: 'None of these situations apply to me.',
});
export const OTHER_REASONS = Object.freeze({
FINANCIAL_HARDSHIP:
'I’m experiencing extreme financial hardship (such as loss of your job or sudden decrease in income).',
ALS:
'I have ALS (amyotrophic lateral sclerosis), also known as Lou Gehrig’s disease.',
TERMINAL_ILLNESS: 'I have a terminal illness.',
VSI_SI:
'I have a status from the Defense Department of Very Seriously Injured or Ill (VSI) or Seriously Injured or Ill (SI).',
OVER_85: 'I’m age 85 or older.',
FORMER_POW: 'I’m a former prisoner of war (POW).',
MEDAL_AWARD: 'I’m a Medal of Honor or Purple Heart award recipient.',
NONE: 'None of these situations apply to me.',
});
export const ESCAPE_HATCH = Object.freeze(
<div className="vads-u-margin-y--4">
If you’d like to use VA Form 21-4138 for your statement without selecting an
answer here, you can{' '}
<a href="/supporting-forms-for-claims/statement-to-support-claim-form-21-4138/personal-information">
go to VA Form 21-4138 now.
</a>
</div>,
);
export const LAY_OR_WITNESS_HANDOFF = Object.freeze(
<div>
<p>
Based on your answer, you should submit your statement with VA Form
21-10210, Lay/Witness Statement.
</p>
<h2 className="vads-u-font-size--h3">
What to know before you submit a lay or witness statement
</h2>
<ul>
<li>
You can submit a statement to support your own VA claim or someone
else’s VA claim. People also sometimes call this a “buddy statement.”
</li>
<li>
To submit a statement to support someone else’s claim, you’ll need to
give us information like their date of birth, Social Security number, VA
file number (if available), and contact information.
</li>
<li>
Each statement needs its own form. If you want to submit more than one
statement, use a new form for each statement.
</li>
</ul>
<PrimaryActionLink href="/supporting-forms-for-claims/lay-witness-statement-form-21-10210/introduction">
Start your statement
</PrimaryActionLink>
<va-omb-info
res-burden={10}
omb-number="2900-0881"
exp-date="06/30/2024"
class="vads-u-margin-y--4"
/>
{ESCAPE_HATCH}
</div>,
);
export const NOD_OLD_HANDOFF = Object.freeze(
<div>
<p>
Since it’s been more than 1 year since we made a decision, you should file
a <strong>Supplemental Claim.</strong>
</p>
<p>
We can help you gather any new evidence you identify (such as medical
records) to support your claim.
</p>
<p>A reviewer will decide if this new evidence changes the decision.</p>
<PrimaryActionLink href="/decision-reviews/supplemental-claim/file-supplemental-claim-form-20-0995/start">
File a Supplemental Claim online
</PrimaryActionLink>
<div className="vads-u-margin-y--4">
<a
href="/decision-reviews/supplemental-claim/"
target="_blank"
rel="noopener noreferrer"
>
Learn more about supplemental claims (opens in new tab)
</a>
</div>
{ESCAPE_HATCH}
</div>,
);
export const NOD_SUPPLEMENTAL_HANDOFF = Object.freeze(
<div>
<p>
Based on your answer, you may want to file a{' '}
<strong>Supplemental Claim.</strong>
</p>
<p>
We can help you gather any new evidence you identify (such as medical
records) to support your claim.
</p>
<p>A reviewer will decide if this new evidence changes the decision.</p>
<PrimaryActionLink href="/decision-reviews/supplemental-claim/file-supplemental-claim-form-20-0995/start">
File a Supplemental Claim online
</PrimaryActionLink>
<div className="vads-u-margin-y--4">
<a
href="/decision-reviews/supplemental-claim/"
target="_blank"
rel="noopener noreferrer"
>
Learn more about supplemental claims (opens in new tab)
</a>
</div>
{ESCAPE_HATCH}
</div>,
);
export const NOD_HLR_HANDOFF = Object.freeze(
<div>
<p>
Based on your answer, you may want to request a{' '}
<strong>Higher-Level Review.</strong> A higher-level reviewer can review
the case again and determine whether an error or a difference of opinion
changes the decision.
</p>
<p>
This is not the right option for you if you would like to submit new
evidence.
</p>
<p>
For disability compensation claims, you can request a Higher-Level Review
online.
</p>
<PrimaryActionLink href="/decision-reviews/higher-level-review/request-higher-level-review-form-20-0996/">
Request a High-Level Review online
</PrimaryActionLink>
<p>
<strong>Note:</strong> At this time, you can use our online Higher-Level
Review form for only disability compensation claims. For other types of
claims, you’ll need to request a Higher-Level Review either by mail or in
person.
</p>
<div className="vads-u-margin-y--4">
<va-link
download
href="/decision-reviews/higher-level-review/request-higher-level-review-form-20-0996"
text="Get VA Form 20-0996 to download"
/>
</div>
<div className="vads-u-margin-y--4">
<a
href="/decision-reviews/higher-level-review/"
target="_blank"
rel="noopener noreferrer"
>
Learn more about Higher-Level Reviews and how to request one (opens in
new tab)
</a>
</div>
{ESCAPE_HATCH}
</div>,
);
export const NOD_BA_HANDOFF = Object.freeze(
<div>
<p>
Based on your answer, you may want to request a{' '}
<strong>Board Appeal.</strong> That means a Veterans Law Judge at the
Board of Veterans’ Appeals will review your case.
</p>
<p>
When you fill out the form, you’ll need to request the type of review you
want from the Board:
</p>
<ul style={{ margin: '6px' }}>
<li>
<strong>Direct review</strong>, if you don’t want to submit evidence or
have a hearing
</li>
<li>
<strong>Evidence submission</strong>, if you want to submit additional
evidence without a hearing
</li>
<li>
<strong>Hearing</strong>, if you want to have a hearing with a Veterans
Law Judge (with or without new evidence)
</li>
</ul>
<PrimaryActionLink href="/decision-reviews/board-appeal/request-board-appeal-form-10182/introduction">
Request a Board Appeal online
</PrimaryActionLink>
<div className="vads-u-margin-y--4">
<a
href="/decision-reviews/board-appeal/"
target="_blank"
rel="noopener noreferrer"
>
Learn more about Board Appeals and how to request one (opens in new tab)
</a>
</div>
{ESCAPE_HATCH}
</div>,
);
export const ADDITIONAL_INFO_OTHER_HOUSING_RISKS = Object.freeze(
<va-additional-info
trigger="What to know before sharing details about other housing risks"
data-testid="otherHousingRisksAdditionalInfo"
>
<div>
<p>
We understand that you may have other housing risks not listed here. If
you feel comfortable sharing more about your situation, you can do that
here. Or you can simply check this option and not include any details.
We’ll use this information only to prioritize your request.
</p>
<p>
<b>Note:</b> If you need help because of domestic violence, call the
National Domestic Violence hotline <va-telephone contact="8007997233" />{' '}
(TTY: <va-telephone contact="8007873224" />) or text "START" to 88788.
Staff are there to help 24 hours a day, 7 days a week. All conversations
are private and confidential.
</p>
</div>
</va-additional-info>,
);
export const PRIORITY_PROCESSING_NOT_QUALIFIED = Object.freeze(
<div>
<va-alert>
Based on your responses, you may not qualify for priority processing.
</va-alert>
<p>
It’s possible we don’t have enough information about your situation yet.
You may use this form (VA Form 21-4138) to submit a detailed explanation
about your circumstances.
</p>
</div>,
);
export const PRIORITY_PROCESSING_QUALIFIED = Object.freeze(
<div>
<va-alert status="success" uswds>
Based on your responses, you may qualify for priority processing. The next
step is for you to complete a priority processing request.
</va-alert>
<h2 className="vads-u-font-size--h3">How to request priority processing</h2>
<p>
We may need supporting documents based on the situation. If you don’t have
supporting documents, you can still submit your request. But we’ll process
your request faster if you submit all of the documents that you have
available. You can start your request now, or you can keep reading to
learn what types of evidence to submit.
</p>
<div className="vads-u-margin-y--3">
<va-alert>
Note: Since you’re signed into your account, you can save your
application in progress and come back later to finish filling it out.
</va-alert>
</div>
<PrimaryActionLinkWithOnClick href="/supporting-forms-for-claims/request-priority-processing-form-20-10207/introduction">
Start your request
</PrimaryActionLinkWithOnClick>
<h2 className="vads-u-font-size--h3">Types of evidence to submit</h2>
<p>You can submit any of these types of evidence.</p>
<p>
<strong>Note:</strong> Please don’t send original documents. Send copies
instead.
</p>
<h3 className="vads-u-font-size--h4">For extreme financial hardship</h3>
<ul>
<li>Eviction or foreclosure notice</li>
<li>Notices of past-due utility bills</li>
<li>Collection notices from creditors</li>
</ul>
<h3 className="vads-u-font-size--h4">
For ALS or other terminal illnesses
</h3>
<ul>
<li>Medical evidence and diagnosis</li>
</ul>
<p>
<strong>Note:</strong> If you want us to get your private treatment
records, you’ll need to submit an authorization to release non-VA medical
information to us (VA Forms 21-4142 and 21-4142a).
</p>
<a
target="_blank"
rel="noopener noreferrer"
href="/supporting-forms-for-claims/release-information-to-va-form-21-4142/introduction"
>
Submit an authorization online to release non-VA medical information to us
(opens in new tab)
</a>
<h3 className="vads-u-font-size--h4">
For Very Seriously Injured or Ill (VSI) or Seriously Injured or Ill (SI)
</h3>
<ul>
<li>Military personnel records, such as a determination from the DOD</li>
<li>Medical evidence showing severe disability or injury</li>
</ul>
<h3 className="vads-u-font-size--h4">For former prisoners or war</h3>
<ul>
<li>Military personnel records, such as DD214</li>
<li>Service number and branch and dates of service</li>
<li>Dates and location of internment</li>
<li>Detaining power or other relevant information</li>
</ul>
<h3 className="vads-u-font-size--h4">
For Medal of Honor or Purple Heart award recipients
</h3>
<ul>
<li>Military personnel records, such as DD214</li>
<li>
Information showing receipt of Medal of Honor or Purple Heart award
</li>
</ul>
<h2 className="vads-u-font-size--h3">How to submit supporting evidence</h2>
<ul>
<li>
You can upload your documents online as you complete this form. This
will help us process your request faster.
</li>
<li>You can also send copies of your documents by mail.</li>
</ul>
<va-additional-info
trigger="Where can I send documents by mail?"
data-testid="ppQualifiedMailingAdditionalInfo"
>
<div>
<p>
Find the benefit type you’re requesting priority processing for. Then
use the corresponding mailing address.
</p>
<p>
<strong>Compensation claims</strong>
<br />
Department of Veterans Affairs Compensation Intake Center
<br />
PO Box 4444
<br />
Janesville, WI 53547-4444
</p>
<p>
<strong>Pension and survivors benefit claims</strong>
<br />
Department of Veterans Affairs Pension Intake Center
<br />
PO Box 5365
<br />
Janesville, WI 53547-5365
</p>
<p>
<strong>Board of Veterans' Appeals</strong>
<br />
Department of Veterans Affairs Board of Veterans' Appeals
<br />
PO Box 27063
<br />
Washington, DC 20038
</p>
<p>
<strong>Fiduciary</strong>
<br />
Department of Veterans Affairs Fiduciary Intake Center
<br />
PO Box 5211
<br />
Janesville, WI 53547-5211
</p>
</div>
</va-additional-info>
<va-omb-info
res-burden={5}
omb-number="2900-0736"
exp-date="02/28/2026"
class="vads-u-margin-y--4"
/>
</div>,
);
export const RECORDS_REQUEST_HANDOFF = Object.freeze(
<div>
<p>
Based on your answer, you should request your personal records with VA
Form 20-10206, Freedom of Information Act (FOIA) or Privacy Act (PA)
Request.
</p>
<h2 className="vads-u-font-size--h3">
What to know before you request your personal records
</h2>
<p>
You must be a U.S. citizen or a legal permanent resident to access your
records under the Privacy Act (PA).
</p>
<p>
You can only use this online form to request only your own personal
records. If you’re a third-party representative or power of attorney
requesting records for someone else, you can’t submit this online form.
You’ll need to submit a FOIA request online using the Public Access Link
(PAL).
</p>
<p>
<a href="https://vapal.efoia-host.com/app/RequestsandFees.aspx">
Request records online through a FOIA request.
</a>{' '}
You’ll need to have proper authorization on record for your request to be
processed.
</p>
<h2 className="vads-u-font-size--h3">
Types of information you can request
</h2>
<p>You can request any of these kinds of personal records:</p>
<p>
<strong>Your compensation and pension records</strong>
</p>
<ul>
<li>
Certificate of Release or Discharge from Active Duty (DD Form 214)
</li>
<li>Claims file (C-file)</li>
<li>Disability examinations (C&P exams)</li>
<li>Official military personnel file (OMPF)</li>
<li>Pension benefit documents</li>
<li>Service or military treatment</li>
<li>Other compensation and pension records</li>
</ul>
<p>
<strong>Your benefit records</strong>
</p>
<ul>
<li>Education benefit</li>
<li>Fiduciary services</li>
<li>Financial records</li>
<li>Home loan benefit</li>
<li>Life insurance benefit</li>
<li>Vocational rehabilitation and employment</li>
<li>Other benefit record</li>
</ul>
<div className="vads-u-margin-y--3">
<va-alert>
Note: Since you’re signed into your account, you can save your
application in progress and come back later to finish filling it out.
</va-alert>
</div>
<PrimaryActionLink href="/records/request-personal-records-form-20-10206/introduction">
Start your request
</PrimaryActionLink>
<va-omb-info
res-burden={5}
omb-number="2900-0736"
exp-date="02/28/2026"
class="vads-u-margin-y--4"
/>
{ESCAPE_HATCH}
</div>,
);
export const NEW_EVIDENCE_HANDOFF = Object.freeze(
<div>
<p>
If you have an open claim, you can add evidence to support it. Evidence
may include documents like court papers or service treatment records.
</p>
<PrimaryActionLink href="/track-claims/your-claims">
Upload evidence using our claim status tool
</PrimaryActionLink>
<p>
If you prefer to mail copies of your documents, we recommend filling out
and including VA Form 20-10208 (Document Evidence Submission) along with
the evidence.
</p>
<div className="vads-u-margin-y--4">
<va-link
download
filetype="PDF"
href="https://www.vba.va.gov/pubs/forms/VBA-20-10208-ARE.pdf"
text="Get VA Form 20-10208 to download"
/>
</div>
<p>
<strong>Compensation claims</strong>
</p>
<p className="va-address-block">
U.S. Department of Veterans Affairs
<br />
Compensation Intake Center
<br />
P.O. Box 4444
<br />
Janesville, WI 53547
<br />
United States of America
</p>
<p>
<strong>Pension claims</strong>
</p>
<p className="va-address-block">
U.S. Department of Veterans Affairs
<br />
Pension Intake Center
<br />
P.O. Box 5365
<br />
Janesville, WI 53547
<br />
United States of America
</p>
<h2 className="vads-u-font-size--h3">What happens after I submit?</h2>
<p>
After you submit evidence, we’ll review the documents and contact you with
updates.
</p>
<p>
If you’ve also applied for a VA pension or for disability benefits, you
can check the status of those claims online.
</p>
<a className="vads-u-font-weight--bold" href="/track-claims/your-claims">
Check the status of your claim
</a>
{ESCAPE_HATCH}
</div>,
);