VA Form 21-4142 — Authorization to Disclose Information to the Department of Veterans Affairs — gives your private doctor, hospital, or clinic permission to send your medical records directly to the VA for your disability claim.

Key Resources — VA Form 21-4142Download VA Form 21-4142 →Download Companion Form 21-4142a →

What Is VA Form 21-4142?

When you file a VA disability claim, the VA automatically requests your military service records and your VA medical records. But private records — your own doctor, a specialist, a civilian hospital — require your written permission. That is what Form 21-4142 does.

There is also a companion form called VA Form 21-4142a (General Release for Medical Provider Information) for authorizing release from multiple providers on a single form.

When Should You Use VA Form 21-4142?

Important Limits

VA Form 21-4142 does not automatically cover mental health records (in some states), alcohol or drug treatment records, or HIV-related records. These may require additional consent language.

One Form Per Provider

Submit a separate 21-4142 for each provider. If you saw five different doctors, you need five completed forms — each with that provider's name, address, and treatment dates.

Faster Alternative: Gather Records Yourself

Using Form 21-4142 means the VA sends a written request to your provider — a process that often takes two to four months. A faster approach: contact providers directly, request your own records, and submit them with your claim. You verify completeness and avoid waiting. This is especially useful with a deadline or on a supplemental claim.

How to Complete VA Form 21-4142

  1. Download the form from va.gov/find-forms/about-form-21-4142/.
  2. Fill in your personal information — name, SSN, VA file number, date of birth, and address.
  3. Identify the provider — full name, address, city, state, and ZIP. Precision matters — a wrong address means the request fails.
  4. List dates of treatment — specify the date range. Use approximate ranges if you are unsure.
  5. Describe the records — briefly identify the condition or type of records, e.g., "lower back injury treatment."
  6. Sign and date — the form is not valid without your signature.
  7. Repeat for each provider — one form per provider.
  8. Submit with your claim — attach to your VA Form 21-526EZ or upload through VA.gov to an open claim.

How Long Does the VA Keep Trying?

After the VA receives your 21-4142, it will attempt to retrieve records for up to one year. If the provider does not respond, the VA will notify you. Do not assume records arrived — follow up if your claim is taking a long time.

How This Fits Into Your Overall Claim

VA Form 21-4142 is a supporting document — it does not start your claim. You still need VA Form 21-526EZ to apply. Consider also asking your private doctor to write a nexus letter — a medical opinion connecting your condition to service. That letter, combined with your records, often makes the difference between a denial and an approval. For the full picture, see our guide on how to file a VA claim.

Next Steps