Section V: New and Relevant Evidence
For your supplemental claim to be complete, you must submit additional evidence that is NEW AND RELEVANT to support granting the benefit(s)
sought or you must identify existing relevant records that you would like VA to obtain. (NEW evidence means information not previously submitted to
VA, and RELEVANT evidence means information that tends to prove or disprove a matter at issue in the claim).
If you know of evidence not in your possession and want VA to try to obtain it for you, give VA enough information about the evidence so that we can
request it from the person or agency that has it. List all relevant evidence in the custody of a VA medical center (VAMC) or other Federal department or
agency. VA will retrieve relevant records from a Federal facility or VAMC that you adequately identify and authorize VA to obtain. If the holder of the
evidence declines to give it to VA, asks for a fee to provide it, or otherwise cannot get the evidence, VA will notify you and provide you with an
opportunity to submit the information or evidence.
VA will make every reasonable effort to obtain relevant records not held by a Federal facility that you adequately identify and authorize VA to obtain.
These may include records from State or local governments and privately held evidence and information you tell us about, such as private doctor or
hospital records from current or former employers.
Note 1: Unless your supplemental claim (www.va.gov/decision-reviews/supplemental-claim/) is based on a change in law, you'll need to submit
supporting evidence that's new and relevant for your application to be complete. You can also identify evidence you'd like us to gather for you.
Note 2: If you would like VA to attempt to obtain your private provider, (excluding community care (paid for by VA)) or VA Vet Center health
records, VA requires your consent by completing VA Forms 21-4142, Authorization to Disclose Information to VA, and 21-4142a, General Release for
Medical Provider Information to VA. VA forms are available at www.va.gov/vaforms.
Section VI: 5103 Notice of Acknowledgment
For Compensation, Pension, Dependency Indemnity Compensation (DIC), and Accrued benefit claims: If you are filing for review of an issue more
than one year after VA provided notice of our decision, please visit one of these pages on VA.gov to review the 38 U.S.C. 5103 information regarding
evidence necessary to substantiate your claim:
• Evidence to support a claim for Veterans Disability Compensation and related Compensation benefits:
https://www.va.gov/disability/how-to-file-claim/evidence-needed/
• Evidence to support a claim for VA pension, DIC, or accrued benefits:
https://www.va.gov/resources/evidence-to-support-va-pension-dic-or-accrued-benefits-claims/
Then, check the "YES" checkbox in Item 23 to confirm your receipt of this information. If you cannot review the information online and would like the
information mailed to you, check the "NO" checkbox in Item 23 and VA will send you this notice through the mail.
Section VII: Option for Veterans Benefit Administration (VBA) to notify VHA about Certain Upcoming Event(s) during the Claim and/or
Appeal Process
VHA provides free treatment for mental and physical health conditions related to experiences of Military Sexual Trauma (MST). These services are
available to individuals with veteran status and most former service members with an Other Than Honorable or uncharacterized (entry-level) discharge,
even if your claim for service connection is denied. To learn more, including how to access this care, go to www.mentalhealth.va.gov/mst or contact the
VHA MST Coordinator at a VA medical facility near you.
If you are filing a claim for compensation for a condition due to a personal traumatic event(s) involving MST and you are registered and/or enrolled for
VHA health care, you have the option for VBA to electronically notify VHA about certain upcoming event(s) during your claim and/or appeal process. If
you would like VBA to send these electronic notifications to VHA, please indicate your decision by selecting a checkbox in Item 24. A response is not
required. VBA will not send electronic notifications to VHA without your consent. If you do not respond, VBA will not send electronic notifications to
VHA, nor will there be a change in your prior decision.
Section VIII, IX, X, and XI: Certification and Signatures
Please be sure to sign this supplemental claim, certifying that the statements on the form are true and correct to the best of the veteran/claimant's or
authorized representative's knowledge and belief.
Page 3
VA FORM 20-0995, MAY 2024
PRIVACY ACT NOTICE: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code
of Federal Regulations 1.576 for routine uses (i.e., civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed
to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status,
and personnel administration) as identified in the following VA systems of records published in the Federal Register: 58/VA21/22/28, Compensation, Pension, Education and Veterans
Readiness and Employment Records -VA; 55VA26 Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant
Records, and Vendee Loan Applicant Records -VA; and 36VA29, Veterans and Armed Forces Personnel Programs of Government Life Insurance -VA. Your obligation to respond is
required to obtain or retain benefits. VA uses your SSN to identify your claims file. Providing your SSN will help ensure that your records are properly associated with your claim file.
Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. VA will not deny an individual benefits for refusing
to provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The requested information is
considered relevant and necessary to determine maximum benefits under the law. The responses you submit are considered confidential (38 U.S.C. 5701). Information submitted is
subject to verification through computer matching programs with other agencies.
RESPONDENT BURDEN: An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB
control Number. The OMB control number for this project is 2900-0886, and it expires 05/31/2027. Public reporting burden for this collection of information is estimated to average 15
minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the
burden to VA Reports Clearance Officer at
[email protected]. Please refer to OMB Control No. 2900-0886 in any correspondence. Do not send your completed
VA Form 20-0995 to this email address.