A lay statement is a written statement from you, the veteran, describing your condition and how it affects your daily life. Be as detailed and specific as possible.
VETERAN INFORMATION
Include these details for EACH CONDITION:
Date of Onset:
Circumstances of Onset:
Has this Worsened, Stayed the Same, Improved, or Resolved:
Symptoms:
Testing (x-rays, scans, labs, etc):
Treatments (medications, surgery):
Functional Impact:
SIGNATURE & DATE
Sign here
WHAT TO INCLUDE IN YOUR LAY STATEMENT:
• When your condition started and what caused it
• Current symptoms and their severity
• How it affects your daily activities, work, and relationships
• Specific examples of limitations you experience
• Any treatment you've received and its effectiveness