A useful structure
- Identify your service.
Give relevant service dates, trade or occupation, units, ships, bases and deployments. - Describe the event, duty or exposure.
Explain what happened, where and when, how often it occurred, and what you personally observed. Distinguish known facts from estimates. - Explain the health timeline.
Describe when symptoms first appeared, when you sought care, when the condition was diagnosed and how it changed. Avoid making a medical conclusion beyond your knowledge. - Explain the effect today.
Use specific examples of limits on daily tasks, mobility, sleep, concentration, work, relationships or independence, as relevant to the claim. - Connect the statement to the records.
Refer to supporting documents by name and date. If a record is missing or a date differs, explain what you know and why. - Review for accuracy.
Check names, dates and sequence. Remove speculation and repetition. Keep a dated copy of the final statement.
Personal statement template
Use this as a starting point and adapt it to the facts of your own claim. Delete any section that does not apply.
1. Service background
I served in [branch/trade/unit] from [date] to [date]. My relevant duties included [describe duties, locations, deployments].
2. Relevant event, duty or exposure
Between approximately [dates], I [describe what you personally did, observed or were exposed to]. This occurred at [location] and [frequency/duration, if known]. I know this because [personal knowledge/record/source]. Details I cannot confirm are [identify uncertainties].
3. Health timeline
I first noticed [symptom or issue] around [date/period]. I sought medical attention [when/where, if known]. I was diagnosed with [condition] by [provider] on/about [date]. Relevant records include [list records].
4. Current effects
The condition affects me by [describe specific examples, frequency and severity]. For example, [one or two factual examples].
5. Supporting information
The documents that may help explain my account are [document/date]. [Explain any missing records, gaps in treatment or differences in dates, if relevant.]
6. Declaration
This statement is accurate to the best of my knowledge and recollection. Where I have estimated dates or details, I have identified them as estimates.
Signed: ____________________ Date: ____________________