VA Form 21-0781A, Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault is a form issued by the Department of Veterans Affairs (VA) and filed by veterans who have been diagnosed with PTSD caused by their military service. A personal assault is a primary reason for filling out the form.
The latest version of the form was released on July 1, 2017. An up-to-date VA Form 21-0781A is available for digital filing and download below or can be found through the VA website.
The VA 21-0781A requests some information about the traumatic incident including the exact time, date, location, and a description of the event. In addition, the filer can include names, ranks, and addresses of the people who can verify the details of the incident. Providing precise details will ensure that the VA can get all the information they need to accept the claim. VA Form 21-0781, Statement in Support of Claim for Service Connection for Post-traumatic Stress Disorder (PTSD), is a related form and is the main part of placing a claim for PTSD with the VA.
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.