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OMB Approved No. 29000659 Respondent Burden: 1 hour 10 minutes Expiration Date: 07/31/2020 VA DATE STAMP DO NOT WRITE IN THIS SPACESTATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POST-TRAUMATIC
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How to fill out va form 21 0781a

01
Start by downloading and printing the VA Form 21-0781a from the official VA website.
02
Read the instructions carefully to understand the purpose of the form and the information it requires.
03
Gather all relevant medical documentation, such as doctor's reports, test results, and any other supporting evidence.
04
Begin filling out the form by providing your personal information, including your full name, social security number, and contact details.
05
Specify the type of claim you are filing for, whether it's related to a service-connected disability, personal trauma, or another cause.
06
Describe the event or incident that caused the disability or trauma in detail. Include dates, locations, and any witnesses, if applicable.
07
Provide a detailed account of your current symptoms, limitations, and how they impact your daily life.
08
Attach any supporting medical documentation, such as doctor's reports, X-rays, or laboratory results.
09
Review the completed form to ensure all information is accurate and legible.
10
Sign and date the form, and make a copy for your records before submitting it to the appropriate VA office.

Who needs va form 21 0781a?

01
VA Form 21-0781a is needed by individuals who are filing a claim for disability benefits with the Department of Veterans Affairs (VA).
02
It is specifically required for those who are seeking compensation or pension benefits based on a personal trauma, such as physical assault, sexual harassment, or similar incidents.
03
This form helps the VA gather detailed information about the event or incident, the resulting disability or trauma, and any supporting evidence.
04
It is important to consult with a VA representative or legal expert to determine whether you need to fill out this form in your specific case.
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VA Form 21-0781a is the Statement in Support of Claim for PTSD Secondary to Personal Assault.
Veterans who are seeking VA disability benefits for PTSD secondary to personal assault are required to file VA Form 21-0781a.
VA Form 21-0781a should be filled out with detailed information about the personal assault that resulted in PTSD, including date, location, circumstances, and supporting evidence.
The purpose of VA Form 21-0781a is to provide a statement detailing the personal assault that led to PTSD in order to support a claim for VA disability benefits.
Information such as date, location, description of the personal assault, names of witnesses, and any available supporting documents must be reported on VA Form 21-0781a.
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