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VA 21-0781a 2021-2024 free printable template

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OMB Approved No. 29000659 Respondent Burden: 1 hour and 10 minutes Expiration Date: 06/30/2024VA DATE STAMP(DO NOT WRITE IN THIS SPACE)STATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POST-TRAUMATIC
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How to fill out va form 21 0781a


How to fill out va form 21 0781a

Gather all necessary information needed to complete the VA Form 21-0781a, such as personal information, medical history, and details about the stressful event.
Download the VA Form 21-0781a from the official VA website or obtain a copy from your local VA office.
Fill out the form accurately and completely, making sure to provide all requested information in the appropriate sections.
Review the completed form to ensure that all information is correct and legible.
Sign and date the form before submitting it to the VA for processing.

Who needs va form 21 0781a?

Individuals who have experienced a traumatic event during their military service and are seeking compensation for post-traumatic stress disorder (PTSD) or other related mental health conditions may need to fill out VA Form 21-0781a.

Who needs a VA Form 21-0781a?

Form VA 21-0781a, Statement in Support of Claim for Service Connection Post-Traumatic Stress Disorder, should be completed by a military serviceman suffered stressful incident or incidents that occurred in service and are contributed to a person’s current conditions.

What is VA Form 21-0781a for?

The VA Administration will make their own investigation order to assess whether this person is owed any benefits in connection with the incident; based on the information provided the VA will conduct research of military records and other sources identified in this form.

A submitter must provide all available sources (military and non-military) that may provide information concerning reported incident.

Is VA Form 21-0781a accompanied by other forms?

The Statement in Support of Claim for Service Connection Post-Traumatic Stress Disorder should be submitted along with this Statement if you would like the VA to obtain the treatment records from the particular provider.

How do I fill out VA Form 21-0781a PDF?

You should complete the following blocks in order to complete VA PTSD Statement:

  • Veteran’s personal information;

  • Stressful Incident description (date, location, unit assignment, and dates of the unit assignment);

  • Description of the Incident;

  • Other Sources of Information;

  • Any other information to be important;

Once completed, the form 21 0781a should be signed and dated.

Where do I send VA Forms 21-0781a?

Once completed and signed, this Statement in Support of Claim for Service Connection Post-Traumatic Stress Disorder should be directed to the chain commander or any other person responsible for such an evaluation.


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