VA Form 21-0781 Instructions: Statement in Support of Claim for PTSD
What Is VA Form 21-0781?
Veterans who are seeking service-connected benefits for post-traumatic stress disorder (PTSD) can fill out and submit VA Form 21-0781: Statement in Support of Claim for Service Connection for PTSD. The Department of Veterans Affairs (VA) uses VA Form 21-0781 to help determine if service connection for PTSD is warranted.
Essentially, this form allows veterans to list the traumatic incident or incidents (i.e., stressors) that occurred during military service that led or contributed to their PTSD diagnosis. Veterans should provide a description of what occurred, the approximate date and geographic location, their unit and dates of assignment, and the full names and assignments of anyone who was killed or injured during the incident. VA requests veterans complete the form with as many specific details as possible.
VA Form 21-0781 Instructions
The Statement in Support of Claim for Service Connection for PTSD—VA Form 21-0781—can be filed online, or printed out and submitted via mail or in-person at a local VA Regional Office. It contains three sections: Veteran’s Identification Information, Stressful Incidents, and Veteran Signature.
Section I: Veteran’s Identification Information
In Section I, you must list your identifying information, such as your name, social security number, VA file number, date of birth, service number, telephone number, and email address.
Section II: Stressful Incidents
In Section II, VA requires that veterans list specific details about their in-service stressor. The document provides space to write about two specific stressors. If more space is needed, you can attach additional pages indicating the item number to which you are elaborating on.
Some examples of stressors include:
- Experiencing an IED explosion
- Witnessing a fellow service member be injured or killed
- Being part of a burial crew
- Experiencing an injury as a result of combat
You should include the following information (if possible) regarding the traumatic event contributing to your PTSD:
- Date first incident occurred (month, day, and year)
- Dates of unit assignment
- Location of the incident
- Unit assignment during the incident (e.g., division, wing, battalion, etc.)
- Description of the stressor/incident (you may need additional pages for this section)
- Medals or citations you received because of the incident
In addition, if one or more individuals were injured or killed during the incident, you should provide the following information about them:
- Name of person
- Rank
- Date of injury/death
- If and how they were injured or killed
- Unit assignment during the incident (division, wing, battalion, cavalry, ship, etc.)
Although writing about these experiences can be very painful, it is important to include as much detail as possible as this will improve the likelihood of VA granting service connection.
Additionally, it is essential that the information you report is as accurate as possible. If you cannot recall the exact date or location of a stressor, you can provide a wider margin for when the event occurred. Importantly, if VA finds official records that contradict your statements regarding the stressor, VA may deny the claim or reject the stressor.
If you can provide substantial evidence supporting your account of the stressor, then VA should give you the benefit of doubt. This is referred to as the benefit of doubt doctrine.
Section III: Veteran Signature
Finally, in Section III, you must certify the form by providing your signature and the date.
Should I Use VA Form 21-0781 or VA Form 21-0781a?
While VA Form 21-0781 and 21-0781a are both Statements in Support of Claim for Service Connection for PTSD, VA Form 21-0781a is specific to veterans seeking service connection for PTSD secondary to personal assault. Therefore, veterans who developed PTSD in relation to or because of personal assault (e.g., military sexual trauma) should submit VA Form 21-0781a instead of or in addition to VA Form 21-0781.
In Section II of VA Form 21-0781a, VA requests most of the same information as it does in VA Form 21-0781; however, 21-0781a also has a section (box 9) for contact information of other sources, such as individuals to whom the veteran reported the incident.
VA Form 21-0781a also provides a space in box 10 for veterans to note any other information that may help their claim. Some examples of information that may be helpful to include are:
- Sudden behavioral changes following the incident
- Changes in performance and performance evaluations
- Increased or decreased use of prescription or over-the-counter medications
- Episodes of depression, panic attacks, or anxiety
- Substance abuse
Need Assistance with Your PTSD Claim or Appeal?
Did VA deny your claim for PTSD disability benefits? If so, Chisholm Chisholm & Kilpatrick may be able to help. The veterans’ advocates at CCK have decades of collective experience helping veterans secure their rightfully earned PTSD benefits. Reach out to CCK today at 800-544-9144 to see if we may be able to help you too.
