Create Va Form 21 0781a

Va Form 21 0781a: What Is It?

This form is known as a Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault. The VA Form 21-0781A is used by the United States Department of Veterans Affairs. This form will be completed by veterans who have been diagnosed with PTSD due to their military service. This form should be used by individuals who have personal assault as a contributing factor to their PTSD.

This form will ask for information about the stressful incidents that contributed to the veteran’s Post-Traumatic Stress Disorder. Details should include the date the incident occurred, where it occurred, what unit the filer was assigned to at the time, and a description of the event. The filer can include the names and addresses for people who can verify the details of this incident as well. This will ensure that the Department of Veterans Affairs can get all the information they need.