How To Complete VA Form 21-0781

VA Form 21-0781 & 21-0781a: Statement in Support of Claim for PTSD

In order to apply for service-connection for PTSD, veterans need to need to complete VA Form 21-0781 or 21-0781a to support their claims. The purpose of these forms is for you to describe the stressor that contributed to the development of your Post Traumatic Stress Disorder (PTSD). However, the types of stressors addressed by each form are different. VA Form 21-0781a specifically addresses stressors related to incidents of personal assault, including physical assaults and military sexual trauma. If your PTSD is caused by any other type of stressor, you should complete VA Form 21-0781. 

These forms are important to include with your PTSD claim because they provide the VA with the information necessary to start validating your stressor. Though the VA is required to search federal records in an effort to verify the occurrence of your stressor, the quality of the information you provide to the VA regarding when, where, and how your stressor plays a critical role in determining how successful the VA will be in attempting to identify federal records that might corroborate your claim.

Describing the Incident

In each of these forms, you will be required to describe the incident that occurred. Reliving these types of traumatic memories can be very painful, but it is important to include as much detail as possible to improve the likelihood of your stressor being validated by the VA. That being said, it is also important that the information you do include is as accurate as possible. If you were to report to the VA that an incident occurred in October of 1986, but then remembered later on that it actually occurred in July of 1987, the VA could find that you are an unreliable historian and deny your PTSD claim. Because of this risk, while including details about the incident itself is incredibly important, dates are best left to the time of year around which the incident occured (typically, a three-month period is best). Unless you are absolutely positive that the incident occurred on a particular day or month, it is better to identify a three-month period in which you believe the event occurred. 

Due to the difficulties that can arise when recounting a personal trauma, it may also be a good idea to have someone whom you told about the incident assist you in filling out the form. They could help you to clarify your statement and point out any discrepancies in your report. For VA Form 21-0781, in particular, it may be helpful to call your fellow servicemembers and talk with them about what you experienced. They could help jog your memory regarding dates and times of incidents, which is extremely useful for finding proof for your claim.

Be Specific

When it comes to filling out VA Form 21-0781, if your stressor focuses mainly on how afraid for your life you were while on deployment or in a similarly life threatening situation during training, you need to focus on what that felt like. For example, be extremely descriptive when discussing how it made you feel to be experiencing live fire or having to drive through an area in which IEDs were present. Or if you had different experiences, open up about how they affected your life after service. If you were berated by a commanding officer every day of bootcamp to the point that you no longer felt safe around other people anymore, describe how it felt to lose that sense of trust and security. Focusing on how your stressor incident made you feel and how your behavior changed as a result can go a long way toward strengthening the validity of your claim.

VA Form 21-0781a asks veterans to provide additional information related to the assault they experienced while in service. One of the most underutilized sections on this form is the area for documenting “behavioral changes” that occurred before and after the incident. In this section, you should report if you experienced any changes in performance, submitted sudden requests for leave or change of duty, began seeking treatment from a mental health professional after the incident, or exhibited other such changes in behavior that can corroborate the occurrence of your stressor. 

There is also a section on VA Form 21-0781a where you can identify any other sources that may be able to provide information about the incident, such as a counselor, family friend, or commanding officer who may have knowledge of what happened. By providing the VA with contact information for these individuals, or even better, including their sworn declarations with your application, you can improve your chances of having your PTSD claim approved by the VA.

What to Remember

Recounting traumatic experiences is never easy no matter how much time has passed. The most important thing to remember when filling out these forms is that telling your story can help ensure that you receive the compensation you deserve for your PTSD. Always remember:

  • Providing details is important but make sure that the details you provide are as accurate as possible
  • If you are filing for PTSD secondary to an in-service personal assault, be sure to note any behavioral changes on your VA Form 21-0781a.
  • When describing the incident on either VA Form 21-0781 or 21-0781a, make sure to note how it has affected your life since you left the military in the remarks sections. 

If you complete VA Form 21-0781 or 21-0781a using the approach described in the article, you will be well on your way to having a successful statement in support of claim ready for your PTSD filing. 

Contact an Attorney About Your PTSD Claim

If you are having any difficulty completing your VA Form 21-0781 or 0781a or would like some help determining how best to approach your claim for service connection for PTSD, please contact our office for a free case evaluation. Our veterans law attorneys are experienced in helping veterans win their claims for service connection for PTSD before the VA and are ready to help you obtain the service-connected disability benefits to which you are entitled.