The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
http://www.vba.va.gov/pubs/forms/VBA-21-0781a-ARE.pdf
Form number
21-0781a
Row ID
4260
Form title
Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault (Fillable)
Issue date
Revision date
Form administration
VBA
Number of pages
3
Deleted
False
Form name
Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault
Form Language
English
Related to
Benefits
VA disability compensation
VA health care
When to use

Use VA Form 21-0781a if you’ve been diagnosed with PTSD related to or because of personal assault, and you want to apply for related benefits or services.

Online tool
You can apply online instead of filling out and sending us the paper form.
https://www.va.gov/disability/how-to-file-claim/
Related forms
About VA Form 21-0781
Helpful links
How to apply for VA health care
Find out how to apply for VA health care. This can be a first step in getting treatment and support for PTSD.
VA mental health services
Learn how to get started using VA mental health services. You can use some services even if you’re not enrolled in VA health care.
PTSD treatment
Find out how to access PTSD health services through VA. Our National Center for PTSD is the world leader in PTSD research, education, and treatment.