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  • Va Form 21 4142a 2020

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Authorization to Disclose Personal Information to a Third Party. Related to: Burials and memorials, Careers and employment, Disability, Education and training, Health care, Housing assistance, Life insurance, Pension, Records. Form last updated: January 2023.

In order to get a disability rating and subsequent benefits for PTSD, veterans must complete VA Form 21-0781. This is a statement in support of a claim for service connection for PTSD. If your PTSD was the result of physical assault or military sexual trauma, you should use VA Form 21-0781a.

A VA disability rating for PTSD is based on statutes that outline what symptoms meet which level of disability. PTSD is only rated at 10%, 30%, 50%, 70% or 100%. It's important to be as honest as you can with the VA examiners about the severity of your symptoms.

Use VA Form 21-4142a to give us permission to get medical provider information from a non-VA source like a private doctor or hospital. This will allow us to gather information like the name and address of a facility and your medical treatment dates.

Use VA Form 21-0781 if you've been diagnosed with PTSD (posttraumatic stress disorder) and want to apply for related benefits or services.

When to use this form. Use VA Form 21-4138 when you want to submit a VA “buddy statement” or other statement from someone with firsthand knowledge of information you believe will help support your request for VA benefits.

Am I eligible for disability benefits from VA? You may be eligible for disability benefits if you have symptoms related to a traumatic event (the “stressor”) or your experience with the stressor is related to the PTSD symptoms, and you meet all of these requirements.

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232