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  • 21-0781a Statement In Support Of Claim For Service Connection For Post-traumatic Stress Disorder

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OMB Approved No. 29000659 Respondent Burden: 1 hour 10 minutes VA DATE STAMP DO NOT WRITE IN THIS SPACE STATEMENT IN SUPPORT OF CLAIM FOR SERVICE CONNECTION FOR POSTTRAUMATIC STRESS DISORDER (PTSD).

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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.

Write very clearly, or type on a computer if you can. Describe the traumatic events in the order that they happened. Tell where the event happened, what unit you were in at the time, and when it happened (as best you can). Provide as much detail as you can and also describe the feelings you had about what happened.

So, if you are writing a buddy statement for a family member with PTSD, you might write, “My brother, [Veteran], currently shows signs of anger issues, anxiety, panic attacks, and insomnia. He has angry outbursts about three times per week.” Be sure to only include facts like this if you know that they're true.

During the C&P Exam Be honest about your PTSD symptoms, even embarrassing ones; Provide as much detail about your PTSD symptoms as possible; Take time to consider each question before providing an answer; and. Describe specific instances where your PTSD symptoms affected your daily life.

Here is an example a spouse might provide in a lay statement: “My husband was outgoing before his deployment. Since he came back, he doesn't want to spend time with our family or go out on dates with me.”

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.

A PTSD stressor statement tells a story about change. You were one person before the stressful events occurred, and in some respects a different person afterward. Once you've described the stressful events, you'll need to describe how they have affected you.

How to write your claim: List the Name of the VA Disability You're Claiming in the First Section of the VA Form 21-4138. Explain the Approximate Timeframe Your VA Disability Began Along with Why It Should Be Service Connected (or Why Your VA Rating Should Be Increased for Conditions Already Service Connected)

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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