VA Form 21-0781

Use VA Form 21-0781 if you’ve been diagnosed with a mental health condition related to a traumatic event during your military service and want to apply for related benefits or services. This form is optional. But if you submitted a disability compensation claim related to a mental health condition, this form could help with your claim. We’ll use the information you provide to help identify records and other evidence to support your claim.

When you may want to submit a separate VA Form 21-0781 (PDF)

• You already submitted a claim online for disability compensation and you chose not to answer the mental health questions, or
• You filed a claim for disability compensation using a downloaded PDF form (not the online form), or
• You received a letter from us asking you to submit VA Form 21-0781 in addition to your claim for disability compensation

When you don’t need to submit a separate VA Form 21-0781 (PDF)

If you’re filling out an online Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ) for a new mental health condition, we'll prompt you to answer questions about your condition. If you answer those optional questions online about your mental health condition, you don’t need to also submit a Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s) (VA Form 21-0781).

Use the online application to apply for disability compensation for a new mental health condition

Information about mental health conditions and traumatic events

Here are some examples of mental health conditions:

• Posttraumatic stress disorder (PTSD)
• Major depressive disorder
• Generalized anxiety disorder
• Bipolar disorder

Traumatic events during your military service may include any of these types of events:

• Combat events, like engaging in combat with enemy forces, experiencing fear of hostile military or terrorist activity, serving in an imminent danger area, or serving as a drone aircraft crew member
• Sexual assault or harassment (also known as military sexual trauma or MST)
• Traumatic personal events, like physical assault, battery, robbery, mugging, stalking, or harassment by a person who wasn’t part of an enemy force, or domestic abuse or harassment by a partner
• Other traumatic events, like getting into a car accident, witnessing a natural disaster, working on burn ward or graves registration, witnessing the death, injury, or threat to another person or to yourself, that was caused by something other than a hostile military or terrorist activity, or experiencing or witnessing friendly fire that occurred on a gunnery range during a training mission