About VA Form 21-0781a
- Related to: Disability, Health care
- Form last updated: June 23, 2022
When to use this form
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.
Downloadable PDFDownload VA Form 21-0781a (PDF)
You can apply online instead of filling out and sending us the paper form.Go to the online tool
Related forms and instructions
Helpful links related to VA Form 21-0781a
Find out how to apply for VA health care. This can be a first step in getting treatment and support for PTSD.
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.
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.