About VA Form 21-0781a
- Form name: Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault
- Related to: Disability, Health care
- Form last updated: July 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
VA Form 21-0781
Form name: Statement in Support of Claim for Service Connection for PTSD
Use VA Form 21-0781 if you’ve been diagnosed with PTSD (posttraumatic stress disorder) and want to apply for related benefits or services.Download VA Form 21-0781 (PDF)
Helpful links related to VA Form 21-0781a
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.
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.