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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: June 9, 2020

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 PDF

Download VA Form 21-0781a (PDF)

Online tool

You can apply online instead of filling out and sending us the paper form.

Go to the online tool
  • 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)
  • 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.

  • PTSD treatment

    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.

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