VA Form 21-0781 - Attachment to the Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s)

Sep 15, 2026

Uploaded by Jasmine

VA Form 21-0781 provides an attachment used to support a claim for mental health disorder(s) linked to an in-service traumatic event(s). The form explains when it should be used and gives examples of qualifying combat, personal, and other traumatic events. It clarifies that the form is optional but may help the claim by allowing VA to review military records and other evidence, including alternative evidence and statements about behavioral changes. It also lists related VA forms that may be required depending on the type of claim.

LanguageEnglish

CategoryForms

FormatPDF

Pages7

Reading Time3 min

AccessFree to download

When To Use This Form

What Form Is Required

Evidence That Can Be Used to Support Your Claim

If You Need Assistance

Department ofVeterans Affairs # ATTACHMENT TO THE STATEMENT IN SUPPORT OF CLAIMED MENTALHEALTH DISORDER(S)DUE TO ANIN-SERVICE TRAUMATIC EVENT(S) When To Use This Form: | Use this form,VA Form 21-0781,Statement in Support of Claimed Mental Health Disorder(s)Due to an In-Service Traumatic Events),to
provide a statement in support of a claimed mental health disorder(s)(e.g.,post-traumatic stress disorder(PTSD),depression,anxiety,bipolar
disorder,etc.)due to an in-service traumatic event(s)to include: | | --- | | ·Combat traumatic event(s)(e.g.,engaged in combat with the enemy,experienced fear of hostile military or terrorist activity,
served in an imminent danger area,served as a drone aircraft crew member,etc.)
·Personal traumatic event(s)(e.g.,sexual assault or sexual harassment,also known as military sexual trauma(MST),
physical assault,robbery,stalking,domestic intimate partner abuse,or harassment,etc.)
·Other traumatic event(s)(e.g.,involvement in car accident or natural disaster,worked on burn ward or graves registration,
witnessed the death,injury,or threat to the physical integrity of another person not caused by the enemy,or an experience that
involved friendly fire that occurred on a gunnery range during a training mission,etc.) | | Note:This form is optional and not required.However,completing this form could assist with your claim.VA can use the information you
provide to review your military records and other sources of information for evidence to support your claim. | ## What Form Is Required: | Whether or not you complete this form,you must submit one of the following based on the type of claim sought.VA forms are
available at www.va.gov/vaforms. | | | --- | --- | | Ifyou are filing a new claim or a claim for increased disability
compensation .. | please complete and submit VA Form 21-526EZ,Application for
Disability Compensation and Related Compensation Benefits | | Ifyou disagree with a prior decision or an evaluation(a claim after an
intial claim for the same or similar benefit was previously decided)and
have new and relevant evidence... | please complete and submit VA Form 20-0995,Decision Review
Request:Supplemental Claim. | # Evidence That Can Be Used to Support Your Claim: | VA will obtain or attempt to obtain evidence that supports your claim: | | --- | | ·Ifyour claim is for mental health disorder(s)related to combat,personal traumatic event(s),or other traumatic | | event(s),service treatment records and/or personnel records can be used to support the occurrence of the traumatic event(s)
·If your claim is for PTSD related to a personal traumatic event(s),alternative sources of evidence or changes in your behavior | | | | such as a change in work performance,substance abuse,economic or social behavioral changes,etc.can also be used to support the
occurrence of the traumatic event(s). | | | | NOTE:VA will obtain and/or request your service treatment records,personnel records and any other Federal records you identify. | | Lay testimony can be used: | | ·Ifyou have any individual(s)/witness(es)who know about the personal traumatic event(s)or would have a knowledge | | of a behavioral change(s)you experienced after the personal traumatic event(s),and wants to provide a statement on | | your behalf,use VA Form 21-10210,Lay/Witness Statement,and attach it or send it to the address provided in this ttachment.
Ifyour individual(s)/witness(es)is a veteran,they may be requested to provide their DDForm 214,Certificate of Uniformed Service,
or other evidence of service. | | | Ifyou know of evidence not in your possession and want VA to try to get it for you: ·Complete and sign VA Form 21-4142,Authorization to Disclose Information to the Department ofVeterans Affairs (VA),and ·Complete and sign VA Form 21-4142a,General Release for Medical Provider Information to the Depa

FAQs

What is VA Form 21-0781 used for?

VA Form 21-0781 supports a claimed mental health disorder(s) connected to an in-service traumatic event(s). It helps VA evaluate evidence for disorders such as PTSD, depression, anxiety, or related conditions.

Is VA Form 21-0781 required to file a claim?

The form is optional, not required. Completing it may assist the claim by providing information VA can use to review records and other evidence.

What evidence can help support a traumatic-event-related mental health claim?

Service treatment and/or personnel records may support the traumatic event. Alternative evidence—such as behavior or work-performance changes—can also be used, and lay/witness statements may be submitted using VA Form 21-10210.

Sep 15, 2026

Uploaded by Jasmine