Landon · September 23, 2026 · 16 min read · Updated November 8, 2026
VA Form 21-0781 is an optional statement you file with a claim for a mental health condition, such as PTSD, depression or anxiety, that you connect to a traumatic event in service. The current edition is dated March 2024, and it replaced both the older PTSD version of the 21-0781 and the separate Form 21-0781a for personal assault. Get it from VA's Form 21-0781 page or as the direct PDF, then use the two filled-in fictional examples below to see how each item reads.
To fill it out, choose the event type in Item 8, describe each event with an approximate place and date in Item 9, list any official report and other evidence sources in Items 11 and 12 (and behavior changes in Item 10 if the event was personal), and list treatment in Item 13.
The 21-0781 is not the claim itself. The form's instructions say a new claim still needs Form 21-526EZ (or the online application), and a claim after a prior decision needs Form 20-0995. VA's form page says that if you answer the optional mental health questions in the online application, you do not also need the separate 21-0781; it suggests the PDF if you skipped those questions, filed on a paper application, or got a VA letter asking for it.
If writing about the event is hard right now, the Veterans Crisis Line is printed on the form itself: call 988 and press 1, text 838255 or chat at VeteransCrisisLine.net. Free help with the form is also available from an accredited Veterans Service Organization (VSO), and you can find a VSO near you.
How the March 2024 form replaced the old 21-0781 and 21-0781a
Until 2024, VA used two forms: the June 2021 Form 21-0781 for PTSD, and the June 2021 Form 21-0781a for "PTSD Secondary to Personal Assault." The March 2024 Form 21-0781 "supersedes VA Form 21-0781, JUN 2021" and is now titled "Statement in Support of Claimed Mental Health Disorder(s) Due to an In-Service Traumatic Event(s)." VA retired the 21-0781a in June 2024, and its old VA.gov page now forwards to the 21-0781 page. If you are looking for a 21-0781a PDF, use the current 21-0781.
| Topic | Old 21-0781 (June 2021) | Old 21-0781a (June 2021) | Current 21-0781 (March 2024) |
|---|---|---|---|
| Conditions covered | PTSD | PTSD after a personal assault | Any mental health condition, such as PTSD, depression, anxiety or bipolar disorder |
| Event types | Stressful incidents, with fields for people killed or injured and medals received | Personal assault | Combat, personal (with or without MST) and other events on one form; check all that apply |
| Dates | An exact date (MM/DD/YYYY) for each incident, with the instruction to "provide dates within at least a 60-day range" | An exact date (MM/DD/YYYY) for the first incident and dates of unit assignment | Months or years if known; the form says "approximate dates are acceptable" |
| Other people | Names, ranks and units of people killed or injured | Names and mailing addresses of other sources | Not required, and VA will not contact anyone you name |
| Behavior changes | Not asked | Examples and one free-text box | A checklist in Item 10 |
| Reports, sources, treatment | Not asked | Free text | Checkboxes in Items 11 and 12; treatment in Items 13A to 13E |
| MST notification option | None | None | Section VI |
The practical change is the burden on dates and names. The old forms asked you to "be as specific as possible"; the current one says VA "will still review and consider all the evidence available" if you can give only approximate dates or locations.
Why the event type in Item 8 matters
Item 8 asks whether the event was combat, personal (with or without military sexual trauma) or other, and you can check more than one. The choice matters because VA's PTSD rule, 38 C.F.R. 3.304(f), sets different proof for different events:
- Combat. If you engaged in combat and the stressor relates to it, your own testimony can establish that it happened, as long as it fits the circumstances of your service and there is no clear and convincing evidence to the contrary.
- Fear of hostile military or terrorist activity. Your testimony can establish the stressor if a VA psychiatrist or psychologist, or one VA contracts with, confirms the stressor supports the PTSD diagnosis and your symptoms relate to it, and the event fits the places and circumstances of your service. The rule's examples include improvised explosive devices, incoming artillery, rocket or mortar fire, and suspected sniper fire. This path does not require that you engaged in combat.
- Personal assault, including military sexual trauma. Evidence from outside your service records can corroborate the event, including records from law enforcement, rape crisis centers, counseling centers, hospitals or physicians, pregnancy or sexually transmitted disease tests, and statements from family, roommates, fellow service members or clergy. Changes in behavior after the event also count, and VA must tell you about these alternatives before it denies the claim.
- Other events, such as a training accident, a natural disaster or witnessing a death. The general rule applies: credible supporting evidence that the event happened. That is why the location, date and source items matter most for these events.
Separate paragraphs cover PTSD diagnosed during service and former prisoners of war. Section 3.304(f) is written for PTSD; for depression, anxiety and other conditions, VA's general service-connection rules apply, and the same event details still help VA find records. The PTSD condition guide and the MST condition guide cover ratings and evidence for each.
What each section asks for
The identification section asks for sensitive personal details. Enter them only on the official form and through a secure submission channel, not in a shared worksheet.
| Section and items | What it asks | If you are unsure |
|---|---|---|
| I, Items 1 to 7 | Name, Social Security number, VA file number, birth date, service number and contact details | Enter only on the official form |
| II, Item 8 | Event type: combat, personal (not MST), personal (MST) or other; check all that apply | Choose what fits what happened; the MST box points you to Section VI |
| II, Items 9A to 9C | For each event, up to six rows: a brief description, the location and the dates | The form says approximate dates are acceptable. Naming other people is not required, and if you do name them, VA will not contact them |
| III, Item 10 | Behavior changes after a personal traumatic event: a checklist (10A), details such as when the change happened or where it is documented (10B) and any others (10C) | The form says that if your event was combat only, you may skip to Item 11 |
| III, Item 11 | Whether an official report was filed: for a sexual assault report, restricted, unrestricted or neither; a police report; or other reports such as an after action report, incident report, formal complaint, or JAG, CID or NCIS report | Check Yes only if you know a report exists. The form notes that restricted and unrestricted reporting did not exist before 2005, and that VA may send a follow-up letter if you are unsure which type was filed |
| III, Item 12 | Possible sources of evidence, such as a rape crisis center, a counseling facility or clinic, family or roommates, a faculty member, fellow service members, a chaplain, diaries, civilian police reports or civilian medical reports | Check only sources that exist. A witness who wants to write a statement uses Form 21-10210 |
| IV, Items 13A to 13E | Treatment related to the event: where (private provider, Vet Center, community care, VA medical center or clinic, military treatment facility), name and location, and dates | VA already has access to VA medical center, clinic and military treatment facility records, so no consent form is needed for those, and you need not give dates for that treatment if it began in 2005 or later. For VA to request private provider or Vet Center records, it needs your consent on Forms 21-4142 and 21-4142a. Check 13E if you do not have dates |
| V, Item 14 | Remarks | Optional. Use it for details that did not fit, such as a report you believe exists but cannot confirm |
| VI, Item 15 | For MST claims only: whether VA's benefits office may notify VA health care of upcoming exams, hearings and decisions | Read the explanation first; the form says your choice will not affect the status or outcome of the claim |
| VII, Items 16A and 16B | Signature and date | Sections VIII to X apply only to a signature by mark, an alternate signer or a representative |
Items 9 through 13 do the most work. The form says location and time details help VA identify records, and that VA will still review all the evidence if you can give only approximate details.
Filling out the traumatic events section
Section II gives you up to six rows, each with a brief description (9A), the location (9B) and the dates (9C). Use one row per event. If the same kind of event happened many times, such as repeated attacks during one deployment, one row can describe the pattern and its date range.
The brief description (9A)
The form asks you to "briefly summarize the nature of the traumatic event(s)." Its own examples are short: "Mugged" and "Sexually assaulted by drill instructor." A sentence or two is enough: what happened and your part in it. You do not need graphic detail or a diagnosis here. A separate personal statement is the place for a longer account.
The location (9B)
The prompt lists "unit assignment, residence, off-base, duty station or state, if known." For combat and other events, give your unit and the base or area, because VA researches records by unit and date. For a personal event, "barracks at my duty station" is enough.
How precise your dates need to be (9C)
The current form asks for "month(s) or year(s), if known," and says "approximate dates are acceptable." Its examples include "SUMMER OF '70" and "BOOT CAMP."
The 60-day window many guides repeat came from the June 2021 form, which said to "provide dates within at least a 60-day range." The current form dropped it, but VA's claims manual keeps a similar yardstick: before VA asks for more records research on a stressor, the veteran or the records must provide a stressor that can be documented, its location, "the approximate date (within a two-month period) of the event," and the unit of assignment (M21-1, Part VIII, Subpart iv, Chapter 1, Section A, topic 3.o). That research step is for stressors not related to MST or personal assault.
So for a combat or other event, narrow the date to about two months if you honestly can, anchored to something you remember, such as the month a deployment began or a unit move. If you cannot, give your best range and mark it approximate. Never invent a precise date.
Behavior changes for MST and personal assault claims
The form says "VA understands that in-service traumatic event(s) may not have been reported or documented." For a PTSD claim based on in-service personal assault, 38 C.F.R. 3.304(f)(5) lets evidence of behavior changes after the assault serve as credible evidence that it happened. The regulation's examples, which it says are not a complete list, are:
- a request for a transfer to another military duty assignment;
- deterioration in work performance;
- substance abuse;
- episodes of depression, panic attacks, or anxiety without an identifiable cause; and
- unexplained economic or social behavior changes.
VA "will not deny" such a claim without first telling you these kinds of evidence count and giving you a chance to provide them.
Item 10A turns these into a longer checklist that adds, among others, changes in health care visits, leave or medication use, disciplinary or legal difficulties, changes in eating habits or weight, pregnancy or sexually transmitted infection tests, and the breakup of a significant relationship.
Check only boxes that are true, and use 10B to say roughly when each change happened and where it might be documented, such as "performance evaluation for 2009." Those documents are often in your personnel file, which VA obtains. A family member, roommate or fellow service member who noticed the change can describe it on Form 21-10210; the 21-10210 guide shows how a witness fills it in.
The treatment history section
Section IV asks about treatment "related to the impact of the traumatic event(s)." If you answer Yes in 13A, check each type of place in 13B, give its name and location in 13C and month-and-year dates in 13D, or check "Don't have date" in 13E. Approximate dates are acceptable.
What else you file depends on where you were treated. VA already has access to VA medical center, clinic and military treatment facility records, and if that treatment began in 2005 or later you can skip the dates. Private provider and Vet Center records need your consent on Forms 21-4142 and 21-4142a; community care paid for by VA does not. If treatment began years after service, list the real first date.
An annotated fictional example
This example is fictional. A service member has a clinician-diagnosed mental health condition and remembers a vehicle collision during a training exercise, but only the season.
| Item | Fictional entry | Why it is written this way |
|---|---|---|
| 8, event type | Other traumatic event | A training collision fits the form's examples of other events |
| 9A, brief description | "The vehicle I was riding in struck an obstacle during a training movement. I was shaken and later had recurring memories of the collision." | It describes the event and the experience without a clinical conclusion |
| 9B, location | "Training area near my unit's installation; exact range name unknown." | The place helps VA search without inventing a range name |
| 9C, dates | "Approximately fall 2017; exact day unknown." | The form accepts approximate dates |
| 11, official report | No box checked | The veteran does not know whether a report was filed, so a Yes would be a guess |
| 12, sources | Fellow service members | A crew member who was in the vehicle may remember the collision |
| 13, treatment | Private provider; first visit about 03-2019 | A later treatment date stays a later date; Forms 21-4142 and 21-4142a let VA request the private records |
| 14, remarks | "A unit safety office report may exist for this collision." | Remarks can point VA to a possible record without claiming it exists |
For a personal assault or military sexual trauma, Items 10 and 12 carry more weight, because the rule allows behavior changes and outside sources to corroborate the event. You do not need to fit your experience to this collision example.
A second fictional example: a combat event and an MST event
This example is also fictional. Alex Moreno has diagnoses of PTSD and depression from a VA clinician and lists two events: rocket attacks during a 2008 deployment, and a sexual assault by a senior member of the unit after it came home. The entries are deliberately brief; the form does not ask for graphic detail.
| Item | Alex's fictional entry | Why it is written this way |
|---|---|---|
| 8, event type | Combat traumatic event(s); personal traumatic event(s) (involving MST) | More than one box is allowed; the MST box points to Section VI |
| 9A to 9C, row 1 | "Repeated rocket and mortar attacks on the base. One rocket hit near my work area and I took cover in a bunker." Forward operating base in Iraq, assigned to a transportation company. Approximately March to April 2008. | Event, unit, area and a window of about two months, which fits the fear of hostile military activity rule |
| 9A to 9C, row 2 | "Sexually assaulted by a senior member of my unit." Barracks at my home duty station. Approximately fall 2008, after my unit returned from deployment. | It mirrors the form's own short example; no name is required |
| 10A, behavior changes | Request for a change in duty assignment; increased use of leave; changes in performance evaluations; increased use of alcohol; changes in or breakup of a significant relationship | Only true boxes are checked |
| 10B, details | "Asked to move to another section about November 2008. My 2009 evaluation was lower than my 2007 one. Took more leave that winter. My engagement ended in early 2009." | Each change has a rough time and a record where it may show |
| 11, official report | Yes; restricted | The form says the report type helps VA request a copy |
| 12, sources | A counseling facility or health clinic; family members or roommates; personal diaries or journals | A sibling Alex confided in and a journal from that year exist |
| 13A to 13D, treatment | Yes. Vet Center in Alex's city, 01-2021 to present; VA medical center mental health clinic, 06-2022 to present | Vet Center records need Forms 21-4142 and 21-4142a; VA medical center dates are optional because treatment began after 2005 |
| 14, remarks | "My sibling will submit a statement on Form 21-10210 about the changes they saw in 2008 and 2009." | It tells VA a witness statement is coming |
| 15, MST notification | Chooses A, consent, after reading the explanation | Another veteran might choose B; the form says the choice does not affect the outcome |
Alex also writes a separate statement about how both events changed daily life on Form 21-4138; the 21-4138 guide walks through that form.
Before you submit
For every report, medical visit or person you list, keep a separate source note: who holds it, the date or range, what it might show and whether you have it. The form says VA will obtain your service treatment records, personnel records and other federal records you identify. If you want VA to request private records, use Forms 21-4142 and 21-4142a. A witness who chooses to write a statement can use Form 21-10210. If you want to describe the event and its effects in your own words beyond the form's boxes, see VA personal statement examples or start a draft with Claim Raven's free personal statement builder.
Compare your entries with the records you have, mark approximate dates as approximate, sign the certification and keep a copy and your submission receipt. File the claim itself through VA's disability application. If you would like someone to review the form with you first, an accredited Veterans Service Organization helps at no charge.
What the Board data shows for PTSD appeals
In Claim Raven's analysis of Board of Veterans' Appeals decisions from 2024 to 2025, 45.4% of 1,609 decided PTSD condition records ended favorably, 28.2% were denied and 26.4% were remanded. When the Board quoted lay evidence, such as the veteran's account or a witness statement, 53.3% of 537 PTSD records were favorable, compared with 32.9% of 413 where it did not. These are appeals of already-disputed claims, so they describe patterns, not your odds or the effect of one form. Claim Raven's PTSD research post looks at what else the Board weighs. If VA already denied a PTSD claim, find the element the denial left unresolved before you file the form again, and see the PTSD condition guide for ratings.
Claim Raven sells claim-preparation tools, including the free personal statement builder linked on this page, which writes a separate statement rather than filling in Form 21-0781.
VA Form 21-0781 questions
What is VA Form 21-0781 used for?
It is an optional statement you file with a claim for a mental health condition, such as PTSD, depression or anxiety, that you connect to a traumatic event in service.
Is VA Form 21-0781a still used?
No. VA retired the 21-0781a, which covered PTSD after a personal assault, in June 2024, and its old VA.gov page now forwards to the 21-0781 page. The March 2024 Form 21-0781 covers combat, personal and other events, including military sexual trauma, on one form.
Does VA Form 21-0781 file my PTSD claim?
No. The form's instructions say a new claim still needs Form 21-526EZ or the online application, and a claim after a prior decision needs Form 20-0995.
Do I need exact dates on VA Form 21-0781?
No. The form says approximate dates are acceptable. For a combat or other event, a date narrowed to about two months, plus your unit and location, matches what VA's claims manual lists as the minimum for more records research.
Will VA contact the people I name on the form?
The form says naming other people is not required, and if you do name them, VA will not contact them. A witness who wants to write a statement can use Form 21-10210.
What evidence can support a personal assault or MST claim?
Evidence from outside your service records can corroborate the event, including police, counseling or medical records and statements from family, roommates, fellow service members or clergy. Changes in behavior after the event also count.
Where do I get the VA Form 21-0781 PDF, and can I fill it out on a computer?
VA's Form 21-0781 page links the current March 2024 PDF. The form says you may complete it online or by hand, so you can type into the PDF, then print or upload it. VA's page lists no separate online 21-0781; the online disability application asks optional mental health questions instead.
Is VA Form 21-0781 the same as a PTSD stressor statement?
In practice, yes. A stressor statement describes the in-service event linked to your condition, and the 21-0781 is VA's form for it. The current version covers any mental health condition, not only PTSD, and you can add a longer account in your own words on Form 21-4138.
What does a filled-in VA Form 21-0781 example look like?
This page has two fictional examples: a training collision remembered only by season, and a form listing a rocket attack and an MST event with behavior changes, a restricted report, Vet Center treatment and the Section VI choice. Neither names another person, because the form says that is not required and VA will not contact anyone you name.
Sources and scope
Checked November 8, 2026: VA's Form 21-0781 page (form revision date March 2024; page last updated September 23, 2026) and the seven-page March 2024 form (instructions on pages 1 and 2, Items 1 to 9 on pages 3 and 4, Items 10 to 12 on pages 4 and 5, Items 13 to 16 on pages 5 and 6, witness and representative signatures on page 7); archived copies of the June 2021 Forms 21-0781 and 21-0781a for the comparison table; 38 C.F.R. 3.304(f) (eCFR, up to date as of November 5, 2026); M21-1, Part VIII, Subpart iv, Chapter 1, Section A; and the Veterans Crisis Line. The collision example and Alex Moreno are fictional and omit all personal identifiers. Recheck the download before you use it, since VA revises forms.
VA Form 20-0996 Example: Higher-Level Review, Filled In Item by Item
VA Form 20-0995 Example: Supplemental Claim, Filled In Item by Item
VA Form 21-8940 Example: Two Filled-In TDIU Applications and a Checklist