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. 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. Download the current form from VA's Form 21-0781 page before you start. The March 2024 version covers all mental health conditions, and VA discontinued the separate Form 21-0781a on June 28, 2024.
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. If you apply online for a PTSD-related condition and upload the PDF, VA's form page says to select the option showing you already completed Form 21-0781, so you can skip the online PTSD questions.
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.
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 police, rape crisis center, counseling or medical records, pregnancy or sexually transmitted infection 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.
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 counseling facility or clinic, family or roommates, 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.
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.
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.
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.
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.
Sources and scope
Checked September 23, 2026: VA's Form 21-0781 page 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); and 38 C.F.R. 3.304(f) (eCFR, current through August 27, 2026). The collision example is fictional and omits all personal identifiers. Recheck the download before you use it, since VA revises forms.
VA Form 21-10210: How to Fill Out a Lay or Witness Statement
VA Form 21-4138: How to Fill Out a Statement in Support of Claim
VA Form 21-526EZ Example: Filling Out the 2026 Form