VA Form 21-0781Verified official record

Traumatic-event mental health statement

Statement in Support of Claim for Service Connection for Mental Health Conditions Due to an In-Service Traumatic Event

Provides information about an in-service traumatic event connected to a mental health claim.

When it may apply

Purpose and use

Use for PTSD or another mental health claim based on an in-service traumatic event when VA requests this information.

When not to use it

Do not use this form for a different benefit or review path unless current VA instructions identify it for that purpose.

Responsibility

Who completes and signs it?

Completed by
veteran or claimant
Signed by
veteran or claimant
Availability
online and pdf
Submission
follow current form instructions
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Important limitations

  • Verify the current revision and submission instructions on the official VA page before signing or sending the form.
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