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VA Form 21-0781 Printable, Fillable in PDF – VA Form 21-0781 is a form that a veteran who has been diagnosed with Post-Traumatic Stress Disorder (PTSD) must complete in order to be considered for benefits or services related to his or her diagnosis. This program is designed to help veterans chronicle the traumatic experiences that occurred during their military service and led to their condition. This document offers the applicant the opportunity to account for two different occurrences. It will be necessary for the filer to add particular information such as the date, place, and unit to which the soldier was attached at the time of these occurrences in order to be considered complete. Once this document has been completed, the information included within it will assist the Department of Veterans Affairs in understanding the issue and providing appropriate assistance.
What Exactly Is The VA Form 21 0781?
The Department of Veterans Affairs in the United States uses a VA Form 21-0781 to document the veteran’s service. Post-Traumatic Stress Disorder Service Connection Claim Form (also known as a Statement in Support of Claim for Service Connection for Post-Traumatic Stress Disorder) (PTSD). Post-Traumatic Stress Disorder (PTSD) is a condition that affects veterans who have been diagnosed with it. They will be required to keep a record of the stressful events that occurred during their military service and that led to the condition.
A total of two stressful occurrences may be recorded on this form, however additional can be added if required. The filer will need to record the date and location of each occurrence, as well as the unit to which the soldier was attached, as well as a full account of the event. A serviceperson’s death or injury during a stressful occurrence should also be documented. This provides the Department of Veterans Affairs with the opportunity to analyze the incident and determine what transpired.
The Most Frequently Encountered Applications
A stressful event or series of stressful episodes that happened while the veteran was serving that the veteran believes led to his or her present post-traumatic stress disorder is typically described using this form (PTSD).
VA Form 21 0781 Is Made Up Of Many Different Parts
The following areas are included in a VA Form 21-07811 Claim for Service Connection for Post-Traumatic Stress Disorder:
- Veterans Identification Numbers and Letters
- Stress-Inducing Situations
- Signature of a Veteran
Detailed Instructions On How To Complete VA Form 21 0781
You must supply the following information on VA Form 21-0781 in order to complete the form:
- Veterans Identification Information
- Veteran/beneficiary full name
- Social security number
- VA file number
- Date of birth
- Veteran’s service number
- Preferred email address
- Primary telephone number
- Secondary telephone number
- Stressful Incidents
- Date incident occurred
- Dates of unit assignment
- Location of incident
- Unit assignment during the incident
- Description of the incident
- Medals or citations received because of incident
- Information about persons who were killed or injured during the incident
- Name
- Rank
- Date of injury/death
- Indicate whether: killed in action, killed non-battle, wounded in action, injured non-battle, other
- Unit assignment during the incident
- Remarks
- Veteran’s Signature
- Certification that information is true to the best of knowledge
- Signature
- Date signed
Notice Under the Privacy Act
Other than for routine purposes (for example, civil or criminal law enforcement, congressional communications, epidemiological or research studies, the collection of money owed to the United States, litigation in which the United States is a party or has an interest, the administration of VA programs and d) as authorized by the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576, the VA will not disclose any information collected on this form to any source other than as authorized by the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.5 It is entirely up to you whether or not you reply. To collect supporting evidence for stressful occurrences that occur while on duty, the desired information is required. It will be impossible for VA to conduct a full investigation of your service records without the complete and correct information provided by you. The answers you provide will be treated as strictly confidential (38 U.S.C. 5701).