21-0781a

Statement in Support of Claim for PTSD Secondary to Personal Assault

Specialized form for PTSD claims based on Military Sexual Trauma (MST) or personal assault. Allows for alternative evidence when assault may not be documented in service records.

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Used in these claim stages:

initial_claim supplemental_claim

Last updated by VA: January 1, 2024

How to Complete This Form

This form is for PTSD claims based on personal assault, including Military Sexual Trauma (MST).

1. Complete your personal information
2. Describe the assault event(s) - include as much detail as you're comfortable sharing
3. Identify any behavioral changes after the assault:
- Requests for transfer
- Changes in performance
- Substance use changes
- Relationship changes
4. List any people you told about the assault
5. Sign and date the form

You're not required to report the assault in detail. VA understands these events are often unreported.

Helpful Tips

- You don't need to have reported the assault during service
- Alternative evidence can include: personnel records showing changes, lay statements, medical records showing behavioral health treatment
- VA has specially trained personnel for MST claims
- You can request a same-gender examiner for your C&P exam
- Consider using the VA's MST Coordinator at your local VA

Common Mistakes to Avoid

- Not knowing that alternative evidence is acceptable
- Not identifying behavioral changes that may be in records
- Not requesting accommodations for the C&P exam
- Assuming the claim will be denied because assault wasn't reported

Deadline Information

Submit with your PTSD claim. There is no time limit for filing.