Edit, Download, and Sign the Claim for Service Connection for PTSD Form
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How do I fill this out?
To fill out this form, start by gathering all relevant information regarding your service incidents. Ensure you provide clear and detailed descriptions for each stressful event. Be specific with dates, locations, and unit assignments to facilitate thorough record research.

How to fill out the Claim for Service Connection for PTSD Form?
1
Gather information about your service incidents.
2
Fill in your personal identification details accurately.
3
Describe each stressful incident in detail.
4
Provide information about any witnesses or sources of support.
5
Review the completed form for accuracy before submission.
Who needs the Claim for Service Connection for PTSD Form?
1
Veterans experiencing PTSD due to service-related incidents need this form to document their claim.
2
Family members of veterans may assist their loved ones in completing this form effectively.
3
Counselors or therapists may recommend this form to veterans seeking official recognition and support.
4
Advocates helping veterans with claims benefit from having this form filled out accurately.
5
Organizations supporting veterans can use this form to help individuals claim their benefits.
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What are the instructions for submitting this form?
Submit this completed form by mailing it to the Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. Alternatively, you may contact the VA toll-free at 800-827-1000 for inquiries or guidance. Ensure you keep a copy for your records and follow the submission guidelines outlined within the form.
What are the important dates for this form in 2024 and 2025?
The expiration date for this form is June 30, 2024. It is advised to submit the form well ahead of this date to ensure your claim is processed timely. Track any changes in deadlines or instructions by visiting the VA official website often.

What is the purpose of this form?
The purpose of this form is to support veterans in documenting their claims for PTSD related to personal assaults during service. It collects critical information about stressful incidents that may have impacted the veteran's mental health. Properly filling out this form is vital for the VA's assessment and subsequent action on claims.

Tell me about this form and its components and fields line-by-line.

- 1. Veteran's Name: Full name of the veteran as it appears on official documents.
- 2. Social Security Number: The veteran's SSN for identification purposes.
- 3. VA File Number: The veteran's unique identification number with the VA, if applicable.
- 4. Date of Birth: The veteran's birthdate for verification.
- 5. Service Number: The veteran’s service or identification number in military records.
- 6. Email Address: An optional field for providing contact details.
- 7. Incident Description: Detailed account of each stressful incident experienced.
- 8. Unit Assignment: Information about the military unit to which the veteran was assigned.
- 9. Witness Information: Details of any individuals who can provide further information on incidents.
What happens if I fail to submit this form?
Failure to submit this form may result in delays or denials in your claim for benefits. It is crucial to provide complete and accurate information to facilitate the VA’s assessment. Incomplete forms can hinder the VA's ability to support your claim effectively.
- Delays in Claim Processing: Incomplete forms can significantly delay the processing of your claim.
- Denial of Benefits: Failure to provide necessary information may lead to denial of your claim.
- Need for Additional Evidence: If the form is not filled correctly, the VA may request further documentation.
How do I know when to use this form?

- 1. Claiming VA Benefits for PTSD: Utilized when applying for VA benefits related to PTSD.
- 2. Documenting Stressful Incidents: Helps veterans document specific incidents that contribute to their mental health struggles.
- 3. Supporting Evidence for Additional Claims: Can be used as supporting evidence in connection with other claims or forms.
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