Va Form 21-0781 -

"On or about [Month, Day, Year], while assigned to [Unit, Company, Battalion] in [Location, e.g., Fallujah, Iraq], my convoy was struck by an IED. I was the [position, e.g., driver/turret gunner]. The explosion occurred at approximately [time of day]. I witnessed [specific: the vehicle in front of me lift off the ground, see human remains, hear screams, etc.]. Following the blast, I [describe your action: pulled casualties from wreckage, returned fire, secured the area]. I did not personally sustain a physical wound, but I observed [describe death or injury to others]. I still vividly remember [one specific sensory detail: smell of burnt explosives, the silence after the blast, a specific sound]."

__________________________________________________ va form 21-0781

You're looking for a copy of VA Form 21-0781! "On or about [Month, Day, Year], while assigned

Describe what happened and, importantly, your emotional response at the time. Unit Assignment: Your specific unit during the event. I witnessed [specific: the vehicle in front of

Using VA Form 21-0781 can provide several benefits to veterans, including: