Same identification used on VA Form 21-526EZ. Must match exactly so VA cross-files this form to your claim.

(use same details as 21-526EZ)

• ×Mismatched name or SSN with the 21-526EZ - form gets filed separately, examiner doesn't see it before C&P.

Check ALL that apply: (a) Combat, (b) Fear of hostile military or terrorist activity, (c) Military Sexual Trauma (MST), (d) Other (witness to death/serious injury, training accident, sexual harassment short of MST, etc.). You can claim multiple categories on the same form - many veterans have more than one.

Check all applicable boxes

• ×Checking only "combat" when you also experienced MST or witnessed a non-combat tragedy - you leave evidentiary support on the table.
• ×Not checking "fear of hostile activity" when you served in a combat zone but were never in a direct firefight - this is a separate, lower-threshold category under 3.304(f)(3).
• ×Hesitating to check "MST" because of stigma - the form is reviewed by a small specialty team and your privacy is protected by 38 USC 1720D.

When did this happen? Exact date is best, but month/year is sufficient. VA will use this to verify through unit records, unit chronologies, or after-action reviews.

e.g., On or about March 15, 2009

• ×Saying "I don't remember" when even the season helps - "Spring 2009 during deployment" is enough for the VA to develop it.
• ×Listing the date you sought help instead of the date the event occurred - they are different and rating depends on the event date.

Be specific: base/FOB name, city, province/state, country. For naval service: vessel name, hull number, port. For aviation: airfield name. The more specific you are, the easier VA verifies through DoD records.

e.g., FOB Shank, Logar Province, Afghanistan

• ×Generic location ("Iraq", "the desert") - VA can't verify without a specific FOB/COB/installation name.
• ×Misspelling a foreign place name - even one letter off can fail the DoD records search.

Your full unit designation as it appeared on orders: company, battalion, regiment/brigade, division. For Marines: same plus regimental designation. For Navy: ship + squadron if aircrew. For Air Force: squadron, group, wing.

e.g., A Co, 1st Bn, 504th Parachute Infantry Regiment, 82nd Airborne Division

• ×Listing only the largest unit ("82nd Airborne") - VA needs the company/battalion-level designation to verify through unit chronologies.

Describe the event in your own words. Include who was involved, what happened, what you saw/heard/experienced, and why it has affected you. Be as specific as you can without dramatizing - the VA examiner needs facts. For MST: 38 CFR 3.304(f)(5) accepts non-record evidence ("markers") because military assaults are often unreported; describe both the event and any subsequent behavior changes.

e.g., While on convoy security from FOB Shank to FOB Salerno on 03/15/2009, the lead vehicle struck an IED. PFC Martinez was killed instantly and SGT Williams lost both legs. I was in vehicle 3 and provided first aid to SGT Williams while waiting 47 minutes for MEDEVAC. After this event I began having nightmares, became hypervigilant, and could not sleep more than 2-3 hours per night.

• ×Minimizing the event ("It wasn't that bad") because you compare yourself to others who had it worse - your trauma is your trauma.
• ×Skipping the post-event behavior change for MST - markers are critical evidence under 3.304(f)(5).
• ×Long emotional narrative without facts - examiners need the who/what/when/where/how.
• ×Using "we" when "I" is required - VA needs your individual experience, not the unit's.

Names, ranks, and (if known) current contact info of anyone who was there. Witnesses can submit buddy statements (VA Form 21-10210) supporting the event. Even names without contact info help VA cross-reference unit rosters.

e.g., SGT John Williams (injured in same event); CPT Sarah Lee (platoon leader); CPL Mike Chen (medic on scene); SSG Robert Davis (witness, not injured)

• ×Listing witnesses without ranks - VA cross-references by name + rank + unit.
• ×Not contacting witnesses for buddy statements - corroboration is the single biggest evidence boost for stressor verification.

Combat Action Badge (Army), Combat Infantryman Badge (Army), Combat Medical Badge, Combat Action Ribbon (Marines/Navy/CG), Combat Action Medal (Air Force), Purple Heart, Bronze Star with V device, Silver Star - these are presumptive evidence of combat exposure under 38 USC 1154(b). List the award and the action that earned it.

e.g., Combat Action Badge, awarded 04/02/2009 for the 03/15/2009 IED engagement

• ×Forgetting to list awards earned for the specific event - combat decorations are 38 USC 1154(b) presumptive evidence, eliminating the need for further stressor verification.
• ×Listing decorations from other events when the form asks about THIS specific stressor - keep them tied 1:1.

Per 38 CFR 3.304(f)(5), VA accepts non-record evidence ("markers") to corroborate MST stressors because military assaults are often unreported. Markers include: sudden requests for unit transfer, deployment refusal, sudden performance decline (NCOERs/EERs), substance abuse, divorce, marital problems, pregnancy tests, STD testing, depression/anxiety treatment, attempted suicide, increased absenteeism. List every marker you can think of.

e.g., Requested unit transfer 2 weeks after the event (denied); EER dropped from "Excellent" to "Marginal" the quarter after; sought chaplain counseling May 2009; began drinking heavily; marriage ended Aug 2010

• ×Skipping markers because "they're not proof" - the entire 3.304(f)(5) framework exists because formal proof often does not exist for MST.
• ×Listing only one or two markers when many are present - every one strengthens the claim.
• ×Not including civilian post-service markers (sudden divorce, job loss, hospitalization) - these count too.

You are certifying under penalty of perjury that the statements are true to the best of your knowledge. Sign and date in the presence of the form (electronic signature acceptable on VA.gov). Knowingly false statements are a federal crime - but uncertain memory ("approximately" or "to the best of my recollection") is fine.

(signature/date when filing)

• ×Refusing to file because memories are imperfect - "to the best of my recollection" is the right standard.
• ×Forgetting to date the signature - VA will return for completion.