Designing with compassion: A trauma-informed approach to digitizing VA disability forms

About VA OCTO

The Department of Veterans Affairs (VA) is focused on delivering benefits and healthcare services to Veterans, family members and caregivers. The VA’s Office of the Chief Technology Officer (OCTO) is a team of problem solvers in civic tech from diverse backgrounds. OCTO manages the Veteran digital experience, consisting of public-facing websites and native mobile applications as well as the technical and operational infrastructure that supports that experience, all of which have a huge impact on the lives of millions of Veterans, their families, and the people that serve them. VA OCTO’s goal in hosting U.S. Digital Corps Fellows is to bring in fresh talent to join this mission-driven team to help create a better customer experience for Veterans and their families so that they can receive the benefits they’ve earned.

The challenge

VA Form 21-0781 is an optional form that Veterans with mental health conditions can fill out to provide additional information in support of their disability claim. In June 2024, VA released a new version of the form with critical updates, including adding new questions, removing triggering questions, and expanding the scope of the form to ask about not just PTSD, but also all other mental health conditions.

Some of the key constraints and challenges associated with making this update included:

• “Form within a form” - The team needed to build the new VA Form 21-0781 within the broader disability compensation application (VA Form 21-526EZ), which is an already lengthy form itself. There were also some areas where both forms were asking for the same information in slightly different ways, creating some areas of redundancy that needed to be addressed.

• Sensitive subject matter - Filling out VA Form 21-0781 is a very emotionally burdensome experience as it asks Veterans about their traumatic experiences from the military and the behavioral changes they experienced as a result.

The approach

A U.S. Digital Corps Design Fellow led the redesign of VA Form 21-0781. The Fellow owned the entire design process, from mapping out user flows to a round of concept testing to wireframing and multiple prototypes. The Fellow set up regular checkpoints with experts in trauma-informed design (e.g. social workers), the Veterans Benefits Administration (VBA), and OCTO colleagues, in order to ensure that all perspectives were considered throughout the process.

To address the “form within a form” challenges, the Fellow:

• Established a new design pattern by adding a step to the disability application called “additional forms” and pulling out the 0781 into its own separate card and flow.
• Streamlined data collection by identifying areas of redundancy between the two forms, and solutionizing a way to collect all necessary information without being redundant, including grouping items with similar tasks together (ex. uploading documents).

To address the “sensitive subject matter” consideration, the Fellow:

• Partnered with social workers and the trauma-informed community of practice at OCTO to develop a trauma-informed approach to the work, which included checking in weekly and asking for their feedback on the designs.
• Collaborated with VBA to get to the core of why certain questions are being asked and what information is actually necessary. This allowed the Fellow to make smart design choices to minimize user burden as much as possible.

After many iterations of wireframes and prototypes and one round of concept testing with twelve users, the Fellow successfully redesigned VA Form 21-0781. Some key highlights include:

• Emergency support alerts that are present on all pages of the 0781 to provide Veterans with mental health support all throughout the experience

  “When you talk about certain things, you’re back at the situation. And that’s a massive trigger. And to have the support at the bottom [of the page] reminds me, I can talk to a person to talk me off the edge”

  -Veteran feedback

• Incorporating instructional content and exit paths into the 0781, so that the user can take a break at any time and know that their work is being saved.
• An “additional forms” design pattern that can be used not only for the 0781, but also for the future implementation of other additional forms for the disability application.
• Providing Veterans with example responses from VBA as they write the narrative of their traumatic events, which helps the Veteran by providing direction and helps VBA by giving them the details they need to process the claim.

  “I like that it gives the Veteran the option to share what they are comfortable with, before asking to put every single detail. Because that can be traumatic, reliving every detail.”

  -VBA staff feedback

The impact

Any Veteran with a mental health condition related to a traumatic event during their time of military service will benefit from this updated form, which is faster and easier to fill out. This is significant, given that almost a quarter of Veterans using VA healthcare have PTSD at some point in their lives, and about 1 in 3 female Veterans and 1 in 50 male Veterans report experiencing MST. (source)

The OCTO design community will also benefit from this achievement by using the established design pattern for a “form within a form” for their own projects. This could save teams at least 3-6 months of work, as they can adapt this pattern instead of having to test, synthesize, and retest a new form pattern.

VA is on a mission to care for those who have served in our nation’s military and for their families, caregivers, and survivors. Designing with compassion is one way to carry out this mission and care for Veterans in their journey of applying for disability benefits.