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M21-1, Part IX, Subpart i, Chapter 2 – Automobile and Adaptive Equipment Allowance Under 38 U.S.C. Chapter 39

Overview


In This Chapter

This chapter contains the following topics:
Topic
Topic Name
1
2
3
4
5
6
7

1.  Eligibility for Automobile and Adaptive Equipment Allowance


Introduction

This topic contains information on eligibility for automobile and adaptive equipment allowance, including


Change Date

April 25, 2016

IX.i.2.1.a.Eligibility Requirements for Financial Assistance for a Conveyance

To be eligible for financial assistance in purchasing a new or used automobile (or other conveyance), a Veteran or service member must have acquired one of the following disabilities as a result of injury or disease incurred or aggravated during active military service, or as a result of medical treatment or examination, vocational rehabilitation, or compensated work therapy provided by the Department of Veterans Affairs (VA) (38 U.S.C. 1151):
  • loss, or permanent loss of use (LOU), of one or both feet
  • loss, or permanent LOU, of one or both hands,
  • permanent impairment of vision in both eyes with a
    • central visual acuity of 20/200 or less in the better eye with corrective glasses, or
    • central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field has an angular distance no greater than 20 degrees in the better eye, or
  • a severe burn injury defined as disability caused by deep partial thickness or full thickness burns resulting in scar formation that causes contractures and limits motion of one or more extremities or the trunk and precludes effective operation of an automobile, or
  • amyotrophic lateral sclerosis (ALS).
Notes:
  • Per VAOPGCPREC 60-1990, eligibility for an automobile grant may be based on functional as well as organic LOU of an extremity or blindness. Example:  A conversion reaction may cause functional, as opposed to organic, blindness.
  • Eligibility based on burn injury only applies to claims filed on or after October 1, 2011.

Reference:  For more information on the eligibility requirements for the automobile allowance and adaptive equipment, see


IX.i.2.1.b.  Issuing a Certificate of Eligibility

A certificate of eligibility for financial assistance in the purchase of a new or used automobile or other conveyance may be made to a Veteran
  • once in his/her lifetime
  • in an amount not exceeding the amount specified in 38 U.S.C. 3902, and
  • if the eligibility requirements are met.
Exception:  PL 112-154 authorizes VA to provide or assist in providing eligible Veterans with a second automobile or other conveyance when the
  • first vehicle purchased with VA financial assistance is destroyed as a result of any natural catastrophe
  • destruction was not the Veteran’s fault, and
  • Veteran does not receive compensation for the loss from a property insurer.
The law prohibits VA from making payments for automobile/conveyance grants directly to Veterans.  VA is required to pay the benefits to the seller.
 
Notes:
  • The term automobile or other conveyance is not defined in the statute or regulation.  It is written and interpreted broadly to allow VA the maximum authority to approve the financial assistance.  The term encompasses a wide variety of drivable motorized vehicles including, but not limited to, cars and station wagons, sport utility vehicles, minivans or vans, pickup trucks, motor homes, and commercial trucks or farm machines such as a tractor, harvester, or combine.
  • The Chief Medical Director makes the determination as to what is specifically necessary for the disability or individual.  If it is found that a specific requested conveyance is not necessary for the disability or individual, then the Chief Medical Director or designee makes that decision.
References:  For more information on

IX.i.2.1.c.  Eligibility Requirements for Adaptive Equipment

A Veteran or service member who qualifies for the automobile allowance also qualifies for adaptive equipment.  To be eligible to receive only adaptive equipment (as opposed to the automobile allowance), the Veteran or service member must be entitled to disability compensation for ankylosis of one or both knees or hips based on
  • the establishment of service connection, or
  • entitlement under 38 U.S.C. 1151 as the result of
    • VA treatment or examination
    • compensated work therapy, or
    • vocational training under 38 U.S.C. Chapter 31.
The adaptive equipment benefit may be paid more than once, and it may be paid to either the seller or the Veteran.
Reference:  For more information on ankylosis of one (or both) knees or hips, see38 U.S.C. 3902(b)(2).

IX.i.2.1.d.  Definition: Adaptive Equipment

The term adaptive equipment includes, but is not limited to
  • power steering
  • power brakes
  • power window lifts
  • power seats, and
  • special equipment necessary to assist the eligible person into and out of the automobile or other conveyance.

IX.i.2.1.e.Veterans Who Do Not Qualify for Benefits

Even though compensation for disability of paired service-connected (SC) and non-service-connected (NSC) organs is payable under 38 CFR 3.383, Veterans do notqualify for the automobile and adaptive equipment allowance based on bilateral visual impairment if the impairment of vision in one eye is due to an NSC disease or injury.
Notes:
  • Entitlement to the automobile and adaptive equipment allowance may be based on disability of paired extremities under 38 CFR 3.383 because eligibility under 38 U.S.C. Chapter 39 requires the SC loss, or LOU, of only one hand or one foot.
  • Public Law 108-454 effective December 10, 2004, extended eligibility for the automobile and adaptive equipment allowance to Veterans with qualifying disability under 38 U.S.C. 1151.

Reference:  For more information on entitlement to compensation for loss of paired SC and NSC organs or extremities, see 38 U.S.C. 1160.


IX.i.2.1.f.  Eligibility for 38 U.S.C. Chapter 31 Beneficiaries

Automobile adaptive equipment may be furnished to a beneficiary under 38 U.S.C. Chapter 31 if Vocational Rehabilitation and Employment determines that the equipment is necessary to
  • overcome an employment handicap to which an SC disability materially contributes, and
  • achieve the goals of the program of rehabilitation.
Reference:  For more information on eligibility, see 38 CFR 21.216(a)(3).

IX.i.2.1.g.Reduction of Benefits Due to Tort Judgment or Settlement

Automobile or adaptive equipment benefits must be reduced by an “offset amount” in cases where a judgment or settlement of a tort claim against the United States is granted for disability established under 38 U.S.C. 1151, if the tort judgment or settlement
  • becomes final
    • on or after December 10, 2004, but
    • before the date VA awards the automobile or adaptive equipment allowance, and
  • includes an amount specifically designated for automobiles or adaptive equipment.
Notes:
  • Contact local Regional Counsel to determine whether a judgment or settlement qualifies for offset.
  • If the offset amount exceeds the amount of the automobile or equipment benefits awarded, the excess amount is offset against VA compensation.
Reference:  For more information about tort claims and compensation under 38 U.S.C. 1151, see M21-1, Part IV, Subpart ii, 3.D.

2.  Application for Automobile and Adaptive Equipment Allowance

 


Introduction

This topic contains information on applications for automobile and adaptive equipment allowance, including

Change Date

March 1, 2019

IX.i.2.2.a.Applying for Automobile Allowance

A formal claim on VA Form 21-4502, Application for Automobile or Other Conveyance and Adaptive Equipment, is required if the Veteran or service member is applying for the automobile allowance.
The application for an automobile or other conveyance is considered an application for the adaptive equipment specified for the claimant’s disability by directive of the Chief Medical Director.  The instructions on the VA Form 21-4502 contain a list of adaptive equipment that has been preapproved for particular disabilities.
Notes:
  • There is no time limit for filing a claim.
  • Upon receipt of the application, before referring the claim to the rating activity
    • establish an end product (EP) as directed in M21-4, Appendix B
    • select an appropriate claim label for initial claims, and
    • send the claimant the notice required under 38 U.S.C. 5103, when needed.
  • A spouse-payee may file an application for an automobile on behalf of an incompetent Veteran, in accordance with VAOPGCPREC 36-1991.
  • There are several claim labels that can be appropriate in initial claims for an automobile or other conveyance and adaptive equipment.  In most cases involving SC compensation use Automobile Allowance.  However, the DRAS Automobile Allowance or PMC – Automobile Allowance labels may be necessary in some cases.
  • Where one of the auto-related claim labels is applicable it is important that it is properly applied to ensure appropriate prioritization through the National Work Queue (NWQ).  NWQ prioritizes the distribution of initial auto and adaptive equipment claims utilizing the claim label.
References:  For more information on

IX.i.2.2.b.Applying for Adaptive Equipment Only

A formal claim on a VA Form 10-1394, Application for Adaptive Equipment – Motor Vehicle, is required if the Veteran is entitled to adaptive equipment only.  Typically this form is provided by the outpatient clinic to the Veteran for forwarding to the finance activity, or submitted by the prosthetics department on his/her behalf to the local finance activity.
VA Form 10-1394 is also required for approval of equipment not specified on theVA Form 21-4502 for the Veteran’s particular disability.
 
Notes:
  • There is no time limit for filing a claim for adaptive equipment based on ankylosis.
  • Upon receipt of the application, before referring the claim to the rating activity
    • establish an EP as directed in M21-4, Appendix B
    • for initial claims, select the claim label Vehicular Adaptive Equipment, and
    • send the claimant the notice required under 38 U.S.C. 5103, when needed.
  • There are several claim labels that can be appropriate in initial claims for adaptive equipment only.  In most cases involving SC compensation use Vehicular Adaptive Equipment as provided above.  However, theDRAS Vehicular Adaptive Equipment or PMC-Vehicular Adaptive Equipment may be needed in some cases.
  • Where one of the adaptive-equipment-only claim labels is applicable, it is important to ensure it is properly applied to ensure appropriate prioritization through NWQ.  NWQ prioritizes the distribution of initial adaptive equipment claims using the claim label.
References:  For more information on

IX.i.2.2.c.Handling Incomplete Applications for the Automobile Allowance or Adaptive Equipment

If an application from a person on active duty is incomplete in any essential part or the medical evidence or service status is insufficiently documented
  • return the application to the VA prosthetics department, if it is responsible for the deficiency; otherwise
  • advise the service member of the deficiency, and
  • ask him/her to obtain the necessary evidence.

 

3.  Rating Claims for Automobile and Adaptive Equipment Allowance


Introduction

This topic contains information on rating claims for automobile or adaptive equipment allowance, including


Change Date

November 6, 2017

IX.i.2.3.a.  Referring Automobile or Adaptive Equipment Claims to the Rating Activity

If prior rating decisions do not establish the existence of a qualifying SC disability, refer the claim to the rating activity after any necessary development.

 


IX.i.2.3.b. When to Prepare a Rating Decision for Automobile or Adaptive Equipment Eligibility

Prepare a rating decision whenever
  • a claim for automobile or adaptive equipment is received from a Veteran or a service member and the issue has not been previously considered, or
  • the issue of eligibility for automobile or adaptive equipment is inferred from a disability rating that fulfills the applicable disability criteria.
Important:  If the Veteran submits a claim for a second automobile allowance, process the request in accordance with the instructions in M21-1, Part IX, Subpart i, 2.5.b.

IX.i.2.3.c.Definition:  Deep Partial Thickness and Full Thickness Burns

Deep partial thickness burns occur when there is complete destruction of the epidermis and severe damage to the dermal layer.
Full-thickness burns occur when there is complete destruction of the epidermis and dermis.  There may also be damage to the underlying subcutaneous fat layer.

IX.i.2.3.d.Determining Eligibility Based on Burn Injury

To determine eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment based on burn injury, the rating activity should
  • look for any full thickness or deep partial thickness scars that cause contracture and limit motion of one or more extremities or the trunk and
  • review medical and lay statements for credible evidence that the burn injury precludes effective operation of an automobile.
Notes:
  • If the extent or cause of the limitation is not clear, request an examination for the joint or joints affected to clarify the extent of the disability and/or its link to the SC injury.
  • Do not request a medical opinion as to whether the functional limitation of the severe burn scar prevents effective operation of an automobile.  This is a legal, rather than a medical, determination.
Reference:  For more information on considering issues within the scope of the claim, see M21-1, Part III, Subpart iv, 6.B.2.

4.  Notifying Claimants of Automobile and Adaptive Equipment Allowance Eligibility

 


Introduction

This topic contains information on notifying claimants of awards and denials, including notifying claimants of

Change Date

March 1, 2019

IX.i.2.4.a.Notifying Claimants of Potential Automobile Allowance Eligibility

Use the table below to inform the claimant of potential eligibility after receiving the rating decision.
If the Veteran or service member is eligible for …
Then …
the automobile allowance
  • furnish VA Form 21-4502, if one is not of record, and
  • instruct the claimant to complete and return the form.
adaptive equipment only
  • furnish VA Form 10-1394 and
  • instruct the claimant to
    • complete all items in Section I, except Items 5 and 6
    • specify the disability upon which the claim is based in Item 7E, and
    • return the completed form to the nearest VA medical facility.

IX.i.2.4.b.  Notifying Claimants of the Reason for Denial of the Automobile Claim

If an application is not approved, fully inform the claimant of the
  • evidence considered,
  • findings favorable to the claimant under 38 CFR 3.104(c), and
  • reason for denial.
References:  For more information on

 

5.  Processing Claims for Automobile and Adaptive Equipment Allowance

 


Introduction

This topic contains information on processing claims for automobile and adaptive equipment allowance, including

Change Date

March 1, 2019

IX.i.2.5.a.  Reviewing VA Form 21-4502 and Determining Prior Payment Status

Follow the steps in the table below to review VA Form 21-4502, with Section I,Application, completed by the Veteran or service member, to determine whether prior payment has been made.
Step
Action
1
Does the claims folder contain a copy of a prior VA Form 21-4502annotated by the finance activity indicating prior payment of the automobile allowance?
  • If yes, proceed to Step 8.
  • If no, proceed to the next step.
Important:  Historically, when a VA Form 21-4502 was processed, the form was filed in the left flap of a paper claims folder.  However, it is important to review the entire paper claims folder or electronic claims folder (eFolder) to identify a prior payment.
2
Has the Automobile Allowance Paid corporate flash been appended to the claimant’s corporate record?
  • If yes, proceed to Step 8.
  • If no, proceed to the next step.
3
Does the Share M15 screen (or the equivalent in the Veterans Service Network) display
  • in the Auto Allowance Paid field, or
  • the terminal digit of the year in which the last payment was made in the Auto Adaptive Equipment field?
  • If yes, proceed to Step 8.
  • If no, proceed to the next step.
4
Did a prior rating decision establish entitlement to the automobile or adaptive equipment allowance?
  • If yes, proceed to Step 6.
  • If no,
    • send a Section 5103 notice to the claimant
    • refer the claim to the rating activity for consideration after the duty-to-notify/assist response period has expired, and
    • procced to the next step.
5
Did the rating activity establish entitlement to either the automobile or adaptive equipment allowance?
  • If yes, proceed to Step 9.
  • If no,
    • disallow the claim, and
    • notify the claimant accordingly.
6
Does either of the following situations apply?
  • The claimant was rated with the qualifying disability more than five years prior to receipt of VA Form 21-4502.
  • There is indication that adaptive equipment payments have been made.
  • If yes,
    • refer the claim to the finance activity to review for prior payment, and
    • after the finance activity completes the review and returns the claim to authorization, proceed to the next step.
  • If no, proceed to Step 9.
7
Does the finance activity’s review show that a prior payment for an automobile or conveyance was made?
  • If yes, proceed to the next step.
  • If no, proceed to Step 9.
8
Follow the instructions in the table below.
If the claim is for …
Then …
an automobile or conveyance, and the Veteran is contending entitlement to a second allowance due to the catastrophic circumstances discussed in M21-1, Part IX, Subpart i, 2.1.b
process the claim in accordance with M21-1, Part IX, Subpart i, 2.5.b.
an automobile or conveyance and the Veteran
  • is not contending entitlement to a second allowance due to the catastrophic circumstances discussed in M21-1, Part IX, Subpart i, 2.1.b, or
  • previously received a second allowance
  • disallow the claim, and
  • inform the claimant accordingly.
adaptive equipment
  • prior payment does notnecessarily disqualify the application, and
  • proceed to the next step.
9
Complete VA Form 21-4502, Section II, Certificate of Eligibility, by entering all the qualifying disabilities.
10
Have VA Form 21-4502 signed by the Veterans Service Center Manager (VSCM) or by a designee no lower than coach.
11
  • Release the original VA Form 21-4502 to the applicant and send him/her a notification letter, unless referral to an outpatient clinic is required, and
  • clear the pending EP.
Reference:  For more information on the requirement of referring claims to an outpatient clinic, see M21-1, Part IX, Subpart i, 2.6.f.
12
Place a copy of the VA Form 21-4502 in the claims folder.

IX.i.2.5.b.  Processing Requests for Second Automobile Allowance 

Regional offices must refer all claims for a second automobile allowance to Compensation Service for an advisory opinion unless review of the claims folder demonstrates that the second allowance was previously paid.
Follow the steps in the table below to route claims for second automobile allowances to Compensation Service for review.
Step
Action
1
Prepare a memorandum using the format prescribed in M21-1, Part III, Subpart vi, 1.A.1.h, and in it, include the following:
  • Veteran’s name
  • file number
  • date of original automobile allowance grant
  • make, model, and year of vehicle purchased with original grant
  • circumstances surrounding the vehicle’s destruction, including date (month, day, and year) of destruction
  • city and state where vehicle was located at the time of destruction
  • description of the disaster and damage done to the vehicle, and
  • verbal or written confirmation that the Veteran has certified to VA that he/she has not received compensation from an insurer for the loss.
2
Treat the memorandum as the equivalent of an administrative decision, and follow the instructions in M21-1, Part III, Subpart v, 1.A.3.e to obtain and document all required signatures.
3
Upload the memorandum and any other relevant documentation to the eFolder in the Veterans Benefits Management System.
4
Use the table below to route the claim to Compensation Service for review.
If the claim is …
Then …
being processed in the NWQ environment
  • append the Compensation Service Review special issue indicator to at least one contention, and
  • add the Compensation Service Case Review tracked item.
not being processed in NWQ
Note:  Ensure that the e-mail
  • specifies the Veteran’s name and claim number, and
  • includes the subject line, Second auto allowance request.
 
Important:  Send any questions concerning the processing or referral of requests for second automobile allowances to VAVBAWAS/CO/211 Policy Staff.
Reference:  For more information on NWQ claims processing, see the NWQ Phase 1 & 2 Playbook.

IX.i.2.5.c.Applying for “Other” Types of Conveyance

Prior to taking any action on the application, if the TYPE OF CONVEYANCE APPLIED FOR field on VA Form 21-4502 is checked Other, make a determination of approval or disapproval of the type of conveyance in the form of an administrative decision in the format prescribed in M21-1, Part III, Subpart v, 1.A.3.b for the approval of the VSCM or a designee no lower than a coach.

IX.i.2.5.d.Processing Applications for “Other” Types of Conveyances

Follow the steps in the table below when the applicant is found eligible for a conveyance other than an automobile or similar vehicle and has submitted a VA Form 21-4502 with Section I, Application, completed.
Step
Action
1
Complete and approve Section II, Certificate of Eligibility, of VA Form 21-4502.
2
Refer the form to the outpatient clinic with a copy of the rating decision.
3
Annotate the copy of VA Form 21-4502 to show the date and place of referral.
4
Place a copy of VA Form 21-4502 in the claims folder.

IX.i.2.5.e.Releasing VA Forms 21-4502 and 10-1394 to the Applicant for a Conveyance

After determination of any adaptive equipment for a conveyance other than an automobile or similar vehicle, the outpatient clinic must release VA Form 21-4502and supplemental authorization on VA Form 10-1394 to the applicant.  The applicant must send the forms to the finance activity for payment.

IX.i.2.5.f.Entitlement Based on Vehicle Lease

The transfer of possession of a vehicle under a contract amounting to a lease doesnot qualify for the automobile allowance under 38 U.S.C. 3902(a).

IX.i.2.5.g.  Determining Whether the Vehicle Is Purchased or Leased

Use the table below to determine whether the vehicle is purchased or leased.
When the …
Then the agreement is a …
applicant and vendor are absolutely bound at the outset to a purchase and sale
purchase.
  • applicant
    • retains the option of considering the payments as rent, and
    • is not obligated to purchase the vehicle at the end of the lease period, or
  • dealer retains the right to take the car back even after the applicant meets all the payments due
lease.

6.  Processing and Paying Eligibility Requests and Certificates of Eligibility

 


Introduction

This topic contains information on processing and paying eligibility requests and certificates of eligibility, including

Change Date

November 16, 2004

IX.i.2.6.a.Payment if the Vehicle was Purchased Before Adjudicative Action Established Eligibility

Ordinarily, an application on VA Form 21-4502 is completed and approved by the authorization activity to certify eligibility before the claimant takes possession of, or title to, the vehicle.
However, payment of the automobile allowance is not precluded if the vehicle was purchased before the adjudicative action establishing eligibility, provided the claimant was actually eligible on the date on which the claimant signed the sales contract.  The claimant’s eligibility is controlled by the effective date of the qualifying disability.

IX.i.2.6.b.Receiving Eligibility Requests for Vehicles Acquired Prior to Receipt of Allowance

The Veterans Service Center (VSC) receives requests in duplicate for eligibility data for reimbursement of adaptive equipment for a vehicle acquired prior to receipt of the automobile allowance from the medical center or outpatient clinic.
The request identifies the claimant and the reason for the request.
Example:  “Was claimant eligible under 38 U.S.C. 3902 on [Date expense was incurred for purchase, installation, repair, or reinstallation of adaptive equipment]?

IX.i.2.6.c.Processing Eligibility Requests for Vehicles Acquired Prior to Receipt of Allowance

After receiving eligibility requests for vehicles acquired prior to receipt of the automobile allowance, use the table below to determine eligibility.
If …
Then …
the claimant has not previously filed a claim for the automobile allowance and adaptive equipment
determine basic eligibility as described inM21-1, Part IX, Subpart i, 2.1.
  • there is evidence of entitlement or non-entitlement on record, or
  • a determination of basic eligibility has already been made
  • determine the eligibility of the claimant for an automobile allowance on the date furnished by the medical facility
  • annotate the request form to show Claimant (was) (was not) eligible on [date furnished by the medical facility]
  • add a copy of the eligibility request in the claims folder, and
  • return the original to the requester.
a request for eligibility for adaptive equipment only is received (based on SC ankylosis)
review the claims folder to determine if the Veteran is entitled.
If the Veteran is entitled, annotate the request to show
  • eligibility because of SC ankylosis (LOU) of one or both knees or hips.
  • If eligibility is not established, furnish a copy of the rating decision.

IX.i.2.6.d. Finance Activity Responsibility to Record and Report the Payment

When the original VA Form 21-4502 with Section III completed by the claimant is returned and scheduled for payment, the finance activity
  • annotates the copy of the application in the claims folder to show the
    • date
    • amount authorized for payment, and
    • initials of the voucher auditor
  • records the payment in the master record, and
  • forwards a copy of the completed VA Form 21-4502 to the outpatient clinic of jurisdiction.

IX.i.2.6.e.Preventing Duplicate Payment

The VSC permanently retains the annotated copy of VA Form 21-4502 in the  claims folder to prevent duplicate payment in the event a subsequent claim is received.

IX.i.2.6.f.Referring Adaptive Equipment Claims to the Finance Activity

Refer all claims for adaptive equipment to the finance activity.  It will determine if the adaptive equipment is preapproved for reimbursement based upon the effective date of entitlement, the Veteran’s SC disability, or if it is specifically authorized by the local VA outpatient clinic.  If it is not, then the finance activity will forward the claim to the outpatient clinic serving the applicant’s residence.  The designee of the Chief Medical Director will consider the claim.  The prosthetic department will signify its approval by completing VA Form 10-1394.  This form is then returned to finance for payment.
These claims may be independent of any initial application for an automobile, and may involve repair, replacement, or reinstallation of adaptive equipment.

7.  Processing Disagreements With Decisions on Automobile and Adaptive Equipment Allowance Claims

 


Change Date

March 1, 2019

IX.i.2.7.a.  Disagreements With Decisions on Automobile and Adaptive Equipment Allowance Claims

Use the table below to determine the next steps when the claimant files a disagreement relating to the denial of a claim for automobile and adaptive equipment allowance.
If …
Then the …
the disallowance resulted from the denial of basic eligibility
authorization activity addresses the disagreement and processes any pending legacy appeals.
  • the claimant has established basic eligibility to the automobile allowance and adaptive equipment, and
  • the issue is the result of disallowance by the medical facility for certain adaptive equipment
  • authorization activity transfers the claims folder to the medical facility to prepare a decision on the issue, and
  • medical facility returns the decision and claims folder to the authorization activity for release of the decision.
a legacy substantive appeal is filed because of disallowance by the medical facility
authorization activity forwards the claims folder to the medical facility for processing and certification of the legacy appeal.
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