An Authorization for Automobile or Other Conveyance and Adaptive Equipment is a form used by the Department of Veterans Affairs and is formally known as a VA Form 21-4502. This form is used by a veteran who wishes to file a claim for an allowance to purchase a vehicle or some sort of adaptive equipment due to a medical disability. This application has three sections. In the first, the veteran will need to specify the type of vehicle or equipment he or she is requesting, whether it is a car, van, truck, or other adaptive equipment. The second section will be completed by the Department and will detail information about the veteran’s disability that warrants such an allowance. The last section of this form will be completed after the vehicle has been purchased, and will detail information such as the price, make, and model of the vehicle or equipment.
Table of Contents
A VA Form 21-4502 is known as an Authorization for Automobile or Other Conveyance and Adaptive Equipment. This form is used by the Department of Veterans Affairs in the United States. This form will be used by a veteran who wishes to file a claim for an allowance to purchase an automobile or adaptive equipment due to a medical disability.
The application for automobile or other conveyance and adaptive equipment will require information about the claimant and their medical disability. The first section will require personal information and information about the conveyance the claimant is requesting. This could be a new motor vehicle, truck, or other adaptive equipment. Section II will need to be completed by the VA. This part will detail the claimant’s qualifying disability. The final section will only be completed after a vehicle has been purchased by the veteran. It will detail the information about the equipment, such as price, make, and model.
The form specifies the types of equipment that are authorized for each disability. Â If you need adaptive equipment that is not on the list, you should request approval from the nearest VA health care facility or regional office.
The VA Form 21-4502 is commonly used by disabled veterans to request an automobile allowance or an allowance for adaptive medical equipment for a medical disability that was received during military service.
To apply for a one-time payment to help you buy a specially equipped vehicle you need to fill out VA Form 21-4502.  If approved, the VA will pay the vehicle’s seller directly.
To apply for adaptive equipment only, you need to fill out VA Form 10-1394. Â If approved the VA may pay you or pay the equipment seller directly. Â Adaptive equipment includes things like automatic transmission, power brakes, power seats, and power steering.
To receive these VA benefits, you must show a disability that’s related to your service and includes at least one of the following: loss or permanent loss of use of one or both feet; loss or permanent loss of use of one or both hands; permanent decreased vision in both eyes: 20/200 vision or less in your better eye with 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; a severe burn injury (deep partial thickness or full thickness burns resulting in scar formation that can cause contractures and limit motion of one or more extremities or the trunk); amyotrophic lateral sclerosis (ALS); or ankylosis in one or both knees or hips.
A VA Form 21-4502 contains the following sections:
To apply for benefits to help you buy a specially equipped vehicle, you will need to fill out VA Form 21-4502. Â To apply for an adaptive-equipment grant, you will need to fill out VA Form 10-1394. Â You need to file your claim and get approval before making the purchase.
To complete a VA Form 21-4502, you need to provide the following information:
The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (ex: civil or criminal law enforcement, litigation in which the United States is a party or has an interest, the administration of VA programs and delivery of VA benefits, verification of identity and status, and personnel administration) as identified in the VA system of records, 58VA21/22/28, Compensation, Pension, Education and Vocational Rehabilitation and Employment Records - VA, published in the Federal Register.
The VA needs this information in order to determine eligibility for automobile or other conveyance and adaptive equipment allowance (38 U.S.C. Chapter 39). Title 38, United States Code, allows us to ask for this information if this number is not displayed. It should take and average of 15 minutes to complete the form.
