Introduction This topic contains information on processing claims for automobile and adaptive equipment allowance, including reviewing VA Form 21-4502 and determining prior payment status applying for “other” types of conveyance processing applications for “other” types of conveyance releasing VA Form 21-4502 and VA Form 10-1394 to the applicant for a conveyance entitlement based on vehicle lease, and determining whether the vehicle is purchased or leased. Change Date August 6, 2008 a. Reviewing VA Form 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 serviceperson, and to determine whether prior payment has been made. Step Action 1 Upon receipt of VA Form 21-4502, review the claims folder to determine whether it contains a copy of a prior VA Form 21-4502 annotated by the finance activity indicating prior payment of the automobile allowance. If yes, go to Step 5. If no, go to Step 2. Important: Although a previously processed VA Form 21-4502 is generally filed in the left flap of a claims folder, it is important to review the entire claims folder. 2 Does the Share M15 screen (or the equivalent in the Veterans Service Network ()) display a “Y” 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, go to Step 5. If no, go to Step 3.
9 Have VA Form 21-4502 signed by the Veterans Service Center Manager (VSCM) or by a designee no lower than coach. 10 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 290. Reference: For more information on the requirement of referring claims to an outpatient clinic, see M21-1, Part IX, Subpart i, 2.6.f. 11 Place a copy of the form in the claims folder. b. 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.2 for the approval of the VSCM or a designee no lower than a coach. c. 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 File a copy of VA Form 21-4502 in the claims folder. d. Releasing VA Forms and 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 and supplemental authorization on VA Form 10-1394 to the applicant. The applicant must send the forms to finance activity for payment.
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 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. 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]?” 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 in M21-1, Part IX, Subpart i, 2.1. there is evidence of entitlement or nonentitlement 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]” file the 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 (loss of use) of one or both knees or hips, or that the Veteran is not eligible, and if eligibility is not established, furnish a copy of the rating decision. 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 prominently 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. e. Preventing Duplicate Payment The VSC permanently retains the annotated copy of VA Form 21-4502 in the award section of the claims folder to prevent duplicate payment in the event a subsequent claim is received. 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 Notice of Disagreements (NODs) or Substantive Appeal Change Date November 16, 2004 a. Processing an NOD or Substantive Appeal Use the table below to determine the next steps when the claimant files an NOD or substantive appeal relating to the denial of a claim for automobile and adaptive equipment allowance. If … Then … the disallowance resulted from the denial of basic eligibility authorization furnishes the statement of the case (SOC) and certifies the appeal when the substantive appeal is received. the claimant has established basic eligibility to the automobile allowance and adaptive equipment, and the issue is the result of disallowance by the medical activity for certain adaptive equipment authorization transfers the claims folder to the medical facility for preparation of an SOC, and the medical facility returns the SOC and claims folder to authorization for release of the SOC. a substantive appeal is filed because of disallowance by the medical activity authorization forwards the claims folder to the medical activity for processing and certification of the appeal.