3. Rating Claims for Automobile and Adaptive Equipment Allowance Introduction This topic contains information on rating claims for automobile or adaptive equipment allowance, including referring automobile or adaptive claims to the rating activity when to prepare a rating decision for automobile or adaptive equipment eligibility definition of deep partial thickness and full thickness burns determining eligibility based on burn injury, and processing requests for a second automobile allowance. Change Date December 22, 2015 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. 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 serviceperson 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, 2.3.e. 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. d. Determining Eligibility To determine eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment based on burn
3 Review the VA Form 21-4502 with the claims folder to determine whether a prior rating decision established entitlement to the automobile or adaptive equipment allowance. If yes, go to Step 5. If no send a notice to the claimant refer the claim to the rating activity for consideration after the duty-to-notify/assist response period has expired, and go to Step 4. 4 Did the rating activity establish entitlement to either the automobile or adaptive equipment allowance? If yes, go to Step 5. If no disallow the claim, and notify the claimant accordingly. 5 Does any one of the following situations exist? The claimant was rated with the qualifying disability more than five years prior to receipt of VA Form 21-4502. The claims folder was recently transferred from another RO. There is indication that adaptive equipment payments have been made. If yes refer the claim to finance activity to review for prior payment, and after finance activity completes the review and returns the claim to authorization, go to Step 6. If no, go to Step 8. 6 Does finance activity’s review show that a prior payment for an automobile or conveyance was made? If yes, go to Step 7. If no, go to Step 9.
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]” 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 (loss of use) of one or both knees or hips. 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 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 claims folder to prevent duplicate payment in the event a subsequent claim is received.