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 To determine eligibility for financial assistance in the purchase of an
7 Follow the instructions in the table below. 8 Complete VA Form 21-4502, Section II, Certificate of Eligibility, by entering all the qualifying disabilities. 9 Have VA Form 21-4502 signed by the Veterans Service Center Manager (VSCM) or by a designee no lower than a 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 VA Form 21-4502 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.3.d 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.
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.
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.