What it is
VA Form 21-4502 (Application for Automobile or Other Conveyance and Adaptive Equipment) is the application for the auto-allowance benefit under 38 U.S.C. 3901–3904. VA pays up to $27,074.99 (rate effective October 1, 2025) directly to the seller toward one vehicle, and separately authorizes adaptive equipment needed to safely operate or ride in it.
When you use it
File this form if a service-connected condition caused: loss or permanent loss of use of one or both hands or feet; permanent vision impairment of 20/200 or worse in the better eye (or qualifying field defect); a severe burn injury; or ALS. Ankylosis of one or both knees or hips qualifies for adaptive equipment only, not the auto allowance.
What to gather before you fill it out
- Your VA file number or SSN and the rating decision establishing the qualifying disability
- Make, model, and seller information if you have a vehicle picked out
- A statement from your VA clinician describing the loss of use or burn severity if not already documented
- For adaptive equipment, VA Form 10-1394 (separate application handled through your VA prosthetics office)
How to submit
Apply online at VA.gov, mail the completed PDF to the Pension Management Center on the form, or bring it to a VA regional office. Do not buy the vehicle before VA approves the allowance, payment goes to the seller, not to you.
Common pitfalls
- Purchasing the car first: the auto allowance is paid to the dealer at sale; reimbursements after the fact are routinely denied
- Confusing the two benefits: the $27,074.99 auto payment is generally one-time; the adaptive equipment grant is separate and can be reauthorized for a later vehicle
- Submitting without service connection already established for the qualifying loss, file an 8940/526EZ first if needed
- Knee or hip ankylosis claimants checking the auto box: that condition qualifies only for adaptive equipment under 38 U.S.C. 3901(1)(B)
Related forms
VA Form 10-1394 (Adaptive Equipment. Motor Vehicle), VA Form 21-526EZ (underlying service-connected claim), VA Form 21-2680 (aid and attendance, if relevant).
Sources
https://www.va.gov/find-forms/about-form-21-4502/ ; https://www.va.gov/disability/eligibility/special-claims/automobile-allowance-adaptive-equipment/ ; https://www.va.gov/disability/compensation-rates/special-benefit-allowance-rates/ ; 38 U.S.C. 3901–3903; 38 CFR 17.155.