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About VA Form 21-4502

Form name: Application for Automobile or Other Conveyance and Adaptive Equipment (UNDER 38 U.S.C. 3901-3904)
Related to: Disability
Form last updated: June 2023

When to use this form

Use VA Form 21-4502 if you’re a Veteran with a disability and you want to apply for compensation for a vehicle that meets your needs. This may include a specially equipped vehicle for you to drive or adaptive equipment to help you get in and out of your vehicle.

Downloadable PDF

Download VA Form 21-4502 (PDF)
  • Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.

  • Find out how to file a claim for disability compensation or increased disability compensation.

  • Find out if you need to complete additional forms for your disability claim.

  • Find out if you can get a VA automobile allowance if you’re a Veteran living with a service-connected disability that prevents you from driving.