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 2022
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)Helpful links related to VA Form 21-4502
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Eligibility for VA disability benefits
Find out if you qualify for compensation for a presumptive disability or other service-connected conditions.
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How to file a VA disability claim
Find out how to file a claim for disability compensation or increased disability compensation.
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File additional forms for your disability claim
Find out if you need to complete additional forms for your disability claim.
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VA automobile allowance and adaptive equipment
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.