VA Form 10-1394: Eligibility, Filing, and Submission

VA Form 10-1394, the Application for Adaptive Equipment – Motor Vehicle, is what veterans and active-duty service members use to ask the VA to pay for modifications to a personal vehicle, things like hand controls, wheelchair lifts, or power seats. You submit it to the Prosthetic and Sensory Aids Service at your local VA medical center, and once the claim is approved, the VA either pays the equipment vendor directly or reimburses you. The one rule that governs everything else: get VA authorization before you buy or install anything. Purchasing first and applying later is the most common way these claims get denied.¹

Who Qualifies for Adaptive Equipment

You need a service-connected disability in one of these categories:²

Permanent loss or loss of use of one or both feet, or one or both hands.
Central visual acuity of 20/200 or worse in the better eye with corrective lenses, or a peripheral field narrowed to 20 degrees or less in the better eye.
A severe burn injury, as determined by VA regulations.
Ankylosis of a knee or hip. This qualifies you for adaptive equipment only, not the separate automobile purchase grant.³

Active-duty service members with any of these disabilities qualify as well. Form 10-1394 covers only adaptive equipment. The separate automobile purchase allowance is filed on VA Form 21-4502.

Get a Prescription and Pre-Authorization First

All adaptive equipment has to be prescribed by a VHA physician or a Certified Driver Rehabilitation Specialist (CDRS), and the prescription is written specifically for your disability and driving needs.⁴ If you haven’t had a driver rehabilitation evaluation, your VA medical center can refer you for one. The evaluation covers behind-the-wheel assessment, equipment recommendations, and sometimes state licensing help.⁵

Before any of the paperwork, call the Prosthetic and Sensory Aids Service at your nearest VA medical center. They confirm eligibility, coordinate the clinical evaluation, and generate the prescription that lets Form 10-1394 move through cleanly. The form itself states in bold that all van modifications require prior authorization before purchase.⁶

How to Fill Out Part I

You only complete Part I. Part II is filled in by VHA prosthetics staff who decide entitlement and approval, and Part III is completed by VBA when payment is processed.⁶ Download the current fillable PDF from the VA forms website so you’re working with the latest version.

Part I asks for:

Fields 1–4, personal information: your full name, Social Security number, mailing address, and telephone number.
Field 5, driver’s license status: whether you hold a valid driver’s license or permit. If you answer no, you are only entitled to ingress and egress equipment, meaning devices that help you get in and out of the vehicle rather than operate it.
Field 6, Certificate of Eligibility: whether you already have VA Form 21-4502 on file. This links your adaptive equipment claim to the automobile allowance program when applicable.
Fields 7A–7G, vehicle information: type of vehicle (car, van, truck, SUV), whether you bought it with the VA automobile allowance, and the year, make, model, and VIN. For repairs, replacement, or reinstallation, field 7G asks for the date the original equipment was provided.
Fields 8–9, signature and date.

Watch field 7B. If you purchased your vehicle using the VA automobile allowance, some adaptive equipment reimbursements may not be approved because they were already covered under the purchase grant. Expect the prosthetic representative to check what’s already been paid for.

What to Attach

The documents that go with your form depend on who installed the equipment and whether you or the VA is paying the vendor. A registered provider is one registered with the National Highway Traffic Safety Administration (NHTSA); anyone else is unregistered.⁴

When the VA is paying a registered provider directly, submit an itemized estimate and a final itemized invoice. The invoice should show the business name, address, date of service, and a breakdown of equipment and installation costs.⁶

When you paid a registered provider out of pocket and want reimbursement, submit the itemized estimate, the final itemized invoice, and a paid receipt or bill of sale.

When you paid an unregistered provider and want reimbursement, submit the final itemized invoice, a paid receipt or bill of sale, and the completed Form 10-1394 itself with the documentation package.

Financial figures on your invoices need to match what’s on the form. Discrepancies slow processing.

Where to Submit the Form

The fastest route is usually hand-delivering the form to the Prosthetic and Sensory Aids Service at your local VA medical center during business hours. The prosthetic representative can review it on the spot and flag anything missing before it enters processing.¹

Other options:⁴

Mail it to the Prosthetic and Sensory Aids Service at your local VA medical center.
Fax it toll-free to 844-531-7818, or 248-524-4260 for foreign claimants.
Submit through My HealtheVet, the VA’s online patient portal.
Mail it to the Claims Intake Center: Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444.

Mailing to Janesville generally takes longer than dropping the form at your local prosthetics office, where the same team already handling your prescription and vendor coordination will process it.

What Happens After You Submit

Once Prosthetic and Sensory Aids receives your Part I, a prosthetic representative completes Part II, deciding entitlement, verifying the documentation, and approving or disapproving the claim. If approved, VBA completes Part III and issues payment.⁶

Payment goes one of two ways: directly to the vendor, or as reimbursement to you. Which one applies depends on whether you’ve already paid and whether the vendor is a registered NHTSA provider. For direct-to-vendor payment, the approved form goes to the vendor, who installs the equipment and then submits the form and an itemized invoice to the VA.¹ The VA does not publish a specific processing timeline for adaptive equipment claims, and turnaround varies by facility workload. You can check status through the VA’s online benefits portal.

Limits, Repairs, and Replacement

The VA covers adaptive equipment on up to two vehicles within any four-year period. Each vehicle with prescribed equipment has to stay on your record for at least four years unless there are extenuating circumstances, so you cannot cycle through vehicles quickly and have each one equipped.⁴

Repairs, replacement, and reinstallation of previously authorized equipment are covered under 38 U.S.C. § 3902(c).³ The same pre-authorization rule applies. Contact prosthetics before any repair work, use Form 10-1394 for the request, and fill in field 7G with the date the original equipment was installed.

If Your Claim Is Denied

A denial letter has to explain why, and it comes with VA Form 20-0998, which lays out your review options.⁶ You have three paths:⁷

File a Supplemental Claim on VA Form 20-0995 with new evidence such as additional medical records, an updated prescription, or corrected invoices.
Request a Higher-Level Review on VA Form 20-0996, asking a more senior reviewer to look at the existing evidence.
File a Board Appeal on VA Form 10182 to bring the case before a Veterans Law Judge at the Board of Veterans’ Appeals.

A supplemental claim is usually the practical choice when the denial is about missing paperwork or an incomplete prescription. A higher-level review puts fresh eyes on the same record when the disagreement is about medical necessity. Board appeals take the longest but give you the most formal hearing.

1
Veterans Affairs. Automobile Allowance and Adaptive Equipment
2
Office of the Law Revision Counsel. 38 U.S. Code 3901 – Definitions
3
Office of the Law Revision Counsel. 38 USC 3902 – Assistance for Providing Automobile and Adaptive Equipment
4
U.S. Department of Veterans Affairs. Automobile Adaptive Equipment (AAE)
5
U.S. Department of Veterans Affairs. Driver Rehabilitation Fact Sheet
6
U.S. Department of Veterans Affairs. VA Form 10-1394 Application for Adaptive Equipment
7
Veterans Affairs. VA Form 20-0998