HomeVA ProstheticsVA Handbook 1173.15 - Clothing Allowance BenefitProcedures

15.5. Procedures

a. When a rating decision is processed which initially establishes service connection, and the patient, because of a service-connected disability, wears or uses a prosthetic or orthotic appliance, the veteran must be informed of potential eligibility for the clothing allowance by the Veterans Service Center. The veteran is instructed to apply for the clothing allowance benefit at a VHA health care facility utilizing VA Form 10-8678, Application for Annual Clothing Allowance, and submitting it to the nearest VHA health care facility.

b. When other veterans with potential eligibility are identified by Prosthetic Representatives at VHA health care facilities, assistance must be provided to the claimant after VA Form 10- 8678 is completed. The completed application will be processed at the health care facility. Documentation of all actions, favorable or unfavorable, will be recorded in the patient's Computerized Patient Record System (CPRS) record.

c. Annotate VA Form 10-2319 (ADP), Record of Prosthetic Service, on page 3 to reflect receipt of VA Form 10-8678, as follows:

(1) Access the Add/Edit Clothing Allowance option under the PSC/Entitlement Records section of the Prosthetic official's menu.

(2) Enter the patient's name at the prompt, and then complete the remainder of the fields beginning with the date the claim was processed by the Prosthetic activity.

(3) Enter the name of the person performing the clothing allowance examination.

(4) Enter appropriate identifying information at the "Clothing Allowance Description" prompt, including the appliance for which the claim was made.

(5) When entitlement is not recommended, indicate one or more of the following at the "Clothing Allowance Description" prompt:

(a) Appliance causing wear or tear is not worn, or medication causing damage is not used;

(b) Appliance not worn for service connected condition, or medication not used for service connected condition;

(c) Appliance worn, not medically prescribed, or medication used not medically prescribed.

d. Notification letters for all determinations made must be sent to each veteran and their designated power of attorney. This includes denials.

e. When the veteran certifies use of an appliance and/or medication which damages clothing and there is no record of VA issue, a physical examination needs to be scheduled prior to a recommendation for denial of entitlement. In determining whether these devices and/or medications tend to damage clothing, each individual application is to be considered on the objective findings of the case; this may include a medical examination and an inspection and evaluation of the device(s) claimed to cause damage to the clothing. Staff must ensure that they do not routinely require the production of worn or torn clothing. NOTE: Reasonable doubt should be resolved in favor of the veteran.

f. Appeals must be handled according to the official appeals process administered by the facility Chief Business Officer.

g. VHA Prosthetic and Sensory Aids Service is responsible for the award action on the annual re-certification portion of the Clothing Allowance benefit. However, the funding for the Clothing Allowance remains in the VBA benefit appropriation. The Veterans Integrated Service Network (VISN) Prosthetic Representative (VPR) coordinates the award action at the facility level and ensures all appropriate staffs have been trained in the procedures of processing payment for clothing allowance benefits in VBA's Benefits Delivery Network (BDN). NOTE: All training and user manuals can be located on the prosthetic website at: http://vaww.va.gov/prosthetics .

h. Authorization of a clothing allowance to a veteran, who is in receipt of military retired pay and for whom an active master record does not exist, must be made each year for the current annual payment. If continuing eligibility has been established, payment of the next and succeeding annual clothing allowance payment may be made without re-determination of eligibility. For non-static disabilities, reapplication, using VA Form 10-8678, is required for each subsequent annual payment. NOTE: Veterans Service Center officials have been instructed to verify addresses in cases involving continuing eligibility on, or about, August 1 of each year through individual communication.

i. Veterans rated as service connected and determined to be eligible on a continuing basis (per 38 CFR 3.810(a)(1)) for loss of use (at a rate specified in 38 CFR 3.350(a),(b),(c),(d), or (f)(1)), are not required to reapply. Their clothing allowance is included in the automated payment process; this, however, does not preclude the possibility of future recertification as to the wear or use of the appliance.

j. Veterans whose determination, completed at a VHA facility, states "the condition requiring use of such device is not static," are required to reapply at the local VHA facility on an annual basis prior to August 1 of each year.

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