VA Form 10-8678 Application for Annual Clothing Allowance

What Is VA Form 10-8678?

VA Form 10-8678, Application for Annual Clothing Allowance is a document used to apply for a clothing allowance. A clothing allowance is a one-time or yearly payment for veterans wearing a prescribed prosthetic or orthopedic appliance or using a prescribed skin medication that is damaging their clothes. Applying for clothing allowance is possible only after the veteran has applied for and claimed disability compensation.

The latest version of the form was released by the Department of Veterans Affairs (VA) in June 2015 with all previous editions obsolete. A VA Form 10-8678 fillable version is available for download below.

To be considered eligible for more than one clothing allowance, the veteran must wear or tear more than one type of article of their clothing or medications must irreparably damage more than one type of their clothing.

Types of clothing and garments eligible for clothing allowance include shirts, blouses, pants, skirts, shorts and similar items, which were permanently damaged by appliances or skin medications. Shoes, hats, scarves, underwear, socks, and similar garments are not included.

Items that tend damage clothing include prosthesis, rigid braces, ankle or foot orthosis (AFO) with hooks, rigid AFO, manual wheelchairs without clothing guards, specialized wheelchairs with sliding board or sliding transfer functionalities, and wheelchairs with positioning and posturing adaptations, crutches, wrist braces, prosthesis, rigid orthotics, service dogs, colostomy or ileostomy, cervical braces.

Skin medication is cream, salve, ointment, lotion, or semisolid medicine that is used to treat, prevent, heal, protect and alleviate symptoms from a skin condition. The veteran can file a claim for clothing allowance if the medication causes irreparable staining, discoloration, bleeding, and damage not removable by laundering or dry cleaning.

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OMB Approved No. 2900-0198
Respondent Burden: 10 minutes
Expiration Date: 5/31/2018
APPLICATION FOR ANNUAL CLOTHING ALLOWANCE
PRIVACY ACT INFORMATION: No benefits may be granted unless this form is completed fully as required by law (38 C.F.R. 3.810). Responses you submit are
considered confidential (38 U.S.C. 5701). They may be disclosed outside VA only if the disclosure is authorized under the Privacy Act, including the routine uses
identified in the VA system of records, 24VA136 “Patient Medical Record - VA”, published in the Federal Register. Information submitted is subject to verification
through computer matching programs with other agencies.
RESPONDENT BURDEN: VA may not conduct or sponsor, and the respondent is not required to respond to this collection of information unless it displays a valid
OMB Control Number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have
comments regarding this burden estimate or any other aspect of this collection of information, call 1-877-222-8387 for mailing information on where to send your
comments.
ELIGIBLITY / ENTITLEMENT FOR AN ANNUAL CLOTHING ALLOWANCE: A Veteran who wears or uses a prescribed
prosthetic, orthopedic appliance, and/or skin medication for a service connected disability may be eligible for an annual clothing
allowance. To be entitled, the prosthetic, orthopedic appliance must cause wear / tear; skin medication must cause irreparable staining to
your outergarments.
WHO IS ELIGIBLE FOR MORE THAN ONE ANNUAL CLOTHING ALLOWANCE? Effective December 16, 2011, Veterans
who wear or use more than one qualifying prescribed prosthetic or orthopedic appliance and/or prescription medication for more than
one service-connected disability or skin condition may be eligible for more than one clothing allowance. To be eligible for more than
one clothing allowance, the qualifying appliances must wear or tear more than one type of article of the Veteran's clothing and/or
medications must irreparably damage more than one type of the Veteran's clothing or outergarment.
WHAT TYPES OF CLOTHING ARE INCLUDED? Clothing such as shirts, blouses, pants, skirts, shorts and similar garments
permanently damaged by qualifying appliances and/or skin medications are considered in clothing allowance decisions. Shoes, hats,
scarves, underwear, socks, and similar garments are not included.
WHERE TO FILE A CLAIM? If you have previously submitted a claim for disability compensation, send this application (VA Form
10-8678) to the Prosthetic and Sensory Aids Service (121) at your local VA Medical Center. If you have not made an application for
disability compensation, complete VA Form 21-526 and send to the VBA regional office nearest your home.
INSTRUCTIONS: This application should be submitted to the Prosthetic and Sensory Aids Service at your nearest VA Medical Center
on or before August 1st of the benefit year for which you are applying. For example: If you are applying for the 2014 benefit, this
application should be received on or before August 1, 2014.
2. VETERAN'S SSN
1. LAST NAME, FIRST NAME, MIDDLE NAME OF VETERAN
3. MAILING ADDRESS OF VETERAN (No. and Street or Rural Route, City or P.O., State and Zip Code) If new address check box.
4. VETERAN'S DAYTIME TELEPHONE NUMBER (include area code)
4a. EVENING TELEPHONE NUMBER (include area code)
4b. VETERAN'S EMAIL ADDRESS
5. CALENDAR YEAR FOR APPLICATION
CERTIFICATION: I hereby apply for the annual clothing allowance benefit authorized under 38 USC §1162. In doing so I certify that because of my
service-connected disability or disabilities, I regularly (1) wear or use the prosthetic or orthopedic appliance(s) listed in section 7 which tends to wear
out or tear my clothing; or (2) use a skin medication(s) listed in section 7 which causes irreparable staining to my outergarments. Note: If I have
multiple prostheses, orthopedic appliances, or skin medications as listed in section 7, the combination of these items causes me to replace my
outergarments faster than if I used a single item.
ACKNOWLEDGEMENT: I acknowledge that by applying or receiving more than one clothing allowance benefit, an application for the annual
clothing allowance benefit requires a yearly submission to the nearest Prosthetic and Sensory Aids Office on or before August 1st of the calender year.
DATE
6. SIGNATURE OF VETERAN (Sign in ink)
VA FORM
10-8678
Page 1 of 2
JUNE 2015
OMB Approved No. 2900-0198
Respondent Burden: 10 minutes
Expiration Date: 5/31/2018
APPLICATION FOR ANNUAL CLOTHING ALLOWANCE
PRIVACY ACT INFORMATION: No benefits may be granted unless this form is completed fully as required by law (38 C.F.R. 3.810). Responses you submit are
considered confidential (38 U.S.C. 5701). They may be disclosed outside VA only if the disclosure is authorized under the Privacy Act, including the routine uses
identified in the VA system of records, 24VA136 “Patient Medical Record - VA”, published in the Federal Register. Information submitted is subject to verification
through computer matching programs with other agencies.
RESPONDENT BURDEN: VA may not conduct or sponsor, and the respondent is not required to respond to this collection of information unless it displays a valid
OMB Control Number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have
comments regarding this burden estimate or any other aspect of this collection of information, call 1-877-222-8387 for mailing information on where to send your
comments.
ELIGIBLITY / ENTITLEMENT FOR AN ANNUAL CLOTHING ALLOWANCE: A Veteran who wears or uses a prescribed
prosthetic, orthopedic appliance, and/or skin medication for a service connected disability may be eligible for an annual clothing
allowance. To be entitled, the prosthetic, orthopedic appliance must cause wear / tear; skin medication must cause irreparable staining to
your outergarments.
WHO IS ELIGIBLE FOR MORE THAN ONE ANNUAL CLOTHING ALLOWANCE? Effective December 16, 2011, Veterans
who wear or use more than one qualifying prescribed prosthetic or orthopedic appliance and/or prescription medication for more than
one service-connected disability or skin condition may be eligible for more than one clothing allowance. To be eligible for more than
one clothing allowance, the qualifying appliances must wear or tear more than one type of article of the Veteran's clothing and/or
medications must irreparably damage more than one type of the Veteran's clothing or outergarment.
WHAT TYPES OF CLOTHING ARE INCLUDED? Clothing such as shirts, blouses, pants, skirts, shorts and similar garments
permanently damaged by qualifying appliances and/or skin medications are considered in clothing allowance decisions. Shoes, hats,
scarves, underwear, socks, and similar garments are not included.
WHERE TO FILE A CLAIM? If you have previously submitted a claim for disability compensation, send this application (VA Form
10-8678) to the Prosthetic and Sensory Aids Service (121) at your local VA Medical Center. If you have not made an application for
disability compensation, complete VA Form 21-526 and send to the VBA regional office nearest your home.
INSTRUCTIONS: This application should be submitted to the Prosthetic and Sensory Aids Service at your nearest VA Medical Center
on or before August 1st of the benefit year for which you are applying. For example: If you are applying for the 2014 benefit, this
application should be received on or before August 1, 2014.
2. VETERAN'S SSN
1. LAST NAME, FIRST NAME, MIDDLE NAME OF VETERAN
3. MAILING ADDRESS OF VETERAN (No. and Street or Rural Route, City or P.O., State and Zip Code) If new address check box.
4. VETERAN'S DAYTIME TELEPHONE NUMBER (include area code)
4a. EVENING TELEPHONE NUMBER (include area code)
4b. VETERAN'S EMAIL ADDRESS
5. CALENDAR YEAR FOR APPLICATION
CERTIFICATION: I hereby apply for the annual clothing allowance benefit authorized under 38 USC §1162. In doing so I certify that because of my
service-connected disability or disabilities, I regularly (1) wear or use the prosthetic or orthopedic appliance(s) listed in section 7 which tends to wear
out or tear my clothing; or (2) use a skin medication(s) listed in section 7 which causes irreparable staining to my outergarments. Note: If I have
multiple prostheses, orthopedic appliances, or skin medications as listed in section 7, the combination of these items causes me to replace my
outergarments faster than if I used a single item.
ACKNOWLEDGEMENT: I acknowledge that by applying or receiving more than one clothing allowance benefit, an application for the annual
clothing allowance benefit requires a yearly submission to the nearest Prosthetic and Sensory Aids Office on or before August 1st of the calender year.
DATE
6. SIGNATURE OF VETERAN (Sign in ink)
VA FORM
10-8678
Page 1 of 2
JUNE 2015
9. Month and
11. List all impacted
7. Type of Appliance or Name of Skin
8. List of Service-Connected
Year Appliance
10. Name and location of VA facility that issued appliance or
FOR VA USE
location(s)
Medication (Artificial leg, metal brace,
Disability/Disabilities Requiring Use
or Skin
skin medication (if not a VA facility include facility's phone
ONLY
(Chest, Back, Buttock, Left or
wheelchair, etc.)
of Appliance(s) or Skin Medication(s)
Medication was
number)
APPROVED?
Right Leg, Left or Right Arm)
issued
(MM/YYYY)
Example A
Yes
No
Example B
Yes
No
1.
Yes
No
2.
Yes
No
3.
Yes
No
4.
Yes
No
5.
Yes
No
PENALTY- The law provides severe penalties which include fine or imprisonment, or both, for the willful submission of any statement or evidence of a material fact, knowing it to be false, or for the fraudulent
acceptance of any payment to which you are not entitled.
FOR VA USE ONLY
# ELIGIBLE
# NOT ELIGIBLE
# UPPER Extremity (2 maximum)
# LOWER Extremity (2 maximum)
12. AMOUNT OF CLOTHING ALLOWANCES
13. EXAMINATION/EVALUATION DATE (If applicable)
14. NOTES:
15. GENERATED BY:
DATE
16. AUTHORIZED BY:
DATE
VA FORM
10-8678
Page 2 of 2
JUNE 2015

Download VA Form 10-8678 Application for Annual Clothing Allowance

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How to Fill out VA Form 10-8678?

  • Item 1. Provide the full name of the veteran;
  • Item 2. Enter the veteran's social security number;
  • Item 3. Enter the veteran's full mailing address including the ZIP code If the address has changed since the last appeal to the VA, the box in Item 3 should be checked;
  • Items 4 and 4a. Enter the daytime and evening phone numbers of the veteran. Item 4b. Enter their email address;
  • Item 5. Enter the calendar year the application is filed; and
  • Item 6. Sign and date the form.

The next page of the form is a table for providing information about the veteran's condition and treatment they receive. If a veteran has multiple appliances or skin medications, the combination of these items causes them to replace outer garments faster than if they used a single item:

  • Item 7 is for entering the type of appliances or names of medications;
  • Item 8 is for listing all service-connected disabilities requiring the use of the listed appliance or skin medication;
  • Item 9 requires the date the appliance or skin medication was prescribed in MMYYYY format;
  • Item 10 requires entering the name and location of the VA facility issued appliance or skin medication; and
  • Item 11 is for the impacted area.

The two leftmost columns of the table and Items 12-16 are for VA use only. These Items include information about the number of clothing allowances, examination or evaluation date and the name and signature of the VA official, who authorized the form with a date.

The completed VA Form 10-8678 must be signed and dated by the veteran.

Where to Mail VA Form 10-8678?

The completed VA Form 10-8678 should be submitted to the Prosthetic and Sensory Aids Service at the nearest VA medical center. The form may be presented in person or mailed. The location of the nearest VA medical center can be found through the VA website.

The form should be filed before August 1st of the benefit year for which the veteran is applying. If a claim is submitted after August 1, the veteran would receive payment the following year. If the application is approved, the veteran will receive payments between September 1 and October 31.

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