Form 10-8678 at a glance
What it is: VA Form 10-8678 is the Application for Annual Clothing Allowance.
Who signs: Sign in ink in the SIGNATURE box and enter the DATE (MM/DD/YYYY).
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.
A filled-in Form 10-8678 example: a Veteran applies for the clothing allowance
How to fill out Form 10-8678, box by box
Veteran name, last 4 of SSN, address and telephone
Enter the name of the Veteran as Last Name, First Name, MI in box 1, and the last 4 of the SSN (9999) in box 2.
In box 3, enter the address: Number and street or rural route, PO Box, City, State and Zip Code.
In box 4, enter the Veteran's telephone number, including the area code ((999) 999-9999).
Terminate the benefit
Box 5: check it to elect to terminate the benefit as I no longer use any device, orthopedic appliance, or skin medication, which previously qualified me for the clothing allowance benefit pursuant to 38 USC §1162. If you check this box, then you do not need to complete Sections 6, 7 and 8. If you check this box, then all awards will be terminated. In the future, if you wish to continue receiving recurring payments, then you will need to submit a new application.
Disability, device and area of the body
For each device, orthopedic appliance or skin medication, write the service-connected disability requiring its use in box 6, its name in box 7, and in box 8 which area of the body it impacts: UPPER or LOWER, LEFT or RIGHT.
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 sections 6-8 which tends to wear out or tear my clothing; or (2) use a skin medication(s) listed in sections 6-8 which causes irreparable staining to my outergarments. Note: I understand that I must notify VA when I no longer am prescribed and use the above items which may impact my entitlement to the annual clothing allowance benefit.
More rules for Form 10-8678
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.
If your situation is different
You are sending this application
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.
You are applying for a benefit year
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. Submission of an annual application is no longer needed if you are not changing your existing award(s).
Common questions about Form 10-8678
Is there a penalty?
The law provides severe penalties including fine or imprisonment, or both, for willful submission of any false statement or evidence of material fact.
Sources
[1] VA Form 10-8678 (JUN 2026), Application for Annual Clothing Allowance, U.S. Department of Veterans Affairs (the Official source link on this page).
