The M4A4 Sherman served in the Chinese Nationalist Army as part of the Chinese Expeditionary Forces (中國遠征軍), with 32 tanks supplied through the Lend-Lease program. These tanks equipped the 1st Provisional Tank Group, stationed in India under the command of US Army Colonel Rothwell H. Brown. After World War II, the Chinese Expeditionary Forces—comprising the New First Army and the New Sixth Army—participated in the Chinese Civil War with M4A4 Shermans. Both armies were ultimately defeated by the Chinese People's Liberation Army during the Liaoshen Campaign in Northeast China. Following the war, a memorial for fallen Chinese Expeditionary Force soldiers was erected in Tengchong, Yunnan.

Introduced in Update 1.91 "Night Vision", the M4A4 was one of the few US-built M4 Sherman medium tanks shipped to China during World War II. Its armour configuration resembles that of the M4 variant, particularly with the hatches that protrude from the hull’s sloped contour. These protrusions disrupt the armour's sloping, diminishing its overall effectiveness. Although additional welded plates were added to mitigate this vulnerability, the frontal hull remains a significant weak spot, and knowledgeable opponents will likely aim for it. The M4A4 variant also features a new composite Chrysler multibank engine (comprising five automobile engines), which required a longer hull, extended by 15 cm.