Download DD Form 294 Application for a Review by the Physical Disability Board of Review (Pdbr) of the Rating Awarded Accompanying a Medical Separation
How to Fill out DD Form 294?
The form is made up of three pages with filing guidelines provided on the third page. DD Form 294 instructions are as follows.
- Item 1 contains the personal identifying data of the individual filing the form. This includes their name, branch of service, pay grade at the moment of separation, date of separation and their Social Security number. Item 1b must specify the legal name of the service member during their service. If the name was later changed, the current name should also be specified;
- Item 2 identifies the previously awarded disability rating;
- The applicant may explain why they consider their current rating inaccurate in Item 3 and continue in Item 12 if additional space is necessary. The rating will be reviewed for fairness even if Item 3 is empty;
- Items 4 and 13 are for listing any attached evidence that may support the applicant's request. The applicant will have at least two weeks to gather the proof;
- Item 5 is for specifying whether the applicant has a Department of Veterans Affairs (VA) rating for the unfitting condition or has been rated for another condition. The VA determination letter must be included with the application;
- The applicant must consent to allowing the Physical Disability Board of Review (PDBR) to access their VA records by ticking the applicable box in Item 6. The PDBR will review the disability rating even if the consent is not given, but will not take the information provided in Item 5 into account;
- Item 7 provides the information about the representative or counsel if the applicant has one;
- A spouse, the next of kin, or legal representatives may submit the application for a deceased service member and identify themselves in Item 8;
- The address and contact information of the applicant or representative are provided in Item 9;
- Item 10 confirms the decision of the service member to give up their right to petition the Service's Board for Correction of Military/Naval Records to subsequently review the rating which rendered them unfit under 10 U.S.C. 1552;
- Item 11 contains the applicant's signature and the date of filing and Item 15 is for any additional remarks applicable to their case.