Dd Form 294 - Application For A Review By The Physical Disability Board Of Review Of The Rating Awarded Accompanying A Medical Separation From The Armed Forces Of The United States Page 3
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3INSTRUCTIONS FOR COMPLETING DD FORM 294
Please print or type all information. Items are self-explanatory unless otherwise noted below.
Item 1.b. Use the name which you served under while in the Armed Forces. If your name has been changed, then also include your
current name after adding the abbreviation "AKA". If the former member is deceased or incompetent, see Item 8.
Item 2. Indicate the percentage of disability rating for the condition(s) which rendered you unfit. This is the only rating that the
PDBR will review.
Item 3. You may, but are not required to, explain why you believe the rating is inaccurate. If you make no assertion, your rating will
still be reviewed for accuracy and fairness.
Item 4. In accordance with DoDI 6040.44, you will be afforded at least two weeks prior to a review of your rating to provide
documentary evidence outside DoD possession (including, for example, evidence from civilian medical providers). Unless requested
by a Service Record Assembly Unit, you need not provide your Service medical records or the record of your disability separation.
Item 5. Indicate whether you have received a VA rating for the unfitting condition(s) and whether you have been rated for another
condition(s). You must include the VA determination letter or explain why you do not have it available. The PDBR will consider the
rating awarded by the VA for your unfitting condition(s) and compare it in reviewing your Service disability rating with particular
attention to a VA rating with an effective date within 12 months of your separation. (See DoDI 6040.44 Enclosure 3, paragraph 5(a)(4)
for more details.) Delay submitting this application if you want the PDBR to consider a pending VA rating; it will not reconsider a case.
Item 6. This consent is required for the PDBR to gain access to your VA records. If you do not consent, the PDBR will review your
disability rating, but will not conduct the comparison discussed in Item 5 above.
Item 7.a. - d. Skip or enter N/A (not applicable) if you do not have a representative/counsel. If you later obtain the services of either,
inform the Board immediately. The military services do not provide counsel representation nor do they pay the cost of such
representation. Contact your local VA office or Veterans Service Organization for further information about other organizations that
may assist you.
Item 8. If the former member is deceased or incompetent, the application may be submitted by the next of kin, a surviving spouse or
a legal representative. Legal proof of death or incompetency and satisfactory evidence of the relationship to the former member must
accompany this application.
Item 9.a. Indicate the address to be used for correspondence regarding this application. If you change this address while this
application is pending, you should notify the PDBR immediately.
Item 10. By requesting a PDBR review, you are giving up your right under 10 U.S.C. 1552 to petition your Service's Board for
Correction of Military/Naval Records to subsequently review the rating for the medical condition(s) which rendered you unfit.
The decision of the Secretary on this issue will be final. You may still ask your Service Board for Correction of Military/Naval
Records (BCMR/BCNR) to consider other issues including those related to your disability separation. If you have filed with
your Service BCMR/BCNR prior to the implementation of DoDI 6040.44 (June 27, 2008), you may still request PDBR review of your
disability rating.
COMPARISON - BCMR/BCNR VS. PDBR REVIEW OF RATING
CHARACTERISTIC
BCMR/BCNR
PDBR
Panel Composition
3 civilians in grade of GS-15 and above.
3 military officers in grade of 05/06 (or civilian equivalents.
Medical separation 20% or less where member did not
May apply for review of military record, within three years
Review Authority
retire finalized between 11 September 2001 and 30
of error/injustice (may be waived in the interest of justice).
September 2009 (may be extended).
Application submitted, then case summarized by PDBR
Application submitted, medical, personnel or legal
medical member (or other experts) for presentation to
Review Process
advisories prepared and served on applicant with chance
PDBR before vote. Applicant can submit records from
to comment before panel review and vote.
non-DoD sources.
Panel Outcome
Recommendation or decision.
Recommendation only.
Member has the burden of proof to establish error or
Member need not allege anything, review accomplished
Burden of Proof
injustice. There is a presumption of regularity.
upon request.
Standards
Will correct errors in records and/or remove an injustice.
Rating reviewed for fairness and accuracy.
Impact of subsequent VA
Will compare VA rating with particular attention to one
Within discretion of the Board.
Rating
given within 12 months.
Item 11.a. and b. A signature and date, entered by the applicant or people identified in Item 8, are required.
DD FORM 294, JAN 2009
Page 3 of 3 Pages
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