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Department of Defense form 294. Official designation: DD Form 294, Application for a Review by the PDBR of the Rating Awarded Accompanying a Medical Separation from the Armed Forces of the United States, January 2009. Purpose: Application for a Review by the Physical Disability Board of Review (PDBR) of the Rating Awarded Accompanying a Medical Separation from the Armed Forces of the United States. Current edition not stated, status not stated.
Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.
The form reaches military personnel across the services, civilian employees of the Department, and the personnel and records specialists who receive it.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Formats offered: PDF. Length: 3 pages. Fillable field count: roughly 30.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
What the form asks for
- 1. Applicant data. a. Branch of Service. Press space bar to mark X in first box if Army, second box if Marine Corps, third box if Navy, fourth box if Air Force, or fifth box if Coast Guard.
- b. Name while serving (last, first, middle initial). If name has changed, enter "AKA", then current name.
- c. Pay grade at time of separation.
- d. Date of separation (4 digit year, 2 digit month, 2 digit day).
- e. Social security number.
- 2. Final disability rating awarded by service for unfitting condition. X first box if 0 percent, second box if 10 percent, or third box if 20 percent.
- 3. Issues why the rating for the condition which rendered the member unfit should be changed (continue in item 12 if necessary).
- 4. In support of this application, the following documents are submitted as evidence (continue in item 13 if necessary).
- 5. VA rating information. a. I have received a VA disability rating that includes the condition for which I was found unfit. X first box if yes, second box if no, third box if not applicable, or fourth box if pending.
- b. I have attached my VA determination letter (N/A if 5.a. is no or pending). X first box if yes, second box if no, third box if not applicable.
- 6. VA consent. X first box if do, or second box if do not, freely authorize the VA to release information to PDBR.
- 7.a. Counsel/Representative (if any). Name (last, first, middle initial) and Address (see Item 7 of the Instructions).
- b. Telephone number (include area code).
- c. E-mail address.
- d. Fax number (include area code).
- 8. Applicant must sign in item 11.a. below. If the record in question is that of a deceased or incompetent person, legal proof of death or incompetency must accompany the application. If the application is signed by other than the applicant, print the name:
- If signed by other than applicant, indicate relationship: X first box if spouse, second box if widow, third box if widower, fourth box if next of kin, fifth box if legal representative, or sixth box if other.
- Specify other relationship.
- 9.a. Current address of applicant or person in item 8 above (forward notification of any change in address.
- b. Telephone number (include area code).
- c. Cell phone number (include area code).
- d. E-mail address.
- 11. Certification. a. Signature - Required. Applicant or person in Item 8 above.
- b. Date signed (current date).
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Guidance for specific entries sits on the form face and in not stated; the directive is authoritative where the two do not agree.
Once executed, routing follows not stated and the submitting organization's own instruction. Keeping a copy is standard.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
This page distributes a published Department of Defense document and describes it. It is not a source of legal advice and makes no representation about acceptance of any completed form. Questions of applicability, eligibility or procedure belong to not stated, the servicing personnel office, or the office named in not stated.
Questions and answers
- What is DD Form 294?
- DD Form 294, Application for a Review by the PDBR of the Rating Awarded Accompanying a Medical Separation from the Armed Forces of the United States, January 2009
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?