You need DD Form 294, and this page gives you the blank plus the steps for handling it. Start with what the form does: 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. Its official title is 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.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
After that, turn to timing. The requirement comes from not stated; the form is maintained by not stated. Local implementing instructions fill in the dates, so check with the office that will receive your copy.
Finally, decide how you will complete it. You can type into a fillable file or print a blank and write by hand, and the rest of this page walks you through both paths in order.
Start at the header. Complete your identification before anything else, then work through the main entries, then finish at the certification. Skipping around causes contradictions between the top of the form and the bottom.
Before your first entry, look at the corner of the page and compare the printed date with not stated. If they do not match, stop and download again. Old copies circulate in shared drives for years, and a DD form is revised centrally for every service at once, so a superseded blank may not carry the fields your reviewer expects.
Work through the fields one at a time and leave nothing blank. When a box does not apply to you, write N/A rather than skipping it, so the reviewer can see you read the question. Follow the date format printed beside each date field instead of the one you normally use.
Do not skip past the Privacy Act Statement. It is placed ahead of the personal data fields on purpose: it explains under what authority you are being asked, what happens to the information, and what follows if you decline. Take the minute it costs.
Sign last, and sign properly. On paper that means ink in the signature block. Electronically it means a digital signature, usually applied with your Common Access Card in a reader that supports it. Typing your name into the field does not sign anything. Then add the date beside your signature — an unsigned or undated form is the most common reason one comes back.
Then check your work against the usual failures: an obsolete edition, empty required boxes, handwriting nobody can read after scanning, wrong date format, missing signature or date.
Look up an unclear item on the form face before anywhere else, then in not stated. Should the two texts conflict, the directive is the one you follow.
Download the form
First, look at what you can download. The set covers PDF, the form runs 3 pages, and you will complete roughly 30 fields.
Download the pdf first. After it opens, test a field with your cursor. Fillable means you type, tab to the next box, and save your work inside the file. Printable means the page is a flat blank, so print it and write your answers in ink.
Prefer typing over writing. Your form will likely be scanned and emailed onward, and typed text reproduces at every stage while pen strokes fade or blur. When you do write, print in capitals so the receiving clerk can read it.
Check your software before choosing xfdl. That format belongs to IBM Lotus Forms, long used for Defense form distribution, and it needs the matching viewer. Get the viewer installed, then come back for the file.
Whichever you pick, you pay nothing — every format here is a free download. One last tip: open your pdf in a desktop reader rather than in a browser tab, because browser viewers sometimes drop the interactive fields you need.
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).
With the form finished, route it to the office named in not stated or in your organization's own instruction. Keep a copy first. People rarely regret having one and frequently regret not having one.
When DD Form 294 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
Watch out for one trap here. If your instructions cite a DA form as well, do not assume the numbers are connected. DA numbering belongs to the Army alone; DD numbering belongs to the Department and is administered by not stated or another Department office. The same number in each system means two unrelated forms, so read the prefix before you download.
Come back and check the edition next time you need this form. Editions change when the prescribing directive is reissued, when the information collected changes, or when the required notice language is updated, and none of those events reaches you directly. Verifying not stated at the moment you download is the whole defence.
Before you go, note what is not covered here. You have the blank form and instructions for completing it; you do not have legal guidance, and no statement on this page determines what any office will do with your submission. Direct those questions to not stated, to the personnel office that serves you, or to the office designated 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?