(Use when PEB recommends severance or retired pay)
Re: (Grade and name)
U.S. Army Physical Evaluation Board
I have read the DA Form 199 (Physical Evaluation Board Proceedings) and your
letter explaining the rights of my (relation) regarding your findings and recommendations.
My decision is shown in the appropriate box below.
I agree with the findings and recommendations of the board.
I do not agree with the findings and recommendations of the board. I have attached
a rebuttal explaining my reasons.
I request until (date) to prepare and submit a rebuttal. If my rebuttal is not received
by that date, I understand the appointed counsel may submit a rebuttal in behalf of
my (relation) if the counsel thinks it necessary.
Figure 5-14. Form letter for NOK (legal guardian) response to action of formal PEB
action when severance or retirement pay is recommended.