Dear (Next-of-kin, legal guardian):
This Physical Evaluation Board considered the physical condition of your (relation), (grade and
name) on (date). (Grade and name), Judge Advocate General's Corps, the appointed military counsel,
represented your (relation)'s interests before the board.
As recorded on the attached DA Form 199 (Physical Evaluation Board Proceedings), (relation) was
found unfit because of physical disability. It is recommended that (he/she) be (separated/retired) from the
Army. (If separation is recommended, add a statement as to whether the member is entitled to severance
pay.) (If retirement is recommended, add a statement giving the percentage ratings.) The findings and
recommendations will be reviewed at Headquarters, Department of the Army, and are not final until
The purpose of this letter is to inform you of your (relation)'s rights and request your decision on
these rights in (his/her) behalf. You may concur with the findings and recommendation of the board. You
may submit a written rebuttal to the finding and recommendation of the board, explaining why you do not
agree. This board and the reviewing authority will consider your rebuttal. You may also request more time
in which to prepare your response if this time is insufficient. You are allowed 7 days plus mail time in which
to reply. A form reply on which you may indicate your choice by checking a block is inclosed. Please be
sure to sign the form.
If your reply is not received within the allotted time, the appointed military counsel will take proper
action in behalf of your (relation).
(Signature of recorder)
1. PEB proceedings
2. Reply form letter
3. Self-addressed envelope
1. Develop and prepare letter appropriate to case.
2. Do not use a preprinted form letter.
3. Enclosure 2 will be a reply form letter (see figures 5-14 and 5-15).
Figure 5-13. Notice to next of kin (legal guardian) advising of formal PEB action.