Office Symbol
Date
MEMORANDUM FOR Commander, (Official designation of MTF)
SUBJECT: Request for Expeditious Discharge for Physical Disability
1. I request discharge for physical disability based upon the findings and
recommendations of a medical evaluation board (MEBD). The MEBD considers me
unqualified for retention in the military service because of a physical disability that was
found to have existed prior to my entry into active service (EPTS). The MEBD found the
disability neither incidental to, nor aggravated by, military service.
2. I have been fully informed and understand that I am entitled to the same consideration
and processing as any member of the Army separated for physical disability. I understand
this includes consideration of my case by the adjudicative system established by the
Secretary of the Army for processing disability separations. However, I elect not to
exercise this right. I also understand the Veterans Administration (VA) will determine
3. If this application is approved, I understand I will be separated by reason of EPTS
physical disability. I also understand that I will receive a discharge in keeping with the
character of my service, as decided by the officer designated to effect my separation.
(Witness-PEBLO)________
(Member)____________
Date__________________
Grade______________
Figure 5-4. Request for Expeditious Discharge for
Physical Disability
MD0755
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