PEB LETTERHEAD
Office Symbol
(Name and rank of member)
(Date)
(SSN)
SUBJECT: Waiver of Right to Rebut
Commander
U.S. Army Physical Disability Agency
Forest Glen Section-WRAMC
Washington, DC 20012
1. A copy of the formal PEB proceedings in the case of the above named member was
forwarded to the member by certified mail. The attached receipt shows that the copy was
duly delivered.
2. The member has been properly advised of his rebuttal rights. However, he has not
responded within the allotted time, or requested an extension of time. According to
established policy, the member is considered to have waived his right to rebut. The
member's counsel has submitted a (rebuttal or statement instead of rebuttal) in the
member's behalf. The (rebuttal or statement) is attached. The member's counsel has not
submitted a rebuttal or statement in the member's behalf.
3. Procedural requirements have been met. The case file is forwarded for review and
disposition.
FOR THE PRESIDENT:
Encl
Signature
(Recorder)
Figure 5-16. Statement of waiver of right to rebut PEB action.
MD0755
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