FortCampbellTransitionCenter

Disability SeparationRequestChecklist

Unit S1 will verify the following documents are up-to-date, in iPERMS or attached, as indicated:

All enlistment, reenlistment and extension contract documents are in iPERMS. If reenlistment contracts cannot be located, contact unit retention and obtain a screenshot. Attach the screenshot to the separation request email.

ERB/ORB (Enlisted Record Brief/Officer Record Brief) is current with deployments, awards and schools.

Out-processingrecordreviewhasbeenconducted usingtheiPERMSRecordReviewTool.

_Attach most recent and current end-of-month LES (Leave and Earnings Statement)to the separation request email.

Leaveformcompleted and signed by Soldier and authorizing official (controlnumbernotrequired).If leave is not being taken, a memorandum from Company Commander indicating desired separation date is required. Leave start date or separation date must be within 30 days of notification of receipt of PDIR.

PriorserviceDDForm214s,Reserve/ARNGdischargeorders,NGB-22, NGB23-B, ReserveDAForm5016orotherservicedocumentsareiniPERMSorattachedtothe retirement requestemailtotheTransition Center.

SFL-TAPDDForm2648-EattachedtotheretirementrequestemailtotheTransitionCenter(ifSFL-TAPiscomplete).

____Soldier Information Sheet – all applicable fields must be completed.

(VerifyingOfficial-S1NCOICordesignatedrepresentative)

MEDICAL COUNSELING STATEMENT

  1. I, ______(SOLDIER’S FULL NAME) HAVE BEEN COUNSELED IN ACCORDANCE WITH ALARACT MESSAGE 188/2007 DATED AUGUST 28, 2007 PERTAINING TO MY ELECTION OF A SEPARATION DATE TO MEDICAL SEPARATE FROM THE ARMY. (______)SOLDIER INITIALS
  1. I UNDERSTAND THAT SHOULD I ELECT TO BE SEPARATED PRIOR TO THE 20TH OF THE MONTH THAT THIS DECISION COULD RESULT IN OVERPAYMENT BY THE ARMY WHICH WOULD CREAT A DEBT THAT I WILL BE RESPONSIBLE TO REPAY. (______) SOLDIER INITIALS.
  1. I UNDERSTAND THAT DVA SERVICE CONNECTION FOR DISABILITY INCURRED IN OR AGGRAVATED BY MILITARY SERVICE MAY BE ESTABLISHED FROM THE DAY FOLLOWING MY DATE OF SEPARATION FROM THE ARMY. BY LAW ENTITLEMENT TO PAYMENT IS NOT AUTHORIZED UNTIL THE FIRST OF THE MONTH FOLLOWING THE MONTH IN WHICH SERVICE CONNECTION IS ESTABLISHED. DVA COMPENSATION IS PAID, LIKE MILITARY PAY, IN ARREARS. BECAUSE OF THESE RULES I UNDERSTAND THAT ELECTING A SEPARATION DATE EARLIER IN THE MONTH WILL RESULT IN A CORRESPONDING DELAY IN RECEIPT OF DVA PAYMENTS AND I MUST PLAN ACCORDINGLY. (______) SOLDIER INITIALS
  1. I UNDERSTAND THAT SHOULD I ELECT TO BE SEPARATED ON THE LAST DAY OF THE MONTH THIS DECISION WILL RESULT IN THE LOSS OF ONE MONTH OF VETERAN’S DISABILITY BENEFITS AND PAYMENTS. (______) SOLDIERS INITIALS
  1. I REQUEST TO BE SEPARATED ON: ______(DATE).