BOARD FOR CORRECTION OF MILITARY RECORDS (BCMR) APPLICATION

APPLICATION FORM REFERENCE

This application supplements DD Form 149 - Application for Correction of Military Record Under the Provisions of Title 10, U.S. Code, Section 1552

SECTION I: APPLICANT INFORMATION

Full Legal Name: [________________________________]

Former Name(s): [________________________________]

Social Security Number: [________________________________]

Date of Birth: [__/__/____]

Current Mailing Address:
[________________________________]
[________________________________]
[________________________________]

Phone Number: [________________________________]

Email Address: [________________________________]

SECTION II: MILITARY SERVICE INFORMATION

Branch of Service: ☐ Army ☐ Navy ☐ Marine Corps ☐ Air Force ☐ Coast Guard ☐ Space Force

Component: ☐ Active Duty ☐ Reserve ☐ National Guard

Service Number (if different from SSN): [________________________________]

Date of Entry on Active Duty: [__/__/____]

Date of Release/Discharge: [__/__/____]

Current Military Status:
☐ Active Duty
☐ Reserve/National Guard (Active Status)
☐ Retired
☐ Discharged
☐ Deceased (application by authorized representative)

Rank/Grade at Time of Issue: [________________________________]

Highest Rank/Grade Achieved: [________________________________]

SECTION III: APPLICABLE BOARD

☐ Army Board for Correction of Military Records (ABCMR)
Address: Army Review Boards Agency, 251 18th Street South, Suite 385, Arlington, VA 22202-3531

☐ Board for Correction of Naval Records (BCNR) (Navy/Marine Corps)
Address: 701 S. Courthouse Road, Suite 1001, Arlington, VA 22204-2490

☐ Air Force Board for Correction of Military Records (AFBCMR) (Air Force/Space Force)
Address: SAF/MRBR, 3351 Celmers Lane, Joint Base Andrews, MD 20762-6435

☐ Board for Correction of Military Records of the Coast Guard
Address: Commandant (CG-00H), Attn: Office of the General Counsel, 2703 Martin Luther King Jr. Ave SE, Washington, DC 20593

SECTION IV: TYPE OF CORRECTION REQUESTED

☐ Discharge upgrade
☐ Change reason/narrative for discharge
☐ Change reenlistment eligibility (RE) code
☐ Change separation program designator (SPD) code
☐ Correction of performance evaluation(s)
☐ Promotion consideration/correction
☐ Medical retirement/separation correction
☐ Disability rating correction
☐ Award/decoration entitlement
☐ Pay and allowances correction
☐ Date of rank correction
☐ Removal of adverse information from record
☐ Correction of records to reflect service-connected condition
☐ Change of records to reflect PTSD/TBI/MST diagnosis
☐ Other: [________________________________]

SECTION V: TIMELINESS

A. Three-Year Requirement

Under 10 U.S.C. § 1552(b), applications must be filed within three years after discovering the error or injustice.

Date of Discovery: [__/__/____]

How Error/Injustice Was Discovered:
[________________________________]
[________________________________]

B. Request for Waiver (if applicable)

☐ My application is within the three-year limit
☐ My application exceeds the three-year limit, and I request a waiver in the interest of justice

Reasons Justifying Waiver:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

SECTION VI: EXHAUSTION OF REMEDIES

A. Prior Administrative Actions

Have you previously applied to any of the following regarding this matter?

☐ Discharge Review Board (DRB)
- Date: [__/__/____]
- Outcome: [________________________________]
- Case Number: [________________________________]

☐ Physical Evaluation Board (PEB)
- Date: [__/__/____]
- Outcome: [________________________________]

☐ Physical Disability Board of Review (PDBR)
- Date: [__/__/____]
- Outcome: [________________________________]

☐ Board for Correction of Military/Naval Records (prior application)
- Date: [__/__/____]
- Outcome: [________________________________]
- Case Number: [________________________________]

☐ Other Administrative Board: [________________________________]
- Date: [__/__/____]
- Outcome: [________________________________]

B. Reason for Current Application

☐ First application to BCMR
☐ Request for reconsideration based on new evidence
☐ DRB denied relief and I am now applying to BCMR
☐ Other: [________________________________]

SECTION VII: DETAILED STATEMENT OF ERROR OR INJUSTICE

A. Specific Error or Injustice

Describe the specific error or injustice in your military records that you want corrected:

Current Record States:
[________________________________]
[________________________________]
[________________________________]

Record Should State:
[________________________________]
[________________________________]
[________________________________]

B. Detailed Narrative

Provide a complete and detailed explanation of the error or injustice. Include all relevant facts, dates, names, and circumstances:

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

C. Legal Basis for Correction

Explain why this constitutes an error or injustice under applicable law, regulation, or policy:

☐ ERROR - The record is factually incorrect or inconsistent with applicable law, regulation, or policy in effect at the time

☐ INJUSTICE - The record, while technically correct, is unjust under the circumstances when considered against the standards of the military service

Explanation:
[________________________________]
[________________________________]
[________________________________]
[________________________________]

SECTION VIII: SPECIAL CONSIDERATIONS

A. PTSD/TBI/MST Liberal Consideration

(Pursuant to Hagel Memo, Kurta Memo, Wilkie Memo, and current DoD guidance)

☐ I request liberal consideration based on PTSD
☐ I request liberal consideration based on TBI (Traumatic Brain Injury)
☐ I request liberal consideration based on MST (Military Sexual Trauma)
☐ I request liberal consideration based on other mental health condition: [________________________________]

Connection to Record Issue:
[________________________________]
[________________________________]
[________________________________]

Supporting Documentation:
☐ VA disability rating decision
☐ Medical diagnosis documentation
☐ Mental health treatment records
☐ Lay statements regarding symptoms/behavior
☐ Other: [________________________________]

B. Sexual Orientation Discharge Review

(For discharges under "Don't Ask, Don't Tell" or prior policies)

☐ I was discharged based on sexual orientation
☐ Date of discharge: [__/__/____]
☐ I request upgrade to Honorable discharge

SECTION IX: SUPPORTING DOCUMENTATION CHECKLIST

Required Documents

☐ DD Form 149 (completed and signed)
☐ DD-214 (all copies available)
☐ Complete service personnel records
☐ Complete service medical records

Supporting Evidence

☐ Performance evaluations
☐ Awards and decorations documentation
☐ Letters of recommendation/character reference
☐ Personal statement
☐ Witness statements/affidavits
☐ Medical records (VA and/or private)
☐ Mental health records
☐ Legal documents (court records, etc.)
☐ Prior board decisions
☐ Relevant regulations/policies in effect at time of incident
☐ Photographs or other physical evidence
☐ News articles or other publications
☐ Expert opinions
☐ Other: [________________________________]

SECTION X: WITNESS INFORMATION

Witnesses Who Can Support Your Application

SECTION XI: REPRESENTATION

A. Self-Representation

☐ I will represent myself

B. Veterans Service Organization (VSO)

☐ I am represented by a VSO:
- Organization: [________________________________]
- Representative Name: [________________________________]
- Address: [________________________________]
- Phone: [________________________________]
- Email: [________________________________]

C. Legal Counsel

☐ I am represented by legal counsel:
- Attorney Name: [________________________________]
- Bar Number/State: [________________________________]
- Firm: [________________________________]
- Address: [________________________________]
- Phone: [________________________________]
- Email: [________________________________]

SECTION XII: HEARING REQUEST

☐ I request a personal appearance hearing before the Board
☐ I do not request a personal appearance and agree to a records-only review

Note: Hearings are not guaranteed and are granted at the Board's discretion. If granted, hearings are typically held at the Board's location, and travel is at the applicant's expense.

SECTION XIII: DESIRED RELIEF

State specifically what correction(s) you want the Board to make to your records:

1. [________________________________]

2. [________________________________]

3. [________________________________]

4. [________________________________]

SECTION XIV: IMPACT STATEMENT

Describe how the current error or injustice has affected you:

A. Benefits Impact

☐ Denied VA benefits: [________________________________]
☐ Denied GI Bill education benefits
☐ Denied VA healthcare
☐ Denied VA disability compensation
☐ Denied military retirement pay
☐ Other benefits denied: [________________________________]

B. Employment Impact

[________________________________]
[________________________________]

C. Personal/Family Impact

[________________________________]
[________________________________]

D. Other Impacts

[________________________________]
[________________________________]

SECTION XV: AFFIDAVIT SUPPORTING APPLICATION

AFFIDAVIT

I, [________________________________], being duly sworn, state as follows:

1. I am the applicant in this matter (or I am the authorized representative of the applicant).

2. The statements made in this application are true and accurate to the best of my knowledge and belief.

3. I have attached all available documentation supporting my request.

4. I understand that:
   - The burden of proof is on me to demonstrate error or injustice by a preponderance of the evidence
   - The Board will review my military records and the evidence I submit
   - The Board's decision will be based on the evidence presented
   - I may request reconsideration if I obtain new evidence

5. I authorize the Board to obtain any records necessary to process this application.

Applicant Signature: [________________________________]

Date: [__/__/____]

Notary Acknowledgment:

State of [________________________________]
County of [________________________________]

Subscribed and sworn to before me this [____] day of [________________], 20[____].

Notary Public Signature: [________________________________]

Commission Expires: [__/__/____]

[NOTARY SEAL]

SECTION XVI: AUTHORIZATION FOR RECORDS RELEASE

I, [________________________________], authorize the Board for Correction of Military Records to obtain any records necessary to process this application, including but not limited to:

• Military personnel records
• Military medical records
• VA medical records
• VA claims records
• Any other records deemed relevant by the Board

Signature: [________________________________]

Date: [__/__/____]

SECTION XVII: REPRESENTATIVE CERTIFICATION

(Complete if represented)

I certify that I have been authorized by the applicant to represent them before the Board for Correction of Military Records. I have reviewed this application and believe it accurately represents the applicant's request for correction.

Representative Signature: [________________________________]

Printed Name: [________________________________]

Organization/Title: [________________________________]

Date: [__/__/____]

EXHIBITS LIST

SOURCES AND REFERENCES

• 10 U.S.C. § 1552 - Correction of Military Records
• DD Form 149 - Application for Correction of Military Record
• Army Board for Correction of Military Records
• Board for Correction of Naval Records
• Air Force Board for Correction of Military Records
• National Archives - Correcting Military Records

This template is provided for educational and informational purposes. BCMR applications are complex and the burden of proof rests with the applicant. Strongly consider seeking assistance from a Veterans Service Organization (VSO) or qualified attorney experienced in military records correction.