ADDENDUM TO DA FORM 4187

Early Reserve Retirement Eligibility for

Disabled Members of the Army National Guard

1. According to my NGB Form 23 and counseling, I have at least 15 years but less than
20 years of qualifying service for non-regular retired pay at age 60. I understand that
under the provisions of AR 40-501, Chapter 3, I am unfit for continued military service
because of physical disability, and I must be separated. Also, I have been informed that
the following options are available to me:

a. I can elect TO BE TRANSFERRED to the USAR Control Group (Retired) and be

issued Notification of Eligibility for Retired Pay at Age 60 with 15 Years of Service; or

b. I can elect NOT TO BE TRANSFERRED to the USAR Control Group (Retired),

and NOT BE issued Notification of Eligibility for Retired Pay at Age 60 with 15 Years
of Service.

2. I understand that under the provisions of Public Law 103-337, Section 517, dated 5
October 1994, to qualify for the Early Reserve Retirement Eligibility for Disabled
Members of the Army National Guard, I must meet the following criteria:

a. Complete at least 15 years of qualifying service for non-regular retired pay at Age
60; and

b. No longer meet the qualification for membership in the Selected Reserve solely
because under the provisions of AR 40-501, Chapter 3, I am unfit for further military
service because of physical disability; and

c. The disability was not the result of intentional misconduct, willful neglect, or
willful failure to comply with standards and qualifications for retention established by the
Secretary of the Army or was incurred during a period of unauthorized absence; and

d. Satisfy the requirements of paragraphs (3) and (4), Section 1331 (a) and new
Subsection (f) 10 U.S.C. (i.e., have performed the last six (6) years of qualifying service
for non-regular retired pay at Age 60 IAW Section 1332); and

e. Request transfer to the USAR Control Group (Retired).

3. I understand that if I elect transfer to the USAR Control Group (Retired) that future
service in an active status or on active duty in a retired status will only be as specifically
authorized by the Secretary of the Army when deemed essential to the national defense.

4. I understand that if I elect transfer to the USAR Control Group (Retired) that I am not
entitled to earn additional retirement points toward non-regular retired pay at Age 60
unless specifically authorized by the Secretary of the Army when deemed essential to the
national defense. Retired pay at Age 60 will only be based on retirement points earned
prior to transfer to the USAR Control Group (Retired).

I understand these options as they have been explained to me and I have been
provided a copy of this statement.
Digitally signed by Wayne I Lewis
Wayne I Lewis Jr JrDate: 2017.10.25 23:52:41 -05'00'
__________________________________ _________________________________
Signature of Member Signature of Counselor

10/25/2017
__________________________________ __________________________________
Date Date

Lewis, Wayne I. 434475781

__________________________________
Daunis, Geoffrey E. SFC
__________________________________
Typed Name and SSN of Member Typed Name and Rank of Counselor

__________________________________
Signature of Witness

__________________________________
Date

Lanclos, Robert L. SFC

__________________________________
Typed Name and Rank of Witness

DATA REQUIRED BY THE PRIVACY ACT

Authority: Title 5, Section 3012; Title 10, USC, EO 9397.

Principle Purpose: Used by a service member to acknowledge understanding of
reserve component benefits for non-regular retired pay at Age 60 to which the
soldier may be entitled to under the provisions of Public Law 103-337, Section 517,
dated 5 October 1994, Routine uses: To initiate the processing of a personnel action
on the basis of the soldier’s understanding of these benefits. Disclosure: Voluntary.
Failure to provide Social Security Number may result in a delay or error in
processing the request for personnel action.