Any person subject to this chapter who, with the intent to avoid work, duty, or service—

feigns illness, physical disablement, mental lapse, or mental derangement; or

intentionally inflicts self-injury;

That the accused was assigned to, or was aware of prospective assignment to, or availability for, the performance of work, duty, or service;

That the accused feigned illness, physical disablement, mental lapse, mental derangement, or intentionally inflicted injury upon himself or herself; and

That the accused’s purpose or intent in doing so was to avoid the work, duty, or service.

[Note: If the offense was committed in time of war or in a hostile fire pay zone, add the following element]

That the offense was committed (in time of war) (in a hostile fire pay zone).

The essence of this offense is the design to avoid performance of any work, duty, or service which may properly or normally be expected of one in the military service. Whether to avoid all duty, or only a particular job, it is the purpose to shirk which characterizes the offense. Hence, the nature or permanency of a self-inflicted injury is not material on the question of guilt. The seriousness of a sham physical or mental disability is also not material on the question of guilt. Evidence of the extent of the self-inflicted injury or feigned disability may, however, be relevant as a factor indicating the presence or absence of the purpose.

The injury may be inflicted by nonviolent as well as by violent means and may be accomplished by any act or omission which produces, prolongs, or aggravates any sickness or disability. Thus, voluntary starvation which results in debility is a self-inflicted injury and when done for the purpose of avoiding work, duty, or service constitutes a violation of this article.

Bona fide suicide attempts should not be charged as criminal offenses. When making a determination whether the injury by the Servicemember was a bona fide suicide attempt, the convening authority should consider factors including, but not limited to, health conditions, personal stressors, and DoD policy related to suicide prevention.

Dishonorable discharge, forfeiture of all pay and allowances, and confinement for 1 year.

Dishonorable discharge, forfeiture of all pay and allowances, and confinement for 3 years.

Dishonorable discharge, forfeiture of all pay and allowances, and confinement for 5 years.

Dishonorable discharge, forfeiture of all pay and allowances, and confinement for 10 years.

In that __________ (personal jurisdiction data), did, (at/on board—location) (in a hostile fire pay zone) (subject-matter jurisdiction data, if required) (on or about _____ 20 __) (from about _____ 20 __ to about _____ 20 __), (a time of war) for the purpose of avoiding ((his) (her) duty as officer of the day) ((his) (her) duty as aircraft mechanic) (work in the mess hall) (service as an enlisted person) (__________) (feign (a headache) (a sore back) (illness) (mental lapse) (mental derangement) (__)) (intentionally injure himself/herself by __________).