DA Form 7652 Disability Evaluation System (DES) Commander's Performance and Functional Statement

DA Form 7652 Instructions

See the Army Regulation 635-40, Disability Evaluation for Retention, Retirement, or Separation, for additional information and filing guidelines. The Disability Evaluation System (DES) evaluates a service member's fitness to perform their duties. The evaluation procedures can be divided into four steps:

1. A wounded, injured, or ill soldier is treated by an attending physician at a medical treatment facility.
2. If the wound, injury, or illness has a long-lasting effect or results in a permanent condition, the attending physician refers the soldier to the DES. During this stage, the soldier is assigned a Physical Evaluation Board Liaison Officer (PEBLO).
3. The Medical Evaluation Board (MEB) determines if the service member can return to their duties straight away or if they will be able to perform them within a year. If the soldier does not meet medical retention standards, the case is transferred to the PEB.
4. The PEB reviews the MEB report to determine if the soldier is fit for duty. If determined fit, the soldier may return to duty, but their role may be modified. Otherwise, the command will initiate a separation or retirement process.

DA Form 7652 is requested by the Physical Evaluation Board Liaison Officer (PEBLO). The document is prepared by the soldier's commander and contains important data for MEB and PEB. Medical terminology is not necessary, common descriptions are accepted. The soldier may take part in filling out DA 7652 to make sure that it reflects their medical condition adequately. The description of the soldier's current duty performance must include the following:

• The branch of service and age of the soldier;
• Any special limitations that may result from their physical condition.
• The tasks expected of an individual of this office, grade, rank, or rating.
• A description of the current duty assignment of the soldier, along with anticipated future assignments and career specialties.

How to Fill Out DA Form 7652?

1. Section I contains the following boxes: the date of filing, the soldier's name and grade, PMOS, home phone, cell phone, a U.S. Department of Defense (DoD) email, their component, the name, address, and phone number of their organization, a unit identification code, and Expiration - Term of Service (ETS).
2. Section II requires administrative information that should be confirmed by the appropriate personnel activity. It includes 16 questions and a column for additional remarks.
3. Section III is a performance assessment made by the commander. It has to be filled with a description of the effect of the soldier's current condition on their ability to perform their duties. This part may also contain any additional comments necessary to clarify information provided in Section II. The bottom part of Section III requires the commander's name, signature, date, DoD email, phone number, component, and grade.
4. Section IV is for a battalion or first Lieutenant Colonel (LTC)-level commander's comments and review. The comments may be provided as the individual in charge sees fit. It can be detailed additional data or a simple validation of the first-line commander's observations. Section IV should be certified with the name, signature, date, DoD email, phone number, component, and grade of the battalion or first LTC-level commander.
5. The completed form is submitted to PEBLO within 5 days of receiving the request.