Da 7652-2026

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The document outlines the Physical Disability Evaluation System (PDES) Commander’s Performance and Functional Statement, which is used to assess a Soldier's medical impairments and their impact on duty performance. It includes sections for demographic information, administrative details, performance evaluations, and validation by the commander. The purpose is to provide necessary information for the Physical Evaluation Board (PEB) regarding a Soldier's fitness for duty and potential disability benefits.

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Click ‘Get Form’ to open the da 7652 in the editor.
Begin by filling out Section I: Soldier Demographic Information. Enter the date, last name, first name, middle name, PMOS, birthdate, age, and unit of assignment.
Proceed to Section II: Administrative Information. Confirm each data item with appropriate personnel and mark 'Yes' or 'No' for each question regarding the Soldier's administrative status.
In Section III: Performance Information, provide detailed assessments of the Soldier's performance related to their medical conditions. Use 'Yes', 'No', or 'N/Obs' for each item and elaborate in Section III D as necessary.
Complete Section IV: Commander's Validation and Signature by entering your printed name, rank, signature, unit address, phone number, email address, DSN, and fax number.

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