Physical Disability Evaluation System (Pdes) - Commander'S Performance And Functional Statement
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6PHYSICAL DISABILITY EVALUATION SYSTEM (PDES)
COMMANDER'S PERFORMANCE AND FUNCTIONAL STATEMENT
For use of this form see HQDA Letter 635-08-1; The proponent agency is DCS, G-1.
PRIVACY ACT STATEMENT
10 USC chapter 61 and 5 USC 301
AUTHORITY:
To provide information to the PEB on the impact of a medical impairment on a Soldier's ability to perform duties and to provide
PURPOSE:
administrative information that impacts disability adjudication and/or benefits if the Soldier is determined unfit.
See Purpose
ROUTINE USES:
Information is required in order to properly adjudicate the Soldier's case in the best interests of the Soldier and the Army.
DISCLOSURE:
SECTION I: SOLDIER DEMOGRAPHIC INFORMATION
1. DATE (YYYYMMDD)
2a.
LAST NAME
2b. FIRST NAME
2c. MIDDLE NAME
3.
PMOS
4. BASD
5. COMPONENT
6a.
BIRTHDATE
6b.
AGE
7. UNIT OF ASSIGNMENT
(YYYYMMDD)
SECTION II: ADMINISTRATIVE INFORMATION
Instructions: The information in this section should be confirmed by the appropriate personnel activity and with the Soldier.
DATA ITEM
Yes
No
1. Is Soldier charged or under investigation for an offense chargeable under the UCMJ, which could result in
dismissal or punitive discharge?
2. Is Soldier pending voluntary or involuntary administrative separation under AR 635-200 (enlisted) or
If answer is YES, specify
AR 600-8-24 (officer)?
the chapter and paragraph.
Chapter
, Para
3. Does Soldier have an approved voluntary retirement?
If answer is YES, list date
Date retirement approved:
retirement was approved.
4. Is officer within 12 months of mandatory retirement for age or years of service or approved for Selective
If answer is YES, list
Early Retirement?
mandatory retirement date.
Date of officer's mandatory retirement:
5. REGULAR COMPONENT SOLDIERS ONLY: Does Soldier have prior service in the Selected or Individual
If answer is YES, specify
Ready Reserve?
type of service. Ex: Served
as a member of the ARNG or
a USAR Troop Program Unit.
6. RESERVE COMPONENT SOLDIERS ONLY: Is Soldier within 12 months of his or her mandatory
If answer is YES, list
removal date?
mandatory removal date.
Mandatory Removal Date:
7. RESERVE COMPONENT SOLDIERS ONLY.
If the answer to question to 6 is yes, will Soldier have 20 qualifying years of service at time of his or her
mandatory removal date for purposes of eligibility for non regular retirement?
8. ACTIVE COMPONENT ONLY. Is Soldier within 12 months of his or her Retention Control Point (RCP)
If answer is YES, list RCP
and will Soldier be eligible for length of service retirement at the RCP?
date.
RCP date:
If answer is YES, list the
9. Was Soldier's retirement for length of service delayed by Stop Loss?
applicable MILPER Stop Loss
MILPER MESSAGE
message.
10. If an enlisted Soldier, is the Soldier due an automatic advancement? (See AR 600-8-19 concerning
If answer is YES, list date
promotable status of enlisted Soldiers in the PDES.)
Soldier due next automatic
Date due automatic promotion:
advancement.
11. If an enlisted Soldier, is the Soldier on a semi-centralized or centralized promotion list?
12. If an officer, is the Soldier on an approved promotion list?
13. Has Soldier previously held higher rank?
If answer is YES, list rank
Highest rank held:
and explain the reason
Soldier is not serving in
highest rank previously
held.
Page 1 of 5
DA FORM 7652, DEC 2008
APD LF v2.03ES
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