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DATA ITEM (Continued)

Yes

14. Was Soldier on 24 September 1975, a member of the Armed Forces, to include the Reserve

components, the National Oceanic and Atmospheric Administration (NOAA and formerly the Coast and

Geodetic Survey), the U.S. Public Health Service, or under a binding written agreement to become such a

member? (NOTE: A Soldier who was a contracted cadet of a U.S. Service Academy or a contracted

ROTC cadet or a member of an Armed Force of another country on that date is included in the meaning of

Armed Forces.)

If answer is YES, attach

15. Was Soldier's current referral to MEB/PEB the result of evaluation by an MOS/Medical Retention

MMRB results.

Board (MMRB)?

SECTION III. PERFORMANCE INFORMATION

You are entering information into a performance-based system. Focus your comments on chronic conditions. The PEB must understand the impact of your

Soldier's conditions on his/her ability to perform duties in the primary MOS. Severe, acute physical conditions generally need little performance discussion

because the PEB members easily understand the limitations.

Should the PEB determine the Soldier is not fit for either a mental disorder or residuals of a Traumatic Brain Injury (TBI), the PEB must gauge the Soldier's

capacity to perform in the civilian sector. For these conditions, the PEB looks at the Soldier's current functioning in the military, without regard to whether the

Soldier is performing in his/her PMOS.

In all cases of Medical Corps officers with a clinical specialty area of concentration and assigned to a clinical position, the officer's first line medical supervisor

will complete Sections III and complete and sign in IV. In all cases of officers of the Judge Advocate General Corps (JAG), Sections III and IV will be

completed by the officer's Staff Judge Advocate, Command Judge Advocate, or agency/section supervisor.

SECTION III A. For each Soldier, regardless of condition(s).

For each item, mark Yes, No, or N/Obs (not observed). In Section III D: fully explain every 'No.'

ITEM

Yes

N/Obs

1. Soldier performs duties in MOS (to include assigned MOS duties in unit).

2. Soldier in appropriate TO&E or TDA position for grade and MOS.

3. Soldier's medical conditions/limitations affect unit accomplishing mission. If Yes, fully explain in Section III D.

4. I recommend retaining this Soldier.

SECTION III B. For each Soldier with a mental disorder (including Post Traumatic Stress Disorder (PTSD), major depressive disorder, anxiety

disorder, bipolar disorder, etc.).

Consider Soldier's performance over the past several months. Indicate whether performance seems to be improving, worsening, or static. For example, where

Soldier demonstrated periods of not completing tasks to time and quality standards, but is now completing tasks to standards indicate Soldier had issues but

is now performing normally.

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DA FORM 7652, DEC 2008

APD LF v2.03ES