Da Form 5892 Fillable PDF Details

The DA Form 5892, officially the PEBLO Estimated Disability Compensation Worksheet, is a core document in the Army disability evaluation process. The Physical Evaluation Board Liaison Officer (PEBLO) completes this form with the soldier during counseling to provide an estimate of monthly disability compensation based on the Physical Evaluation Board's findings and the soldier's years of service.

How the Form Calculates Disability Compensation

DA Form 5892 computes two possible monthly compensation amounts: one through the Department of Defense (DoD), based on the soldier's disability rating percentage multiplied by their monthly basic pay, and a second amount through the Department of Veterans Affairs (VA) based on the combined disability rating. The soldier receives whichever amount is higher, not both simultaneously. In certain cases, the compensation may be exempt from federal income tax when the disability was incurred in the line of duty under qualifying conditions defined by AR 635-40.

Key Fields on DA Form 5892

The form captures essential data points including the soldier's total years of active service, monthly basic pay rate, assigned disability percentage, and estimated monthly compensation. A REMARKS section is included for the PEBLO to note any adjustments or special circumstances. Completion of the form requires acknowledgment from both the soldier (or their authorized representative) and the PEBLO to confirm the counseling session took place and that the soldier understands the estimated compensation figures.

Related Forms in the Disability Evaluation Process

Soldiers navigating the Integrated Disability Evaluation System often complete several documents alongside DA Form 5892. A disability claim form provides a formal record of the service-related condition, while the DA Form 87 Certificate frequently accompanies Army administrative proceedings. For soldiers pursuing a formal VA claim, the 1199 Notice and Proof of Claim for Disability is a key supporting document.

QuestionAnswer
Form NameDa Form 5892 Fillable
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform 5892, da peblo worksheet, peblo da dec, da 5892 fillable

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2. Once your current task is complete, take the next step – fill out all of these fields - REMARKS, DA FORM DEC, Previous Editions are Obsolete, Page of, and APD PE v with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

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Common Mistakes When Completing DA Form 5892

Soldiers frequently overlook the REMARKS section or enter an incorrect version number in the APD PE v field. Always confirm that the counseling date on the form matches the date of the Physical Evaluation Board findings letter. If any required field is left blank, the PEBLO must correct and countersign the form before it can be submitted to the evaluation board for processing.

Other Army Forms You May Need

The disability evaluation process often involves multiple documents. Alongside DA Form 5892, you may need to complete a disability claim form to document your medical condition for the PEB record. Soldiers compiling their service history may also reference the DA Form 67-9-1 OER Support Form to provide a complete performance record during the evaluation.