Fill Out Form DA 2173 in 2026

DA Form 2173, Statement of Medical Examination and Duty Status, is a U.S. Army record used when a Soldier is injured, becomes ill, or develops a disease while on duty. It records the medical condition, the facts of the event, and the Soldier’s duty status at the time.

The Army uses this information during a line-of-duty determination. That process decides if the condition arose while the Soldier was serving and was not caused by misconduct. The decision may affect access to medical care, pay, disability benefits, and other entitlements. The form does not guarantee benefits. It provides an official record that medical staff and Army officials use to review the case.

Form DA 2173 is used after a Soldier becomes ill, is injured, or dies while serving. It records the medical examination and the person’s duty status at the time. This information helps the Army decide if the condition or death occurred in the line of duty.

The details may also support a formal line-of-duty investigation. The decision can affect medical claims and eligibility for benefits tied to military service. It also helps officials assess if the illness or injury could lead to a claim against the government.

The U.S. Department of the Army issues Form DA 2173. Its proponent agency is the Deputy Chief of Staff, G-1 (DCS, G-1). The Army Publishing Directorate (APD) publishes and maintains the official edition. If you search for DA Form 2173 Army Pubs, check the APD catalog for current information.

PDFLeader has a blank version preloaded in our browser-based editor, so you do not need to download a template from another source. You can fill out the form and download the completed PDF for future use. PDFLeader does not file or submit Form DA 2173.

After you download DA Form 2173, give it and the related medical records to your unit representative or commander through your chain of command. Follow your unit’s instructions for in-person delivery or another approved internal method. Do not mail the form or upload it to a public portal.

Your unit representative or commander starts the case electronically in the MEDCHART Line of Duty module. The commander or SARC then completes and signs the remaining sections. The completed record moves through Army channels for final processing at the National Guard Bureau level, as required by Army medical and personnel rules.

The attending physician or hospital patient administrator at the medical treatment facility completes Section I, blocks 6 through 18. This person records the injury, diagnosis, and medical opinion. The unit commander or adviser completes Section II. The commander confirms the Soldier’s duty status and enters the duty station in block 19.

After completion, reviewing and approving authorities use Form DA 2173 to decide if incapacitation benefits may continue. If more inquiry is needed, an appointed investigating officer uses it during the line-of-duty investigation. The officer may also prepare DD Form 261 to finalize the determination, which can affect the Soldier’s benefits and personnel record.

You can add a simple electronic signature to Form DA 2173 on PDFLeader, then download your copy. Current Army guidance calls for a handwritten signature and does not accept an electronic signature for this form. Print and sign the downloaded form by hand before submitting it through the required channel. Check the latest AR 600-8-4 and confirm current rules with your medical treatment facility or unit, as requirements may change.

Have personnel, unit, accident, and medical records on hand to confirm each entry. Start with the Name of Individual Examined, shown as Last, First, and Middle Initial, then the SSN, Grade, and Organization and Station, including the unit name, location, and full ZIP code. For Accident Information (Date and Place), you need the accident date, city, and state.

For Section I, gather the admission status, hospital or treatment facility name, hour and date admitted, and injury or disease description. Item 11 requires the attending medical professional’s opinion on Alcohol/Drug Use and Mental State, including the substance if known. Item 34 needs the Line of Duty Determination and the typed name and grade of the unit commander or unit adviser. The form does not identify a supporting document that must be attached to these fields.

Form DA 2173 must be completed no later than seven days after notice of the injury, illness, or disease is received. Under AR 600-8-4, it must also be submitted within 30 days after the reported condition for related allowances or benefits to take effect.

Army Reserve Component members should request a line-of-duty determination within 24 to 72 hours after a change in duty status. In some cases, they may make the request up to 180 days later. Meeting the earlier time frame helps prevent delays in the review and benefits process.

More than 30 days of active duty removes the requirement for Reserve Component Soldiers. Under AR 600-8-4, these Soldiers do not need a line-of-duty investigation or DA Form 2173.

A new DA Form 2173 is also not required when a memorandum in lieu of the form supports entry into the Disability Evaluation System. For an informal line-of-duty case, a white cell member may complete Section II instead of preparing a new form. In a death or formal investigation, DD Form 261 may serve as the main determination document.