DA Form 2173, Statement of Medical Examination and Duty Status is a form used during Line of Duty Investigations (LDI) in cases when a Soldier receives an injury, illness or disease during Active Duty service, Inactive (IDT) and Active Duty (AD) training or traveling to and from IDT/AD. The latest version of the form was released by the Department of the Army (DA) in October 1972. An up-to-date fillable DA Form 2173 is available for download and digital filing down below or can be found on the Army Publishing Directorate (APD) website.
The DA Form 2173 must be completed by the authorized personnel no later than 7 days after receiving notice of the injury, illness or disease unless the injury was not a direct result of Active Duty or IDT. The form expires either in 60 days after the incident (in case of an informal LDI) or in 90 days (in case of a formal LDI). The statement must be submitted within the adequate period of time for all allowances to come into effect within 30 days after reported injury, illness or disease. The completed DA 2173 must undergo a detailed review and be approved by superiors for the continuation of incapacitation benefits.