Da form 2173 line of duty pdf

Statement of medical examination and duty status keywords. She said she didnt know why the peb cant rely on the same materials the va relied on. Performing organization report number the judge advocate generals school, army charlottesville, va 229031781 ja 23192 9. Soldiers manual and trainers guide mos 91g soldiers manual, skill levels 12345 and trainers guide. Answer all questions by placing an x in the appropriate block. Da form 2173, statement of medical examination and duty status is used in cases of either a formal or an informal line of duty lod determination process. Download fillable da form 6 in pdf the latest version applicable for 2020. Initial medical documentation is required to process a da form 2173. Use this stepbystep guide to complete the af form 348 quickly and with ideal accuracy. Dd 2475, dod educational loan repayment lrp annual application. Da form 348 sample pdf documents docucu dd form 314, dec 53 preventive maintenance designed using perform pro. Reports of survey and line of duty determinations na 6.

This treatment will continue until the problem is resolved or. Sworn statement for use of this form, see ar 19045. Dd form 261, report of investigationline of duty and misconduct status completed. Dd form 261, report of investigation line of duty and. The soldier provides the commander with the da 2173 and medical documentation. Printable da form 2173 statement of medical examination. Da form 3881, rights warning and waiver certificate. Da form 6 download fillable pdf or fill online duty roster. Memorandum from commander navy personnel command pers9952 and dd form 261 u. Da form 2173 fill online, printable, fillable, blank. Personnelgeneral line of duty policy, procedures, and.

This form is used during line of duty investigations ldi in cases when a soldier received an injury, illness or disease during active duty, inactive duty training or traveling to and from idt. The line of duty lod does not have to be complete in the module, but there must be a. The latest version of the form was released by the. Da form 2173, statement of medical examinations and duty status, must be completed. Af form 348 fill out and sign printable pdf template signnow. Line of duty care you may qualify for line of duty care if you incur or aggravate an injury, illness, or disease while in the line of duty performing adt, idt, drill weekend, or any other training while on orders. The unit uploads the signed da 2173, medical documents, orders or drill roster within the electronic lod module emmps. The latest technologies high quality electronic pubs and forms view u. Mrp2adme process wtc for approval via the active duty order.

The timeline for completing an informal investigation is no more than 60 days. Members remaining on active duty while incapacitated will receive their active duty pay and allowances instead of incapacitation pay. Memorandum reserve medical entitlements, determination section, headquarters. Da form 2173, statement of medical examination and duty status. Da form 2173 statement of medical examination and duty status, or dd form 261 report of investigationline of duty and misconduct status must be included in the official records of the case.

It contains standardized training objectives, in the form of task summaries, to train and evaluate soldiers on critical tasks that support unit missions during wartime. It does not matter how far the civilian facility is away from your duty location. Da form 2173 one page with all required signatures air force. Mar 25, 2015 i was told the line of duty da form 2173 cant be changed. Moore, the examining nurse, checked the boxes on form 2173 to indicate that sgt. Jun 04, 2018 if there is a medical clinic on base or if you have to go to urgent car from a civilian provider make sure you carry with you a line of duty form 2173 and have the doctor to fill out section 2 this form is a must. This form is used during line of duty investigations ldi in cases when a soldier received an injury, illness or disease during active duty, inactiveduty training or traveling to and. Mos 91g and for trainers and first line supervisors. Dd form 261, report of investigation line of duty and misconduct status completed. Da form 2173, statement of medical examination and duty. Af form 348 two pages with all required signatures. Direct service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veteran s own willful misconduct or, for claims filed after october 31, 1990, the result of his or her abuse of alcohol or drugs.

Fill da form 2173, download blank or editable online. Da form 2173 statement of medical examination and duty status. Home medical reference and training manuals da form 2173, statement of medical examination and duty status patient affairs branch processing a formal investigation patient affairs branch figure 32. The latest fillable version of the form can be downloaded below. Statement of medical examination and duty status for use of this form see ar 60084 the proponent agency is. Army da administrative publications and forms by the army publishing directorate apd. Da form 2173, statement of medical examination and duty status patient affairs branch figure 33.

Sep 26, 2019 case that facility will complete section i of da form 2173. If a not in the line of duty determination is made, the service member will not be reimbursed for cost associated with this injuryillness or disease. Line of duty office is located on 1st floor of the bed tower side. When a board or council has substantial evidence, however, showing that a prior decision may be incorrect for any reason, they must include such. This information constitutes an official statement. The definition of line of duty in this regulation is confined to the. Home medical reference and training manuals da form 2173, statement of medical examination and duty status patient affairs branch processing a formal investigation patient affairs branch figure 3. They will only receive incapacitation pay upon release from active duty. Army publications, pdf forms fillable savable, pdf forms fillable, pdf forms saveable, pdf forms savable, eforms, eforms, pdf forms, adobe acrobat forms created date. Da form 2173 fillable da 2173 fill online, printable. Dd 2475, dod educational loan repayment lrp annual. Line of duty lod dental care utilizing the active duty dental program addp purpose. Absence without authority materially interferred with the performance of military duty explain in item 30 type of duty missed, hours of duty, and how it did or did not interfere with performance 19 duty station a. It takes precedence o ver all other publications relating to line of duty.

Authors administrative and civil law division, ti ag sa 7. Da form 2173 statement of medical examination and duty status lod determination and approval letter. Printable da form 2173 statement of medical examination and. Mrp2adme process wtc for approval via the active duty. Da form 2173 with approval memorandum or da form 261, an updated physical profile da form 3349, and all required medical documentation to include current. The advanced tools of the editor will guide you through the editable pdf template. Injuries resulting from a motor vehicle accident, the accident report is required. Da form 6 is often used in united states army, army forms, business, united states federal legal forms and united states legal forms. View, download and print da 2173 statement of medical examination and duty status, oct 1972 pdf template or form online. The addp is available for service members on active duty for greater than 30 days. The line of duty investigation process, page 5 section i informal line of duty investigations, page 5 general 31, page 5 da form 2173 32, page 5 evidence collection 33, page 5 line of duty determination 34, page 5 forwarding investigation 35, page 6 actions by appointingapproval authority 36, page 6. Soldiers requiring lods for medical boards, the medical documentation needs to be within thirty days of injury. Injury is considered to have been incurred in line of duty not applicable on deaths 34. Fill out the duty roster online and print it out for free.

Forward your form to the address listed in section 1, block a. Oct 9, 2018 printable da form 2173 statement of medical examination and duty status. The defense health agencygreat lakes dha gl, formerly known as military medical support office mmso, is. And another lod reflecting the connection the peb wants to see cant be provided.

Soldiers who contract or aggravate an injury, illness, or disease while in the line of duty, during inactive duty, active duty, or travel to and from such duty are authorized military medical treatment for those conditions. The way to complete the online af form 348 on the internet. If the circumstance surrounding the wound, injury, illness, or disease requires a formal lod investigation, then do form 261 report of investigation line of duty and misconduct status must be submitted prior to processing the packet. Line of duty lod dental care utilizing the active duty. Enlisted members on active duty in specified military specialties. I was told the line of dutyda form 2173 cant be changed. Da form 2173 statement of medical examination and duty. When an informal investigation is not completed within the given time, the reasons the report is late should be included in the remarks section of da form 2173 statement of medical examination and duty status. This includes when traveling directly to or from your place of duty. To get line of duty care, your unit must issue a line of duty lod determination or a notice of eligibility. It implements titles 5, 10, and 32, united states code. It contains standardized training objectives, in the form of task summaries, to train and evaluate soldiers on critical tasks.

Trainers and first line supervisors should ensure soldiers holding mossl 91g12345 have access to this publication. Download da form 2173, statement of medical examination and duty status to conduct line of duty investigations within the us army in cases of injury or illness. Soldiers must inform civilian providers to submit their health insurance claim form directly. The latest version of the form was released by the department of the army da in october 1972.