Mark "X" in the appropriate box, "Injury, Disease, or
Resulting in Death," and explain the nature of injury or
Mark "X" in the appropriate boxes
Example: "Individual was, was not under the influence,
Mark "X" in the appropriate box, "The Following Disability
May Result: Temporary, Permanent Partial, Permanent
Mark "X" in the appropriate box, "Blood Alcohol Test Made,
Yes or No"
If block #13 is marked "Yes," then complete block #14 with
Enter details of the accident or the history of the disease
Enter current date
Enter name of attending physician or patient administrator
Signature of entry in Block #17
Section II--of DA Form 2173 will be completed by the unit commander or unit
3-10. APPEALS AND REVISIONS OR CORRECTIONS OR LINE OF DUTY
a. Appeals. The service member may appeal, in writing within 30 days after
receipt of the notice of findings. If an appeal is not submitted within this time limit, the
member must fully explain the reason for the delay.
b. Revision or Correction of LD Findings.
(1) The Secretary of the Army, or The Adjutant General acting for the Secretary,
may at any time change a finding. The correct conclusion based on the facts must be
shown. If the change is from in "line of duty" to "not in line of duty," or other evidence is
considered which supports a NLOD finding, the member must be informed of the proposed
change and its basis and be given a chance to respond in writing. Any statement or
evidence that the member submits must be considered before taking corrective action.
When a determination is changed after final action to award or not award statutory benefits