DA FORM 2675-R Fillable – Army Pubs 2675-R PDF

DAFORMFILLABLE.COM | DA FORM 2675-R Fillable – Army Pubs 2675-R PDF – When it comes to handling workplace injuries or disabilities within the Army, DA FORM 2675-R plays a crucial role. This form, officially titled “Certification of Work Incurred Injury or Disability (LRA),” is a vital document for both service members and administrative personnel. Here, we delve into what DA FORM 2675-R entails, its importance, and how it is used.

DA FORM 2675-R – Certification Of Work Incurred Injury Or Disability (LRA)

Form Number DA Form 2675-R
Form Title Certification Of Work Incurred Injury Or Disability (LRA)
Form Date 05/01/1982
Form Proponent PMG

What is DA FORM 2675-R?

DA FORM 2675-R is a standardized form used by the U.S. Army to certify injuries or disabilities that occur as a result of or during employment. This form ensures that all pertinent information regarding such incidents is properly documented and processed in accordance with Army regulations.

Key Details of the Form

  • Pub/Form Number: DA FORM 2675-R
  • Publication Date: May 1, 1982
  • Form Title: Certification of Work Incurred Injury or Disability (LRA)
  • Proponent: PMG (Provost Marshal General)
  • Status: Active
  • Prescribing Directive: AR 190-8

The form is also available in electronic media, indicating its adaptation to modern needs for accessibility and efficiency.

Importance of DA FORM 2675-R

The DA FORM 2675-R is crucial for several reasons:

  1. Documentation: It provides a formal method to document any injuries or disabilities that military personnel suffer during their service, which is essential for transparency and record-keeping.
  2. Benefits and Compensation: This documentation aids in the processing of benefits and compensation claims, ensuring that service members receive the support they are entitled to under military regulations.
  3. Legal and Administrative Use: The form serves as a legal document in administrative procedures and may be used in legal settings if disputes arise concerning the incident.

Prescribed by AR 190-8

The use of DA FORM 2675-R is prescribed by AR 190-8, which outlines procedures related to enemy prisoners of war, retained personnel, civilian internees and other detainees. This directive underscores the form’s role in broader administrative practices within the Army.

How to Use DA FORM 2675-R

Using DA FORM 2675-R involves several critical steps:

  1. Filling Out the Form: The form must be completed by the attending medical officer or a qualified health professional who can provide a detailed description of the injury or disability, including how and when it occurred.
  2. Review and Approval: Once filled out, the form must be reviewed and approved by designated authorities to ensure all information is accurate and complete.
  3. Submission for Processing: After approval, the form is submitted for processing. This step is crucial for initiating any claims for compensation or other administrative actions.

Distribution and Accessibility

The form is marked with a Distribution Restriction Code A, which means it is approved for public release, and distribution is unlimited. This ensures that the necessary personnel can access the form easily and without restriction.


DA FORM 2675-R is an essential tool within the U.S. Army for managing cases of work-incurred injuries or disabilities. By providing a structured way to document and process these incidents, it helps maintain the integrity of military operations and ensures that service members receive the care and compensation they deserve. Whether you are a military personnel handling administrative duties or a service member seeking to understand your entitlements, familiarizing yourself with DA FORM 2675-R is beneficial.

DA FORM 2675-R Fillable – Army Pubs 2675-R PDF DOWNLOAD

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