ABSTRACT Introduction Active duty service members (ADSMs) are affected by neuromusculoskeletal injuries (NMSKIs) more than any other physical health condition, leading to 25 million limited duty days (LDDs) annually and delayed recovery/return to duty (RTD) times.1 Ultimately, these outcomes are a clear threat medical and operational readiness.2 It is well documented how the COVID-19 pandemic obstructed the status quo for military operations and medical care provided to Military Health System (MHS) beneficiaries. While much of the existing studies have targeted health outcomes affected by the COVID-19 disease, few have explored the pandemic’s influence on recovery rates for ADSMs post-NMSKI. Methods The retrospective cohort study was composed of ADSMs ages 18 to 64 diagnosed with NMSKIs from March 1st, 2017 to February 28th, 2022 with 12 months post-injury DEERS eligibility. The Military Health System Data Repository (MDR) was queried for electronic health record data to identify ADSMs’ eligibility, military, demographic, injury, rehabilitation, and recovery/reinjury data. The pre-COVID-19 period was defined as March 1st, 2017-February 28th, 2020, and the post-COVID-19 period was defined as March 1st, 2020-February 28th, 2022. Adjusted logistic regression models assessed potential associations between military, demographic, injury, rehabilitation, and recovery characteristics and period of diagnosis (pre/post-COVID-19). Time-to-first recovery post-incident NMSKI was estimated using Kaplan–Meier survival analysis, stratified by COVID-19 period. The differences in time to first recovery distributions were assessed through log rank tests. Results Post-COVID-19, recovery rates waned from 90.7% to 89.0%, while sustained recovery rates notably fell from 82.7% to 71.9%. Median time to recovery was 0 days (IQR: 0–41 pre-COVID-19; 0–43 post-COVID-19), indicating right-skewed distributions across COVID-19 periods. After the pandemic began, there was a significant decrease in the odds of sustained recovery among ADSMs in the 12 months post-NMSKI (OR: 0.91, 95% CI: 0.90-0.92). There were no observed significant differences in time to first recovery pre-/post-COVID-19 (χ² = 2.5, p = 0.12) for ADSMs with acute injuries (median times: 0 days). A significant difference was detected among ADSMs with non-acute injuries pre-/post-COVID-19 (χ² = 251, p < 0.001), yet median recovery times (0, 1 day, respectively) indicate minimal clinical impact. Greater outpatient rehabilitation utilization was associated with higher odds of recovery. ADSMs receiving lower proportions of in-person outpatient rehabilitation had decreased odds of recovery compared with those receiving ≥75% of care in-person. Higher proportions of outpatient rehabilitation delivered during the COVID-19 period or in Medically Underserved Areas (MUAs) were each associated with increased odds of recovery. Such associations persisted pre- and post-COVID-19, though the magnitude of effect was dampened post-COVID-19. Conclusion Recovery rates post-NMSKI decreased modestly post-COVID-19, with a striking decline in sustained recovery rates. Median times to recovery remained short and static across COVID-19 periods, though analyses indicated significant difference in recovery times among ADSMs with non-acute injuries. While slightly attenuated post-COVID-19, increases in various proportions of outpatient rehabilitation were each associated with higher odds of recovery. Additional research is required to measure the impact of COVID-19 infection on recovery times. Topic: nervous system disorders, musculoskeletal diseases, neuromusculoskeletal injuries, rehabilitation, recovery, return to duty, reinjury, injury types, body regions, COVID-19 pandemic, military personnel, military health system, soldiers, army, military occupation, rank, pain, disability, public health, incident injury, diagnosis coding, international classification of diseases, centers for disease control and prevention (u.s.) 1. Malish RG, Arnett AD, Place RJ. Returning to duty from temporary disability in the U.S. Army: observational data and commentary for commanders, providers, and soldiers. Mil Med. Nov 2014;179(11):1190-7. doi:10.7205/MILMED-D-14-00131 2. Mauntel TC, Tenan MS, Freedman BA, et al. The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System. Mil Med. Mar 28 2022;187(3-4):e282-e289. doi:10.1093/milmed/usaa304