Background Following serious injury, the Military Health System leverages comprehensive care and rehabilitation to improve outcomes and increase successful return-to-duty (RTD) of active duty service members (ADSMs). Disparities in care utilization may impact outcomes, but factors impacting care levels are unknown. Methods The MDR identified ADSMs experiencing serious physical injuries (concussion, blindness, fracture, spinal cord, amputation, burns, shrapnel, multiple) from Oct 2004 and Sep 2015. Out- and inpatient encounters were totalled in the year following injury. Poisson regression evaluated the impact of race/ethnicity, rank, sex, and marital status on healthcare rates with a 2-sided alpha of 0.05. Results Injury prevalence for the 177,647 injured ADSMs ranged from 68% with concussion to 0.8% with shrapnel injuries. Injured ADSMs were mostly male (84%), married (56%), junior enlisted (56%), and White (62%) with a median age of 25. As compared to White ADSMs, outpatient care rates were significantly higher for American Indian (AI) (2%), Asian (1%) and Hispanic ADSMs (4%), and lower for Black (1%) and Other (1%) ADSMs. As compared to officers, care rates increased 1% and 3% for junior and senior enlisted, respectively. Compared to White ADSMs, inpatient care rates decreased significantly for AI (8%), Asian (5%) and Black (3%) ADSMs. Rates were significantly higher for females as compared to males (5%), and junior (6%) and senior (11%) enlisted versus officers. With the exception of amputation, burns, and shrapnel care which was increased, out- and inpatient care rates were significantly lower for Black versus White ADSMs. Care rates for other races varied by injury type. Inpatient care rates for Jr and Sr enlisted ADSMs were consistently higher or not different than officers, while outpatient care differed with injury type, with the exception of spinal cord injury and concussion outpatient care rates, which were significantly lower. While males and female outpatient care rates did not differ, inpatient care was increased for females for all injury types with the exception of shrapnel injuries. Conclusions These early results suggest differences in care utilization rates exist following serious physical injury among ADSMs. Results may relate to injury risk and severity, which will be explored in continued analyses.