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Were you at Camp LeJeune anytime between Aug. 1st 1953 to Dec. 31st 1987? - Qualifier Choose... Yes No

And were you stationed or located at the camp for at least 30+ days? - Qualifier Choose... Yes No

Why were you, or your loved one stationed or posted at Camp Lejeune? Choose... Air Force Air Force Reserve Air National Guard Army National Guard Army Reserve Civilian Worker Coast Guard Coast Guard Reserve Dependent DOD Contractor Government Service Employee Marines Navy Navy Reserve Other

Were you on active duty during your station at Camp Lejeune? Choose... Yes No

Where were you exposed at within the camp? Choose... Barracks Berkley Manor Camp Geiger Courthouse Bay French Creek Hadnot Point Holcomb Boulevard Hospital Point Knox Trailer Park Mainside Barracks Midway Park Montford Point/Camp Johnson New River Onslow Beach Paradise Point Rifle Range Watkins Village Other

Other Exposure Locations:

Bladder Cancer Choose... Yes No

Bladder Cancer Date

Breast Cancer (Male) Choose... Yes No

Breast Cancer Date

Esophageal Cancer Choose... Yes No

Esophageal Cancer Date

Kidney Cancer Choose... Yes No

Kidney Cancer Date

Leukemia Choose... Yes No

Leukemia Date

Liver Cancer Choose... Yes No

Liver Cancer Date

Lung Cancer Choose... Yes No

Lung Cancer Date

Multiple Myeloma Choose... Yes No

Multiple Myeloma Date

Non-Hodgkin Lymphoma Choose... Yes No

Non-Hodgkin Lymphoma Date

Birth Injuries Choose... Female Infertility Miscarriage

Birth Injury Date

Other Birth Injury Details

Other Injuries Type Choose... Aplastic Anemia Myelodysplastic Syndrome Hepatic Steatosis Neurobehavioral Effects Parkinson's Disease Renal Toxicity Scleroderma Kidney Disease

Other Injury Date

Does the injured individual receive disability benefits through the VA? Choose... Yes No

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