3M Earplugs Follow-Up Qs

  1. Do you have an attorney for a potential claim?

    - If you were not in the military using the earplugs, where were they purchased from? (Name and address)

  2. Have you served in any branch of the US Military between the years 2003 and 2015?
  3. Have you been medically diagnosed with any of the following hearing conditions? (select all that apply)
    1. Tinnitus / Hearing Loss / No DX
  1. While in service or as a non military personnel, did you use the "Combat Arms" Dual-Ended Earplugs made by 3M that appeared to be yellow and green or yellow and black?
  2. Which branch of the military did you serve in?
  3. When did your service for this military branch begin?
  4. When did your service for this military branch end?
  5. Was your hearing loss diagnosed at a Veterans Hospital Facility or a Private Medical Facility?
  6. What date were you diagnosed? (Month and year if possible, if not the year is okay)
  7. Please provide the name and address of the diagnosing medical facility OR name of your Military Base if Dx by Med Board or during Reverse SRP.
  8. Provide any information helpful to your case including where and how you were deployed when hearing damage occurred.
  9. Date of birth of injured.
  10. City and state the injured was born (JLG only)
  11. Injured SSN
  12. Physical and mailing address of injured.
  13. Best method of contact
    1. Text / Email / Phone