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3M CombatArms (CAEv2) Earplug Claims

Name*

First Name

Last Name

Phone*

Email*

Zip Code

I used 3M CombatArms CAEv2 earplugs in my military service from 2003 to 2015:*

Yes No

I have medically diagnosed PERMANENT HEARING LOSS from service-related activity after 2003:*

Yes No

I have been prescribed a HEARING AID for my hearing loss:*

Yes No

I have been medically diagnosed with TINNITUS from service-related activity after 2003:*

Yes No

Age