February 25, 2005M21-1, Part III
SUGGESTED LETTER TO USE TO REQUEST PARTICIPATION OR RADIATION DOSE INFORMATION FROM THE DEFENSE THREAT REDUCTION AGENCY
Defense Threat Reduction Agency00/21
Attn: TDND/NTPRC 12 345 679
8725 John J. Kingman Rd., Mail Stop 6201JONES, John A.
Ft Belvoir, VA 22060-6201
We have received a claim for service connection under provisions of 38 C.F.R. 3.309 for conditions allegedly due to radiation risk activity.
Veteran’s identifying information:
Full name: John A. Jones
VA Claim No: C 12 345 679
Social Security No: 234 56 7890
Branch of Service: Navy
Assigned Unit: USS SEVERN (AO-61)
The veteran, Mr. Jones, participated in OPERATION CROSSROADS (ABLE & BAKER) FROM July 7, 1946, to August 24, 1946. His duties and activities included COOK.
The alleged radiogenic disease is SKIN CANCER [specific site of lesion must be included]. A copy of the claimant’s statement is enclosed.
The claimant’s name and address is:
John A. Jones
793 Smith St.
Hometown, CA 92027
Please verify the veteran’s participation in the radiation risk activity described above and provide the associated radiation dose. If no individual radiation dose record is available, please provide a dose reconstruction for his unit.
Please send your reply to [give regional office address, as shown below]:
Department of Veterans Affairs
2022 Camino Del Rio North
San Diego, CA 92108
Your assistance in this matter is appreciated.
[Name and Title of Veterans Service Center Manager]