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Veterans Benefits AdministrationM21-1, Part III - page 67 / 71

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February 25, 2005M21-1, Part III

Change 131

Appendix B

Exhibit B-9

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

Dear Sir/Madam:

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

Telephone:

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

Regional Office

2022 Camino Del Rio North

San Diego, CA  92108

Your assistance in this matter is appreciated.

Sincerely yours,

[Name and Title of Veterans Service Center Manager]

5-B-13

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