SURVEY: Why Did They Die?
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Why Did They Die?

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TOPIC: To-date there is no online database of veterans who died because of an illness that may or may not be associated with their military or war service in areas where chemical or radiation elements were militarily deployed. There is no publicly accessible database that informs sick veterans if they share an illness that is common to other veterans they served with in the same unit or on the same vessel. This Survey will create an online database of deceased veterans so that living veterans can find out if members of their unit or vessel share the same illness, and thereby determine if something they were jointly exposed to is at the root of their illness.

1. What was the deceased veteran's FULL NAME?
(If you are a living veteran who has been diagnosed by the VA as having an issue with one of the organ failures or problems listed below in Section 7, you may include yourself in this database.)

2. What was his or her rank?

3. What was his or her Service Number (if known)?

4. Which armed conflict or country did this veteran serve in?

    Grenada 1983
    Persian Gulf Region 1990-1995
    Persian Gulf Region 2001-Present
    Panama 1989
    Somalia 1991-1994
    Vietnam 1947-1975
    None of the above
    Other:

5. Which Service Branch?

    Air Force
    Army
    Coast Guard
    Marine Corps
    Navy

6. What unit or on what vessel did this veteran serve with?

7. Did this veteran suffer from any organ failure?

    Brain
    Heart
    Kidney
    Liver
    Lung
    Pancreas
    Prostate
    None of the above
    Other:

7b. Was cancer diagnosed?

    No
    Yes

8. Was the VA this veteran's primary care provider?

    No
    Yes

9. And I have this comment to make...

Your full and complete contact email address:


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Contact person for this Survey:
Roger Simpson, Public Information Office
The American War Library
817 East Via Carmelitos
Virginia Building 319
Long Beach CA 90805-7549

Telephone: 1-562-422-4100 (Pacific Time Zone)

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