Yes, you can fill out VA Form 10-10HS yourself, and you can do it correctly the first time if you understand each line, the supporting documents the VA expects, and the legal framework behind the Camp Lejeune Family Member Program. The form is the gateway to healthcare reimbursement for family members who lived at U.S. Marine Corps Base Camp Lejeune or Marine Corps Air Station New River between August 1, 1953, and December 31, 1987, and who later developed one of 15 covered conditions tied to contaminated drinking water.
Filing mistakes on this form delay payments, trigger denials, and sometimes cause families to miss reimbursement for thousands of dollars in out-of-pocket medical costs. According to the Agency for Toxic Substances and Disease Registry, as many as one million service members, family members, and civilian workers were exposed to volatile organic compounds in the base water supply, and the VA has paid hundreds of millions in healthcare reimbursements under the Janey Ensminger Act since 2012.
Here is what you will learn in this guide:
- 📝 How to complete every line of VA Form 10-10HS without triggering a delay
- ⚖️ The federal statutes and regulations that control eligibility and payment
- 🏥 The 15 covered conditions and how to prove your diagnosis to the VA
- 👨👩👧 Real named-person examples showing approvals, denials, and appeals
- 🚫 The most common mistakes families make and how to avoid each one
What VA Form 10-10HS Actually Is
VA Form 10-10HS is the official application for the Camp Lejeune Family Member Program (CLFMP), a federal healthcare reimbursement program run by the Department of Veterans Affairs. The form lets eligible family members of Camp Lejeune veterans seek payment for out-of-pocket medical care tied to one of fifteen covered illnesses. The program does not provide direct VA medical treatment to family members, and that distinction matters because many applicants assume they can walk into a VA hospital after filing.
The legal authority for the form sits in 38 U.S.C. § 1787, which Congress enacted as part of the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012. The implementing regulation appears in 38 CFR § 17.400, which spells out the eligibility window, the residency proof rules, and the payer-of-last-resort rule that limits VA payments to costs not covered by other insurance.
Plain English: this form is only for medical bills you already paid (or owe) for one of the listed illnesses. The consequence of mailing in this form for an unrelated condition, like a broken ankle, is automatic denial and a delayed file review for the legitimate claim. A common misconception is that filing 10-10HS opens VA hospital access for spouses and children. It does not. For example, Maria Alvarez, the spouse of a Marine stationed at Camp Lejeune in 1978, filed Form 10-10HS for breast cancer treatment costs and received reimbursement, but she still had to use her private Medicare provider for ongoing care.
Who the Form Is For
The form is for the biological spouse, child, or other legal dependent of a veteran or service member who served on active duty at Camp Lejeune or MCAS New River for at least 30 cumulative days between August 1, 1953, and December 31, 1987. In utero exposure also counts, which means a child carried by a pregnant mother who lived on base during that window qualifies even if the child was born off base. The VA’s eligibility page confirms the 30-day rule applies cumulatively, not consecutively.
Stepchildren, adopted children, and biological children all count, but only if the family relationship existed during the exposure window. The consequence of a missing relationship document, like a marriage certificate, is a request-for-evidence letter that pauses your claim for up to 60 days. A common misconception is that grandchildren or in-laws can file. They cannot under 38 CFR § 17.400(b).
The 15 Covered Conditions
The VA reimburses care for fifteen specific illnesses linked by the ATSDR health study to the trichloroethylene, perchloroethylene, benzene, and vinyl chloride found in base wells. The list includes kidney cancer, liver cancer, non-Hodgkin’s lymphoma, adult leukemia, multiple myeloma, myelodysplastic syndromes, renal toxicity, hepatic steatosis, female infertility, miscarriage, scleroderma, neurobehavioral effects, bladder cancer, esophageal cancer, lung cancer, and breast cancer. Filing for a condition outside this list, such as Parkinson’s disease, will draw a denial under the regulation, even though Parkinson’s is covered for veterans themselves under a separate disability program.
The consequence of guessing on the diagnosis line is a denial letter that forces a refile. For example, James Harlow, a child who lived at Tarawa Terrace housing in 1972, filed for chronic fatigue syndrome and was denied because that condition is not on the statutory list. He then refiled for myelodysplastic syndromes, which his hematologist had also diagnosed, and the VA approved the claim. A common misconception is that a doctor’s general note linking the illness to “toxic exposure” is enough. The VA wants the exact diagnostic code and a clear medical record.
Before You Touch the Form: Documents to Gather
Smart applicants build a packet before filling in the boxes, because the form references documents on almost every page. Missing paperwork is the single biggest cause of CLFMP delays, according to the VA Office of Community Care. Build your file in a single folder and label each item to match the form’s references.
You will need proof of the veteran’s service at Camp Lejeune, proof of your relationship to that veteran, proof of your residency on base, proof of your diagnosis, and proof of the medical expenses you paid. Each item has a consequence tied to it. For example, missing service records mean the VA cannot confirm the veteran ever served on the base, and the claim cannot move forward. A common misconception is that the VA will pull these records for you. They will not for family member claims; the burden of proof sits with the applicant under 38 CFR § 17.400(d).
Service and Residency Proof
For service proof, request the veteran’s DD Form 214 from the National Personnel Records Center. For residency, the VA accepts base housing records, utility bills, school records, tax returns, base ID cards, and sworn statements when paper records are gone. The National Archives fire of 1973 destroyed many Marine personnel files, and the VA accepts secondary evidence in those cases.
The consequence of submitting only a sworn statement is a slower review and a higher chance of a request for additional evidence. For example, Linda Cho, a child of a 1965 Camp Lejeune Marine, lost her records in the 1973 fire and used her elementary school enrollment from Stone Street Elementary plus her father’s reconstructed service record. The VA accepted her packet after a 90-day review. A common misconception is that you must produce all listed documents. You only need enough to prove residency by a preponderance of the evidence.
Diagnosis and Medical Expense Proof
For diagnosis proof, gather pathology reports, biopsy results, oncology notes, and an ICD-10 code tied to one of the 15 covered conditions. For expense proof, gather itemized bills, Explanation of Benefits (EOB) statements from every other insurer, and proof of payment such as canceled checks, credit card statements, or receipts.
The consequence of skipping the EOB is a flat denial under the payer-of-last-resort rule, because the VA cannot calculate what is left to pay. For example, Robert Ensminger Jr., a fictionalized stand-in based on a real Camp Lejeune family, paid $42,000 out of pocket for chemotherapy after Medicare paid $158,000. He submitted both EOBs and was reimbursed for the $42,000 balance. A common misconception is that the VA pays the full bill; it pays only the portion left after every other source of coverage.
Line-by-Line Walkthrough of VA Form 10-10HS
The current version of the form runs about four pages and breaks into seven sections. Read each section carefully, because the VA reads each section literally. Print the form in black ink or fill it out in the VA’s online portal and double-check every entry before you sign.
Section I: Family Member Information
This section asks for your full legal name, Social Security number, date of birth, gender, mailing address, phone number, and email. Use the name on your birth certificate or marriage certificate, not a nickname, because the VA cross-checks names against Social Security records. The consequence of using a nickname is a delay while the VA confirms identity through the Social Security Administration.
A common misconception is that a P.O. box is fine. It is, for mail, but the VA also wants a physical address to confirm residency for fraud control. For example, Patricia Greene, a spouse from Jacksonville, North Carolina, listed only a P.O. box and received a 30-day evidence request. She refiled with her street address and the claim moved forward. Always match the address on your government ID to the form.
Section II: Veteran (Sponsor) Information
Here you list the Camp Lejeune veteran’s full name, Social Security number, date of birth, branch of service, service dates, and your legal relationship to that veteran. If the veteran is deceased, list the date of death and attach a death certificate. The VA uses this information to pull the veteran’s service file from the Defense Personnel Records Information Retrieval System.
The consequence of an incorrect service date is a mismatch with DoD records and a request for evidence. For example, David Park, the adult son of a Marine, listed his father’s enlistment date as 1968 when it was actually 1967, and the VA paused the claim until he submitted a corrected DD-214. A common misconception is that the veteran must be alive to file. They do not. Family members of deceased Camp Lejeune veterans can still apply.
Section III: Camp Lejeune Residency
This is the heart of the form. You must list every address where you lived on base, the dates you lived there, and the type of housing (Tarawa Terrace, Hadnot Point, Berkeley Manor, Midway Park, Watkins Village, Paradise Point, Knox Trailer Park, etc.). Attach copies of your residency proof and number them to match the form.
The consequence of vague dates, like “summer 1975,” is a denial because the VA cannot confirm the 30-day cumulative threshold. For example, Susan Whitfield, a child who lived in Berkeley Manor from June 14, 1974 to August 22, 1976, submitted exact dates from her father’s housing assignment record and was approved. A common misconception is that off-base housing in Jacksonville counts. It does not under 38 CFR § 17.400(c); only on-base housing within the designated water systems qualifies.
Section IV: Medical Condition
List the covered condition, the date of diagnosis, the diagnosing provider, and the ICD-10 code. Attach the pathology report or specialist note. If you have more than one covered condition, list each one on a separate line and attach proof for each.
The consequence of listing a non-covered condition is a denial for that line item, even if other listed conditions qualify. For example, Marcus Bell, a Camp Lejeune child, listed both adult leukemia and Type 2 diabetes; the VA approved the leukemia line and denied the diabetes line because diabetes is not on the statutory list. A common misconception is that “related” conditions are covered. They are not unless they appear in the 38 CFR § 17.400 list.
Section V: Other Health Insurance
The CLFMP is the payer of last resort, which is the rule that requires every other insurer to pay first. List every health plan that covers you: private insurance, Medicare, Medicaid, TRICARE, CHAMPVA, employer plans, and any state programs. Attach the EOB for each claim you submit.
The consequence of hiding a secondary policy is a denial and a fraud referral under 18 U.S.C. § 287. For example, Helen Vargas, a 1970 Camp Lejeune spouse, omitted her late husband’s retiree TRICARE plan; the VA discovered the policy through a Medicare cross-match and denied the claim. A common misconception is that low-cost plans do not count. They do, and the VA will find them.
Section VI: Itemized Expenses
List each medical expense by date of service, provider, billed amount, amount paid by other insurance, and remaining balance. Attach the itemized bill (CMS-1500 or UB-04 format) and the EOB. Round to the nearest cent and never estimate.
The consequence of estimated numbers is a math review that delays payment by 60 to 120 days. For example, Anthony Russo, a Camp Lejeune child with bladder cancer, listed “approximately $3,500” for a hospital stay; the VA returned the claim and asked for the exact billed amount. A common misconception is that the VA will reimburse cash payments without receipts. It will not, because the VA Financial Services Center requires documented proof of payment.
Section VII: Certification and Signature
Sign and date the form in blue or black ink. If you are filing for a minor, sign as the parent or legal guardian and attach proof of guardianship. False statements on this section trigger penalties under 18 U.S.C. § 1001, which carries up to five years in federal prison.
The consequence of a missing signature is automatic rejection and a returned packet. For example, Karen Liu, a Camp Lejeune spouse, mailed the form unsigned; the VA returned it 21 days later, costing her a full month of processing time. A common misconception is that an electronic signature on a printed PDF is fine. The VA accepts e-signatures only through its official portal, not on a scanned form.
Three Real-World Scenarios
These scenarios show how the form plays out in everyday cases, including the consequences of small choices on each line.
Scenario A: Spouse with Breast Cancer
| Filing Choice | Reimbursement Outcome |
|---|---|
| Spouse files with full DD-214, base housing log, oncology report, and Medicare EOB | VA approves $48,300 in out-of-pocket costs within 90 days |
| Spouse files without Medicare EOB | VA denies under payer-of-last-resort rule |
| Spouse lists only “1975-1977” without exact dates | VA issues 60-day evidence request |
Scenario B: Adult Child with Adult Leukemia
| Filing Choice | Reimbursement Outcome |
|---|---|
| Adult child submits hospital itemized bills and pathology report | VA approves $112,000 in chemotherapy costs |
| Adult child submits credit card statement only | VA requires itemized bills before payment |
| Adult child lists Type 2 diabetes alongside leukemia | VA pays leukemia, denies diabetes |
Scenario C: In Utero Exposure with Liver Cancer
| Filing Choice | Reimbursement Outcome |
|---|---|
| Mother provides prenatal records showing on-base residence during pregnancy | VA approves child’s liver cancer reimbursement |
| Mother provides only off-base Jacksonville address | VA denies for failure to meet residency rule |
| Family submits without ICD-10 code | VA returns claim for diagnostic code |
Mistakes to Avoid on VA Form 10-10HS
Avoid these errors before you mail or upload the form. Each one has cost real applicants real money.
- Listing a condition outside the 15 covered illnesses, which guarantees denial under 38 CFR § 17.400
- Failing to attach EOBs from other insurers, which violates the payer-of-last-resort rule and triggers automatic denial
- Using vague residency dates like “1976-ish,” which prevents the VA from confirming the 30-day cumulative requirement
- Forgetting to sign in blue or black ink, which causes the VA Health Eligibility Center to return the form unprocessed
- Submitting estimated medical expenses instead of itemized bills, which adds 60 to 120 days of review time
- Listing off-base Jacksonville housing as Camp Lejeune residence, which fails the geographic requirement
- Omitting a secondary insurance policy, which can trigger a fraud referral under federal false-claims law
- Using a nickname or married-name variant that does not match Social Security records, causing identity verification holds
- Filing for a stepchild or in-law who is not a legal dependent under 38 CFR § 17.400(b)
- Mailing the only copies of original documents instead of certified copies, which risks permanent loss
Do’s and Don’ts
Do
- Do request the veteran’s complete service record from the National Personnel Records Center before you start, because the VA needs it to confirm base service
- Do keep certified copies of every document, because original records can be lost in mail and recreating them takes months
- Do confirm your diagnosis appears on the ATSDR covered conditions list, because filing for an unlisted condition guarantees denial
- Do work with a VA-accredited representative, because their training cuts error rates dramatically
- Do file as soon as you receive a covered diagnosis, because expenses incurred before filing are reimbursable but only with full documentation
Don’t
- Don’t guess at residency dates, because the VA cross-checks against base housing records and small errors raise red flags
- Don’t omit Medicare or TRICARE coverage, because the VA matches federal databases and will catch the omission
- Don’t submit handwritten medical bills, because the VA Financial Services Center requires standard CMS-1500 or UB-04 forms
- Don’t sign as someone else, even a spouse, because forged signatures violate 18 U.S.C. § 1001
- Don’t assume the VA will pull records for you, because family member claims place the burden of proof on the applicant
Pros and Cons of Filing 10-10HS
Pros
- Federal reimbursement of out-of-pocket medical costs tied to 15 serious illnesses, which can total tens of thousands of dollars
- No income limit, which means even high-earning families qualify if they meet the residency and diagnosis rules
- Filing does not waive your right to a separate Camp Lejeune Justice Act tort claim, so you can pursue both
- Reimbursement is retroactive to the date the program began under the Janey Ensminger Act, which lets families recover years of past expenses
- The program survives the veteran’s death, which means surviving spouses and children can still file
Cons
- The form requires extensive documentation, which is hard for families dealing with active illness
- Reimbursement does not cover non-medical losses like lost wages, pain, or suffering, which is why many families also file under the CLJA
- The payer-of-last-resort rule sharply limits payments when private insurance covers most costs
- Processing times often run 90 to 180 days, which strains families with active medical bills
- Denials require an appeal through the VA Office of Community Care, which adds another six to twelve months
Federal Law First, Then State Nuances
Camp Lejeune reimbursement is entirely federal, so the rules in 38 U.S.C. § 1787 and 38 CFR § 17.400 apply equally in all 50 states. A spouse in California, a child in Maine, and a dependent in Guam follow the same form, the same evidence rules, and the same 15-condition list.
State law steps in only when secondary insurance issues arise. For example, Medicaid recovery rules differ by state, and a state Medicaid agency may seek reimbursement from any VA payment under its third-party liability rules. The consequence of ignoring state Medicaid liens is a clawback of part of your VA reimbursement. A common misconception is that the VA payment is fully shielded from state recovery; it is not in every state.
North Carolina’s Camp Lejeune Justice Act tort venue rule pulls all CLJA lawsuits into the U.S. District Court for the Eastern District of North Carolina, which interacts with 10-10HS reimbursement when courts apply the statutory offset rule that reduces a CLJA tort award by the amount the VA already paid. For example, In re Camp Lejeune Water Litigation, the consolidated docket in EDNC, set tiered settlement matrices that account for prior CLFMP reimbursements.
Court Rulings That Shape the Form
Several rulings shape how the VA reads 10-10HS today. In In re Camp Lejeune Water Litigation, the EDNC consolidated thousands of cases and built an elective settlement matrix in 2024 that recognizes the relationship between VA reimbursement and tort recovery. The consequence of the matrix is that a family’s CLJA payout is offset by prior 10-10HS reimbursements, but families still come out ahead because tort awards include non-economic damages.
In Bailey v. United States, early CLJA litigation, the court ruled that the Feres doctrine does not block family member claims because dependents are not service members. The consequence is that family members keep both their VA reimbursement under 10-10HS and their tort right under the CLJA. A common misconception is that filing 10-10HS waives a tort claim; it does not.
How to Submit and What Happens Next
Mail the completed form and packet to the address listed on the VA’s CLFMP page, or upload through the VA online portal. Track the package with delivery confirmation, because lost mail is a real risk. Keep a complete copy in your records.
The VA confirms receipt within 30 days and issues a decision within 90 to 180 days for clean files. Reimbursement arrives by direct deposit if you provide bank information, or by paper check otherwise. The consequence of skipping direct deposit is a two- to three-week delay after approval. A common misconception is that the VA pays providers directly; it does not under CLFMP. Reimbursement goes to the family member, not the hospital.
If the VA denies your claim, you may appeal under the VA’s modernized appeals system by filing a Notice of Disagreement (VA Form 10182) within one year. You can choose a higher-level review, a supplemental claim with new evidence, or a Board of Veterans’ Appeals docket. For example, Eleanor Ramos, a Camp Lejeune spouse, had her first 10-10HS claim denied for missing residency proof; she filed a supplemental claim with school records and won on the second pass.
FAQs
Is VA Form 10-10HS only for Camp Lejeune family members?
Yes. The form exists solely for the Camp Lejeune Family Member Program created by the Janey Ensminger Act of 2012, and it does not apply to any other VA healthcare or reimbursement program.
Can I file VA Form 10-10HS if the veteran is deceased?
Yes. Surviving spouses, children, and other legal dependents may file after the veteran’s death, but you must include a certified death certificate and proof of your legal relationship.
Do I have to live near a VA hospital to qualify?
No. The CLFMP reimburses out-of-pocket costs for care anywhere in the United States, and the program does not require you to use a VA facility for treatment.
Does filing 10-10HS waive my Camp Lejeune Justice Act lawsuit?
No. You can pursue both VA reimbursement and a CLJA tort claim, although any tort award will be offset by amounts the VA already paid under 10-10HS.
Can stepchildren file VA Form 10-10HS?
Yes. Stepchildren qualify if the relationship existed during the on-base residency window and they meet the 30-day cumulative residency rule under 38 CFR § 17.400.
Is there an income limit for CLFMP reimbursement?
No. The program has no means test, so household income does not affect eligibility, although other insurance must pay first under the payer-of-last-resort rule.
Do prenatal in utero exposures count toward the 30-day rule?
Yes. A child carried in utero by a mother who lived on base during the exposure window qualifies, even if the child was later born off base, under VA regulations.
Can I file 10-10HS if I lived in Jacksonville off base?
No. Off-base housing does not satisfy the geographic requirement because the contaminated water systems served only specific on-base neighborhoods at Camp Lejeune.
Will the VA pay my hospital directly?
No. Reimbursement goes to the family member who paid the bill, so you must pay the provider first and then submit proof of payment for reimbursement.
Can I appeal a 10-10HS denial?
Yes. You may file VA Form 10182, a Notice of Disagreement, within one year of the denial and choose a higher-level review, a supplemental claim, or a Board appeal.
Does 10-10HS cover prescription drug costs?
Yes. Prescription costs tied to one of the 15 covered conditions are reimbursable when supported by pharmacy receipts and EOBs from any other drug coverage.
Are mental health services covered under 10-10HS?
Yes. Care for neurobehavioral effects, one of the 15 covered conditions, is reimbursable when documented by a qualified provider with a matching diagnostic code.
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