Camp Lejeune Water Litigation Under Way as Court Orders Case Management Order No. 2 on Sep. 26th
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IN THE UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF NORTH CAROLINA
SOUTHERN DIVISION
No. 7:23-CV-897
INRE: )
) PDF File: gov.uscourts.nced.201345.23.0_1
CAMP LEJEUNE WATER LITIGATION )
)
Pursuant to this Court's inherent powers and Federal Rules of Civil Procedure 1, 16(c)(2)(L),
and 42(a)(3), the Court appointed Plaintiffs' Lead Counsel and Co-Lead Counsel (collectively,
"Plaintiffs' Leadership") to fairly, effectively, and efficiently represent the interests of all Plaintiffs
and to work collaboratively with counsel for Defendant, the United States. See [D.E. 10]. The Court
enters this Order pursuant to the same inherent powers and Rules.
I. Preamble
The Court expects professionalism, courtesy, and civility throughout this litigation. Federal
courts possess certain "inherent powers," not conferred by statute or rule, ''to manage their own
affairs so as to achieve the orderly and expeditious disposition of cases." Link v. Wabash R.R., 370
U.S. 626, 630-31 (1962). Rule 1 provides that the rules "should be construed, administered, and
employed by the court and the parties to secure the just, speedy, and inexpensive determination of
every action and proceeding." Fed. R. Civ. P. 1. Rule 16(c)(2)(L) authorizes the Court to "adopt□
special proceedings for managing potentially difficult or protracted actions that may involve complex
issues, multiple parties, difficult legal questions, or unusual proof problems." Fed. R. Civ. P.
16(c)(2)(L). Rule 42(a) provides that "[i]f actions before the court involve a common question of
law or fact, the court may: (1) join for hearing or trial any or all matters at issue in the actions; (2)
consolidate the actions; or (3) issue any other orders to avoid unnecessary cost or delay." Fed. R.
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 1 of 18
Civ. P. 42(a). The numerous Camp Lejeune Justice Act ("CLJA") actions filed in this Court
"involve common question[s] of law or fact." Id. Accordingly, this Court has authority to adopt
"other [case management] orders to avoid unnecessary cost or delay." Id. In adopting the procedures
in this Order, the Court draws by analogy, in part, on the procedures recommended for multidistrict
litigation in the Manual for Complex Litigation Fourth (hereinafter "MCL 4th").
II. Applicability of Order
This Order shall govern the practice and procedure in the individual CLJA actions filed in
this Court.
m. Rights and Privileges Preserved
"Judicial involvement in complex litigation does not lessen the duties and responsibilities
of the attorneys. To the contrary, complex litigation places greater demands on counsel in their dual
roles as advocates and officers ofthe court. The complexity oflegal and factual issues makes judges
especially dependent on the assistance of counsel." MCL 4th, supril, § 10.21.
Cooperation by and among Plaintiffs' counsel is essential for expeditiously resolving this
litigation. The communication of information among Plaintiffs' counsel shall not be deemed a
waiver of the attorney-client privilege or the attorney work product doctrine, if the privilege or
doctrine otherwise applies. This Order does not limit the rights of any Party or counsel to assert the
attorney-client privilege or attorney work product doctrine. This Order also does not expand or
create a protection or privilege that a Party does not otherwise already possess.
IV. Pretrial Coordination
Under Federal Rule of Civil Procedure 42(a), the Court may determine common questions
of fact and law for CLJA actions filed in this Court, whether filed before today or after today.
Determining common questions of fact or law shall not operate to deny any Party the opportunity
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to raise nonrepetitive issues that uniquely affect each Party in individual CLJA actions.
A. Master Docket and File
The Clerk will continue to maintain a Master Docket case file under the style "In re Camp
Lejeune Water Litigation" and the identification ''No. 7:23-CV-897." Only Plaintiffs' Leadership
and the United States are permitted to file in the Master Docket. All orders, pleadings, motions,
notices, and other documents will, when filed and docketed in the Master Docket case file, be
deemed filed and docketed in each individual CLJA action that is on file when applicable.
B. Individual Dockets
Each individual Plaintiff's action shall maintain its own individual docket and remain
assigned to a single Judge of this District. Each Judge assigned to actions on an individual docket
shall retain the inherent power_to manage such actions, subject to determinations made on the Master
Docket.
C. Captions and Separate Filings
Orders, pleadings, motions, notices, and other documents filed in the Master Docket case file
will bear a caption similar to that of this Order. If generally applicable to all actions, the document
shall be filed and docketed only in the Master Docket case file, with notation in the caption the
document relates to "ALL CASES." Documents that are intended to apply only to a particular action
or group of actions (for example, actions set for trial) but that are nonetheless appropriately filed on
the Master Docket (see Part VII, infra) will indicate in the caption the case number(s) of the case(s)
to which they apply by the words "This document relates to: [individual case(s), group of cases, as
identified by this Court's case number(s)]." A Party should file documents of this nature both in the
Master Docket case file and the specified individual case files.
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D. Stay
Except as provided otherwise in this Order, all CLJA actions on individual dockets are stayed
pending selection of Plaintiffs for discovery and trial and further orders of this Court. See Link, 370
U.S. at 630-31; Landis v. N. Am. Co., 299 U.S. 248, 254-56 (1936). Counsel for Defendant need
not file Notices of Appearance or responsive pleadings in stayed individual CLJA actions, subject
to further Order of the Court.
V. Regular Status Conferences
The Court will hold regular status conferences. The first status conference shall be held on
a date amenable to the Court. In addition, each undersigned Judge also may hold additional status
conferences as needed for individual CLJA actions.
Lead Counsel, the Government Liaison, Co-Lead Counsel, Liaison Counsel, or their
designees, and counsel for Defendant will be designated and appear in person both to argue motions
and actively participate in status conferences. Plaintiffs' Lead Counsel, the Government Liaison,
Co-Lead Counsel, and Liaison Counsel may attend any status conference, hearing, or other
proceeding in this litigation, even if not designated to argue a particular motion or issue.
Except for the first status conference, Lead Counsel, the Government Liaison, or their
designees must meet and confer with counsel for Defendant before each status conference. They
must then submit a joint status report five business days before the status conference. This joint
status report shall be filed via ECF. It may include any items or issues that may be the subject of
pretrial conferences under Fed. R. Civ. P. 16(c)(2) and should include: (i) an update on the number
of CLJA actions filed in the District; (ii) an update on the stipulations entered into between the
Parties since the last status conference; (iii) a ~ummary of the discovery conducted since the last
status conference; and (iv) any other issues that the Parties wish to raise with the Court. Ifthe Parties
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have differing views on issues raised with the Court, each Party should state their respective
positions on each issue in the report.
VI. Master and Short Form Complaints and Defendant's Answer
The Court orders Plaintiffs' Leadership to file a Master Complaint no later than ten days after
the date of this Order. The Master Complaint will contain allegations that are suitable for adoption
by reference in individual CLJA actions. All individual Plaintiffs who wish to pursue their CLJA
action in accordance with this Order (including the Discovery and Trial Plan in section XI of this
Order) shall use the Short Form Complaint to pursue their CLJA actions. This process will allow
the Parties to assess which portions of the Master Complaint apply in each individual CLJA action.
Individual Plaintiff-specific information to be included in the Short Form Complaint is attached to
this Order, which has been negotiated between Plaintiffs' Lead Counsel and counsel for Defendant
to assist in assessing the Discovery Plaintiff pool (see Part XI.A, infra). Any Plaintiff who filed a
Complaint in this Court before the filing of the Master Complaint and who wishes to pursue their
CUA action in accordance with this Order (including the Discovery and Trial Plan in section XI of
this Order) shall file a Short Form Complaint in the Plaintiff's individual docket within 45 days of
this Order. The stay referenced in section IV.D ofthis Order shall remain operative for any Plaintiff
who decides not to file a Short Form Complaint.
A Plaintiff may file the Short Form Complaint without a JS 44 civil cover sheet and without
the disclosure form ordinarily required by Local Civil Rule 7.3(a). By filing a Short Form
Complaint, Plaintiff's counsel is deemed to have appeared and submitted to the jurisdiction of this
Court. For efficiency, Plaintiff's counsel are required to file a Notice of Appearance or Notice of
Special Appearance only in counsel's first filing. Similarly, Plaintiff's counsel not admitted to
practice before this Court are required to file the pro hac vice motion attached to the Court's April
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24, 2023 order only once. These lawyers will be deemed admitted pro hac vice in all subsequent
CLJA actions provided they follow ordinary procedures to pay the CLJA pro hac vice fee in each
action.
Notwithstanding any Local Civil Rule to the contrary, all Short Form Complaints shall be
filed in the Southern Division of this District.
Defendant shall file a Responsive Pleading to the Master Complaint within 45 days of the
filing of the Master Complaint. Defendant is not obligated to answer the allegations in the Short
Form Complaints. In any individual CLJA action filed by a Discovery Plaintiff in which Defendant
intends to assert an affirmative defense that is not already identified in Defendant's Responsive
Pleading to the Master Complaint, Defendant shall provide notice of such affirmative defense to
Plaintiffs' Leadership in a timely manner so as not to prejudice the Plaintiff.
VII. Motions Practice
All motions that are pending in any CLJA actions, except those motions seeking preservation
of evidence under Federal Rule of Civil Procedure 27, are DENIED WITHOUT PREJUDICE and
with leave to refile in accordance with the procedures of this Order. Motions raising global issues
in the CLJA litigation may be filed by Plaintiffs' Leadership or counsel for Defendant in the Master
Docket after counsel have met and conferred regarding the motion.
No Plaintiff, including pro se Plaintiffs, will file motions or discovery in any CLJA action,
except with permission from Plaintiffs' Leadership or leave of Court for good cause shown.
Provided leave of Court or permission from Plaintiffs' Leadership is obtained, non-repetitive
positions that uniquely affect an individual Plaintiff shall not be filed in the Master Docket but shall
instead be filed in the Plaintiff's individual CLJA action.
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VIII. Pretrial Orden
Within 15 days of this Order, Plaintiffs' Leadership and counsel for Defendant will provide
to the Court proposed pretrial orders for the following issues: (1) a Preservation Deposition Order;
(2) a Deposition Protocol Order; (3) a Protective Order for Protection ofPrivileged Information; and
(4) a Protective Order for Protection of Confidential Information. Within 30 days of this Order,
Plaintiffs' Leadership and counsel for Defendant will provide to the Court a proposed pretrial
Electronic Discovery Order. If the Parties cannot reach agreement on any of the orders, each party
must submit proposed competing orders along with supporting memoranda of no more than ten
double-spaced pages.
IX. Stipulations
Stipulations regarding certain issues will streamline the discovery process and the overall
efficiency of the CLJA litigation, including but not limited to stipulations regarding the findings of
scientific and environmental studies and the authenticity of government records and medical records.
To this end, the Court orders the Lead Counsel, the Government Liaison, or their designees to meet
and confer with counsel for Defendant at least on a monthly basis regarding stipulations and to report
the progress on stipulations at each status conference to the Court.
X. Self-Authentication and Admissibility of Certain Records
All government records, documents, data, and studies (including, but not limited to, those
within the custody and control of Defendant or any government agencies, hospitals, departments, or
other similar entity) are self-authenticating and admissible, subject to relevance and Federal Rule of
Evidence 403, absent a specific dispute concerning authenticity or admissibility and including a
notice of such dispute before the close of fact discovery.
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Any medical records from an individual Plaintiff's private health care providers are self-
authenticating and admissible, subject to relevance and Federal Rule of Evidence 403, absent a
specific dispute concerning authenticity or admissibility and including a notice ofsuch dispute before
the close of fact discovery.
XI. Discovery and Trial Plan
The Court expects the Parties to conduct discovery efficiently. The Court recognizes the
significant burden created by the number of CLJA actions already filed, the anticipated additional
filings, and the costs that Plaintiffs' Leadership must advance to fulfill its responsibilities. The Court
also recognizes that there are issues common to all CLJA Plaintiffs, and Plaintiffs' Leadership is
permitted to engage in general discovery upon entry of this Order.
Staging discovery and trials by ''tracks" of illnesses is the most efficient way to advance the
CLJA litigation and support a global resolution of CLJA claims. The staging approach in this Order
comports with the Federal Rules of Civil Procedure and this Court's inherent powers. See, ~ '
Link, 370 U.S. at 630-31; Fed. R. Civ. P. 1, 16(c)(2){L), 42(a)(3). The staging approach also
recognizes that this Court has four United States District Judges and a heavy docket of CLJA and
non-CLJA actions.
A. Procedures for Track 1 Illnesses
i. The Discovery Pool for Track 1 shall be composed of CLJA actions in which the
Plaintiffs allege that they contracted: (1) bladder cancer, (2) kidney cancer, (3)
leukemia, (4) Parkinson's disease, or (5) non-Hodgkin's lymphoma as a result of
exposure to the water at Camp Lejeune. The selection of these actions does not
reflect any assessment of the merits of these or other CLJA actions. Rather, the
selection focuses on illnesses for which early trials may help to promote early
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resolution for common illnesses.
ii. Discovery Pool Eligibility:
a. To be eligible for selection in the Track 1 Discovery Pool, a Plaintiff: (1)
must have filed his or her Short Form complaint within 30 days of the filing
of the Master Complaint; and (2) not opted out of the Discovery Pool as
discussed below.
b. Plaintiffs' Leadership is responsible for overseeing and directing the
discovery and trials of Plaintiffs who are selected for early discovery and trial
pursuant to this Order. If any Plaintiff chooses not to proceed in a manner
consistent with this Order, such individual Plaintiffs may remove themselves
from consideration of selection into the Discovery Pool by notifying
Plaintiffs' Leadership and counsel for the United States within 30 days of the
filing of the Master Complaint.
iii. Selection of Track 1 Discovery Plaintiffs
a. Within 60 days of the filing of the Master Complaint, for each illness listed
in subsectionXI.A.i, Plaintiffs' Leadership and Defendant will each select ten
Plaintiffs to be included in the Discovery Pool. If fewer than 20 Plaintiffs for
an individual illness are eligible for selection, all Plaintiffs alleging that
illness shall be selected.
b. The selected Plaintiffs in the Discovery Pool shall be designated as "Track
1 Discovery Plaintiffs."
iv. Track 1 Discovery
a. Fact discovery in every Track 1 Discovery Plaintiff's action may begin upon
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selection of the Track 1 Discovery Plaintiffs.
b. Within 30 days ofthe filing ofthe Master Complaint, the Parties shall submit
to the Court an agreed upon plan or competing proposals for a Discovery
Pool Profile Form, which shall streamline written discovery regarding the
Track 1 Discovery Plaintiffs.
c. Each Track 1 Discovery Plaintiff shall complete the Discovery Pool Profile
Form within 45 days of it being finalized or their selection as a Track 1
Discovery Plaintiff, whichever is later.
d. Absent a showing of good cause or agreement of the Parties, Defendant shall
be allowed to take no more than three fact depositions (in addition to treating
physicians) for any individual CLJA action. Absent a showing of good cause
or agreement of the Parties, Plaintiffs will be unable to depose a current or
former government employee more than one time.
e. The parties will complete fact discovery within 90 days ofthe Track 1 Order.
Within 30 days of completion of fact discovery, Plaintiffs shall disclose their
expert witnesses. See Fed. R. Civ. P. 26(a)(2)(B) & (C). Within 30 days of
Plaintiffs' disclosure of their expert witnesses, Defendant shall disclose its
expert witnesses. See id. Within 15 days of Defendant's disclosure of their
expert witnesses, Plaintiffs shall disclose their rebuttal expert witnesses.
Within 45 days of Defendant's disclosure of its expert witnesses, expert
discovery will close.
f. The Parties may take the deposition of any individual disclosed as an expert
witness.
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g. Absent agreement of the Parties or a subsequent Order of this Court,
depositions shall be conducted pursuant to the Federal Rules of Civil
Procedure. The deposition of a witness may be used for any purpose
appropriate under the Federal Rules of Civil Procedure and Federal Rules of
Evidence for any Discovery Plaintiff's action.
v. Motion Practice Specific to Track 1
a. At the appropriate time, the Court and the Parties shall discuss the pretrial
schedule for submission of dispositive motions and for any other pretrial
motions or other matters regarding Track 1 Discovery Plaintiffs.
vi. Track 1 Trials
a. At the appropriate time, the Court and the Parties shall discuss the selection
of a certain Track 1 Discovery Plaintiff or Plaintiffs for a Bellwether trial or
trials. The Parties should be prepared to commence trials for the Track 1
Discovery Plaintiffs in 2024.
b. Each member of this Court will be responsible for scheduling procedures for
the trials in actions assigned to them. Any decisions regarding trial
procedures, selection, structure, timing, or any other issues that are different
from or contrary to the provisions of this Order shall supersede this Order.
B. Procedures for non-Track 1 Illnesses
i. To litigate efficiently the numerous CLJA actions that do not involve Track 1
illnesses, the Parties should be prepared to advance additional trial tracks promptly
after the selection of the Track 1 Discovery Pool. These additional Tracks shall
follow similar procedures to those governing Track 1. Within 60 days from the entry
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Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 11 of 18
ofthis Order, Lead Counsel, the Government Liaison, counsel for Defendant, or their
designees shall submit to the Court an agreed upon group or competing groups of
five additional illnesses for Track 2. This proposal also may suggest potential
revisions to the procedures governing Track 1.
ii. Within 30 days after proposing Track 2 conditions, Lead Counsel, the Government
Liaison, counsel for Defendant, or their designees shall submit to the Court an agreed
upon group or competing groups of five additional illnesses for the purposes of Track
3. This proposal also may suggest any potential revisions to the procedures
governing Track 1 or 2.
C. Additional Discovery Tracks
At the appropriate time, the Court and the Parties shall discuss the establishment ofadditional
discovery tracks for Plaintiffs not covered by Track 1, Track 2, or Track 3.
D. Effect of Earlier Rulings
Each United States District Judge on this Court intends to apply the holdings in Track 1 cases
and ensuing Track cases to other parties who litigate their CLJA actions after Track 1, unless the
Party shows cause why the Court's holdings should not apply. See, e.g., Home Dw<>t USA, Inc.
v. Lafarge N. Am., Inc., 59 F.4th 55, 66--68 (3d Cir. 2023).
XII. Ongoing Procedures for Global Resolution
Discussions regarding a global resolution are imperative. Thus, the Parties shall meet and
confer regarding a process for global resolution and report status of those discussions to the Court
within 30 days from the entry of this Order or the date on which the first Joint Status Report is due,
whichever is earlier.
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Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 12 of 18
The Comt is considering the appointment of a Settlement Master. See Fed. R. Civ. P~
S3(a)(l). The Parties may suggest candidates to the Comt for appointment ~ Fed. R. Civ. P.
S3(b)(1). The Comt will discuss this topic at the first status conference.
XID. Other Matten
A. Common Benefit
The Administrative and Common Benefit Committee shall submit a proposed protocol within
30 days ofthis Order, estab1isbing rules and procedures beyond those contained in the Comt's Order
appointing Plaintiffs' Leadership [D.E. 10] that govern eligibility, record-keeping, submission, and
reimbursement of costs and fees incurred for the common benefit of all Plaintiffs~
B. Litiptlon-Management Database
Plaintiffs' Leadership and counsel for Defendant sball meet and confer and propose to the
Comt a litigation-management database within 60 days from the entry of this Order.
C. Amendment of this Order
The Parties will meet and confer to recommend adjustments to this Case-Order
should the Plaintiffs' Leadership Group or Defendant determine that it has caused prejudice to either
party or that the Comt could improve the Case Management Order.
SO ORDERED. This '1~ day of Septanber, 2023.
;?~; { M1.vr J
RICHARD E. MYERS Il
~!}¥
TERRENCE W. BOYLE
Chief United States District Judge United States District Judge
~iw.nAN~
4. ic.DBVBRm
United States District Judge Unit.ed States District Judge
13
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 13 of 18
IN THE UNITED STATES DISTRICT COURT
FOR ';fHE EASTERN DISTRICT OF NORTH CAROLINA
SOUTHERN DIVISION
No.
-----
IN RE: CAMP LEJEUNE
WATER LITIGATION
_______________/
Tms DOCUMENT RELATES TO: JURY TRIAL DEMANDED
Plaintiff'Fint Middle Last Suffix
SHORT-FORM COMPLAINT
The Plaintiff named below, or Plaintiff's representative, files· this Short Form Complaint
against Defendant United Sta~es of America under the Camp Lejeune Justice Act of 2022
("CLJA"). Pub. L. No. 117--168, § 804, l36 Stat. 1802, 1802-04 (2022). Plaintiff or Plaintifrs
l
representative incorporates by reference the allegations contained in the Master Complaint (DE
~ on file in the case styled In Re: Camp Lejeune Water Litigation, Case No. 7:23-cv-897, in
the United States District Court for the Eastern District of North Carolina. Plaintiff or Plaintiff's
representative· files this Short-Fonn Complaint as permitted.by Pretrial Order No. LJ.
Plaintiff or Plaintiff's representative alleges as follows:
I. INSTRUCTIONS
l. On THIS FORM, are you asserting a claim for :;Jlj!s.fomi:ni'-9:, ~~~f_be~ ~=~~~il~J1-~~-ac~~gi~tf!~(,.:\r·
injuries to YOU or to SOMEONE ELSE you legally :O~ .PER.:~G>.~ f. ~--~l~JUn~s:r~fr .~.u~1}ltend;f~~~V~8··· ••. :;_.
represent? i~lai~~ W(1t1~lti,1?~e indiv!~~,!.f }#1J.uri.~s:::·.:fg' ;~~~P~!~
;~
□ Tome ._a,cl~•!Il.(C?!'~f.~~e_
I[.an4 o~~::.f8~:~~d~ceas_~ ;!~i~µ~~ )<::
□ Someone else :_ you .m4st,~fil~.,9NE F9~-~P.l'.EACH:1 N~~ . /". . ,
(PERSON.' .~<t:."..' ;. •- '.-.~·-~·:;,:~. '/ ·:·\' · :·._-,~:~,}·. · :: . • :,
- 1-
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 14 of 18
II. PLAINTIFF INFORMATION
If you checked "To me" in Box 1, YOU are the Plaintiff. Complete this section with information about YOU.
If you checked "Someone else" in Box 1, THAT PERSON is the Plaintiff. Complete this section with
information about THAT PERSON.
2. First name: 3. Middle name: 4. Last name: S. Suffix:
6. Sex: 7. Is the Plaintiff deceased?
□ Male □ Yes
□ Female □ No
□ Other
Ifyou checked "To me" in Box 1, check "No" here.
8. Residence city: 9. Residence state:
1 ,.. • , \ : .. ,.,., • f.J . ..
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.Skip~,:;~i"(f)~,:·c b{,•aD(i::1;,~;2\.ifrliy
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1 ... ,. Jl:,~- f . ' .... • ..I ::t I i: ;if,Y"-•lff .• ,. • tc ~i-itFt. .:f("'
10. Date of Plaintifrs 11. Plaintiff's residence 12. Was the Plaintifrs death caused by an injury
death: state at the time of their that resulted from their exposure to contaminated
death: water at Camp Lejeune?
□ Yes
□ No
III. EXPOSURE INFORMATION
If you checked "To me" in Box 1, complete this section with information about YOU.
If you checked "Someone else" in Box 1, complete this section with information about 111AT PERSON.
13. Plaintiff's first month of exposure to the water 14. Plaintiff's last month of exposure to the water at
at Camp Lejeune: Camp Lejeune:
15. Estimated total months of e~posure: 16. Plaintiff's status at the time(s) of exposure
(please check all that apply):
□ Member of the Anned Services
D Civilian (includes in utero exposure)
17. If you checked Civilian in Box 16, check all that 18. Did Plaintiff at any time live or work in any of
describe the Plaintiff at the time(s) of exposure: the following areas? Check!!! that apply.
□ Civilian Military Dependent □ Berkeley Manor
□ Civilian Employee of Private Company □ Hadnot Point
□ Civil Service Employee □ Hospital Point
□ In Utero/Not Yet Born □ Knox Trailer Park
□ Other □ Mainside Barracks
□ Midway Park
□ Paradise Point
□ Tarawa Terrace
□ None of the above
□ Unknown
-2-
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 15 of 18
. IV. INJURY INFORMATION
If you checked "To me" in Box 1, complete this section with information about YOU.
If you checked "Someone else" in Box 1, complete this section with information about THAT PERSON.
19. Identify the illnesses or conditions the Plaintiff suffered as a result of exposure to contaminated water at
Camp Lejeune.
~ iVi. :;;;;,;~--~.>t-~-~:~f.t~i!.Vi~;:,y.~·/;'.~:~'.~f#fil:"·~;:-~··!tJ;ll~J·~f:·:.i --~t ~iir;o.xlmi1tefd'liil10t?on~et~i
1
D Adverse birth outcomes (Plaintiff is the PARENT of an individual who died in
utero or was stillborn or born prematurely)
D ALS (Lou Gehrig's Disease)
D Aplastic anemia or myelodysplastic syndrome
D Bile duct cancer
D Bladder cancer
D Brain / central nervous system cancer
D Breast cancer
D Cardiac birth defects (Plaintiff was BORN WITH the defects)
D Cervical cancer
D Colorectal cancer
□ Esophageal cancer
D Gallbladder cancer
D Hepatic steatosis (Fatty Liver Disease)
D Hypersensitivity skin disorder
D Infertility
D Intestinal cancer
D Kidney cancer
D Non-cancer kidney disease
D Leukemia
D Liver cancer
D Lung cancer
D Mutliple myeloma
D Neurobehavioral effects
D Non-cardiac birth defects (Plaintiff was BORN WITH the defects)
D Non-Hodgkin's Lymphoma
D Ovarian cancer
D Pancreatic cancer
D Parkinson's disease
D Prostate cancer
D Sinus cancer
D Soft tissue cancer
D Systemic sclerosis / scleroderma
D Thyroid cancer
-3-
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 16 of 18
The Camp Lejeune Justice Act does not specify a list of covered conditions.
If the Plaintiff suffers or previously suffered from a condition not listed above, and the Plaintiff alleges that the
condition was caused by exposure to the water at Camp Lejeune as required under the Act, please check "Other"
and describe the condition on the following lines.
Note in particular that the Board of Veterans' Appeals of the U.S. Department of Veterans Affairs (the ''VA")
has approved benefits in connection with Camp Lejeune for conditions beyond those listed above.
D Other: Approximate date of onset
V. REPRESENTATIVE INFORMATION
If you checked "To me" in Box 1, SKIP THIS SECTION and proceed to section VI. ("Exhaustion").
If you checked "Someone else" in Box 1, complete this section with information about YOU.
20. Representative First 21. Representative 22. Representative Last 23. Representative
Name: Middle Name: Name: Suffix:
24. Residence City: 25. Residence State:
□ Outside of the U.S.
26. Representative Sex:
□ Male
□ Female
□ Other
27. What is your familial relationship to the Plain tier?
□ They are/were my spouse.
□ They are/were my parent.
□ They are/were my child.
D They are/were my sibling.
□ Other familial relationship: They are/were my _ _ _ __
□ No familial relationship.
-Dinyatl _,ei~Jitint :,!i:'~..l:,~·'-'1:~:·:.<i· ~~-
28. Did the Plaintifrs death or injury cause the Plalntifrs spouse, children, or parents mental anguish, loss
of financial support, loss of consortium, or any other economic or non-economic harm for which you
intend to seek recovery?
□ Yes
□ No
-4-
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 17 of 18
VI. EXHAUSTION
29. On what date was the administrative claim for 30. What is the DON Claim Number for the
this Plaintiff filed with the Department of the Navy administrative claim?
(DON)?
mm/ddlyyyy
□ DON has not yet assigned a Claim Number
VII. CLAIM FOR RELIEF
Plaintiff respectfully requests that pursuant to subsection 804(b) of the CLJA the Court
enter judgment against the Defendant and award damages and all other appropriate relief for the
harm to Plaintiff that was caused by exposure to the water at Camp Lejeune.
VIII. JURY TRIAL DEMAND
Plaintiff demands a trial by jury of all issues so triable pursuant to Rule 38 of the Federal
Rules of Civil Procedure and subsection 804(d) of the CLJA.
Dated: mm/ddlyyyy
[Signature block]
-5-
Case 7:23-cv-00897-RJ Document 23 Filed 09/26/23 Page 18 of 18
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