and procedures for evaluating Gulf War (GW) veterans, including those who served in

DU Questionnaire, has been revised to include the OIF veterans, implement the new

electronic method of transmitting registry data to the Austin Automation Center (AAC)

and/or coordinators to Environmental Health Clinicians and Coordinators.

(13) is responsible for the contents of this Handbook. Questions about DU should be addressed

to the Baltimore DU Follow-up Program at 1-800-815-7533. General questions about the

protocol should be addressed to the Environmental Agents Service at (202) 273-8580.

the last working day of September 2009.

S/ Arthur S. Hamerschlag for

Jonathan B. Perlin, MD, PhD, MSHA, FACP

Acting Under Secretary for Health

DISTRIBUTION: CO: E-mailed 9/2/04

FLD: VISN, MA, DO, OC, OCRO, and 200 – E-mailed 9/2/04

1. Purpose ...... 1

2. Background ............................................................................................................................... 1

3. Scope ......... 1

4. Procedure .. 2

5. Responsibilities ......................................................................................................................... 3

6. References . 3

A VA Form 10-9009D, Depleted Uranium (DU) Questionnaire ............................................ A-1

B VA Form 10-9009F, Depleted Uranium (DU) Program Checklist 24-Hour Urine

Uranium Collection Baltimore Department of Veterans Affairs (VA) Medical Center.... B-1

This Veterans Health Administration (VHA) Handbook outlines the policy and procedures

for evaluating Gulf War (GW) veterans, including those who served in Operation Iraqi Freedom

a. DU is natural uranium left over after most of the U-235 isotope has been removed, such as

that used as fuel in nuclear power plants. DU possesses about 60 percent of the radioactivity of

natural uranium and is a radiation hazard primarily if internalized, such as in shrapnel,

contaminated wounds, and inhalation. In addition to its radioactivity, DU has some chemical

toxicity related to being a heavy metal (similar to lead).

b. Testing of DU for possible military use began in the early 1960’s and was first used by the

United States military in projectiles and armor for tanks during the Gulf War, which began in

1990, and continues to the present (see Title 38 United States Code (U.S.C.) § 101(33)). DU has

also been used in other conflicts, such as OIF and Bosnia. Service personnel who may have had

potential inhalation exposure to DU include those on, in, or near vehicles hit with "friendly fire;"

rescuers entering burning vehicles; individuals near fires involving DU munitions; individuals

salvaging damaged vehicles; and those near burning vehicles.

c. The medical effects of DU exposure are continuing to be evaluated. A group of GW

veterans with retained DU fragments, or DU-contaminated wounds, is being followed at a

special DU Program at the Department of Veterans Affairs (VA) Medical Center, Baltimore,

MD. While no clinically significant adverse effects of DU have been evident to date in this

d. The Baltimore DU Follow-up Program has determined that, for GW friendly-fire victims,

a 24-hour urine determination for uranium is a more sensitive screening test for DU than wholebody

counting.

e. The Austin Automation Center (AAC) functions as the "contractor" to VHA in providing

national level computer support for this DU program.

a. Each VHA facility must offer a GW registry examination to eligible veterans of the GW,

including OIF.

b. The DU Evaluation Protocol (see App. A and App. B) must be utilized to evaluate GW

veterans (including OIF) identified and referred by the Department of Defense (DOD) because of

possible DU exposure, or those veterans who self-refer because they are concerned about

potential exposure to DU.

a. VA Environmental Health programs (formerly designated as Registry programs) must

provide GW Registry examinations to eligible veterans as described in M-10, Part III,

registry examination so the VA system can more quickly identify the types of health problems

these veterans are experiencing.

b. Evaluation of GW veterans for potential DU exposure must be provided utilizing the DU

Evaluation Protocol described in Appendix A (VA Form 10-9009D, DU Questionnaire) and

Appendix B (DU Consult Urine Instructions). Components of the DU evaluation include a GW

Registry Examination, if not previously performed, DU exposure questionnaire and a 24-hour

urine collection for creatinine and uranium.

c. Any positive responses to the DU questionnaire are to be followed up with more detailed

history-taking by the examining health care provider. The full-exposure history must be

recorded in the veteran’s consolidated health record (CHR) and/or the computerized patient

record system (CPRS). All free text on the DU questionnaires must be included in the CHR or

CPRS. Completed DU questionnaires are to be transmitted to the AAC via website

d. The health care provider must contact the DU Follow-up Program at the Baltimore VA

Medical Center (1-800-815-7533) to discuss obtaining a 24-hour urine collection for uranium.

e. Upon completion of the protocol examination, the GW Registry code sheet and the DU

exposure questionnaire will be transmitted by the Environmental Health Coordinator (EHC)

(formerly designated as Registry Coordinators) via website

f. Results of the 24-hour urine for uranium are communicated directly to the veteran by letter

from the Baltimore DU Follow-up Program, with a copy to the VA referring physician for the

veteran's CHR and/or CPRS. The Baltimore DU program staff transmits the urine uranium

g. Follow-up actions for any veteran with an elevated 24-hour urine uranium determination

will be individualized based on discussion between the veteran's VA primary care clinician and

the staff at the Baltimore DU Follow-up Program.

h. Additional diagnostic evaluation of signs or symptoms identified during the GW registry

coordinators, and other appropriate staff follow the policies and procedures required to evaluate

non-Gulf War and non-Operation Iraqi Freedom veterans with potential exposure to DU as

mandated in this Handbook.

(1) Arranging for testing of urine samples for uranium.

(2) Sending, by letter, the results of the 24-hour urine for uranium directly to the veteran,

with a copy to the VA referring clinician.

(3) Transmitting the urine uranium results to AAC via registry website

http://vaww.registries.aac.va.gov/index.asp

(4) Providing consultative advice to VA clinicians regarding DU testing.

a. Voelz, George L., Chapter 13 - "Uranium," in Hazardous Material Toxicology, Eds.

Sullivan, John B. and Krieger, Gary R.Williams and Wilkins, Baltimore, MD, 1992.

c. "Agency for Toxic Substances and Disease Registry," U.S. Public Health Service, 1990.

d. Toxicologic Profile for Uranium. PB91-180 471, U.S. Department of Commerce,

e. McDiarmid, et al. "Health Effects of Depleted Uranium on Exposed Gulf War Veterans,"

Environmental Research, Section A, Vol. 82, pages 168-180, 2000.

f. McDiarmid, et al. "Urinary Uranium Concentrations in an Enlarged Gulf War Veterans

Cohort," Health Physics, Vol. 80, number 3, pages 270-273, 2001.

g. McDiarmid, et al. "Surveillance of Depleted Uranium Exposed Gulf War Veterans:

Health Effects Observed in an Enlarged "Friendly Fire" Cohort," Journal of Environmental

Medicine. Vol. 4, Number 12, pages 991-1000, December 2001.

DEPLETED URANIUM (DU) QUESTIONNAIRE

TT #1 Facility Number (Use PTF No. only) (2 - 4) Suffix (5 - 7)

The information the veteran supplies may be disclosed outside the VA to Federal, State and local government agencies and National

Health Organizations to assist in the development of programs for research purposes and other uses as stated in the "Notice of

Systems of VA Records" published in the Federal Register in accordance with the Privacy Act of 1974.

PART IV (DEPLETED URANIUM [DU])

2. LAST NAME (8-33)

3. FIRST NAME (34-48) 4. SOCIAL SECURITY NUMBER (49-58)

5. PHONE NUMBERS WHERE YOU MAY BE CONTACTED:

5A. DAYTIME PHONE (59-68) 5B. EVENING PHONE (69-78)

( ) ( )

6. TODAY'S DATE (79-86) 7. DATE OF ARRIVAL IN PERSIAN GULF

WAR THEATRE OF OPERATION (87-

94)

8. DATE OF DEPARTURE FROM

PERSIAN GULF WAR THEATRE OF

OPERATION (95-102)

TO BE COMPLETED BY ENVIRONMENTAL HEALTH COORDINATOR OR CLINICIAN

(b)

CODE

(a)

10. WHERE DID YOU SERVE? Enter Code "Y"= Yes or "N"= No in Blocks 104a through 104e.

10a. Code "a" = Kuwait 104a

10b. Code "b" = Saudi Arabia 104b

10c. Code "c" = Iraq 104c

10d. Code "d" = Only on a ship (not ashore)

104e

MAR 2003(RS)

10e. Code "e" = Other (identify below)

104d

9. WHO REFERRED YOU TO THE VA MEDICAL CENTER FOR EVALUATION?

103

Code "a" = Office of the Special Assistant for Gulf War Illness (OSAGWI) of Department of Defense?

Code "b" = Another Department of Defense Office

Code "c" = Department of Veterans Affairs (VA)

Code "d" = Self Referred

Code "e" = Other sources (identify below)

e.g. 05191998 (May 19, 1998) e.g. 06191991 (June 19, 1991) e.g. 11121991 (November 12, 1991)

use black ballpoint or felt-tip pen. Shaded areas are for VA use only. All free text on this code sheet will be retained in medical

health record but not included in the registry dataset at AAC.

narrative response is required: Code "Y" = Yes Code "N" = No Code "D" = Don't Know

11. WERE YOU A LOGISTICS ASSISTANCE REPRESENTATIVE (LAR) WHO INSPECTED DEPLETED

URANIUM CONTAMINATED SYSTEMS TO DETERMINE REPAIRABILITY?

SSN

DEPLETED URANIUM QUESTIONNAIRE, Continued

12. WERE YOU A MEMBER OF A BATTLE DAMAGE ASSESSMENT TEAM (BDAT) WHO EXAMINED U.S.

COMBAT VEHICLES KNOWN, OR SUSPECTED TO BE, DAMAGED OR DESTROYED BY DU?

117

13. WERE YOU A MEMBER OF THE 144 SERVICE AND SUPPLY COMPANY WHO PROCESSED

DAMAGED EQUIPMENT, INCLUDING SOME WITH DU CONTAMINATION?

106

107

14. WERE YOU A MEMBER OF A RADIATION CONTROL (RADCON) TEAM DEPLOYED IN THE PERSIAN

GULF? 108

15. WERE YOU INVOLVED IN THE EXAMINATION OR RECOVERY OF DAMAGED OR DESTROYED

ENEMY VEHICLES? 109

16. WERE YOU INVOLVED IN THE DOWNLOADING OF EQUIPMENT OR MUNITIONS FROM VEHICLES

KNOWN OR SUSPECTED TO BE CONTAMINATED BY DU? 110

17. WERE YOU A MEMBER OF A UNIT MAINTENANCE TEAM PERFORMING MAINTENANCE ON OR IN

SYSTEMS KNOWN OR SUSPECTED TO BE CONTAMINATED BY DU? 111

18. WERE YOU AT DOHA ON JULY 11, 1991, AT THE TIME OF THE FIRE? 112

18a. WERE YOU DIRECTLY INVOLVED IN CLEAN-UP OPERATIONS FOLLOWING THE DOHA

EXPLOSION AND FIRE? 112a

112b 18b. WERE YOU EXPOSED TO SMOKE FROM BURNING DOHA ROUNDS?

19. WERE YOU IN OR ON A VEHICLE HIT BY ENEMY FIRE AT THE TIME IT WAS HIT? IF "NO," SKIP TO

QUESTION 20.

113f

19a. IF "YES," WHAT TYPE OF A VEHICLE?

19a(1) Code "a" = ABRAMS battle tank

113a

19a(2) Code "b" = BRADLEY fighting vehicle

113b

19a(3) Code "c" = Other (identify) :

19a(4) Code "d" = Don't know

19b. IF "YES," WAS THE VEHICLE HIT BY DU MUNITIONS?

20. DID YOU ENTER AN ABRAMS BATTLE TANK TO PERFORM RESCUE OPERATIONS IMMEDIATELY

AFTER IT WAS STRUCK BY ENEMY FIRE?

21. DID YOU ENTER AN ABRAMS BATTLE TANK TO RETRIEVE SENSITIVE ITEMS IMMEDIATELY

AFTER IT WAS STRUCK BY ENEMY FIRE?

22. DID YOU ENTER A BRADLEY FIGHTING VEHICLE TO PERFORM RESCUE OPERATIONS

IMMEDIATELY AFTER IT WAS STRUCK BY ENEMY FIRE?

23. DID YOU ENTER A BRADLEY FIGHTING VEHICLE TO RETRIEVE SENSITIVE ITEMS IMMEDIATELY

AFTER IT WAS STRUCK BY ENEMY FIRE?

MAR 2003(RS)

105

113c

113d

113e

114

115

116

(b)

CODE

(a)

BLOCK

123

123a

SSN

DEPLETED URANIUM QUESTIONNAIRE, Continued

(a)

BLOCK

(b)

CODE

24. WERE YOU IN OR ON ANY VEHICLE HIT BY FRIENDLY FIRE AT THE TIME IT WAS HIT? IF "NO," SKIP

TO QUESTION 25.

Code "Y" = Yes Code "N" = No Code "D" = Don't Know

124a

24a. IF "YES," WHAT TYPE OF VEHICLE?

24a(1) Code" a" = ABRAMS battle tank

118c

24a(2) Code "b" = BRADLEY fighting vehicle

118d

24a(3) Code "c" = other (identify below)

118

24a(4) Code "d" = Don't Know

24b. WAS THE VEHICLE HIT BY DU MUNITIONS?

25. DID YOU ENTER AN ABRAMS BATTLE TANK TO PERFORM RESCUE OPERATIONS IMMEDIATELY

AFTER IT WAS STRUCK BY FRIENDLY FIRE?

26. DID YOU ENTER AN ABRAMS BATTLE TANK TO RETRIEVE SENSITIVE ITEMS IMMEDIATELY AFTER

IT WAS STRUCK BY FRIENDLY FIRE?

27. DID YOU ENTER A BRADLEY FIGHTING VEHICLE TO PERFORM RESCUE OPERATIONS

IMMEDIATELY AFTER IT WAS STRUCK BY FRIENDLY FIRE?

28. DID YOU ENTER A BRADLEY FIGHTING VEHICLE TO RETRIEVE SENSITIVE ITEMS IMMEDIATELY

AFTER IT WAS STRUCK BY FRIENDLY FIRE?

29. DID YOU ENTER ANY ENEMY VEHICLE TO PERFORM RESCUE OPERATIONS IMMEDIATELY AFTER

IT WAS STRUCK BY OUR FIRE? IF "NO," SKIP TO QUESTION 30.

29a(1) Code "a" = Tank

29a(2) Code " b" = Other tracked vehicle (identify below)

29a(3) Code "c" = Truck

118e

29a(4) Code "d" = Other wheeled vehicle (identify below)

119

29a(5) Code "e" = Other type vehicle (identify below)

120

29a(6) Code "f" = Don't know

121

30. DID YOU ENTER ANY ENEMY VEHICLE TO RETRIEVE SENSITIVE ITEMS OR INTELLIGENCE

MATERIAL IMMEDIATELY AFTER IT WAS STRUCK BY OUR FIRE? IF "NO," SKIP TO QUESTION 31.

122

30a. IF "YES," WHAT TYPE OF VEHICLE?

30a(1) Code "a" = Tank

123b

MAR 2003(RS)

123c

10-9009D

118a

118b

123d

123e

123f

124

PAGE 3

SSN:

DEPLETED URANIUM QUESTIONNAIRE, Continued

30a(2) Code " b" = Other tracked vehicle (identify below)

30a(3) Code "c" = Truck

30a(4) Code "d" = Other wheeled vehicle (identify below)

30a(5) Code "e" = Other type vehicle (identify below)

30a(6) Code "f" = Don't know

31. WERE YOU EXPOSED TO SMOKE FROM ANY ENEMY EQUIPMENT STRUCK BY DU ROUNDS?

32. DID YOU REMOVE EQUIPMENT OR OTHER ITEMS FROM A DAMAGED OR DESTROYED U.S. OR

ENEMY VEHICLE? IF "NO," SKIP TO QUESTION 33.

32a If you removed something from a vehicle, please describe it below:

32b Do you still have equipment or other items removed from a damaged or destroyed U.S. or enemy

vehicle?

33. WERE YOU WITHIN 50 METERS (45.72 YARDS) OF A VEHICLE WHEN IT WAS HIT (NOT INCLUDING

VEHICLES YOU WERE IN OR ON THAT WERE HIT)? IF "NO," SKIP TO QUESTION 34.

33a. IF YES, WHAT TYPE OF VEHICLE?

33a(1) Code a = ABRAMS battle tank

33a(2) Code b = BRADLEY fighting vehicle

33a(3) Code c = other (identify below)

33a(4) Code d = Don't Know

33b. WAS THE VEHICLE HIT BY DU MUNITIONS?

34. DID YOU BREATH SMOKE OR DUST FROM VEHICLES HIT BY ENEMY OR FRIENDLY FIRE? IF "NO,"

SKIP TO QUESTION 35.

34a. IF "YES," WHAT TYPE OF VEHICLE?

34a(1) Code "a" = ABRAMS battle tank

34a(2) Code "b" = BRADLEY fighting vehicle

34a(3) Code "c" = other (identify below)

34a(4) Code "d" = Don't Know

34b. WAS THE VEHICLE HIT BY DU MUNITIONS?

(a)

BLOCK

(b)

CODE

128e

124b

124c

124d

124e

124f

125

126

126a

126b

127

127a

127b

127c

127d

127e

128

128a

128b

128c

128d

SSN

DEPLETED URANIUM QUESTIONNAIRE, Continued

"Y" = Yes "N" = No "D" = Don't Know

35a. IF "YES," WHAT TYPE OF VEHICLE?

35a(1) Code "a" = ABRAMS battle tank

35a(2) Code "b" = BRADLEY fighting vehicle

35a(3) Code "c" = Other (identify below)

35a(4) Code "d" = Don't Know

35b. HOW MANY TIMES?

35b(1) Code "a" = 1 Time

35b(2) Code "b" = 2 Times

35b(3) Code "c" = 3- 10 times

35b(4) Code "d" = More than 10 times

35b(5) Code "e" = Don't know

35c. HOW LONG (IN TOTAL) WERE YOU ON BOARD THE VEHICLE(S)?

35c(1) Code "a" = Less than 5 minutes

35c(2) Code "b" = 5-15 minutes

35c(3) Code "c" = 16-30 minutes

35c(4) Code "d" = More than 30 minutes

35c(5) Code "e" = Don't know

35d. WAS THE VEHICLE KNOWN TO BE CONTAMINATED WITH DU?

36a. HOW LONG (IN TOTAL) AFTER THE DESTRUCTIVE EVENT?

36a(1) Code "a" = Less than 12 hours

MAR 2003(RS)

(a)

BLOCK

(b)

CODE

36a(2) Code "b" = 12 hours - 24 hours

129c

130b

129

129a

129b

129d

129e

129f

129g

129h

129i

129j

129k

129l

129m

129n

129o

130

130a

36. DID YOU PASS WITHIN 50 METERS (45.72 YARDS) OF A DAMAGED OR DESTROYED VEHICLE? IF

"NO," SKIP TO QUESTION 37. "Y" = Yes "N" = No "D" = Don't Know

35. DID YOU CLIMB ON OR ENTER VEHICLES HIT BY ENEMY OR FRIENDLY FIRE SOMETIME AFTER THE

IMMEDIATE POST-IMPACT RESCUE PERIOD? IF "NO," SKIP TO QUESTION 36.

41. IF "YES," DESCRIBE BELOW:

SSN

DEPLETED URANIUM QUESTIONNAIRE, Continued

36a(3). Code "c" = more than 24 hours

36a(4). Code "d" = Don't know

36b. IF "YES," WHAT TYPE OF VEHICLE?

36b(1) Code "a" = ABRAMS battle tank

36b(2) Code "b" = BRADLEY fighting vehicle

36b(3) Code "c" = Other (identify below)

36b(4) Code "d" = Don't Know

36c. WAS THE VEHICLE BURNING? "Y" = Yes "N" = No "D" = Don't Know

37. WERE YOU WOUNDED AS A RESULT OR BEING IN, ON, OR WITHIN 50 METERS (45.72 YARDS) OF

THE DAMAGED VEHICLE AT THE TIME IT WAS HIT? IF "NO," SKIP TO QUESTION 38.

37a. WHERE YOU WOUNDED?

37a(1) Code "a" = leg/foot

37b(2) Code "b" = arm/hand

37c(3) Code "c" = face/head

130h

37d(4) Code "d" = neck

130i

37e(5) Code "e" = body

37b. DO YOU HAVE RETAINED FRAGMENTS OR SHRAPNEL IN YOUR BODY?

131

38. DID YOU FIRE DU ROUNDS?

131a

39. DID YOU HANDLE BARE/DAMAGED DU PENETRATOR ROUNDS? IF "NO," SKIP TO QUESTION 40.

131b

131c

39a. DID YOU HANDLE THE ROUNDS WITH GLOVES?

133

39b. DID YOU HANDLE THE ROUNDS WITH SHIELDING?

133a

OTHER EXPOSURES

40. DID YOU HAVE EXPOSURE TO DU THAT IS NOT CAPTURED BY THIS QUESTIONNAIRE?

MAR 2003(RS)

134

131d

131e

130c

130d

130e

130f

130g

131f

132

133b

SSN

DEPLETED URANIUM QUESTIONNAIRE, Continued

41. DO YOU HAVE OTHER EXPOSURES AND EXPERIENCES TO DISCUSS WITH THE PROVIDER?

Code "Y" = Yes Code "N" = No IF "YES," DESCRIBE BELOW:

42. IS THE 24-HOUR URINE COLLECTION FOR URANIUM BEING PERFORMED? Code "Y" =Yes,

Code "N" = No or Code "U" =Unknown. IF "NO" OR "UNKNOWN" PROVIDE EXPLANATION BELOW.

43.

44. OTHER COMMENTS:

45. NAME AND TITLE OF EXAMINER/CLINICIAN:

46. SIGNATURE OF EXAMINER:

registry code sheet. If the veteran has already had a GW Registry examination, only the DU questionnaire

will be sent to AAC. A copy of the questionnaire will also be sent to the DU Follow-up Program at the

Baltimore VAMC with the package requesting the urine uranium test. The Baltimore DU Follow-up program

staff will transmit the results of the urine uranium test directly to the AAC for database entry and to the VAMC

of origin for entry into the veteran's medical record.

TO BE COMPLETED BY THE BALTIMORE VAMC FU FOLLOW-UP PROGRAM STAFF

47. CORRECTED URINE URANIUM (EXPRESSED PER MCG PER G CREATININE) 3 DIGITS TO THE LEFT AND 3

48. REMARKS:

MAR 2003(RS)

137

135

136

.

DEPLETED URANIUM (DU) PROGRAM CHECKLIST 24-HOUR URINE

URANIUM COLLECTION BALTIMORE VA MEDICAL CENTER

CONSULT URINE INSTRUCTIONS (REVISED 07/98)

1. PATIENT NAME: 2. SOCIAL SECURITY NUMBER

3. ADDRESS 4. SPECIMEN DATE

5. TELEPHONE NUMBER 6. DATE OF BIRTH

7. REFERRING VA MEDICAL CENTER AND ADDRESS 8. MAIL CODE

9. REFERRING PHYSICIAN

10. PAGER NUMBER 11. TELEPHONE NUMBER 12. FAX NUMBER (To receive report)

Call the DU Program at 1-800-815-7533 to obtain the specimen collection kits. Each kit includes shipping materials and eight 500 ml

containers to be used for the collection of urine over a 24 hour period. The materials in the kits conform to shipping regulations

#173.199 and FEDEX shipping requirement (IATA Packing Instruction 650)).

The shipper of the diagnostic specimens assumes responsibility for complying with these shipping requirements. Using bottles and

packing materials supplied by the DU Program, and using them according to directions, assures compliance.

Notification of the results can be expected in approximnately 45 days.

Schedule patient for 24-hour urine collection.

DATE A. TIME OF FIRST VOID (DISCARDED) URINE DAY 1 B. TIME OF FIRST VOID URINE DAY 2

Instruct the patient to urinate directly into the collection container(s). Uranium sticks to the sides of the container. Therefore, do not

transfer urine due to potential loss of analyte. Issue 8 containers to patient to ensure full 24-hour collection in approved containers.

Instruct the patient to collect urine beginning after first morning void of Day 1 and end collection after first morning void on Day 2

(the next day).

Seal containers as tightly as possible. Bag each urine container with absorbent material. Make sure each plastic bag is sealed tightly.

SEND SPECIMEN VIA FEDEX. Call the DU Program Office at 1-800-815-7533 as soon as specimen has been shipped.

FEDEX TRACKING NUMBER:

SEND TO:

VA MEDICAL CENTER BALTIMORE

PATHOLOGY AND LABORATORY MEDICINE SERVICE (113)

10 N. GREENE STREET

BALTIMORE, MARYLAND 21201

ATTN: CHEM. LAB (113) (FOR DU PROGRAM)

Before sending this sample, call the DU Program office at 1-800-815-7533 so that delivery can be anticipated. This completed VA

Form 10-9009F and the completed copy of VA Form 10-9009D must be faxed to the DU office at 410-605-7943 before sending the

urine sample.

Another copy of this VA Form 10-9009F, sealed in a ziploc bag, must be enclosed with the sample for identification purposes.