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Did you serve in the U.S. military between 2003 and 2015? YesNo

At any point throughout 2003 and 2015, did you receive earplugs and wear them? YesNo

Which of the following conditions apply to you? Mark all the apply.

• Total hearing loss.
• Partial hearing loss.
• Tinnitus (ringing or other sounds in ears).
• Any other hearing issues.

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