VA Form 10-10068b
Camp Lejeune Family Member Program Claim Form
You are enrolled in CLFMP, received treatment for a covered condition, paid out-of-pocket, and want reimbursement from VA.
- Who fills it
- dependent
- Journey phase
- Keeping Your Award Current
- Estimated time
- 20-30 minutes.
- When to file
- Within 1 year of the date of service.
Official VA form page: https://www.va.gov/communitycare/programs/dependents/clfmp/
Gather before you start
- ▸Itemized medical bills
- ▸Explanation of Benefits from any other insurance
- ▸Your CLFMP enrollment/authorization letter
- ▸Proof of payment
Attach with the form
- ▸Itemized medical bills
- ▸Insurance EOB
- ▸Proof of payment
Section I - Beneficiary Identification
Blocks 1-4Your name, SSN, CLFMP authorization numberPII
Include your CLFMP enrollment/authorization number from the letter VA sent confirming your enrollment in the program.
(name, SSN, CLFMP authorization number)
Common mistakes
- ×Not including CLFMP authorization number - claim cannot be routed without it.
Section II - Services
Blocks 5-16Medical services received, dates, provider, chargesRepeatable
For each claim: date of service, provider name and address, ICD diagnosis code, CPT procedure code if available, and amount charged. Attach itemized bills. CLFMP reimburses only for services related to the covered condition(s) you were enrolled for.
e.g., 04/10/2026; Oncology Associates, 123 Main St, Phoenix AZ; ICD: C50.9 (breast cancer); chemotherapy infusion; $2,400.
Common mistakes
- ×Claiming for a non-covered condition - CLFMP only reimburses for your enrolled covered condition.
- ×Exceeding the 1-year filing deadline.
Authority
- 38 CFR 17.400 - 15 covered conditions for family members at Lejeune 1953–1987.
Section III - Certification
Blocks 17-18Claimant signature and datePII
Sign and date. Mail to: VA HAC, P.O. Box 469064, Denver CO 80246.
(signature/date)
Common mistakes
- ×Mailing to local VA instead of Denver.
Statutory and regulatory authority
- 38 CFR 17.400 - 15 covered conditions for family members at Lejeune 1953–1987.