3M Earplug Lawsuit Claim Form Order Number Free Case Evaluation 3M Earplug Lawsuit Claim Form. IF YOU SERVED BETWEEN 2003 AND 2015. Name Email Address Address Phone Did you use 3M Earplugs? Did you use 3M Earplugs? Yes No Are you suffering from tinnitus? Suffering from tinnitus? Yes No City Date of Discharge Are you suffering from Hearing loss? Hearing loss? Yes No Percentage disability rating? Disability rating of hearing-related injury % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% NA Your message consent I have read the disclaimer .