DVBCWCI1 ;ALB/CMM COLD INJURY PROTOCOL EXAM WKS TEXT - 1 ; 7 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;Narration: Veterans during World War II, the Korean War, and in smaller
;;numbers during other campaigns, have suffered cold injuries, including
;;frostbite (freezing cold injury or FCI) and immersion foot (nonfreezing
;;cold injury or NCI). Documentation of such injuries may be lacking
;;because of battlefield conditions. A number of long-term and delayed
;;sequelae to cold injuries are recognized, including peripheral neuropathy,
;;skin cancer in frostbite scars, and arthritis in involved limbs.
;;
;;Review Examination: Any veteran examined for residuals of cold injury
;;should undergo a cold injury protocol examination IF it has not already
;;been carried out. If the veteran has already had a cold injury protocol
;;examination, only an interval history is required, and the extent of
;;the examination, laboratory tests performed, etc., will be determined
;;by the examiner based on the history, and as requested.
;;
;;A. Review of Medical Records:
;;
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;;HISTORY OF COLD INJURY: If the cold injury protocol form has been
;;filled out by the veteran, most details about the circumstances of the
;;acute cold injury and its subsequent course will be recorded. Review
;;for any needed expansion or clarification by the veteran. If the
;;protocol history form has not been completed, obtain the following
;;history and comment on each:
;;
;; 1. Description of the circumstances of the cold injury.
;;
;;
;; 2. Parts of the body affected.
;;
;;
;; 3. Signs and symptoms - at time of acute injury.
;;
;;
;; 4. The type of treatment and where it was administered.
;;
;;
;; 5. Any treatment since service - where and what type.
;;
;;
;; 6. Current symptoms - specifically inquire about:
;;
;; a. Amputations or other tissue loss.
;;
;;
;; b. Cold sensitization.
;;
;;
;; c. Raynaud's phenomenon.
;;
;;
;; d. Hyperhidrosis.
;;
;;
;; e. Paresthesias, numbness.
;;
;;
;; f. Chronic pain resembling causalgia or reflex sympathetic dystrophy.
;;
;;
;; g. Recurrent fungal infections.
;;
;;
;; h. Breakdown or ulceration of frostbite scars.
;;
;;
;; i. Disturbances of nail growth.
;;
;;
;; j. Skin cancer in chronic ulcers or scars.
;;
;;
;; k. Arthritis or joint stiffness, including limitation of
;; motion of affected areas.
;;
;;
;; l. Edema.
;;
;;
;; m. Changes in skin color.
;;
;;
;; n. Skin thickening or thinning.
;;
;;
;; o. Any sleep disturbance due to associated symptoms.
;;
;;
;; p. Cold feeling (relationship to season or not).
;;
;;
;; q. Numbness, tingling, burning.
;;
;;
;; r. Excess sweating.
;;
;;
;; s. Pain - location, intensity, constancy, precipitating
;; factors (cold, walking, standing, night pain); type
;; (sharp burning, etc.).
;;
;;
;; 7. Current treatment, including nonmedical measures taken - moving
;; to warmer climate, wearing multiple pairs of socks, etc.
;;
;;
;;OTHER MEDICAL HISTORY:
;;
;; 1. Major illnesses, surgery, current medical conditions and their
;; treatment, including diabetes mellitus or hypertension.
;;
;;
;; 2. Smoking history, other risk factors for vascular disease,
;; history of skin cancer.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following and fully describe current findings:
;; 1. General: Carriage, gait, posture.
;;
;;
;; 2. Skin:
;; a. Color.
;; b. Edema.
;; c. Temperature.
;; d. Atrophy.
;; e. Dry or moist.
;; f. Texture.
;; g. Ulceration.
;; h. Hair growth.
;; i. Evidence of fungus or other infection.
;;
;;
;; 3. Scars:
;; a. Location.
;; b. Length.
;; c. Width.
;; d. Color.
;; e. Tenderness.
;; f. Raised or depressed.
;; g. If of head or neck, any disfigurement.
;;
;;
;; 4. Nails:
;; a. All or part missing.
;; b. Evidence of fungus infection.
;; c. Deformed or atrophic.
;;
;;
;; 5. Neurological:
;; a. Reflexes.
;; b. Sensory - subjective complaints of pain, numbness, etc.,
;; Objective sensory changes - pinprick, touch.
;; c. Motor - weakness, atrophy.
;;
;;
;; 6. Orthopedic:
;; a. Pain or stiffness of any joints affected by cold injury.
;; b. Deformity or swelling of any joints.
;; c. Measure range of motion of all affected joints.
;; d. Strength of ligaments in affected areas.
;; e. Pes planus.
;; f. Callus.
;; g. Pain on manipulation of joints.
;; h. Loss of tissue of digits or other affected parts.
;;
;;
;; 7. Vascular:
;; a. Status of peripheral pulses.
;; b. Doppler study to confirm vascular compromise, if indicated.
;; c. Evidence of vascular insufficiency - edema, hair loss,
;; shiny atrophic skin, etc.
;; d. Blood pressure in arms and legs (is ratio normal?)
;; e. Evidence of Raynaud's phenomenon.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Provide:
;; 1. X-rays of affected areas of extremities if never done or if
;; not done in past five years.
;; 2. Doppler study of blood vessels, if indicated.
;; 3. Nerve conduction of studies, if indicated.
;; 4. Biopsy of any area suspicious for malignancy.
;; 5. Scrapings to confirm fungus infection.
;; 6. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;; 1. List each diagnosis and state whether related to cold injury
;; (if that can be determined).
;; 2. Specialty exams that might be needed:
;;
;; a. Neurology.
;; b. Podiatry.
;; c. Dermatology.
;; d. Rheumatology.
;; e. Others as needed.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWCI1 6628 printed Apr 09, 2024@20:55:32 Page 2
DVBCWCI1 ;ALB/CMM COLD INJURY PROTOCOL EXAM WKS TEXT - 1 ; 7 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;Narration: Veterans during World War II, the Korean War, and in smaller
+2 ;;numbers during other campaigns, have suffered cold injuries, including
+3 ;;frostbite (freezing cold injury or FCI) and immersion foot (nonfreezing
+4 ;;cold injury or NCI). Documentation of such injuries may be lacking
+5 ;;because of battlefield conditions. A number of long-term and delayed
+6 ;;sequelae to cold injuries are recognized, including peripheral neuropathy,
+7 ;;skin cancer in frostbite scars, and arthritis in involved limbs.
+8 ;;
+9 ;;Review Examination: Any veteran examined for residuals of cold injury
+10 ;;should undergo a cold injury protocol examination IF it has not already
+11 ;;been carried out. If the veteran has already had a cold injury protocol
+12 ;;examination, only an interval history is required, and the extent of
+13 ;;the examination, laboratory tests performed, etc., will be determined
+14 ;;by the examiner based on the history, and as requested.
+15 ;;
+16 ;;A. Review of Medical Records:
+17 ;;
+18 ;;
+19 ;;
+20 ;;B. Medical History (Subjective Complaints):
+21 ;;
+22 ;;HISTORY OF COLD INJURY: If the cold injury protocol form has been
+23 ;;filled out by the veteran, most details about the circumstances of the
+24 ;;acute cold injury and its subsequent course will be recorded. Review
+25 ;;for any needed expansion or clarification by the veteran. If the
+26 ;;protocol history form has not been completed, obtain the following
+27 ;;history and comment on each:
+28 ;;
+29 ;; 1. Description of the circumstances of the cold injury.
+30 ;;
+31 ;;
+32 ;; 2. Parts of the body affected.
+33 ;;
+34 ;;
+35 ;; 3. Signs and symptoms - at time of acute injury.
+36 ;;
+37 ;;
+38 ;; 4. The type of treatment and where it was administered.
+39 ;;
+40 ;;
+41 ;; 5. Any treatment since service - where and what type.
+42 ;;
+43 ;;
+44 ;; 6. Current symptoms - specifically inquire about:
+45 ;;
+46 ;; a. Amputations or other tissue loss.
+47 ;;
+48 ;;
+49 ;; b. Cold sensitization.
+50 ;;
+51 ;;
+52 ;; c. Raynaud's phenomenon.
+53 ;;
+54 ;;
+55 ;; d. Hyperhidrosis.
+56 ;;
+57 ;;
+58 ;; e. Paresthesias, numbness.
+59 ;;
+60 ;;
+61 ;; f. Chronic pain resembling causalgia or reflex sympathetic dystrophy.
+62 ;;
+63 ;;
+64 ;; g. Recurrent fungal infections.
+65 ;;
+66 ;;
+67 ;; h. Breakdown or ulceration of frostbite scars.
+68 ;;
+69 ;;
+70 ;; i. Disturbances of nail growth.
+71 ;;
+72 ;;
+73 ;; j. Skin cancer in chronic ulcers or scars.
+74 ;;
+75 ;;
+76 ;; k. Arthritis or joint stiffness, including limitation of
+77 ;; motion of affected areas.
+78 ;;
+79 ;;
+80 ;; l. Edema.
+81 ;;
+82 ;;
+83 ;; m. Changes in skin color.
+84 ;;
+85 ;;
+86 ;; n. Skin thickening or thinning.
+87 ;;
+88 ;;
+89 ;; o. Any sleep disturbance due to associated symptoms.
+90 ;;
+91 ;;
+92 ;; p. Cold feeling (relationship to season or not).
+93 ;;
+94 ;;
+95 ;; q. Numbness, tingling, burning.
+96 ;;
+97 ;;
+98 ;; r. Excess sweating.
+99 ;;
+100 ;;
+101 ;; s. Pain - location, intensity, constancy, precipitating
+102 ;; factors (cold, walking, standing, night pain); type
+103 ;; (sharp burning, etc.).
+104 ;;
+105 ;;
+106 ;; 7. Current treatment, including nonmedical measures taken - moving
+107 ;; to warmer climate, wearing multiple pairs of socks, etc.
+108 ;;
+109 ;;
+110 ;;OTHER MEDICAL HISTORY:
+111 ;;
+112 ;; 1. Major illnesses, surgery, current medical conditions and their
+113 ;; treatment, including diabetes mellitus or hypertension.
+114 ;;
+115 ;;
+116 ;; 2. Smoking history, other risk factors for vascular disease,
+117 ;; history of skin cancer.
+118 ;;
+119 ;;
+120 ;;C. Physical Examination (Objective Findings):
+121 ;;
+122 ;; Address each of the following and fully describe current findings:
+123 ;; 1. General: Carriage, gait, posture.
+124 ;;
+125 ;;
+126 ;; 2. Skin:
+127 ;; a. Color.
+128 ;; b. Edema.
+129 ;; c. Temperature.
+130 ;; d. Atrophy.
+131 ;; e. Dry or moist.
+132 ;; f. Texture.
+133 ;; g. Ulceration.
+134 ;; h. Hair growth.
+135 ;; i. Evidence of fungus or other infection.
+136 ;;
+137 ;;
+138 ;; 3. Scars:
+139 ;; a. Location.
+140 ;; b. Length.
+141 ;; c. Width.
+142 ;; d. Color.
+143 ;; e. Tenderness.
+144 ;; f. Raised or depressed.
+145 ;; g. If of head or neck, any disfigurement.
+146 ;;
+147 ;;
+148 ;; 4. Nails:
+149 ;; a. All or part missing.
+150 ;; b. Evidence of fungus infection.
+151 ;; c. Deformed or atrophic.
+152 ;;
+153 ;;
+154 ;; 5. Neurological:
+155 ;; a. Reflexes.
+156 ;; b. Sensory - subjective complaints of pain, numbness, etc.,
+157 ;; Objective sensory changes - pinprick, touch.
+158 ;; c. Motor - weakness, atrophy.
+159 ;;
+160 ;;
+161 ;; 6. Orthopedic:
+162 ;; a. Pain or stiffness of any joints affected by cold injury.
+163 ;; b. Deformity or swelling of any joints.
+164 ;; c. Measure range of motion of all affected joints.
+165 ;; d. Strength of ligaments in affected areas.
+166 ;; e. Pes planus.
+167 ;; f. Callus.
+168 ;; g. Pain on manipulation of joints.
+169 ;; h. Loss of tissue of digits or other affected parts.
+170 ;;
+171 ;;
+172 ;; 7. Vascular:
+173 ;; a. Status of peripheral pulses.
+174 ;; b. Doppler study to confirm vascular compromise, if indicated.
+175 ;; c. Evidence of vascular insufficiency - edema, hair loss,
+176 ;; shiny atrophic skin, etc.
+177 ;; d. Blood pressure in arms and legs (is ratio normal?)
+178 ;; e. Evidence of Raynaud's phenomenon.
+179 ;;
+180 ;;
+181 ;;D. Diagnostic and Clinical Tests:
+182 ;;
+183 ;; Provide:
+184 ;; 1. X-rays of affected areas of extremities if never done or if
+185 ;; not done in past five years.
+186 ;; 2. Doppler study of blood vessels, if indicated.
+187 ;; 3. Nerve conduction of studies, if indicated.
+188 ;; 4. Biopsy of any area suspicious for malignancy.
+189 ;; 5. Scrapings to confirm fungus infection.
+190 ;; 6. Include results of all diagnostic and clinical tests conducted
+191 ;; in the examination report.
+192 ;;
+193 ;;
+194 ;;E. Diagnosis:
+195 ;;
+196 ;; 1. List each diagnosis and state whether related to cold injury
+197 ;; (if that can be determined).
+198 ;; 2. Specialty exams that might be needed:
+199 ;;
+200 ;; a. Neurology.
+201 ;; b. Podiatry.
+202 ;; c. Dermatology.
+203 ;; d. Rheumatology.
+204 ;; e. Others as needed.
+205 ;;
+206 ;;
+207 ;;Signature: Date:
+208 ;;END
