DVBCWCI1.m

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 ---DVBCWCI1   6628     printed  Mar 13, 2025@20:54:43                                                                                                                                                                                                    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