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1DVBCWCI1 ;ALB/CMM COLD INJURY PROTOCOL EXAM WKS TEXT - 1 ; 7 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;Narration: Veterans during World War II, the Korean War, and in smaller
7 ;;numbers during other campaigns, have suffered cold injuries, including
8 ;;frostbite (freezing cold injury or FCI) and immersion foot (nonfreezing
9 ;;cold injury or NCI). Documentation of such injuries may be lacking
10 ;;because of battlefield conditions. A number of long-term and delayed
11 ;;sequelae to cold injuries are recognized, including peripheral neuropathy,
12 ;;skin cancer in frostbite scars, and arthritis in involved limbs.
13 ;;
14 ;;Review Examination: Any veteran examined for residuals of cold injury
15 ;;should undergo a cold injury protocol examination IF it has not already
16 ;;been carried out. If the veteran has already had a cold injury protocol
17 ;;examination, only an interval history is required, and the extent of
18 ;;the examination, laboratory tests performed, etc., will be determined
19 ;;by the examiner based on the history, and as requested.
20 ;;
21 ;;A. Review of Medical Records:
22 ;;
23 ;;
24 ;;
25 ;;B. Medical History (Subjective Complaints):
26 ;;
27 ;;HISTORY OF COLD INJURY: If the cold injury protocol form has been
28 ;;filled out by the veteran, most details about the circumstances of the
29 ;;acute cold injury and its subsequent course will be recorded. Review
30 ;;for any needed expansion or clarification by the veteran. If the
31 ;;protocol history form has not been completed, obtain the following
32 ;;history and comment on each:
33 ;;
34 ;; 1. Description of the circumstances of the cold injury.
35 ;;
36 ;;
37 ;; 2. Parts of the body affected.
38 ;;
39 ;;
40 ;; 3. Signs and symptoms - at time of acute injury.
41 ;;
42 ;;
43 ;; 4. The type of treatment and where it was administered.
44 ;;
45 ;;
46 ;; 5. Any treatment since service - where and what type.
47 ;;
48 ;;
49 ;; 6. Current symptoms - specifically inquire about:
50 ;;
51 ;; a. Amputations or other tissue loss.
52 ;;
53 ;;
54 ;; b. Cold sensitization.
55 ;;
56 ;;
57 ;; c. Raynaud's phenomenon.
58 ;;
59 ;;
60 ;; d. Hyperhidrosis.
61 ;;
62 ;;
63 ;; e. Paresthesias, numbness.
64 ;;
65 ;;
66 ;; f. Chronic pain resembling causalgia or reflex sympathetic dystrophy.
67 ;;
68 ;;
69 ;; g. Recurrent fungal infections.
70 ;;
71 ;;
72 ;; h. Breakdown or ulceration of frostbite scars.
73 ;;
74 ;;
75 ;; i. Disturbances of nail growth.
76 ;;
77 ;;
78 ;; j. Skin cancer in chronic ulcers or scars.
79 ;;
80 ;;
81 ;; k. Arthritis or joint stiffness, including limitation of
82 ;; motion of affected areas.
83 ;;
84 ;;
85 ;; l. Edema.
86 ;;
87 ;;
88 ;; m. Changes in skin color.
89 ;;
90 ;;
91 ;; n. Skin thickening or thinning.
92 ;;
93 ;;
94 ;; o. Any sleep disturbance due to associated symptoms.
95 ;;
96 ;;
97 ;; p. Cold feeling (relationship to season or not).
98 ;;
99 ;;
100 ;; q. Numbness, tingling, burning.
101 ;;
102 ;;
103 ;; r. Excess sweating.
104 ;;
105 ;;
106 ;; s. Pain - location, intensity, constancy, precipitating
107 ;; factors (cold, walking, standing, night pain); type
108 ;; (sharp burning, etc.).
109 ;;
110 ;;
111 ;; 7. Current treatment, including nonmedical measures taken - moving
112 ;; to warmer climate, wearing multiple pairs of socks, etc.
113 ;;
114 ;;
115 ;;OTHER MEDICAL HISTORY:
116 ;;
117 ;; 1. Major illnesses, surgery, current medical conditions and their
118 ;; treatment, including diabetes mellitus or hypertension.
119 ;;
120 ;;
121 ;; 2. Smoking history, other risk factors for vascular disease,
122 ;; history of skin cancer.
123 ;;
124 ;;
125 ;;C. Physical Examination (Objective Findings):
126 ;;
127 ;; Address each of the following and fully describe current findings:
128 ;; 1. General: Carriage, gait, posture.
129 ;;
130 ;;
131 ;; 2. Skin:
132 ;; a. Color.
133 ;; b. Edema.
134 ;; c. Temperature.
135 ;; d. Atrophy.
136 ;; e. Dry or moist.
137 ;; f. Texture.
138 ;; g. Ulceration.
139 ;; h. Hair growth.
140 ;; i. Evidence of fungus or other infection.
141 ;;
142 ;;
143 ;; 3. Scars:
144 ;; a. Location.
145 ;; b. Length.
146 ;; c. Width.
147 ;; d. Color.
148 ;; e. Tenderness.
149 ;; f. Raised or depressed.
150 ;; g. If of head or neck, any disfigurement.
151 ;;
152 ;;
153 ;; 4. Nails:
154 ;; a. All or part missing.
155 ;; b. Evidence of fungus infection.
156 ;; c. Deformed or atrophic.
157 ;;
158 ;;
159 ;; 5. Neurological:
160 ;; a. Reflexes.
161 ;; b. Sensory - subjective complaints of pain, numbness, etc.,
162 ;; Objective sensory changes - pinprick, touch.
163 ;; c. Motor - weakness, atrophy.
164 ;;
165 ;;
166 ;; 6. Orthopedic:
167 ;; a. Pain or stiffness of any joints affected by cold injury.
168 ;; b. Deformity or swelling of any joints.
169 ;; c. Measure range of motion of all affected joints.
170 ;; d. Strength of ligaments in affected areas.
171 ;; e. Pes planus.
172 ;; f. Callus.
173 ;; g. Pain on manipulation of joints.
174 ;; h. Loss of tissue of digits or other affected parts.
175 ;;
176 ;;
177 ;; 7. Vascular:
178 ;; a. Status of peripheral pulses.
179 ;; b. Doppler study to confirm vascular compromise, if indicated.
180 ;; c. Evidence of vascular insufficiency - edema, hair loss,
181 ;; shiny atrophic skin, etc.
182 ;; d. Blood pressure in arms and legs (is ratio normal?)
183 ;; e. Evidence of Raynaud's phenomenon.
184 ;;
185 ;;
186 ;;D. Diagnostic and Clinical Tests:
187 ;;
188 ;; Provide:
189 ;; 1. X-rays of affected areas of extremities if never done or if
190 ;; not done in past five years.
191 ;; 2. Doppler study of blood vessels, if indicated.
192 ;; 3. Nerve conduction of studies, if indicated.
193 ;; 4. Biopsy of any area suspicious for malignancy.
194 ;; 5. Scrapings to confirm fungus infection.
195 ;; 6. Include results of all diagnostic and clinical tests conducted
196 ;; in the examination report.
197 ;;
198 ;;
199 ;;E. Diagnosis:
200 ;;
201 ;; 1. List each diagnosis and state whether related to cold injury
202 ;; (if that can be determined).
203 ;; 2. Specialty exams that might be needed:
204 ;;
205 ;; a. Neurology.
206 ;; b. Podiatry.
207 ;; c. Dermatology.
208 ;; d. Rheumatology.
209 ;; e. Others as needed.
210 ;;
211 ;;
212 ;;Signature: Date:
213 ;;END
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